Traditionally the delivery of health has been prescriptive, top down, didactic and as a response to disease. Though there has been a better understanding of disease and more sophisticated methods of treatment, this has not mirrored by way of results. There have been multiple factors behind this. Thus, modern medicine has seen a shift to a more inclusive, preventative, bottoms up and empowering mode of management and a greater involvement of the community in the awareness, education and long term management of these conditions.
In our inaugural edition, we travel to Bolton in Lancashire to meet a family that has been dedicated to the management of Diabetes – Mrs. Sarbori Basu and Dr. Ambar Basu.
There are over 4.05 million people diagnosed with diabetes and a further estimated 500,000 people have the disease but are unaware. By 2020 it is expected that more than 3.8 million people will have developed diabetes in the UK, rising to more than 5 million by 2025. Current estimates suggest that type 2 diabetes costs the NHS £10 billion, with 80 per cent of this spent on treating avoidable complications such as cardiovascular disorders.
Diabetes begets limb amputation, working age blindness, stroke and renal failure. There are an estimated 20,000 avoidable deaths due to the poor management of diabetes every year.
South Asians, black African and black Afro- Caribbean have a greater risk of developing diabetes. South Asians are up to six times more likely to develop type 2 diabetes.
Disease is more common and ferocious in the poor and deprived and thus hits these communities harder partly due to the lack of awareness, education, myths and beliefs. Thus community participation is paramount to understand the barriers to healthcare delivery and education.
Diabetes UK came up with an exciting concept of involving the community by way of the Diabetes Community Champion programme. This has been successful in various parts of England such as Leicester, Birmingham etc.
This programme was rolled out in Bolton, where there is a significant problem with type 2 diabetes amongst BME (British Black and minority ethnic) communities. Interested members of the public were trained for 2 days to work in the community educating, training and establishing a two way communication with people with diabetes, relatives and friends on all aspects of diabetes prevention and care.
Sarbori Basu has been one of the first community champions in Bolton. Sarbori is a household name in the community due to her involvement in cultural events like music, dance, theatre, organisation of all Pujas at the at the Ramkrishna Vivekananda Mission where she has been the cultural secretary for over 10 years. She also runs a dance school Nritya Kala where she teaches Bharatanatyam.
Being a skilled communicator at the community level, she was best placed to understand the knowledge level of the population, take time and explain nuances of the disease. A short appointment time at the GP surgery or at the Specialist clinic or an overworked Diabetic Nurse is sometimes inadequate to establish two-way communication especially where there are multiple barriers like language. A medical establishment may not be an ideal place where someone who is shy on account of various reasons to discuss details of a disease. Some people feel themselves inadequate in the presence of a medical person in a formal setting. These are just some of the gaps that a Diabetes Champion fulfils.
It takes a while to win the trust of people, break barriers and start getting results. Given the calm and patient persona that she is, Sarbori went about her job in conducting sessions in both formal and informal settings including the Royal Bolton Hospital, several GP practices, community centre etc.
The presentations and sessions which she conducts help the people of the community to express themselves and ask questions. Language is at the heart of raising awareness. Since she speaks in the language which they understand they interact with her in a relaxed and non-hesitant manner. It gives them the opportunity to know other people’s stories and develop a sense of belonging within the community. At the end of every session the attendees are aware of the condition as they have the necessary information and resources regarding diabetes and its management.
Very recently this project completed its first anniversary. At the annual event which was attended by Lead Clinicians of the Bolton and Manchester and by the Mayor of Bolton.
Sarbori’s hard work was recognised and she received her award from the Mayor of Bolton.
Describing some unique experiences Sarbori says “recently I have been involved with the asylum seekers from different communities. This was a challenging one. The people who attended the sessions were mainly from Arabic and Somali background. They could barely understand English. Usually, I do PowerPoint presentations in those sessions but as they were non-English speaking people I had to think of some other ways to communicate. I used non-verbal communication, which was taken well and with the use of flipcharts I tried to explain visual diagrams . It was challenging as well as rewarding . At the end of the session they did try to communicate as much as possible to assure that they gained information which they were not aware of and would try to change their eating habits and lifestyle . They were not at all aware of the risks and complications and were extremely satisfied . They felt valued and expressed their concerns regarding their children and healthy eating . ‘
‘As a CC (Community Champion) I try to organise events, stalls / stands , collaborate with local GP surgeries within the communities’ Sarbori continues . ‘In such sessions I normally use PowerPoint presentation explaining about the Type 1, Type 2 and Gestational diabetes , discuss risk factors, signs and symptoms and complications. The CC s are not trained to give any medical advice. My job is to educate and raise awareness . I attended the first training in Bolton in July 2016 and has been working within the communities since then . Working mainly within the BAME communities it was evident that the risk was 6 times higher than the English community. The reasons being genetic and environmental factors , sedentary lifestyle , intake of sugary food, highly saturated fat like ghee, poor engagement with the healthcare professionals . Due to the language barrier the health messages are often missed or misunderstood. As a CC I try to communicate in the language they understand so that they are at ease and have no inhibitions to express their feelings and concerns. They try to share their stories amongst each other without hesitation and develop a sense of belonging . ‘
The Diabetes UK website has a KNOW YOUR RISK TOOL which are used in an event . The people attending find it extremely useful . This allows an individual to find out their risk of developing Type 2 diabetes in the next 10 years. It is evidence- based and comprises of seven simple questions related to age, gender, ethnicity, family history , waist measurement, BMI and blood pressure. It uses a point system to find out if a person is at low, moderate, increased or high risk of developing Type 2 diabetes. Based on this score, advice is provided in the form of lifestyle changes or a GP referral.
Sarbori said, ‘my aim is to help people with diabetes in better self-management, reduce complications and prevent cases of Type 2 diabetes through education and information, raise awareness and encourage people to have a test if they are at high risk , signpost people to health care services and build a communication between the community and health care settings. ‘
Sarbori’s husband Dr Ambar Basu is a Consultant Diabetologist at the Royal Bolton Hospital. He is the Training Programme Director for Diabetes & Endocrinology in the Northwest and a Senior Clinical Lecturer at University of Bolton. He is involved in dealing with the extremely complicated people with diabetes.
‘A huge part of management of diabetes is lifestyle which is a big challenge to tackle. Communities from the BME background faces many difficulties with their understanding and managing this condition. The community champions could play a vital role in addressing that in Bolton’ he says.
As a family, both are dedicated in improving lives of people affected by diabetes. This is both at community and hospital level. Both are a strong believers in community work and are very keen to involve more and more willing individuals to tackle this global burden.
Along with this, both have a tremendous contribution to Bengali Arts, Culture and Events over decades both individually and as a part of the Ramakrishna Vivekananda Mission, Bolton, UK.
As told to Debashis Bhattacharya