The sun has not quite risen when Dr. Paulette Djeugoue arrives at her diabetes clinic in northern Cameroon. The wooden benches outside are already full with patients, some of whom have spent the night there, waiting.
Dr. Djeugoue is the only diabetes specialist for thousands of miles, and her patients come from villages scattered across the north; some have crossed borders from Nigeria or Chad. She unlocks the door and settles in, with a nurse by her side to translate the half-dozen languages her patients speak. She won’t leave until the sun has set.
Even with the throng of patients at her one-woman clinic, Dr. Djeugoue knows she is seeing just a tiny fraction of those who need care. An estimated 75 percent of people with diabetes in Cameroon have no idea they have the disease; the portion is even higher in the poorer and more rural parts of the country, like this one.
There is a striking epidemiological shift underway here in Cameroon and across much of Africa: People now face as much risk of dying from a noncommunicable disease such as diabetes as they do an infectious one, such as malaria.
Historically, health systems here have been structured and funded to focus on infectious threats, which pass from person to person, and they have made progress in bringing down death rates for H.I.V. and tuberculosis.
Only now are steps being taken to try to bring the resources and personnel essential to address diabetes, a disease that is estimated to afflict some 54 million people in Africa and that can cause blindness, amputations and death. One of the aims now is to screen and treat diabetes as part of primary care.
The push comes as there is growing recognition that the disease has a different, insidious form in places like this, where it has long been misunderstood and overlooked. Last year, the International Diabetes Federation recognized a new form of diabetes, called “Type 5,” that afflicts undernourished people, such as many of the patients Dr. Djeugoue sees.
When Dr. Djeugoue opened her clinic six years ago, she found patients who had been hospitalized a half-dozen times without anyone testing their blood sugar levels. “They were so focused on malaria and typhoid,” she said of her colleagues.
Now, the hospital screens blood sugar for every patient.