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A Patient With Diabetes Begins a New Chapter

PIH program improves the lives of patients with chronic diseases.

Angelique Vuguziga sews clothes inside her family house in Nyamirama, Rwanda. Photo by Pacifique Iradukunda/PIH
Angelique Vuguziga sews clothes inside her family house in Nyamirama, Rwanda. Photo by Pacifique Iradukunda/PIH

Angelique Vuguziga recently celebrated her 28th birthday, in her community of Nyamirama, Rwanda. It was a milestone that ushered in joy, relief and a wellspring of other emotions. Throughout her life, she was presumed dead multiple times.

On a normal cool morning in 2008, Vuguziga felt weak and grasped the side of a chair in her family living room in Nyamirama village, Rwanda. She felt an intense, painful heat rippling through her body. The pain became unbearable and she passed out. She was rushed to the hospital but the cause of her pain was not identified right away. And the illness went undetected for a year.

After several hospital visits, she was diagnosed in 2009 with Type 1 Diabetes.

Vuguziga is among over 13,500 patients with non-communicable diseases who receive care from Partners In Health, locally known as Inshuti Mu Buzima, in Rwanda. Inshuti Mu Buzima serves patients with diabetes in three rural districts: Burera, Kayonza, and Kirehe. In Rwanda, diabetes affects an estimated 3.1%-4.3% of people. Diabetes is an increasing problem in sub-Saharan Africa. With the greatest proportion of people on the continent with undiagnosed diabetes, the projections are even more alarming.

”My body was constantly burning”

Vuguziga was born into a family of 14 people but five of her siblings died as children.”

In 2008, when she was in her first year of high school, Vuguziga started to get sick. While in class, she would feel very tired, experience blurry vision that made it hard to read the board in front of her classroom, and would have to drink plenty of water to suppress the excessive thirst she felt.

“I felt like my body was constantly burning,” she said. “But if you touched my skin, you couldn’t feel the fever.”

Her weight plummeted from 68 to 45 kilograms within weeks, leaving the shape of her bones around the neck, back, and her chest visible. These extreme changes in her physical appearance over a short period led to stigma and alienation.

“People in the community started rumors that I had an illegal abortion,” said Vuguziga. “Whenever I would be walking in the street or at school, people would start mumbling something negative about me.”

Before the illness and the stigma, she was among the top-performing students in her class. However, her deteriorating health started to have a pernicious impact on her academic life, too.

In the first year of high school, she fell to eighth in her class, then to eleventh. In the third term, she missed exams due to illness. Then she dropped out of school.

In 2009, a year after the first symptoms, the disease worsened. She remembers the day she woke up and could not see — both of her eyes were blind.

“My family rushed me to the hospital,” she said. “My mother told the doctors that they would not leave the hospital.” They would rather see her die on the hospital bed, she said, than let her die helplessly at home.

This time around, her symptoms led the doctors to the right diagnosis: she had been battling Type 1 diabetes all along, without any proper medicine.

Type 1 diabetes is a condition where the body can't produce insulin, the hormone which regulates blood sugar levels. If her blood sugar level wasn’t kept under control, she risked long-term damage to her heart, kidneys, eyes and nerves — or worse, death.

The NCD Clinic

Shortly after her diagnosis, Vuguziga—like all patients with non-communicable diseases (NCDs) who seek treatment at PIH-supported health centers and hospitals—started to receive treatment and support from Inshuti Mu Buzima.

Months after starting treatment, she regained her vision and her condition improved. She was able to return to school and completed high school in 2015.

Patients like Vuguziga led Inshuti Mu Buzima to look into the prevalence of diabetes and other NCDs in the communities where it works. The NCDs program, in collaboration with the government of Rwanda, started to investigate how many other NCD patients had undiagnosed illnesses, the barriers that could discourage patients from seeking care, and the resources needed to provide high-quality, timely treatment to patients who couldn’t afford to travel to the district hospital.

To address the problem of a lack of NCD care, Inshuti Mu Buzima, in collaboration with the Rwandan Ministry of Health, developed an innovative model known as the NCDs Clinic that provides treatment for hypertension, heart failure, diabetes, and asthma at the community level by training nurses to do tasks typically performed by physicians, such as prescribing basic medicines for NCDs. Through this model, it was possible to bring NCD care to remote areas of Rwanda, such as the communities where Inshuti Mu Buzima works, proving that high-quality NCD treatment is feasible in low-resource settings.

Partners In Health-supported Nyamirama Health Center where diabetes patients can receive consultation and medication.
Partners In Health-supported Nyamirama Health Center where people can test for diabetes, and start treatment. Photo by Pacifique Iradukunda/PIH

The NCDs Clinic has continued to expand to serve even more patients.

“We conduct regular mass screening outreach campaigns to identify patients with diseases like diabetes, cardiovascular diseases, hepatitis, and other NCDs,” said Symaque Dusabeyezu, Inshuti Mu Buzima’s NCDs Program Manager. “The program further provides social support including vocational training, health insurance, and food support.”

The support for NCD patients is more than just medical. Between 2020 and 2021, 33 patients completed technical and vocational training (TVET) and received startup kits to establish their own businesses, 533 families with chronic diseases were supported with health insurance, and 4,601 patients received food support to cope with the effects of the covid-19 pandemic.

It was through this vocational training that Vuguziga learned sewing and received a sewing machine she used to start a small business in her community.

“After graduating from high school, I wanted to do business,” said Vuguziga. “Having my own sewing business has helped me to pay bills and afford to be on a healthy diet—a crucial lifestyle of a diabetes patient.”

In February 2022, Vuguziga left her childhood village to get married and start her own family. Over 200 people attended her wedding ceremony in Nyagatare, a rural district in eastern Rwanda. As she marked these milestones, the NCD team continue to accompany her through her treatment, making sure she had access to treatment and care.

“It has been quite a journey but I am thankful that I am now healthy,” said Vuguziga. “I look forward to the future with optimism”.

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