Mrs Peng Aoy has been a member of MoPoTsyo since 2006. 7 years ago, she was in her early 40ies when her Diabetes was detected thanks to the urine strip. She only found out about it when MoPoTsyo’s peer educator gave her one urine glucose strip (USD 0.03) for self-screening at home. This type of diabetes screening consists of 2 steps. First, people use this glucose strip by dipping it into their urine within 3 hours after a lunch or dinner. If, after 30 seconds the color of the urinestrip has visibly changed, the person will alert the peer educator who will perform a Fasting Blood Glucose test. For this, the Peer Educator uses a Glucometer that measures the level of sugar in a tiny drop of blood taken from the fingertip with a disposable lancet. The diabetes diagnosis must be based on the blood glucose level, so not just on presence of glucose in urine. The reason for using this two-step approach is that blood glucose strips are 10 to 15 times more expensive than urine glucose strips. While this screening method is not perfect it has worked well for many poor Cambodian diabetic people such as Mrs Peng Aoy. She was completely unaware of her diabetes before she performed herself the urine glucose test. Poor Cambodian people are usually slim but despite this they can be walking around with high blood sugars as a result of their Type 2 Diabetes. Mrs Peng’s Body Mass Index (BMI) is less than 20 so she is lean. About half of all 5,500 members of MoPoTsyo with Diabetes have a BMI of less than 23, not overweight!
Mrs Peng is a single mother of 2 children. She is a walking fruit seller: This morning she bought 15 kg of oranges. She can carry a load of up to 20kg on her head. Then she starts to walk trying to sell it until she has sold everything. That is the income for food and for everything else, Every day she walks many kilometers from Boeungkak lake to Psar Daem Koo where she buys the fruit, then to Independence Monument, then along the riverside and back to the Boeungkak area where she shelters with the children. She explained me how the walking helps her burn her sugars and stay healthy. She recounted how she can feel the difference on days she is not making her round. Despite her physical activity, she is also on prescribed oral medication at a cost of USD 2.52 per month. That is affordable for most Cambodian citizens. However her situation is a bit special:
During the big 2010 fire in Boeungkak lake that destroyed many huts, including hers, she had lost all her property including her official Poverty ID card. This poverty card is becoming increasingly important for social health protection. It entitles her to free care at the public Hospitals ..for acute health problems as the hospital fees are paid for by Health Equity Fund, managed by the Cambodian NGO Family Health Development. That NGO’s funding to pay for these health care costs comes from the Ministry of Health.
However Mrs Peng’s monthly costs of her maintenance medicine are not yet covered by this system, whether she has the card or not. This is why – temporarily – we have been helping her since the fire. After the fire had happened, MoPoTsyo entitled her and other Diabetics that had been affected to medication free of charge: 100% voucher support. But how sustainable is this? If we succeed in linking our existing voucher scheme with the Health Equity Fund for acute care funded by the Ministry of Health, we can tap into a sustainable source of financing for the long term to create coverage for chronic care costs for vulnerable diabetics. It is going to be one of the challenges for 2013 to try to figure out if this can be organised and how. Mrs Peng’s situation shows that for some vulnerable people having to pay even a low amount is undesirable because it cuts into their food expenses or the school fees of the kids. For most other patients such low amounts are not an issue. With growing numbers of chronic patients on prescribed medication, efficient and precise targeting of assistance must be built into the social health protection mechanism to reach them with an effective system that is affordable to the Cambodian society itself. During the last quarter of 2012, the 2 NGO’s began to work together to see if they can figure it out. Time will tell but in the meantime your support is needed...
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