My Time in Nairobi

A quick glance at my wrist showed the Dexcom reading 5 mmol/L92 mg/dl with a steady flat line. That was good because I was carrying a 20 pound box of antibiotics and trying not to fall over the fist-size rocks that stuck out of the ground. I still had about a quarter of a mile to go as I made my way through the half-mile trek to the location where a medical clinic was to be setup. I was a part of a group of volunteers that included several doctors on a medical care trip in Nairobi, Kenya. On this day we were visiting the Tassia slums in Nairobi. I never thought that I would be on the other side of globe as a traveler or a person with type 1 diabetes on a medical mission trip for that matter, yet here I was.

I had arrived Nairobi two days earlier after spending close to 20 hours on an airplane. My body was getting acclimated to the time difference; I had made changes to basal and bolus rates on my insulin pump while on the flight, which helped to keep my blood glucose numbers in range. That was great because this was day two of a 10-day trip for the medical clinics, and this was by far one of the more difficult days.

It involved a half-mile trek through a difficult rock-ridden terrain. There was no pavement, just dirt and rocks on the trail that was about 10-feet wide. Shops and homes merged together on both sides of the trail that left very little room to maneuver. Finally, the group arrived at the location for the clinic. There were 12 people in our group and we quickly setup the clinic to include stations for three doctors and a small pharmacy.

Residents of the slum began to lineup. The clinic was opened and patients were seen. Given the volume of people to be seen there was little time for breaks for the volunteers. Thankfully I had my continuous glucose monitor (CGM) where I could quickly glance at my wrist to trend my blood glucose levels. At one point I looked down and saw 3.8 mmol/L68 mg/dl with double arrows pointed down. Uh oh. I grabbed my backpack which held my supplies and quickly drank down two boxes of juice. My blood glucose level dropped down to around 2.8 mmol/L50 mg/dl before it started to climb back up. I grabbed a few glucose tabs to chew on. Crisis averted and I continued on with my job. Our group saw 418 patients that day.

Before I boarded the first plane I had told my group where my emergency glucagon kit was kept in my bag, but hoped that I wouldn’t have to use the kit. I made more adjustments to basal rates and even set alerts to go off at a higher blood glucose level, just to make sure there were limited close calls after that day. Even though I was with a group that included several doctors, I wanted to make sure that I did my best to keep from needing any medical care while on the trip. I kept my diabetes supplies in a backpack that I carried with me all the time. In that backpack I carried extra infusion sets, syringes, insulin, glucose tablets, glucose gel and even boxes of juice. Along with those supplies I carried two separate blood glucose meters in case I had a problem with one of the meters. Every evening when our group would return to our house, I would double check my supplies and refill anything used throughout the day.

In our group there were a total of three doctors. One was my children’s pediatrician who was one of the team leaders for the group. I have always looked up to him and seeing his previous work on trips to Africa before was one of the driving forces for me to come on this trip. The other two doctors were residents of Kenya. They lived there and provided medical care to residents of the slums all the time. One of my fondest memories of the trip involved having conversations about type 1 diabetes with one of the doctors.

She had never seen an insulin infusion pump or a CGM in real life. She had only ever seen pictures of these devices in textbooks. She was blown away on one occasion where I showed her my blood glucose meter wirelessly transmitting my blood glucose reading to my insulin pump and then seeing a correction bolus given. Then seeing the reading of the CGM on my phone and how it was merely 0.5 mmol/L10 mg/dl off of the finger stick value just further amazed her.

On one occasion, where it was time to change my infusion set and CGM at the same time, I asked her if she wanted to assist me. Her eyes lit up and she responded, “Yes.” I have never seen someone watch with such intent and closeness as she did. It was so gratifying to be able to share this experience with her firsthand. There was not an abundance of people with type 1 diabetes in the area. To be able to show the doctor some of the everyday diabetes tools that I had at my disposal was such a privilege.

The trip was life altering on many levels. Not only was I able to make a positive impact on some of the Kenyans, but such a positive impact was left on myself. In one way it took away some thoughts of doubt that I had buried in my mind. There was a moment several years ago that an opportunity arose where I had a chance to travel overseas for my former employer. I spoke with my supervisor at that time about my desire to be in the group that was traveling overseas. The group was actually traveling to Shanghai, China. My supervisor’s response to my request was, “You’re a diabetic, what if something happens? Maybe this trip isn’t a good idea for you.”

That response always bothered me simply because it felt like she was allowing diabetes to hold me back. That was not the case for this trip. There were no concerns brought up that I wouldn’t be able to handle because of being a person with diabetes. Another positive outcome from my trip was the example that it gave my daughter. She is a teenager and also has type 1 diabetes. I have always tried to be a positive role model for her in terms of diabetes management. I feel that she could see that diabetes cannot hold a person back if you don’t allow it to. I will never forget the trip and the people I met in Africa. For me, this was an experience that truly allowed me to live “Beyond Type 1.”