I am the oldest among five siblings. I was a third-year medical student when my 9-year-old brother M. was diagnosed with type 1 diabetes (T1D) back home in our native Syria. It was very traumatizing event, and it triggered my interest in becoming a pediatric endocrinologist.
Today M. is 20 years old. He still lives in Syria. Even before the war started, getting good diabetes care was a struggle due to the lack of resources. For example, the only insulin available was NPH, regular and occasionally Lantus. There were very few insulin pumps available. Children with T1D were cared for by adult endocrinologists because there were no pediatric endocrinologists in the whole country. There were no diabetes educators, dietitians, psychologists or social workers. On the bright side, the Syrian government provided insulin for free, and people with diabetes had to pay only for supplies such as insulin pen needles and BG testing supplies.
This is my family’s apartment after it was hit by the air forces. Thankfully, my family members were not in it when that happened, so no one was injured.
When the war started, safety became a huge issue on top of the lack of supplies. After a chemical weapon attack, my family moved out of the city to hide in the capital, Damascus. M. was stopped by the military checkpoints several times on the road to get his insulin. Now he has to walk for about four hours every month, risking his life to get his life-saving insulin. On top of this, insulin became extremely expensive after the war.
Unfortunately, M. can’t afford to see the adult endocrinologist. Even if he could, it would be extremely unsafe due to the doctor’s location. So I help M. with his diabetes care from afar. I try to address his questions the best I can. But due to the time difference, he ends up with no help most of the time.
About a year ago, M. developed a bad rash; after investigating extensively, we found out it was from the expired insulin he has been using. He has been using expired insulin—the only insulin available—for at least 12 months now. He gets Lantus occasionally from Lebanon through one of his friends who crosses the borders every three or four months.
About eight months ago, M. stopped reporting his blood glucose levels to me! He said he forgot to check his BG because he was busy in school. Later, I found out that M. was not able to buy glucose test strips because they were so expensive. Now with the financial support I send to M., he can afford to check—but only once or twice a day. There are no ketones strips either, so I worry even more when he has a fever or gets a cold!
M. is going through lots of challenges. Our dad, who was a great high school teacher, passed away in June of this year. That brought great hardship on our family. Now M. is taking care of our mother and two younger sisters. And there are no support services in Syria to help him out.
Despite all the obstacles, M.’s last A1C was 7.9. He finished his first year of college, studying engineering with excellent scores. He is optimistic his situation will get better someday, and he hopes that one day he will be able to use an insulin pump to have a better, more flexible lifestyle.
This World Diabetes Day, think about the plight of people with diabetes all over the globe. When you live in a country with a strong health care system such as the United States, it’s easy to forget how many people still struggle to find the most basic medical care. People with T1D need insulin and testing supplies to manage their disease every single day. They deserve to have easy, affordable access to these things that literally keep them alive, plus treatment from health care professionals. These aren’t luxuries, they are necessities.
As a physician, my goal is to provide the best care to people with diabetes—not only in the community where I live now, but all over the world. I traveled abroad to get the best training, and one day I hope to return to Syria to practice endocrinology. I want the best medical care for everyone, and I wish to be part of the solution in the places that need the most help.
I hope that by telling my story and my brother’s story, I can make a small difference in the world.
Mouhammad is a Pediatric Endocrinology Fellow who practices outside of Syria. His full name and his brother’s name have been withheld to avoid any negative repercussions for the family in Syria.
Insulin for Life USA (IFL-USA) is a 501(c)3 organization whose purpose is to provide free-of-charge insulin and disease management supplies to people with diabetes around the world who otherwise would go without these life-saving provisions. The American Diabetes Association supports IFL-USA’s efforts to collect in-date, unopened supplies from individuals or organizations in the United States and, following careful inspection, deliver them to developing countries to be used by those in need. Learn more at http://ifl-usa.org.