Mercy Hospital's Diabetes Clinic is Taking Off!

While significant strides have been made in combating malaria and other infectious diseases in Sierra Leone, a growing public health challenge is emerging: the rise of chronic diseases such as diabetes. A recent Lancet study revealed that over 445 million people worldwide lack access to life-saving diabetes medication. This disparity is particularly pronounced in low and middle-income countries, where treatment rates are as low as 10%. This double burden of infectious and chronic disease demands a multifaceted approach to healthcare.

This World Diabetes Day, we want to recognize the life-saving work that Mercy Hospital is embarking on to tackle this issue. Below is a write up from Mercy’s Diabetes Clinical Team, which includes Matron Augusta Kpanabum, the new Doctor. Morie Vandi, and Nurse Monica Sheriff, who supervises the diabetes clinical activities:

Matron Augusta Kpanabum, Doctor. Morie Vandi, and Nurse Monica Sheriff getting things set up for Thursday clinical day.

The Mercy UMC Hospital Diabetic Clinic was established in July 2024 following the visit of Misti Levya and her team of missioners. The clinic was created after free diabetes and hypertension screenings organized by the outreach team highlighted an urgent need for dedicated diabetes care in Sierra Leone. Recognizing this need, the team started the clinic with a vision to provide free, quality care to diabetes patients who would otherwise have limited access to proper management and treatment.

Since its inception, the clinic has provided critical support to diabetic patients across Sierra Leone, becoming one of the few hospitals in the country offering free diabetes care. Through the generosity of Insulin for Life USA, they have received free insulin, glucose meters, test strips, and other essential diabetic supplies. This support has allowed us to reach patients from even the most distant parts of the country, including Freetown, the nation’s capital. Patients from these areas make periodic follow-up visits, demonstrating the clinic's wide-reaching impact.

“Starting a clinic like this was crucial for a country like ours, where many individuals are unable to afford the continuous care diabetes requires. The commitment of Misti Levya and her team, and the support from Insulin for Life USA, has been a game-changer for our patients.”--Dr. Morie Vandi, Medical Doctor-in-Charge

The diabetic clinic operates weekly, providing the following essential services:

• Outpatient consultations: Patients receive regular evaluations, medication, and guidance on lifestyle management.
• Health Education and Counseling: Patients are educated on diet, physical activity, and glucose monitoring by our dedicated diabetic nurses.
• Screening Services: Blood glucose, HbA1c, and lipid profile screenings help to monitor and adjust care as needed.
• Complication Screening: The clinic offers early screening for neuropathy and other complications.
• Medication Management: They provide insulin and diabetic supplies free of charge, thanks to Insulin for Life USA. However, oral medications for Type 2 diabetes, which are not covered, remain a challenge due to high out-of-pocket costs for patients.

“Having a diabetic clinic at Mercy Hospital is truly a blessing, especially for those living with the condition. Considering the costs involved in purchasing insulin, glucose meters, and testing strips, this service has significantly reduced the financial burden on patients, allowing them to use their funds for other basic needs.”--Matron Augusta Kpanabum

Since July 2024, the clinic has seen a significant influx of patients:

• New Registrations per Month:
  • July 2024: 45 patients
  • August 2024 to October 2024: Averaged 20 new patients per month
  • Total Registered: 113 patients to date.
• Follow-Up Visits: Approximately 70% of patients return for monthly follow-ups, showing the clinic’s strong influence on adherence.
• Patient Demographics: Our largest group of patients are aged 45-60, many with long-standing Type 2 diabetes and early complications.

Their early outcomes highlight the clinic’s effectiveness:

• Initial Fasting Blood Glucose: At registration, the average fasting blood glucose for patients with type 1 diabetes was 18.4mmol/L, reflecting poor diabetes control (Healthy levels are between 3.9-5.6 mmol/L).
• Improved: As of October 2024, the average FBG for type 1 diabetes patients has reduced to 11.3mmol/L.
• Blood Pressure Management: Over 80% of hypertensive patients show improved control through dual Type 2 Diabetes and Hypertension management.

“Many of our patients arrive feeling hopeless. With consistent guidance and support, we’ve seen transformative changes in their confidence and health. They know they’re not alone.”--Nurse Monica Sheriff, Diabetes Clinical Nurse

While they’ve made remarkable progress, some ongoing challenges persist:

• Medication for Type 2 Diabetes: Unlike insulin, Type 2 diabetes medications are not readily available through donations, leading to high out-of-pocket expenses for many patients, which hampers their management.
• Resource Limitations: The only diagnostic tool available for free is the Fasting Blood Glucose and Post-Prandial Blood Glucose. The other diagnostic tools like HbA1c, Fasting Lipid Profile, Kidney Function Test are needed for full complication screenings, but are however not done by the majority of our patients due to the high out-of-pocket expenditure.
• Patient Education: Low literacy rates among some patients make it challenging for them to follow complex treatment and lifestyle recommendations.

Matron delivering patient education at the clinic.

The clinic has set the following goals to enhance service delivery:

• Enhanced Screening: They have introduced fasting lipid profile, kidney function and more comprehensive complication screenings to better assess and address patient needs.
• Community Outreach: They aim to extend educational and screening services to neighboring communities, identifying individuals who may be undiagnosed or untreated.
• Staff Training: Ongoing training for their staff will ensure the highest level of care for our patients.
• Electronic Records: They’ve begun storing patient records digitally to improve accuracy and continuity of care and understand the management trend.
• Comprehensive Care: With over 80% of our patients affected by type 2 diabetes, they’re hoping to expand comprehensive screening and management services for them. Having new services like fasting lipid profiles and kidney function tests covered by the clinic will help us better monitor and manage complications.

​“Our patients benefit immensely from the resources we’re able to provide, but there’s still a gap when it comes to Type 2 diabetes medications. The financial burden for these medications is a heavy one, and we are seeking ways to bridge this gap.”​--Dr. Morie Vandi, Medical Doctor-in-Charge

The diabetic clinic at Mercy UMC Hospital has made a profound difference since it opened in July 2024, saving lives, reducing complications, and building a support network for diabetic patients throughout Sierra Leone. Thanks to Insulin for Life USA, Helping Children Worldwide, and Misti Levya and her team's vision, they are offering free care and helping to rewrite the future of diabetes care in Sierra Leone.

​While Helping Children Worldwide has traditionally focused on maternal and child health, our partnership with Mercy Hospital has enabled us to support the strengthening of the broader health system. Mercy Hospital's decision to establish a diabetes clinic is a testament to their deep connection to the community, as they recognized the growing prevalence of diabetes among their patients. This initiative also highlights the strength of our partnership, as Mercy Hospital sought our support in developing this project. Importantly, however, this clinic represents their growing independence, demonstrating their ability to identify needs, develop solutions, and implement them on their own. We remain committed to supporting Mercy Hospital in their ongoing efforts to strengthen maternal and child health and the overall health system, while also celebrating their ability to pursue new opportunities independently. We are excited to witness their evolution and support their future endeavors.