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Dr. Sana Ajmal recalled the day her team excitedly called a father whose child, a boy with Type 1 diabetes, had been waiting for months to receive insulin. His son was finally off the waitlist, they announced.
He had already died.
“The father said, ‘We kept waiting, and he’s no more,’” said Dr. Ajmal, founder and executive director of Meethi Zindagi, a Pakistan nonprofit focused on people with diabetes.
It’s a devastating yet regular occurrence. Dr. Ajmal spoke of the moral pressure her organization faces: the desire to save as many lives as possible while maintaining insulin supplies for the children already in the program.
Now, with cross-border attacks between Pakistan and Afghanistan and broader regional conflict affecting supply chains, health care providers report growing uncertainty around the continuity of care for people living with chronic diseases.
Even short interruptions to treatment, insulin access, and nutritious food sources can have life-threatening consequences. Combined with the physical and emotional stress of navigating emergency situations, people living with Type 1 diabetes are at an especially high risk.
Dr. Sana Ajmal poses with a pediatric patient and his sister. (Courtesy photo)
It’s not just Meethi Zindagi’s patients who are vulnerable. Providers who care for patients with diabetes across Pakistan report that economic changes and instability have dangerous consequences for their patients.
“You stop giving them insulin, and they stop injecting insulin. They are so dependent on these resources,” noted Dr. Sumerah Jabeen, head of the diabetes services at Indus University Hospital, Korangi campus.
The Korangi campus is part of a larger system of care known as the Indus Hospital and Health Network. Previously focused on communicable diseases, the hospital welcomed Dr. Abdul Basit, the director of the new Indus Diabetes and Endocrinology Center, last year. Dr. Basit’s leadership has allowed the Indus Hospital and health Network to expand diabetes services and support to a number of clinics.
“We are expecting a big boost in Type 1 numbers,” said Dr. Basit. Currently, the Korangi campus is the only Indus hospital with diabetes services, but he plans to expand the program’s reach. “We expect that in the next two years, we will have 1,000 patients at least.”
The nonprofit organization Meethi Zindagi collaborates with the Indus Hospital and Health Network on increasing diabetes education. While the two offer different models of care, they aim to improve access to diabetes treatment for underserved communities.
Diagnosed with Type 1 diabetes at age 15, Dr. Ajmal of Meethi Zindagi is all too aware of the hardships that come with living with a non-communicable disease. Before her diagnosis, she went into a diabetic coma because of her body’s inability to produce enough insulin. When a cataract threatened her vision, a common diabetes complication, she had to undergo an operation to restore it.
Dr. Ajmal remembered studying for an exam with her mother, a bandage covering one eye, when a man came to her home. He asked Dr. Ajmal’s father, “‘Why are you wasting time and money on her education? She’s not going to survive for long. Let her enjoy her life for whatever is left of it.’”
These remarks drove Dr. Ajmal to pursue higher education, to prove that she was just as capable and deserving as anyone else, she explained. She discovered her passion for community work and started a diabetes youth group where she and others could share their experiences.
“People with diabetes, specifically Type 1, they were isolated,” she said. It was in this support group that she realized the extent to which her peers were struggling, often rationing insulin and blood glucose test strips.
What began as a peer support group while Dr. Ajmal was completing her Ph.D. later developed into Meethi Zindagi, a nonprofit organization dedicated to saving lives and empowering individuals with Type 1 diabetes.
The name itself, “Meethi Zindagi,” translates to “Sweet Life” in English. It’s an unusual name for a diabetes organization, as the disease requires patients to carefully regulate their blood glucose levels and often to limit sugar intake.
Dr. Ajmal recalled the first impressions she received: “When I used to tell people the name ‘Meethi Zindagi,’ sometimes they would laugh.”
But the name reflects the organization’s commitment to bettering lives through insulin access, and has turned into a meaningful reminder of hope and stability. Meethi Zindagi has designed social media campaigns with the message, “Even if our plates are not sweet, our lives are.”
A provider at an Indus Diabetes and Endocrinology Center-supported clinic demonstrates insulin injection for a young patient. (Courtesy photo)
Meethi Zindagi’s main operation is their Insulin Support Program: Pakistani doctors refer their patients to the organization to receive a continuous supply of insulin. Team members then deliver insulin to children’s homes based on their prescriptions. Currently, Meethi Zindagi supports over 1,200 children in 140 cities across Pakistan.
Shipments from Direct Relief have assisted Meethi Zindagi in growing its support program. Cold-chain refrigerators now allow the organization to store insulin in-house, eliminating the need for travel to distant warehouses. This has increased the team’s productivity and allowed more children to receive monthly insulin.
Direct Relief also supplied injection devices to properly administer insulin, which are distributed through the Insulin Support Program.
One child joined the support program with an infection in his stomach area. Due to limited access, he had been using one syringe for the entire month. The needle was so blunt and painful that he could no longer inject the life-saving insulin.
“Life changed for him,” Dr. Ajmal said, noticing his improvement after Meethi Zindagi started providing him with new syringes every day.
In 2022, unprecedented floods left nearly a third of Pakistan underwater. While many of Meethi Zindagi’s patients were impacted, the organization monitored their locations to ensure insulin would still reach them.
“But there were a lot of people who weren’t on our Insulin Support Program, and we really wanted to do something,” Dr. Ajmal said.
With additional medical support from Direct Relief, Meethi Zindagi’s team took it upon themselves to deliver insulin to the most heavily flooded cities. The peer support group would send the supplies to the closest city out of water and then use boats to navigate the affected areas.
Meethi Zindagi community supporters travel by boat to bring insulin and essential diabetes supplies to families stranded by floodwaters. (Courtesy photo)
For 45 days, Meethi Zindagi provided insulin through activating volunteers, locating and saving over 120 people outside of the Insulin Support Program before disaster relief organizations started collaborating and agreeing to include insulin in their operations.
Today, the organization once again finds itself preparing for healthcare instability. The recent suicide bombing in Islamabad, and a new resurgence of war between Pakistan and Afghanistan, have required diabetes providers to closely monitor their cities and supply routes.
“We are in constant touch with people in areas which might be affected,” said Dr. Ajmal.
The unpredictability of the attacks prevents Meethi Zindagi from identifying what cities may be targeted in the future. They keep close tabs on all their patients and confirm that every child has at least a month’s supply of insulin at all times.
Dr. Jabeen expects the hike in fuel prices to affect everything from transportation to basic goods, including medicine. “Everything’s just going to become more expensive, more out of reach for people who are already living under the poverty line,” she said.
Community providers deliver insulin from Meethi Zindagi on foot. (Courtesy photo)
Normally, Ramadan is the biggest giving season for Meethi Zindagi’s local donors. However, Dr. Ajmal reported a decline in donations that she attributes to the instability: “People are uncertain. They don’t know if they want to save for themselves or to donate.”
Right now, the drop in donation frequency and size is noticeable. If the trend continues, it will become a financial challenge.
Dr. Ajmal is worried about what’s to come, warning that if donations decline and supply chains deteriorate further, Meethi Zindagi may be forced to scale back services from 1,200 to 300 children.
“That would mean that these other 900 kids would be left with nothing,” she said.
Since 2022, Direct Relief has shipped more than $4 million in insulin, injection devices, and cold-chain refrigerators to Meethi Zindagi. Direct Relief supports Meethi Zindagi through Life For A Child, which provides life-sustaining medication to underserved children living with Type 1 diabetes in 42 countries.
Direct Relief has also supplied the Indus Hospital and Health Network with over $32 million in medical supplies and equipment since 2020.
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