IN MY OWN WORDS
Fighting for a future
and winning
against all odds:
Suman’s inspiring story
Santosh Gupta
In parts of the world, in many developing
countries in particular, marriage prospects
for young women with diabetes are
hampered by the general societal lack
of awareness of the disease and severe
economic poverty suffered by the majority of
the population. The discriminatory attitudes
that are widely held in many countries can
condemn a woman with diabetes to a life
of social isolation and economic hardship.
Structured support from dedicated
healthcare providers and peers
with diabetes can have a life-changing
impact on these women and their
future prospects. Santosh Gupta
reports from India on the experiences
of one such woman with diabetes.
October 2012 • Volume 57 • Special Issue 1
Once again, Suman is watching anxiously for her father’s
return. Even from a distance she knows from his bowed
head and sad face that the meeting with the matchmaker
did not go well. As he enters their room, he bursts into tears.
“It is the same old story Suman,” he sighs wearily. “The boy’s
family would not consider the marriage because of your
diabetes. They do not know what a loving, hard-working
person you are…”
Suman’s parents are
‘blamed’ for producing
a child with diabetes.
Her father runs a small grocery in the front room of their
house. Their income is less than USD 3 per day. Yet he has
saved all his life to provide a dowry for Suman. Nonetheless,
this is their fifth such rejection. His efforts to fulfil his
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IN
MY OWN
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late wife’s wish that he care for their
daughters are meeting with failure.
Moreover, he and his wife are ‘blamed’
for producing a child with diabetes.
Suman cannot bear to see her father
enduring these repeated rejections on
her behalf. “I don’t need a wonderful
husband!” she jokes, searching her
father’s face for a hint of a smile. “Use
my dowry to send me back to school
to become a teacher. I want to stand
on my own feet!”
Her father wipes his eyes and looks
at his younger daughter. Her sister is
happily married and has children. He
does not want to lose hope that Suman,
too, could live a normal life. But Suman
has serious doubts about marriage.
Some neighbours shun her as though
she is a curse on her family because
she has diabetes. On one occasion, she
overheard a neighbour say it would be
better if she died.
Suman feels guilty that she has to ask
her father for money when she runs
out of insulin or test strips. Most of
the time, to save money, she does
not test her blood. She tries to get by
using less insulin, but several times
that has caused her to be admitted
to the hospital in a coma (diabetic
ketoacidosis due to very high blood
glucose).
But her worst fear is the image that was
seared into her mind one day when
she witnessed a woman with diabetes
suffering terrible physical violence at
the hands of her drunken husband.
He was pouring alcohol over her and
threatening to set her on fire while her
mother and children begged him to
stop. Suman wonders if this would be
her fate if she were to get married and
her husband were to grow frustrated
with the expense of her diabetes.
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DiabetesVoice
The diabetes
programme set her free
from the vicious cycle
of hospital admissions.
Fortunately for Suman, she met Sonia,
who lives in Suman’s neighbourhood
and also has type 1 diabetes. She too
had been rejected for marriage. When
they met, Sonia had been in a diabetes
care and education programme at
Ramakrishna Mission Hospital in
Haridwar for two years. She described
to Suman how the programme set her
free from the vicious cycle of repeated
hospital admissions. She told Suman
that, thanks to the programme, she now
feels well and has the energy to work
and earn money. Sonia had learned to
sew and had started her own business.
She told Suman that the treatment
would be free as long as she followed
her diabetes management plan and
attended the group meetings.
Suman travelled 200 km to Haridwar.
She joined the programme and so
began taking steps to begin managing
her diabetes effectively, which she
found hard at first. The four injections
of insulin a day and finger pricking to
test her blood glucose at least twice a
day took some getting used to. At first,
she would miss injections and not carry
out blood glucose testing. She found
counting her dietary carbohydrates
difficult, and faced various challenges
to follow the programme.
At her first group
meeting, she heard
for the first time that
people with diabetes
are not ‘defective’!
At her first support group meeting,
Suman met a diabetes educator who had
a five-year-old daughter with diabetes.
She heard for the first time that people
October 2012 • Volume 57 • Special Issue 1
IN MY OWN WORDS
conversations, and having benefited
from the support of her peers in the
diabetes programme, Suman’s confidence
increased to the extent that she was able
to speak openly to her future husband
about her diabetes. Indeed, she insisted
on addressing her diabetes with him
– something that other young women
with diabetes had been unable to do. To
Suman’s surprise and delight, he said that
he admired her courage and honesty and
reaffirmed his pledge to marry her.
Suman’s insisted
on speaking openly
to her future husband
about her diabetes.
with diabetes are not ‘defective’. She
felt energized by the support group.
Through an internet support group, she
met several people with diabetes who
were all leading normal lives.
Suman’s self-confidence grew as her
diabetes knowledge increased, and she
shared her new-found awareness with
her father. The next time he visited the
family of another prospective groom,
he was able to speak confidently about
his daughter’s diabetes. He was able
to assure the family that Suman was
perfectly ‘normal’ and able to have
perfect healthy children, just like
anyone else. His visit was successful
and the marriage was set to take place
within three months.
Members of the support group had been
asked to describe diabetes in drawings.
Suman’s work caught my eye. In the
first drawing (picture A) she drew her
doctor teaching two colleagues about
October 2012 • Volume 57 • Special Issue 1
children with diabetes in the presence of
a girl (Suman herself) and a boy. In that
picture, Suman’s dress is ornate and has
intricate needlework, signifying a girl
from a well-to-do family. This was a very
positive image; Suman appeared to be
expressing pride in being a young woman
with diabetes taking charge of her life.
The second drawing, however, was very
disturbing. Suman had depicted the
horrifying incident of abuse suffered
by the woman with diabetes in her
village. I immediately telephoned
Suman to talk to her about the drawing.
Suman confirmed that the woman in
the picture had diabetes and that her
alcoholic husband had attempted to
murder her.
Clearly, Suman was traumatized by the
scene she had witnessed and terrified for
her own safety. We spoke at length about
Suman’s fears and concerns for the future,
particularly married life. Following our
Suman was married at the age of 21 (the
average age in this region is around 18).
She is currently studying to become a
teacher. I met Suman’s husband recently
at a monthly support group meeting,
and asked him whether he would be
Suman’s partner in the care of her type 1
diabetes. When he said “Yes”, it was
music to my ears.
Santosh Gupta
Santosh Gupta is a Pediatric
Endocrinologist and Assistant Professor
of Pediatrics at Washington University
School of Medicine in St Louis USA.
She visits Ramakrishna Mission Hospital
in Haridwar India and runs the diabetes
programme for marginalized population.
Acknowledgements
The diabetes programme at Ramakrishna
Mission Hospital is led by the author and
supported by a grant from the International
Diabetes Federation via Life For a Child
– insulin is supplied by Insulin for Life.
DiabetesVoice 25