Our family will be relocating to Rwanda for two years, and out nine year old son has type 1 diabetes, treated with Lantus and Humalog. Where should we look for medical treatment, including checkups? What should we expect in a hotter and higher climate?

Rwanda is a dangerous place to be with a chronic illness. I would expect you cannot get medications routinely or other supplies so that you should have someone be able to FedEx supplies as needed and keep on hand at least several months of supplies including IV fluids, dextrose, saline and glucagon. Insulin should be kept in reasonable cool temperature. If there is no fridge available, any earthenware jug filled with water and buried in a hole in the ground will keep insulin in good temperature range avoiding the extremes of Africa. There was an article about this in Diabetes Care several years ago.

You will have to assume all of the medical care, although there may be some folks at the medical university who can provide some assistance. I am unclear if you will be able to get hemoglobin A1c done routinely or if quality control will allow you to get reliable results under such circumstances. You can do a crude quality control check by having hemoglobin A1c done on a Monday, Wednesday and Friday of the same week in the local lab — if it is available and see if the results are close. If they are, perhaps you can rely on such results for feedback. Insulin should be kept in reasonable cool temperature.

There are excellent pediatric diabetes teams in Capetown. Also several available in Cairo.

You may want emergency Med-Evac insurance in case there is some disaster, and you need to get to US or Europe rather than rely on local medical care.

Lastly, you may want to make arrangement to have e-mail consultations with your current diabetes treatment team on a monthly basis so that there is some medical oversight and assistance for your child and for you.

Good luck, safe journey, and be prepared.

SB
Additional comments from Dr. David Schwartz:

You should check with your son’s diabetes team to see if they have contacts or references where they will be. Also, you might be able post this question on one of the pediatric endocrine web sites such as the International Society For Pediatric and Adolescent Diabetes for a name/referral.

DS