Medical Personnel Combating Diabetes Through  Food  Cooking  Camps

By Jacky Achan

Having noticed diabetes increasing rapidly and witnessing poor nutrition among people with diabetes, the diabetes association- UDA, introduced a food camp in 2022 to educate them and the public about healthy food options, cooking techniques, and meal scheduling.

In 2005, Mary Nantongo Jjingo, a former bank employee and mother of seven, got shocking news. She had walked into a clinic on Luwum street, Kampala, to check her blood sugar.

The lab attendant who had just returned her results, asked why she had not taken her medicine yet. Shocked, she asked, What medicine?” It was at that point that Nantongo  was told she had diabetes. If felt bad, almost collapsed, and thought I was going to die,” she says.

But the signs had been there. It started in 2003 when Nantongo left her banking job after 14 years. “When you leave work, you run into depression. You wonder how you are going to survive. I was going through that phase,” Nantongo reveals.

Her brother came to her rescue. He hired Nantongo as a bursar in his school in Kakiri town, Wakiso District.

For a long time, her brother and one of his staff member had expressed concern about Nantango’s health and asked her to check blood sugar levels. This was because they noticed her drinking a lot of water even on cold, rainy mornings. But she brushed aside their concern.

It took two years before Nantongo tested her blood sugar levels.

“They were right. I had a problem, but I wasn’t aware,” She says. Her brother and his employee, as it turned out, were both diabetic; thus, their suspicions were correct since they were based on experience.

Nantongo returned to her brother and his employee for guidance. His employee connected me to her doctor who confirmed I was diabetic,” She says.

Scared, Nantongo asked the doctor if she would die. The doctor advised Nantongo to take medicine as prescribed and stop taking sugary things.

A rising burden

In 2021, 716,000 Ugandan adults had diabetes, with 89% not on medication or aware of their condition, presenting with difficult- to treat complications, according to the International Diabetes Foundation.

Dr. William Lumu, president of the Uganda Diabetes Association (UDA), says half of the people with diabetes are unware of their conditions. When you see two diabetics, there is one other diabetic who doesn’t know that they have the disease.”

The World Health Organization reports that non-communicable diseases (NCDs), including diabetes, are the leading causes of death globally, causing 41 million deaths annually. Diabetes, which is prevalent in low and middle-income countries such as Uganda, caused 1.5 million deaths in 2019 alone.

“The challenge is in the food,” says Dr.John Mudusu, a nutritionist at Kabasa Memorial Hospital in Budaka District, Eastern Uganda.

“Ugandans are overeating refined and junk foods, with induce rapid insulin production, hence the increase of diabetes, “he says.

Mudusu explained that   refined foods are ready sugars that are quickly digested, leading to increase blood sugar levels and diabetes due to lack of roughage, which removes undigested food.

Musa Mustyaba, Senior Associate at the Workforce Nutrition Programmed in the Global Alliance for Improved Nutrition (GAIN) Uganda office, emphasize that a healthy diet is crucial for prevention of NCDs.

The nutritionists are advice against excessive consumption of refined carbohydrates, which are high in calories but lack fibre.

“We are seeing people eat more unhealthily than in the past, resulting in NCDs including diabetes,” says Dr. Susan Nakireka, a Mengo Hospital Physician representing Uganda in the East Africa Non-Communicable Disease (NCD) Alliance Initiative.

She warns:” If you do not have a good dietary plan after you have been diagnosed, you will not manage diabetes.” With this ominous warning, Nantongo  joined the food camps movement to learn about healthy eating.

The Food Camp

Having noticed diabetes increasing rapidly and witnessing poor nutrition practices among people with diabetes, the diabetes association -UDA, introduced a food camp in 2022 to educate them and the public about healthy food options, cooking techniques, and meal scheduling.

For two years now, UDA, has held food camps to teach people about the importance of diet in controlling and preventing diabetes.

The first camp was held was held at Mengo Hospital in Kampala, while the second was at Entebbe Grade A Hospital. We had noticed over time that poor feeding is the problem in diabetics,” reveals Nakireka.

“When they come to us and explain their feeding pattern, we noticed they don’t change their food. Food is one of the contributors to diabetes and poor diabetes management,” she says.

To run the camps, Nakireka says an executive team, sits every month to strategize, draws a budget as per plan, and then starts sourcing financial support. In addition, people volunteer to support the camp.”

