Michael Bliss wrote a book called The Discovery of Insulin in the early eighties – I read it just before I left for Ukraine. It was terrifying and heartbreaking to learn the stories of T1Ds before insulin, and it was fascinating and enraging to learn about diabetes research, past and present. I have always wondered about the world, and knowing Peace Corps’ medical rules, I wondered about how T1Ds in Ukraine and elsewhere lived. It was frustrating to know that these people must exist – diabetes is not discerning enough to care about access to insulin – but that access to, or the quality of, healthcare is so lacking in certain countries that the US government wouldn’t consider sending its citizens there to serve.
I met or heard stories of several Ukrainians with type 2 diabetes during my service. I did not get excited about these meetings or tales, mostly because these two diseases are really distinct from one another, and among everyday Ukrainians (like in everyday Americans) there wasn’t a distinction between the two. I met a couple of other volunteers with T1D (bless you, Dr. Valeriy!), and while these meetings always gave me a burst of energy, they didn’t help answer my questions about Ukraine’s T1D infrastructure, because they had the same access to Peace Corps medicine as I did.
Finally, it happened. I was serving as a judge at a national English language competition, and one of the other volunteers, a friend who knew of my quest, met a student competitor who had T1D. I was thrilled! I greeted him enthusiastically and he seemed receptive, so I started in on the stats: how old was he when he was diagnosed, what kind of meter did he use, was he on shots or a pump? His responses weren’t surprising, but they sent me into a funk. This kid was smart and had a great attitude – he’d won a scholarship to the US, and during his time there, had access to an insulin pump. But now, back in Ukraine, he was injecting R and N. He expressed the frustration that we would all feel – he knew what was possible in terms of management, but he either couldn’t afford it or couldn’t access it.
This is where this series ends. I’ll always have Peace Corps stories, all of them flavored by being a volunteer with a chronic disease, but you’ve heard the overarching lessons. I encourage anyone reading this who has questions about programs like Peace Corps to contact me! Peace Corps changed my life. I believe it made me a better person, and I hope I contributed as much to the program as I gained from it. However, it also cemented a kind of slow-burning anger into my being towards entities like bureaucracies and pharmaceutical companies, because what was inconvenient in the US was simply inadequate in Ukraine.
For example, did you know that noncommunicable diseases (NCDs) – like diabetes – have emerged as the leading cause of death in developing countries? Organizations that work in developing countries, like Peace Corps, have an opportunity to play a pivotal role in terms of combating and managing NCDs. Peace Corps physicians are required to complete continuing medical education programs – do they cover endocrinology? Can we help physicians and pharmacists in these countries become better acquainted with treatment of NCDs in the US? I understand the risk involved in sending someone with a bizarre allergy, with asthma, or even with T1D to a place lacking the appropriate infrastructure. I understand this because every day is a risk for me, really. But how many of these places just need a Dr. Valeriy, or someone comfortable with the concept of an illness, to get on board?
My anger was not something that I alone could, or can, address. In my Peace Corps application, I wrote that I knew I couldn’t save the world, but alongside a body of other likeminded volunteers, perhaps? Who knew what we could do?! T1Ds exist everywhere, in every country: we are flawed but we are functional. And we contribute. There is value to be found in our mere existence in organizations like Peace Corps, even if it’s simply that we know different.
Peace Corps was not easy – any T1D that wants to serve has to really want it, each and every day of their service, and they have to fight to get to that point as they progress in the application process. But, we T1Ds exist everywhere. We owe it to one another to remember that, to do more, and to ask for better. It’s one of the best ways to honor the memory of the T1Ds who couldn’t do so themselves.
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