Erin Little’s first taste of running Sucre Bleu was bittersweet. The diabetes nonprofit launched in 2013 and was serving more than 5,000 patients by its second year. Little’s dream of finding a model for low-cost screening of chronic disease patients in India met with legal and fundraising challenges that ultimately meant she had to sacrifice her salary.
“Development work is very challenging,” the 29-year-old said. “I believe it’s similar to politics, in that the hard work you put in is often unrewarded, and over time it is progressively harder to maintain the mission you started out with. Corruption and greed are very real problems that need to be addressed within the sector, although they’re not exclusive to India.”
Sucre Bleu piloted in Bangalore and has since relocated to Mumbai, where it trains community health workers – many themselves diabetic – to screen, diagnose and follow up with patients in areas where access to healthcare is poor.
Diabetes affects more than 60 million people in India, but it remains overlooked. Food insecurity, illiteracy, and poor sanitation, particularly in rural areas, have all been singled out as contributing factors.
Many of India’s inhabitants are also believed to be genetically predisposed: despite much lower obesity rates, India has a higher prevalence of diabetes compared to Western countries, suggesting it occurs at a much lower BMI compared to Europeans.
“Both colonization and the next generation of globalization have made huge shifts in the indigenous diet of these populations,” said Little. “Which to me is actually the biggest cause of Type 2 diabetes. White rice was brought into India by the British, and although the indigenous rice groups (black, red) have a very low-glycemic index, newer, more processed foods have taken over as the staple diet in most of Asia.”
The plan is for Sucre Bleu to evolve into a sustainable business, providing a tiered model of healthcare services for paying patients to subsidise the cost of providing “virtually free” care to those below the poverty line. Moving money overseas has proven a legal headache, however.
“The rules are much stricter with NGOs due to the corruption that often takes place of setting up sham organizations,” she says. Funding restrictions limited Sucre Bleu’s growth, and these models require scale in the “millions” to turn a profit.
“I don’t believe chronic disease programmes will be sustainable unless run as a truly profit-driven business due to major restrictions in regards to public health funding available within the non-communicable disease space.”
Little, a 29-year-old Type 1 diabetic from Kansas, now believes she can reach scale in India “within the next five to ten years”, but in the interim she’d like to achieve that back home, too.
Last year, she decided to bring Sucre Bleu to the US. Sucre Bleu’s American model turns libraries into preventative health care centres, targeting the diabetes belt of the South where poor communities continue to suffer with serious complications. It aims to help 50,000 people by the end of 2018.
“The average American goes to the doctor four times a year,” she said. “The average Japanese person goes almost 15 times a year. Our aim with the new programme is to decrease barriers to entry for people who need to go to a doctor but are afraid of the costs as well as the overall attitudes towards healthcare, like not liking doctors or the smell of hospitals.”
“It’s been much easier to fundraise for programmes within the US rather than in India,” she said. Ultimately, Little hopes that insurance companies and governments will see the economic argument for rolling out the kind of preventative care and screening that Sucre Bleu provides.
“It would be a dream of mine to put Sucre Blue out of business,” she says. “It would mean we have successfully changed the mindset where we are no longer needed.”
Find out more here: http://www.sucreblue.org
Illustration: Lennart Jaspers
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