The last camp was held on November 10,2023, ahead of World Diabetes Day, commemorated annually on November 14.

On the camp day, people started arriving as early as 5:00 am at Entebbe Grade A hospital ground. “The turn-up was big. We saw approximately 500 people and above,” Nakireka reveals.

Stalls were set up in the open ground, and different people could exhibit their services. The food camp was held in that space. We cooked real food and showed people how to prepare a healthy diet,” Nakireka says.

Because UDA is a volunteer association, members offered to buy the food and cook it with the people at the camp.

The nurses and other medical personnel who usually provide health education in the diabetes clinics offered to prepare the food with people had gathered. They demonstrated how food should be prepared and the right food choice to control or prevent diabetes.

Cooked among others were green vegetables, Irish potatoes, fish, katunkuma ( bitter berries), ntula (Africa eggplant or white eggplant), peas, matoke, pumkin and millet bread. We encourage steamed and not fried food,” said Dr. Christopher Kwizera, the Executive Director Uganda NCD Alliance.

Announcements were made, and flyers were disturbed even on social media, including UDA’s Facebook and X platforms and that of their collaborators. Everyone was invited.

Learning to choose the right food, cook it well, and eat a healthy diet has ensured that Nantango , who was at the beginning of her diagnosis in and out of the diabetes clinic for management, keeps her sugar level in control and generally live with the condition.

“It has been almost 20 years of living normally with diabetes,” she says with a victorious smile.

The Dedication

Even before the food camps, Nantongo received nutrition advice from Dr. Lumu and Dr. Samuel  Kalibala at the Diabetes Clinic at Mengo Hospital. They also facilitate the camp.

Lumu guided Nantongo to eat more vegetables, including dodo ( amaranthus or pigweed), bugga ( redroot pigweed or red amaranthus), nakati ( solanum aethiopium), and Sukuma wiki ( collard greens) daily, as they are considered medicine.

Kalibala advised Nantongo to avoid cooking oils, fats, margarines, cheese, spreads, and butter and instead opt for boiled food, which she dutifully follows.

Today, she is an enthusiast for a balanced diet. She has a meal timetable. Each meal is predominantly vegetables with a moderate meat intake.

“On this journey, I must ensure I eat well, mostly vegetables from my kitchen garden. I don’t eat a lot of carbohydrates. I don’t take sugar or sugarcane or overeat; that’s important. And I drink plenty of water.”

Her caretaker, Gloria Nampiima, manages the daily routine. She wakes up early to prepare special meals and give Nantongo her medications on time. It is not easy, but I manage,” Nampiima reveals. She also takes care of other family members’ meals. It takes dedication to stick to a healthy diet,” Nantongo says.

The dietary loyalty has paid off. Nantongo no longer frequents the hospital and does not live in fear of diabetes like it is a death sentence.

By following the doctor’s dietary advice, preparing her food right, and eating well, she has her sugar level under control and is living normally with diabetes.

Diabetic Amputee

Even for Rachael Bawaira, 49, a diabetic amputee, understanding diet was a problem. Meagre financial resources worsened it until she joined the food camps.

In the 1990s, at 23, Bawaira was diagnosed with diabetes. She had just started work upon completing nursing school.

Her diet was inferior. “I was redundant at home, weak, with a persistent mild headache, but now I work. I can spend a month without a headache or general body weakness. I am always busy working compared to the past,” she says.

Bawaira was gifted an artificial limb, overcame stigma, returned to her community, and started fending for her family. Thanks to the food camps, a good diet has ensured her health.

“I wish I was told much earlier about proper dieting; I wouldn’t have been amputated in 2015,” says the single mother of two and guardian to three other children.

“I ate that fine white posho and enjoyed it, thinking it was good. However, at the food camp last year, they cooked the non-refined brown posho. I have been eating it ever since.

“We learnt more about food and how to prepare it, including eating plenty of vegetables. As a result, my sugar levels have been controlled compared to the past. I am doing well and living normally with diabetes,” Bawaira reveals.

“That brown posho is not too expensive. I interchange it with matoke.” She also grows some vegetables, so she doesn’t have to buy them.

Bawaira admits that people diagnosed with diabetes don’t know how to manage their diet efficiently, and the public needs to be educated.

