Right now I’m in Pokhara for a few days. It’s about a 5 hour bus ride from Chitwan (or a 30 minute plane ride… but the bus is CHEAP AND FUN!.. and who doesn’t like that?!) Pokhara is beautiful place where you will find an abundance of fellow travelers and an interesting range of eclectic people.
Whenever I come visit, I stay near Fewa Lake- or more commonly known as “Lake Side”. It is filled with shops, restaurants, and bars – all while having that beautiful Nepali vibe.
Anyway, I came here to check out a Diabetes and Endocrinology clinic that has been established here in Pokhara. It is a well established clinic with 3200 patients! The nurses working there were kind enough to show me around and tell me how it is run.
I asked the nurses what makes a patient come to this clinic in the first place? How do they know they have diabetes? They said that many patients find out they have diabetes once they see a doctor or go to a hospital because the symptoms are too severe to manage. Only then, they will be referred.
I was also pleased to see the amount of patients they have. 3,200 is a massive amount, however, they all can afford the care and pay out of pocket.
Bucketts of Love only gives free care to those who can not afford it. Our camps are meant to find the people who have high blood glucose BEFORE they have to see a doctor or go to the hospital. The demographics of our health camps are for people who cannot afford to go to the hospital if they are sick, so hopefully our education on preventative measures, early signs and symptoms, and managing diabetes, will make a difference.
We also seek the patients that are not located in the city area. These patients that live far in the villages cannot easily travel to a doctor in the city. They are very poor.
People often ask me how a country like Nepal has such a high diabetes rate, and for a little while I was thinking this myself. Their food is actually very healthy with it being mostly fruits, vegetables ….and RICE!
But, here is the problem, aside from people having type 1 DM (that is based on genetics); type 2 is also very common (based on life style). One thing I noticed is that most of the people who have type 2 diabetes are not excessively overweight like they are in the United States. Most (not all) are actually fairly thin. I asked many nurses and doctors why it is so prevalent in Nepal and I got the same answer… “sedentary lifestyle and diet”. I know that is a factor but it did not make sense to me because it did not match up with the lifestyle of Nepal (coming from the United States… I KNOW what a sedentary lifestyle and a bad diet is.. and Nepal has no McDonalds… and no body who lives in the villages have television!)
So then I realized that the RICE is the culprit. Not just rice… but the amount of rice in one serving!
“Each additional daily serving of white rice, a staple of Asian diets, may increase the risk of Type 2 diabetes by 10%, according to the study, which analyzed the results of four previous studies involving 352,384 participants from four countries: China, Japan, U.S. and Australia. Those who ate the highest amounts of white rice had a 27% higher risk of diabetes than those who ate the least, and the risk was most pronounced in Asian people” (Stifferlin, 2012).
Dal Bhat is a popular Nepali dish made with a massive portion of rice with lentil soup and a small side of vegetables and occasionally some meat. The rice takes up the majority of the meal. Rice is one of the main crops here in Nepal so it is cheap and easy to come by. It is also very filling and 1-2 meals per day can suffice. And for desert… they will make a rice pudding (rice and SUGAR!)
So, just tell the Nepali people to eat less rice …right? It’s not that easy. That dish is a huge part of their culture and due to the financial situation, rice is what is available and affordable. They do not have the luxury to go to a supermarket and purchase different foods. This can also explain why they majority of the people here with type 2 diabetes are not overweight. They are active and do not eat processed food or fast food.
This is where it can be tricky. As much education and preventative measures you can give a person, you cannot change their culture, lifestyle and financial situation. Many westerners come to Nepal thinking they can change the country in a few weeks by implanting their ideas and telling the Nepali’s to do it their way because it is “better” (this happens in many underdeveloped countries). This is not the case at all. You have to take into consideration their situation, their habits that are centuries old, and think about the long run and the sustainability of the people. So, there has to be preventative education that a local person can incorporate in their life in a realistic manner.
One solution is to not take SO MUCH rice at once. This amount of rice in one sitting can put your body into a shock and your pancreas will not be able to produce enough insulin to keep up with the intake (this is diabetes!) Rice is better to have in small portions, multiple times per day rather than one large portion twice a day (with that second portion being right before you go to sleep).
I know Bucketts of Love has a long way to go with great aspirations… but .. it is POSSIBLE!
Sifferlin, A. (2012). White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. British Medical Journal, BMJ 2012;344:e1454.