Connective Tissue:
Binding Communities through Managing Diabetes
Shafiq Lokhandwala, Senior Advisor

In a world where the politics of caring for others and the politics of caring for oneself swings like a pendulum, it is increasingly obvious around the world that the politics of self-interest are on the rise. This is evident not just in authoritarian regimes but also in democracies where majorities are voting for leaders that vilify minorities and dehumanize anyone unlike themselves and their self-interest, as the “other”. Regular people today find that their affiliation with the majority brings value, fame and money. Beyond permission, there is reward for disregarding and even stomping on the “other”. Consequently, people are increasingly building new tribal connections that mimic their views, creating a community, a tribe, bound by their dislike and fear of the other.

This piece is predicated on an assumption I believe to be true, despite the politics of the times, that inherent in every human is the capacity to care beyond oneself and that such caring is empowering, and that for most people, giving is at least as rewarding as getting. Glucose Trail, an initiative led by my wife Dr. Naaznin Lokhandwala an Endocrinologist and I, a software engineer who has built and sold a for-profit technology company, is an attempt to harness that caring energy.

Non-communicable diseases like diabetes are silent killers and debilitating not just to the person who has the given disease, but also to the family or caregivers who are consumed by managing it. According to the WHO Global Report on Diabetes published in 2016, “globally, an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. The global prevalence (age-standardized) of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. This reflects an increase in associated risk factors such as being overweight or obese. Over the past decade, diabetes prevalence has risen faster in low- and middle-income countries than in high-income countries.” One in seven people has diabetes in developing countries and diabetes is the eighth leading cause of death worldwide.

Glucose Trail is a diabetes solution that brings care to the patient. It is comprised of:

1. Community Resources (diabetes medications + local lab + home glucose testing + local groceries + local recreation)

2. Community Health care companion (HCC)+ remote diabetes clinician

3. A mobile app linking the remote diabetes clinician to the local HCC to bring diabetes care to the patient.

Glucose Trail piloted in Islamabad, Pakistan, with 100 patients. Twelve women were identified as health care companions, and each reached five to ten relatives and neighbors who are early or mid-stage diabetics. The health care companions ensure patients take their medications, help them get laboratory tests done, and assist in diet management and engagement in physical activity. The health care companions use the Glucose Trail App to help ensure compliance with the medical intervention, and ensure that a doctor, using telemedicine, gets accurate information. Health care companions are supported by local community sponsors, who make a livelihood from providing value products to diabetics and local doctors.

Health care companions train together, then organize diabetes camps where all patients are tested and educated. Connections with others through these events create a community bound by helping extricate loved ones and neighbors from a disease. Given the emphasis on healthy diets and the importance of physical activity as a medical intervention, the community has tasks they need to manage together and take on responsibilities for themselves.  This shared responsibility allows a self-interest, the well-being of their loved ones, to combine with the understanding of a neighbor and their way of life and results in inviting them into their circle. It is my hope and expectation that each person involved as a health care companion will first allow themselves to reach beyond the fragmented confine of their tribe and build their own caring neighborhood. My hope is that the health care companions, as valuable members of the community, will affect their patients in a similar way. As we scale Glucose Trail to 10,000 patients in 2019-2020, and then to 100,000 across Africa and Asia, it is important that we design our program to ensure that health care companions are supported both medically and via the community, so they can be effective friends, medical advisors, and connective tissue that binds a neighborhood.

I am an optimist and a believer that our better angels will eventually triumph; that this initiative and others like it will cut through our shared concerns. Active efforts of caring for people without discrimination and finding real causes that need real solutions will help the pendulum swing back from the narrow concerns of self-interest. With enough activism, the act of helping will also foster an understanding of the other and expose the premise that each person and community is stronger when we are accepting of others and will have a deeper, more meaningful impact in our societies.