She says once someone is diagnosed with diabetes, life changes. People lack knowledge. Some even think its witchcraft until they go to hospital,” says Bawaira.

‘If people are educated about diet before diagnosis, they can prevent diabetes. And if diagnosed, they can start treatment and manage the condition early. That person will live longer and normally with diabetes.”

Nakireka happily notes that people are beginning to show interest in living healthily. They are coming to us. That’s the first step, which is a good thing.”

“But we are still at the formation stage; we have only started. That’s why I wouldn’t say we see a big impact yet. The important thing is that we have started the journey.  People are starting to pay attention to diabetes, delay or avoid it, or live normally with the condition through proper dieting.”

At the food camp, people are taught, in the simplest way, how to choose and prepare food that will not affect their blood sugars.

For those who are not yet diabetic, Nakireka explains how to choose healthy food options, jubilantly declaring: The intervention is working.

“By eating well and regulating portions, their glucose levels, blood pressure, and weight get controlled, and those with diabetes can live their lives normally,” UDA president Lumu says.

Affordability, Cravings, And Other Challenges

Even so, most people cannot afford a balanced diet at home, which forces them to eat unhealthy foods. Some people with diabetes also have cravings for sugary foods like cake. When I don’t have enough money, I eat a slice of the forbidden white bread,” admits Nantongo.

She admits that she sometimes eats what she is not supposed to when financially constrained. I have a weakness for cake, but I take a lot of water to ensure it doesn’t affect me.”

Dr.Mudusu, the Kabasa Memorial Hospital nutritionist, note, The type of food is not a problem; just eat with caution.” The fear is that some people may eat foods that quickly spike sugar levels, hence the restrictions, he says.

Dr. Lumu is equally against restricting diets when sick and says, how food is cooked and what it is eaten is crucial.”

“Even with diabetes, you can eat the carbohydrates as long as you are going to burn them up during your active time of the day; just don’t eat them when you are going to be inactive or when going to sleep,” he advises.

But there is a hindrance, says Nakireka. Unlike in Western diets, where a food package shows how many calories it contains, food in Uganda is not quantified, she says.

Fortunately, UDA has taken measures to deal with the problem. For example, we use easy tools for quantification, including partitioned plates. We tell people that the bigger part is for vegetables, the smallest part is carbohydrates, and the remaining part is for protein. We encourage people to have such plates for their meals,” Nakireka says.

“We also use our hands to determine how much people eat. The fist should be the total amount of carbohydrates you eat; the palm should hold the protein, and then use the two palms for the vegetables you eat, meaning as much as possible.”

People are also taught the quantity to serve based on the food type. There are those foods that are high in starch and those that are high in sugar.

We tell people to choose non-refined brown posho, number three, instead of the refined white posho, number one, if you have to eat rice, eat a small quantity of brown rice instead of white rice,” Nakireka says.

“For those who are not yet diabetic, those at high risk because of family history of diabetes, and young people with increased cases because of the type of food they are expected to, we target prevention.

“If parents can insist that everyone in the household must eat more vegetables and fruits and abandon or eat less food that could cause diabetes, it would be a good thing,”Nakireka says.

Kwizera says, food is medicine before you get sick, and needed by the body when you are sick.”

Growing Interest

In the past, people would not turn up for the camp, says Nakireka. Now we have big numbers seeking our free care because they cannot afford to see specialists in hospital but at the camp.”

However, because of the large numbers, the camp closes before everyone benefits. Since many activities take place at the same time, people miss out on some engagements.

Nakireka says that many months after the camp, they call asking for help, but even if you invite them to come to the hospital, they cannot afford the fee.”

“Sadly, we cannot follow up on those we helped at the camp. The funds cannot enable us to have a follow- up component. It’s the biggest challenge,” reveals Nakireka.

She says the sponsors are getting a bit exhausted. We go to the same people annually.” She reveals it’s costly to have the camp.  We have real food to cook. It costs us many millions in Uganda shillings. We don’t have funds to run these activities,” Dr. Nakireka says.

Be that as it may, the beneficiaries are hopeful that the frequency of the camps will increase, not decrease. We should have the food camp twice or three times a year to raise awareness about diabetes and how to avoid it. And for those with it, to learn how to manage and live normally with diabetes through a good diet,” appealed Bawaira.

This story was written with support from Science Africa and Africa Health Solutions Journalism Initiative .

This story was first published in New Vision