When diabetics would prefer AIDS

The resources for diabetes are so little in this rapidly growing city of 100,000, six hours southwest of the capital Kampala, that Medaro, head of the diabetes clinic at Mbarara University Hospital, said some patients think the unthinkable. "One diabetic patient told me she wished she had HIV because HIV treatment is free and she has to pay for insulin," Medaro said. "I have a man who was first directed to the HIV clinic because he was losing weight. He was getting free treatment, free condoms. On his next visit we discovered the problem was actually diabetes. When the man discovered he had to pay for his diabetes treatment, he came to me and said, 'What is this? I pay for diabetes. I don't pay for HIV. I would rather have HIV.'

"We have 16 patients who developed diabetes from HIV drugs. One of them said to me, 'What do I do, I can't afford the insulin (which costs $2.50 a dose, a lot in a nation of subsistence farmers)?' When patients tell me that, I feel like we are saving them to die."

I was here in Mbarara, accompanying my wife, who is planning a study of African health at the Harvard School of Public Health. The World Health Organization has warned that diabetes, obesity, hypertension, and other diseases of development are well on their way to becoming entrenched worldwide. A current major example is the explosion of diabetes in India. Those diseases do not get as much attention in Africa because of the scourge of AIDS and the perpetual struggle against malaria.

For instance, the Mbarara HIV-AIDS clinic, funded by Bush administration initiatives and other international donations, had immaculate, brightly lit labs with blood-sampling equipment and computer data stations worthy of a Boston hospital. In his diabetes clinic, Medaro sat on a bench in an outdoor waiting area for which he had scrounged $3,500 from a local bank.

"Patients at my clinic were sleeping on the floor or out on the grass," Medaro said. "We've lost 16 patients because of lack of drugs. When I see the treatment for HIV, I become inspired as to what we can do. When I see what we have for diabetes, I feel defeated."

Medaro said that, conservatively, diabetes prevalence in Mbarara has caught up to HIV, between 5 percent and 6 percent of the population. When he opened his diabetes clinic in 2001, Medaro had 50 patients. He now has 1,218 regular patients, with up to 3,800 more people coming from distant villages for consultations. This is in a hospital that deals with 7,000 HIV-infected patients.

There is no McDonald's or Burger King here (yet), but plenty of fast-food copycats have sprung up to serve a heart attack on a plate. "Chips, chips, chips, I see some kids eating nothing but chips," Medaro said. "What is popular is this thing where people roll up meat, eggs, and wheat, fry it or heat it in a microwave, and when they eat it you can see the oil falling down to the ground. It's very tasty and very dangerous."

Medaro reserved particular ire for a regional Coca-Cola bottling plant in town. Signs for Mbarara's schools, from preschool to college, were really billboards for Coke's Fanta soda. While no studies have been done on local increases in sugar-water drinking, Medaro said it has risen dramatically in the last decade-and-a-half of the plant's presence. "The radio station used to give me an hour a week for a show called 'Your Doctor,' " Medaro said. "One of the biggest things I talked about was sodas, sodas, sodas, sugar, sugar, sugar. I said sodas are going to cause a major health problem here. I tried to tell people to stop drinking soda and drink natural, local things like passion fruit.

"That must have been too controversial. After I started saying that, the radio station said all the air time was now booked."

Derrick Z. Jackson can be reached at jackson@globe.com.