Editor in Chief :

Mahmoud Ashraf Ibrahim ,MD

     
Issues per Volume: Quarterly
Current Volume: 1
Current Issue : 1

Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo


Abstract Number : 2

The Activities of Insulin for Life Australia

Ron Raab, Australia 

  Vice President of the IDF and a member of the IDF Insulin Task Force and President of Insulin for Life Australia Incorporated. He is economist and worked at the International Diabetes Institute, Melbourne, and Australia 1980-2000. 

Insulin for Life (IFL) is a not-for-profit, Australian based organization, established in 1999. It evolved from the 20-year program at the International Diabetes Institute, Australia. Mission its major objectives are to:

  • Donate insulin, syringes, test strips and other supplies in urgent situations, and to several countries and Diabetes Associations on a continuing basis.
  • help develop and implement sustainable improvements in insulin supply in countries in need Background to the Challenge
The cost of insulin that the person with diabetes has to pay varies greatly in different countries. This is a critical problem, particularly in those economically developing countries where the full, unsubsidised price is high and must be paid for by the user, over many years or decades. In many such countries, insulin can cost more than 50% of average annual income. Inability to afford insulin is a major cause of morbidity and mortality in persons with diabetes in such countries. In contrast, in developed economies, the price is usually greatly subsidised and the yearly cost of insulin is usually well below 0.5% of average annual income. If persons in developed economies had to pay the same relative amount for insulin, it would cost a person about $US 1,000 per month ($US 12,000 per year)-in other words 100 times more expensive in relative terms than currently.

Major activities: 

1. Donation of insulin and other diabetes supplies.

    During the year to June 2002 supplies were donated to 10 countries. 
    The program commenced at the International Diabetes Institute, Melbourne, and Australia in 1984. Supplies have been donated to the program by clinics and from other sources. Up to June 2002 
    1,200,500 mls insulin 
    210,550-blood glucose strips
    1,362,300 syringes
    Have been donated to 40 countries in all IDF Regions. Meters and other items are also donated. The total value of these items is $US 3,318,000.
    Without the support of individuals and organizations in America, Australia, Germany, Japan and New Zealand, this lifesaving program would not continue. The German Diabetes Association has been a major, long-term supporter and a source of great encouragement. 
2. Sustainable improvements in insulin cost and availability
    Education programs have grown from the networks established. For example, a 5-year education and foot care project evolved in the Philippines 1994-1999, from the initial insulin donation project. The Australian Government supported this with matching grants of $ US 140,000. There is great potential for similar projects. IFL also contributes to the international efforts to try to improve the cost and availability of insulin to the majority of people in the world who have great difficulty securing a regular supply. As one of the International Diabetes Federation Vice Presidents, and a member of the IDF Insulin Task Force, I am often aware of emergency needs very quickly and of overall efforts. Some other practical suggestions Insulin for Life has advocated for consideration include:
  • more efficient use of insulin, for example reducing overuse in people with Type 2 at the expense of those with Type 1 diabetes
  • Encouraging application to the foreign assistance budgets of economically developed countries for programs involving improved access to insulin in developing countries. These funds are large.
  • awareness of the continuing viable role of urine glucose testing, where blood glucose testing is either not available or prohibitively expensive
  • helping investigate alternatives, so that those who prefer animal-sourced insulin will continue to be able to obtain it
  • supplying insulin in vial form rather than as insulin pen cartridges, as it is cheaper to produce in this form
  • extending the nominal use by dates of insulin, as it has a very long life if stored appropriately
  • developing an efficient, equitable system to ensure that withdrawn types of insulin become available for use in humanitarian programs
  • involving organizations such as Rotary and Lions Clubs to assist with improving insulin supply and related activities

Recently an Australian Rotary Club obtained a grant specifically for the purchase of insulin for 150 girls with diabetes for 3 years at the DREAM TRUST center in Nagpur, India, as part of a comprehensive care program. DREAM TRUST has received supplies from IFL since 1996 and has recently also received support from the IDF Sponsor a Child project. IFL has been active about the issue of the effect on price of the withdrawal of the often considerably cheaper animal-sourced insulins in countries where the price is not subsidised. 
Novo Nordisk has recently established a separate fund through the World Diabetes Foundation 
www.worlddiabetesfoundation.org and made a commitment to a major reduction in the cost of insulin for people living in the poorest 49 countries.

CAPTIONS FOR ATTACHED PHOTOS
PHOTO 1 

Recipients of insulin and strips sent to the Diabetes Association of Bolivia, July 2002, with (standing at left) Dr.Elizabeth Duarte Gomez, Project Director and President of the Bolivian Society of Endocrinology. 

PHOTO 2

Insulin and test strips being distributed to people with diabetes in Goma, Democratic Republic of Congo, following the earthquake in January 2002. Building on this contact the IDF African Region facilitated further assistance with the help of Novo Nordisk and Eli Lilly. 

Taming the diabetes monster 

Australian Review Edited
November 30, 2000

Rather than being defeated by his illness, Ron Raab has confronted it, met all its demands and made it work for him and for countless others. 

He is a living example of how it is possible to become your own expert and thrive while many others in the same situation have either died or become seriously debilitated. 

In 1957, at the age of 6, Raab was diagnosed with insulin-dependent diabetes, a condition he would have for life. Figures show that close to half of the people similarly diagnosed in the '50s have since died or suffer disabling complications such as blindness, amputation or kidney failure. 

Today, Raab is a fit and healthy family man who devotes his time to making sure people with diabetes in developing countries have access to life-preserving insulin. 

Every week, thousands of people in the poorer areas of Eastern Europe, Africa, Central America and Asia suffer a painful and slow death which could be prevented if they had proper access to insulin. 

With a background in economics and statistics, Raab founded Insulin for Life Inc (IFL), which collects donated insulin and diabetes supplies and delivers them to places of need. 

In many developing countries insulin costs more than 50 per cent of the average annual income. This contrasts starkly with developed countries, where the price is heavily subsidised and usually costs below 0.3 per cent of the average annual wage. 

Raab says more than $US3.2 million worth of supplies have been delivered since 1986, a volume that would have kept 40,000 people alive for three months. 

As a man who injects himself four times a day, Raab appreciates the need for a reliable supply of insulin. He tests his blood four or five times a day and adjusts his insulin intake. Watching his diet and timing meals to accommodate his jogging are other normal parts of his daily routine. 

"I've given the monster of diabetes all the attention it demands and turned it into a pussy cat," he says. 

"It's become a minor routine inconvenience in my life. But I'm diligent and well informed. For 20 years, I worked at the International Diabetes Institute in Melbourne."

As a child, Raab felt lonely not knowing anyone else with the disease. At that time he was injecting himself with a glass syringe twice a day, and because self-testing and treatment were primitive, he suffered swings in blood sugar that made him weak and could even put him out of action for a couple of days. 

Apart from a brief lapse at university in the 1970s, Raab has taken his diabetes seriously and no longer has complications that interfere with his life. 

While good blood sugar control effectively allows a diabetic to live a normal life, Raab says achieving this requires three things. 

The first is accepting that you're in the driver's seat and that it is up to you to take control. The second is to master the steep learning curve so you're informed enough to experiment until you find the right formula. And the third is to have an unbroken dedication to the routine of remaining well. 

"Basically, you have to become your own expert. If you don't give it what it needs, diabetes will bite you badly." 

Last month, Raab was elected a vice-president of the International Diabetes Federation, which represents diabetes associations in 135 countries. This makes him an international spokesman for the disease. 

 

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