Non-communicable lifestyle diseases such as diabetes and hypertension are no longer diseases of the wealthy. A majority of the urban poor population living in the city’s slums are living with diabetes and the worst part is that they are unable to afford to take treatment.
A study conducted in Kadugondanahalli (K.G. Halli) by Upendra Bhojani from the city-based Institute of Public Health (IPH) corroborates this aspect. Dr. Bhojani and a team of researchers took up the study to explore ways of strengthening the local health systems in the urban poor neighbourhood.
Giving details of the study that has recently been published in Global Health Action, an online medical journal, Dr. Bhojani told The Hindu that financial constraints are a major barrier for K.G. Halli residents in accessing medication for chronic illness.
“We found that most people either discontinued medication or took it only when they observed some notable symptoms such as swelling in legs or frequent urination,” he said.
Compromises made
Quoting the respondents of the study, Dr. Bhojani said: “Medication for diabetes has to be taken all through one’s life and patients cannot afford to miss their daily dose. However, we found in K.G. Halli that some patients reduced their medication dosage so that they could take them for a longer duration,”
“While a 52-year-old woman had reduced the medication from one tablet daily to half a tablet, another 38-year-old patient informed us that he was mixing allopathy medication with ayurvedic therapy to reduce the overall cost.”
Some patients, who had diabetes for three or more years, explained to the researchers how they would realise that their blood sugar and blood pressure was high or low based on the changes in their body. Dr. Bhojani said these patients, based on the symptoms they understood, would accordingly decide when to take medication or alter the prescribed dosage of their medication without seeking professional advice.
“While a 55-year-old patient said he takes the prescribed dose of one tablet only when he has to answer nature’s call frequently, another pointed out that he would take medicines only when there is swelling in his feet. Often the development of co-morbid illness or diabetes complications made patients to start medication,” the doctor said.
Apart from financial constraints, the negative attitudes and inadequate communication of healthcare providers, and the limited and fragmented nature of the existing healthcare services are the other problems faced by K.G. Halli residents.
“Our study demonstrated a gender disadvantage for women in diabetes care. The prevailing nuclear family structure and inter-generational conflicts limited support and care for the elderly,” he said.
“There is a need to strengthen primary healthcare services with special focus on improving availability of health services for diabetes at the community level, promoting patient-centred care, and improving continuity in delivery of diabetes care. There is also a need to improve the status of women and elderly in families and society,” Dr. Bhojani said.
