World Diabetes Day today recognizes the plight of the world's 194 million diabetics. The annual event is an occasion to reflect on the work that still needs to be done to further improve the care infrastructure for people suffering from diabetes. In some countries the issue is especially pressing. In the Central Asian republic of Kyrgyzstan, many diabetics fear they may soon be unable to obtain insulin as the debt-ridden state struggles to find supplies.
Prague, 14 December 2003 (RFE/RL) -- Anara is the mother of a diabetic child in the Kyrgyz capital Bishkek. For her and other relatives of the country's 4,000 diabetics who are dependent on insulin, the threat of a shortage has taken on a terrifying urgency.
"[My son] is nine years old and he has been [diabetic] for five years. We have enough insulin left for one week. [Doctors] say there is no insulin. I have heard that we are going to buy some, but it is unclear when," Anara said.
Like all insulin-dependent diabetics, Anara's son needs injections of the hormone every day. She knows that even a few days without treatment can mean the difference between life and death.
In Type-1 diabetics, the pancreas fails to produce insulin, the hormone needed to convert sugar into energy. This deficiency can cause increased glucose in the blood, which in turn can damage blood vessels and nerve endings. Even with insulin, many Type-1 diabetics suffer from cardiovascular disease and other health problems.
In September, the Kyrgyz Health Ministry reported that Western drugmakers had refused to continue supplying insulin to the Central Asian republic unless it paid a debt of some $750,000. At that time, reserves were sufficient only through the middle of November.
The Health Ministry now says it has enough stocks for two more weeks, and that more is on the way. Deputy Health Minister Guljigit Aliyev said a portion of the debt has been paid off and that shipments of Western-produced insulin are due to resume in the next few weeks.
"In June-July we had some shortages of insulin and the Health Ministry appealed to the government and the Finance Ministry to settle the debts. And we have begun to pay off these debts. We have settled agreements with [the U.S. pharmaceutical company] Eli Lilly and [Denmark's] Novo Nordisk for next year. They have promised to send the insulin at the end of November or the beginning of December. The quantities of insulin will be sufficient for six months," Aliyev said.
But many diabetics and medical professionals claim it is still unclear when and if Kyrgyzstan will receive new shipments of insulin. They are deeply concerned about how diabetics like Anara's nine-year-old son will survive if fresh supplies fail to arrive in time. Viktor Kratshukov from the Kyrgyz Diabetics Association says he has no reliable information that the government has in fact settled its debts and that new contracts have been signed with Western insulin suppliers.
"This is why I cannot say, 'Calm down, everything is fine.' Maybe the [health] minister or another official or someone responsible for the supplies can say it. I look at the situation every day and there is insulin for some time. But I have no information according to which the situation has normalized. I cannot say that," Kratshukov said.
Safina Naila is the president of the Bishkek Diabetics Association and is herself insulin-dependent. "Everything is limited. We are given one dose every day. For instance, I am currently ill and my dose has to be increased. But I cannot do it because everything is limited," she said. "They offered us Ukrainian insulin, which is made from pigs. As a Muslim, I cannot use it."
But Aliyev says the Health Ministry is not ruling out the purchase of cheaper insulin from Ukraine. But some critics say the quality of Ukrainian insulin is inferior to Western-made supplies and poses a serious health risk to the country's diabetics. Aygul Abikova, a endocrinologist and pediatrician, told RFE/RL: "The country has decided to buy insulin from Ukraine. If we use this insulin for children there are risks of side-effects that can lead to blindness, growth-related troubles, and kidney and leg problems. This is why we are against purchase of Ukrainian insulin."
According to Valentina Ocheretenko, head of the Ukrainian Diabetic Federation and vice president of the International Diabetes Federation, even diabetic children and pregnant women in Ukraine use U.S. and Western European insulin rather than Ukrainian insulin.
But Aliyev says security measures will be taken before the registration of insulin purchased from Ukraine. "Yes, indeed. People say that the quality of Ukrainian insulin is not good. Our department has been tasked with examining it," he said. "But all the shipments require certificates. And we will test it when we will register it here in Kyrgyzstan."
Svetlana Mamutova, the chief doctor at Bishkek's endocrinology hospital, told reporters that the Ukrainian insulin preparations could cause "serious complications," which might cost more than buying good-quality insulin.
Mamutova told RFE/RL that the purchase of the life-saving hormone is a priority. She stresses that expenses like this summer's restoration projects in Bishkek for the 2,200th anniversary of Kyrgyz statehood should have been a secondary concern. "What surprises [us] is that the government finds money to remove monuments and buy asphalt," she said. "Of course it is good to have a nice Boulevard [of Freedom] at the center of the city. Still, I do not think it was crucial to change the asphalt. We could have used it for the next five years. However we cannot replace the life of our patients."
(Ainura Asankojoeva of RFE/RL's Kyrgyz Service contributed to this report.)