A migrant being cared for in MSF's mobile clinics in France | Photo: MSF
A migrant being cared for in MSF's mobile clinics in France | Photo: MSF

The risk of developing diabetes is higher for migrants in France. A change in diet, lack of exercise and problems accessing regular health care and check ups are all contributing factors.

Most of her patients have had diabetes for at least seven years without actually realizing it. Dr Laurence Vittaz is an expert in diabetes and a consultant in endocrinology at the Robert Ballanger hospital in Aulnay-sous-Bois in suburban Paris. "This illness is insidious. It doesn’t wreak havoc immediately, but it can cause lots of problems and even be fatal if it is not taken in hand," she says. "If you don’t have regular check-ups, which is often the case with migrants - who are preoccupied by much more urgent problems, like finding accommodation, where they might get money from and whether or not they have a right to stay in the country - then the disease is easy to ignore."

There are lots of migrants, including Africans, among Dr Vittaz’s patients. "Migration can really shake up the living conditions of someone’s life," the endocrinologist explains. "Often they suddenly have access to very industrialized and sugary food - which is not always great quality - and a reduction in physical activity. These are the kinds of factors that influence the development of type-2 diabetes ." Type-2 diabetes is characterized by high levels of glucose (sugar) in the blood.

According to a study by the World Health Organization (WHO), which was released in January 2019, and based on samples collected from 53 countries in Europe, type-2 diabetes is among the most common health problems to affect migrants and refugees after they arrive in Europe.

The link between a bad diet and diabetes

To avoid developing diabetes, you need to "eat better" Dr Vittaz says. "Better" means "less sugar and less fat."

The ideal would be to cook your own food from scratch, not to rely on ready-meals and fast food. "When you cook your own food, you really know what you are putting in it," Vittaz explains. Unfortunately, the lifestyle for most migrants does not allow for that kind of approach.

Some aid organizations are starting to take this problem seriously. Les Restos du Coeur (Restaurants from the heart, a charity providing meals for those in need) which has distributed 130 million meals to those in need in 2018 alone, have started making sure that they offer canned vegetables to people and fewer ready meals.

Physical activity helps guard against developing diabetes

The doctor advises people to start making small changes to their diet: For example, choosing water instead of fizzy drinks, fruit juices and alcoholic drinks. Carbohydrates like pasta or rice also contain sugar, she adds. "You should really limit these kinds of food and portion them up... There is a danger if you are sharing communal plates of rice for instance and you all pick at the big bowl with your chopsticks over the course of an hour. Of course, at the end of that time, you don’t really know how much rice you have actually eaten."

The lack of physical activity is one of the biggest risk factors for developing diabetes. Sometimes if you are having trouble finding work or making friends in a new country, you end up becoming more sedentary.

What are the signs of the disease and how can you treat it?

Sometimes, you can recognize type-2 diabetes because you are suddenly constantly tired and very thirsty. This is one of the most common symptoms of the disease, Vittaz explains. Some patients might also suffer from disturbances with their sight, or vertigo and just feeling generally unwell. "When it really starts to become serious, people might start to lose weight," she says.

If you are in any doubt, Vittaz recommends seeing a doctor. With a quick blood test they can diagnose if you have the disease and can start you on a treatment plan. In this case, you need to follow advice carefully. "When it comes to diabetes, your lifestyle and making sure you take your medicine regularly are of equal importance," Dr Vittaz says.

Having to wait too long to see a specialist is another problem that particularly affects migrants in France. In public hospitals, the waiting lists for an appointment to see a specialist and get tested are very long. In the Aulnay-sous-Bois hospital, for example, you have to wait 4 to 8 months for a first appointment. For more serious cases, for instance when there are symptoms of diabetes in pregnancy, you should go to a doctor without delay. You can tell the doctors who are testing you for the pregnancy so that you can get urgent medical treatment. For pregnant women, diabetes can pose serious risks to both the mother and child.

Practical information

In France, for people who do not have the correct papers and have no health insurance, there are health centers called PASS (Permanent access to health care) that can be found in public hospitals. You can turn up to a PASS clinic without an appointment from Monday to Friday from 9am onwards. Consultations take place in the order of arrival. These clinics are available to everyone.

Author: Bahar Makooi

Translation: Emma Wallis
 

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