In July, Stephen Gitelman, MD, the Mary B. Olney, MD/KAK Distinguished Professor of Pediatric Diabetes and Clinical Research and director of UCSF’s pediatric diabetes program, and a team of UCSF nurse practitioners traveled to Rwanda to learn more about how diabetes care is provided there compared to the US and to help support a weeklong camp for medical professionals and for young people living with diabetes. 

“It's one thing to optimize care in our small part of the world, but diabetes is a global issue,” Dr. Gitelman said. “What we learned in Rwanda will help communities there and could have a broader application for other underdeveloped countries.”

This pediatric diabetes camp, one of the first established in Rwanda, came to fruition thanks to collaboration between a team of dedicated health care providers from UCSF and Partners in Health, an international nonprofit organization that brings health care to those most in need.

Volunteers – including longtime UCSF friend and supporter Joanne Kagle, who helped initiate the idea of a diabetes camp in the East African country – also joined the efforts abroad.

Ms. Kagle met Dr. Gitelman more than two decades ago and recently served on the board of Partners in Health. She helped connect UCSF and the Rwandan government to improve diabetes education and clinical care for the children affected within communities there and to consider possible joint research efforts.

Gedeon Ngoga, MPH, RN, director of PEN-Plus Training for the NCDI Poverty Network with Corey McMahon, BSN,
chief nursing officer at Partners in Health

“We had an idea to bring our diabetes camp model to Rwanda,” Dr. Gitelman said. “Our nurse practitioners played a large role in training local nurses and sharing insights into how we run our clinic and camp. The Rwandan diabetes camp was ready to launch this summer, and they invited us to see that effort.”

Celina Trujillo, MPH, RN, PHN, CPNP, assistant professor in the UCSF Department of Family Health Care Nursing, and Gina Ferrari, MSN, MPH, FNP-C, nurse practitioner and research fellow with Partners in Health, were instrumental in running the almost weeklong camp for patients and medical professionals. Maureen McGrath, MS, PNP-BC, BC-ADM, clinical professor in the Department of Family Health Care Nursing and the founder and director of the School of Nursing’s Diabetes Concentration, also joined the trip. 

“Most of the participants at the camp had type 1 diabetes, and a small percentage had rheumatic heart disease,” Trujillo said. “It was a great opportunity to train medical professionals who care for those young folks.” 

Steve Gitelman, MD, talks with Florent Rutagarama, MD, dean of the School of Medicine and Pharmacy at University of Rwanda, College of Medicine and Health Sciences.

“As in the US, many of the Rwandan campers had not met others with type 1 diabetes, and the camp offered a unique way to foster a sense of community and support among those dealing with this condition,” Dr. Gitelman added.

Trujillo plans to continue supporting their Rwandan colleagues, including Partners in Health nurse staff Gedeon Ngoga and Symaque Dusabeyezu, who trained with UCSF at the diabetes camp to ensure that the camp persists year after year. She feels energized and motivated to continue her work at UCSF after seeing how resilient and innovative the nurses are in other areas. 

“It’s a privilege to go to other countries and be received by the community,” Trujillo said. “I believe it’s extremely important to build relationships and form partnerships with our colleagues overseas to understand their priorities and work together in advancing diabetes care in their countries. What we learn from each other is incredibly valuable.”

After a successful visit, Dr. Gitelman and the team identified several potential areas for collaboration in education, health care delivery, and clinical research. One project could involve testing for beta-cell autoantibodies, a hallmark of type 1 diabetes. Currently, the diagnosis of type 1 diabetes in Rwanda is made purely on clinical grounds.

“Although there are challenges in getting blood samples to appropriate labs, we can use a filter paper assay to collect and ship the samples from Rwanda to us for analysis,” Dr. Gitelman said. “It’s very stable, and the results are similar to what we would get from a blood sample. This assay is a simple first step in determining similarities between type 1 diabetes in Rwanda and in the US.”

Genetic analysis for type 1 diabetes is growing at UCSF, and Dr. Gitelman said they are learning important pathways of the disease and understanding how to screen for it in families. 

“As we develop our precision medicine program, we have the technology to run a whole panel of genetic analyses from a cheek swab or blood sample to get a better sense of its genetic framework,” he said. “Such an analysis will also be quite informative for better understanding causes of type 1 diabetes in Rwanda and whether similar pathways are impacted in the cause of type 1 diabetes there.”  

The goal is to identify therapies that target the aberrant pathways and alter the course of disease by preserving beta cells.

Raising awareness of new-onset type 1 diabetes among health care providers is another area of high priority, as early diagnoses are often missed. In Rwanda, health care providers often assume that the presenting signs and symptoms of a patient are due to an infectious disease such as malaria, rather than new-onset diabetes. 

“The problem with diabetes is that it’s nuanced, so we need someone on the front line who considers the possibility that a sick patient could have diabetes,” Dr. Gitelman said. “We’re looking to work with nonprofits on developing materials that providers can have in their offices and remind them to consider the possibility of diabetes. Earlier diagnosis could avoid acute life-threatening issues such as diabetic ketoacidosis.”  

Dr. Gitelman and his colleagues are also considering pilot studies in Rwanda with technologies widely available for people with type 1 diabetes in the US, such as continuous glucose monitors. They hope to increase availability and expand their use at diabetes camps and clinics. 

“It is quite humbling to view type 1 diabetes through the eyes of the health care providers and affected patients in Rwanda, in a setting where resources and specialized providers are so limited,” Dr. Gitelman said. “However, I am convinced there is so much we can learn together to optimize education, clinical care, and research. We have to think bigger and broader than just the Bay Area to make an impact on world health.”