53-year-old Patricia Nhlapo has gone more than four months without her diabetes and other chronic medication because she cannot afford the R400 return trip to Helen Joseph Hospital in Johannesburg.
Nhlapo lives in Meriting informal settlement in Lenasia South and is unemployed. She depends on her eldest daughter, who is the sole breadwinner in a household of seven, for financial assistance.
"At times I have to choose between buying food at home and going to get treatment."
Nhlapo is one of three Gauteng women whose experiences show how poverty, transport costs and the price of food can make managing diabetes difficult, even when treatment is available through the public healthcare system.
Public transport too high to collect medication
Nhlapo was diagnosed with diabetes in 2024 at Lenasia South Hospital, although she does not know if she has Type 1 or 2 diabetes. She is prescribed Metformin, a medication commonly used as a first-line treatment for Type 2 diabetes to lower blood sugar. She's also dependent on chronic medication for hypertension, heart and kidney problems and blood clots.
When Nhlapo first started treatment at Helen Joseph Hospital, she lived in Finetown near Orange Farm, but has since moved permanently to Meriting to live with her family.
She says since moving to Meriting, she has repeatedly tried to collect her medication at a clinic closer to home. Healthcare workers at the local clinic told her that her multiple medical conditions make her a high-risk patient who requires specialist monitoring that they cannot provide, and that she has to collect her medication at the same facility where she is monitored.
She last received her chronic medication at the start of July and says since August she has experienced dizziness, headaches, swelling of her feet and face, shortness of breath and back pain.
Nhlapo struggles to walk and relies on private transport to attend hospital appointments.
"Emotionally, I'm not okay. I cry a lot and I am always worried about a way forward and whether I will ever get back on treatment."
Pamela Jwili, a registered nurse specialising in diabetes care and education and founder of PNJ Sunshine Healthcare in Boksburg, says going four months without diabetes medication is alarming.
"Prolonged uncontrolled blood glucose increases the risk of complications affecting the kidneys, eyes, nerves and cardiovascular system."
She says patients struggling with transport costs should approach their nearest clinic to explore alternative arrangements, including the Central Chronic Medicine Dispensing and Distribution programme, known as Dablapmeds, which provides alternative collection points for eligible patients.
69-year-old Lindiwe Miya from Orange Farm says her biggest challenge in managing her Type 2 diabetes is affording the foods recommended to patients with diabetes. This includes lean protein, fresh fruit and vegetables, healthy fats and low GI carbohydrates.
Miya lives alone and depends on her old-age pension of R2,400 per month. The social grant must cover essentials such as electricity and transport, as well as burial society contributions, leaving little for food.
Miya says healthcare workers have educated her about healthy eating.
"With my pension money, I buy mostly food that was suggested for my diet, like brown rice, mabele, fruits and vegetables and whole-wheat bread."
When money runs short, she often eats whatever is available. "I end up eating what is available like white porridge, fried tomatoes and chips."
"I would appreciate assistance with diabetic food being subsidised by government so that it can be bought at reduced prices."
Miya buys most of her fresh produce at a nearby shopping mall but says supermarket prices are expensive. According to Miya, street vendors offer cheaper options but they stock a limited variety of fruit and vegetables.
Jwili says people with diabetes do not necessarily need expensive foods to maintain a balanced diet.
"Healthcare workers should provide realistic nutritional guidance based on what patients can afford and access, rather than recommending expensive foods that are beyond their financial means."
"Affordable options include beans, lentils, eggs, pilchards, cabbage, spinach, morogo and seasonal vegetables. Maize meal, bread and other staple foods can still form part of a balanced diet when portions are appropriate and meals are balanced with vegetables and protein," advises Jwili.
43-year-old Mosele Mokanyane from Palm Springs in the Vaal Triangle has Type 2 diabetes, and also struggles to afford the foods recommended by healthcare workers.
Mokanyane is a single mother and supports her 16-year-old daughter and niece at home, while also contributing financially to another household where her parents, siblings and other nieces live.
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She says financial pressures sometimes force her to eat whatever is available, including pap and amagwinya, or fat cakes.
"The most important sacrifice has to do with eating what is available at the time. For example, I consume what is clearly said I should avoid, like pap. But because it is what is affordable, I have little choice to get through a tricky month."
Mokanyane says diabetes has also affected her confidence and emotional wellbeing. "I used to be a very confident woman. Currently, I have not been coping with my physical challenges at all."
"My mental health is affected because of overthinking."
Jwili says depression, anxiety and diabetes-related distress can affect patients' motivation, medication routines and ability to attend appointments.
"Patients should be encouraged to seek support through their primary healthcare facilities, where services may include counselling, mental health assessments, social work support and referral to psychological services. Healthcare workers must create safe, non-judgemental environments where patients feel comfortable discussing their struggles," says Jwili.
"We need to move away from simply asking whether patients are adhering to treatment and start asking whether their circumstances and our healthcare system make adherence possible."
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