I’ll do the V.O, and I’ll consider it professional to learn how to pronounce words that I may not necessarily be familiar with, and I’ll charge them Ksh 10 less. Regardless, I realize I have the sultry feminine voice going, which doesn’t quite work when you want that deep movie voice. They need to hire someone else, or Mr. So and So ought to take his job and his audience more seriously.

In Kenya where armies
of tires and rocks burning,
arrows and pangas bloody,
fight
to quench hate, renew apathy;
in Ukambani the wind blows at will, as usual,
kerosene is up, regardless, men and women
continue their pleas to their sky and God for rain.
Later in the starry darkness, they listen closely
to the radio for news of how much closer the
trouble has traveled.

Trying to be gentle, more productive, and more effective with myself…

By DAGI KIMANI
Special Correspondent

The market for diabetes medicines and diagnostic tests in Kenya will hit $26.8 million in the next four years, according to market consultancy firm Frost & Sullivan.

In 2006, the firm says, the diabetes market in Kenya stood at $18 million, which made it the third biggest in sub-Saharan Africa after South Africa and Nigeria.

According to the consultancy, growth in the market for diabetes medicines and testing kits is premised on easier access to healthcare, as well as a dramatic, if unfortunate, increase in the number of diabetics in the country due to lifestyle changes.

“The anti-diabetic pharmaceutical market in Kenya is benefiting from better access to healthcare delivery, drastic changes in lifestyle and a growing middle class,” noted the firm’s research analyst Lizelle Wentzel in a report made available to The EastAfrican. “More Kenyans are seeking treatment and being diagnosed with the disease.”

According to the consultancy, the use of insulin-based injection treatments is growing especially rapidly as more patients use them concomitantly with oral treatments.

The majority of drugs prescribed for diabetics, however, remain oral, although there are concerns about the glycaemic (sugar) control abilities of these drugs, which may not be entirely efficient in bringing blood glucose levels down to safe levels.

In light of these concerns, a growing number of Kenyan doctors, Frost & Sullivan says, are increasingly turning to insulin, which is more expensive, to complement the oral drug treatments for type II diabetics.

In 2006, for example, the consultancy says, about 43 per cent of all type II diabetics were using insulin in addition to oral treatments. This trend will underpin the expansion of the market, it adds.

“The cost of treatment, especially for type II diabetics, is becoming more expensive,” remarked Ms Wentzel. “This is being exacerbated by the recent trend of complementing oral treatments with insulin so that the required glycaemic control can be attained.”

According to the firm, oral anti-diabetic drugs with greater sugar control abilities and alternative methods of insulin delivery will constitute a key market need in coming years, and pharmaceutical companies that are able to fulfil these needs will stand to make large gains.

Manufacturers will however need to work hard to lower costs in the price-sensitive Kenyan environment, while simultaneously maintaining a high level of quality if they hope to benefit from the greater demand in the country, Frost & Sullivan says.

According to research by Kenyan diabetes experts, Kenya’s prevalence of type II diabetes has now surpassed the World Health Organisation (WHO) estimate of between one and 6 per cent, with incidence being as high as 14 per cent in urban areas.

Writing in a special issue of the East African Medical Journal last July, the researchers attributed the rise in the incidence of the disease to a combination of factors, including diet and urbanisation.

“Several modifiable risk factors are the driving force of the rising prevalence of type II diabetes in Kenya,” wrote Dr C.F. Otieno, a senior lecturer at the University of Nairobi’s Department of Clinical Medicine and Therapeutics. “These factors, which are generally associated with urbanisation, are refined carbohydrate and high-fat diets, sedentary lifestyles and lack of exercise or circumstantial reduction of physical exercise occasioned by the availability of motorised machines.”

According to the researchers, Kenyans were also developing type II diabetes at a much younger age than people in developed countries, with the peak age of onset being between 45 and 55, compared with 64 years in the developed countries.

Kenyans with diabetes are also at a higher risk of life-threatening or crippling complications than people in developed countries, largely because they report to healthcare centres when their disease is already at an advanced stage.

According to a study conducted at the Mombasa Hospital whose results were published in the special issue of the EAMJ, the most common complication among Kenyan patients of the disease is diabetic foot disease (DFD). The second most common complication, the researchers noted, is danage to the retina, which can lead to diabetes-induced blindness.

“Diabetes will fuel the occurrence of chronic complications that Kenya’s healthcare systems are ill-prepared for, both in recurrent expenditure and facilities,” observed Dr Otieno. “Indeed, most patients will die from lack of access to specialised coronary care units, kidney dialysis centres, stroke care units and specialised limb-saving bypass surgical procedures,” he added.

Diabetes is a global public health problem affecting an estimated 197 million people. Over 90 per cent of these have the type II form of the disease.

The fall
is a dark red film to see through.
It colour’s everything that was

before. Shattered windows obscure,
dumb into silence. Their screams
reverberate and cut like frozen water.
They bruise, and do not clean.

The paths of evaporating tar
burnt and broken – perpetually
trembling – endure wrath faithfully.

Memory is eroded here, deleted.

We will spend decades collecting
glass, cutting our hands; scabbing.
Learning to see with no dark redness,
intermittently turning blocks of concrete

over and touching a skull or two
when we can. Their cavities resonate
with weeping and motion. Or it is we
who have become an echo.

What does one return to reclaim?