Mrs Sang Savoeun still remembers some of the French words she learned during her 3 years at the Lycée Tangkol in Baray district. She was born in 1947 some 250 km North of Phnom Penh, in Kampong Thom province, where she grew up during a time when Cambodia was still a French colony. After 1979, having survived the Khmer Rouge regime, she moved to the capital Phnom Penh. There she lives in the Boeungkak area with her husband and family in a modest house along the railroad tracks. Her children and grandchildren are tall and slender. They seem to have inherited her natural grace. Her husband sits near her on the low table. He was a train driver employed by the National Railways until his retirement in 1993 already 20 years ago! During most of his career the engine of his locomotive was powered by coal. Then our conversation is interrupted as the “modern” Cambodian train gently passes by allowing just enough time for residents to move themselves and their possessions temporarily off the tracks as part of their daily routine.
While the grandchildren are playing with balloons in the yard, she tells me how her children have found simple ways to support the family's livelihood: one son is a motodoub driver. She introduces her daughter who is busy doing a nail job on a client’s foot. Another long limbed daughter is the organizer of the early morning "gym classes" in the public garden in front of the Ministry of Defense, which lies just at the other side of the railway tracks.
We go back in time again: In 1997, a local private clinic nearby gave Mrs Savoeun the Diabetes diagnosis. The clinic staff had found a strong presence of glucose in the urine. "3 crosses....that must have been more than 300 mg", she recounts what happened 16 years ago: "I had gone there because the ants were going after my urine. At that time the clinic gave me medicine that would last about one week. After a few weeks when the hyperglycemia symptoms returned, I would go there again to get medicine for another week. At that time I didn't understand how diabetes works”. She continued to live like this until 2005, when Rin, the diabetic MoPoTsyo peer educator, came to her house as part of the new screening program. Then she became member of MoPoTsyo. “I began to exercise, follow the MoPoTsyo food pyramid and began to take one tablet of glibenclamide every day. I felt much better and the sugar levels were well under control, but sometimes too low. Now also I find it difficult to keep within the normal range, not too low and not too high”.
Nowadays she takes 3 types of oral medication: 3 tablets of glibenclamide, 2 tablets of metformin, 1 gemfibrozil. She shows me a smart blue plastic pillbox with 4 compartments. The pill compartment to which the cord is attached contains the pills to take in a row: first one is for the morning, then the one for lunch time and further to the right for medication at dinner time, 3 times a day. "My daughter found this for me in Poipet", she says. “At the 7-11 in Thailand”, the daughter corrects her while she remains bent over the toenails of her client.
Mrs Savoeun also injects herself Insulin one time per day at 7 PM. To show me, she takes a plastic bag out of the cool box where she keeps her 10 ml insulin vial close to a block of ice. "Sometimes I inject only 8 units," she says, "It depends. I don't want my blood sugar to be too low. One time I had only 48 mg Blood glucose when I measured it. When it is too low, I quickly take a sweet drink. I find too high and too low are both unpleasant, so I try to inject the right dose. Until last year I exercised every day but this year I don't exercise anymore because the doctor told me that now I am too old and he is worried that I may fall. " I tell her she should try to find a safe way to continue to exercise. We talk a bit about advantages of cardio, weight lifting and a home bike. I recall with her how when I first met her in 2005 she was having hypo's because of the glibenclamide she had been prescribed and how I recommended her to halve the dose.
A former colleague of her husband walks into the yard politely greeting everyone. The heavy man used to be the train mechanic. “There is only 3 of us left to collect our retirement money from the railway company. It's been privatized”, they explain to me. Since last year he also is diabetic and joined MoPoTsyo. "He is a new member", Mrs Savoeun says. "His blood sugar is about 100 mg before eating now, but it was 129 mg when he joined", she tells me. He has been pre-diabetic for quite some time. “So many people have died already.” she says. “But I am still alive….!” she says laughing. She hesitates and gently slaps my knee because we have known eachother for 8 years now.
As a voucher recipient she benefits from a discount of 70%, a USD 9.13 reduction on her total monthly bill of USD 13.05 for her prescribed medicines. Her bill is relatively quite high compared to most other diabetics. Last month, MoPoTsyo was accepted as a member of the association of Cambodian Social Health Protection Agencies. We are trying to get our medicine-discount system recognized and integrated into the national system so it can become government funded in the future.
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