When 85-year-old Simon Seshibe and his 67-year-old wife, Rahab cannot get their diabetes medication at their local clinic in Sebayeng village northeast of Polokwane, they face a costly search for supplies that sometimes leaves them without treatment for days. The couple rely on chronic medication to manage their diabetes and hypertension. Rahab was diagnosed with Type 2 diabetes in 2009 and Simon in 2014.  The Seshibes collect their chronic medication monthly. When there are medicine shortages at Sebayeng Clinic, they sometimes have to travel to other public health facilities without knowing whether the medicine they need will be available. “When I don’t find these drugs at the community clinic, nurses refer me to either Mankweng, Rethabile or Pietersburg [clinics],” says Rahab.  The pensioners recall severe medicine shortages specifically in February and August this year. During those two months, the elderly couple spent more than R1,000 on medication for both of them at a private pharmacy in Polokwane and around R400 on petrol for a return trip each time. Simon says he is prescribed seven different tablets and ointments, but during stockouts, the responsibility for funding the medication falls to him. “To be diabetic can be costly when drugs are not available at public healthcare facilities.” Missed doses during medicine shortages During medicine shortages, the Seshibes sometimes miss doses for a day or two while trying to find medication at other health facilities or pharmacies. During these periods, Rahab experiences severe thirst, while Simon reports fatigue and frequent urination.  Diabetes is now the leading underlying cause of death in South Africa, accounting for 6.1% of all registered deaths, according to the latest mortality figures from Statistics South Africa. The Seshibes receive old-age grants and supplement their income by renting out a tractor during the rainy season. They also rely on subsistence farming, and their daily diet consists of fruits and vegetables, grown in their backyard, with pap.  But unexpected medicine costs put pressure on their limited household finances. Rahab says they generally manage their grocery budget, but unexpected medication costs means they can’t pay for other essentials like electricity during those months. Other patients face chronic medicine shortages The Seshibes are not the only elderly patients reporting difficulties accessing chronic medication in the area. 76-year-old Mapula Dikgale from the nearby Solomondale township east of Polokwane, says she was referred to Mankweng Hospital, about 16 kilometers away, after her local clinic ran out of her chronic medication in August. She managed to obtain only some of her medication at Mankweng Hospital and was told to return several days later for the rest. “At least there I found some of my medicine but was advised to return for the rest after three to five days. I couldn’t return because I didn’t have transport money,” she says. Dikgale had to go a few weeks without some of her chronic medication until she could borrow transport money from a fellow church member to return to the hospital. Health Department acknowledges supply challenges The Limpopo Health Department acknowledges that public health facilities experience shortages of diabetes medication and other chronic medicines at times. “Medicine availability can occasionally be affected by various factors, including supply-chain disruptions, procurement challenges and market-related constraints,” says department spokesperson Neil Shikwambana. The province’s medicine supply system has faced wider challenges. A controversial 2023 tender to outsource the provincial pharmaceutical depot was followed by reported delivery failures in late 2025, placing hundreds of clinics and hospitals in Limpopo at risk of shortages of essential medicines. Medicine shortages are also affecting healthcare facilities nationally. The National Department of Health recently confirmed supply challenges affecting several essential medicines. These include metformin, used to treat Type 2 diabetes – among the medications prescribed to Simon Seshibe. Department spokesperson Foster Mohale attributed the shortages to several factors, including regulatory compliance problems among some local manufacturers. “The Department has been actively engaging with suppliers and is procuring alternative medicines from other sources to minimise the impact on patients,” Mohale said. “When these facilities are out of stock, I’m forced to buy medication from private pharmacies,” says Rahab. “They are costly, considering that we buy them with social grants.” Author Moyahabo Mabeba Moyahabo Mabeba is an all-round reporter whose journalism career spans almost three decades. He has worked for several national publications and is a former editor of The Journal newspaper. His reporting has a strong human-interest focus, particularly on the experiences of vulnerable communities. A softball fanatic, he also works in marketing and publicity in sporting circles. View all posts

Managing a chronic condition like diabetes requires clear guidance, but a lack of adequate patient education in local clinics is turning routine daily treatments into dangerous hazards. More than four million South Africans are living with diabetes – a condition characterised by high levels of sugar in the blood. It can be treated with drugs and managed through healthy eating and exercise. But if it’s not managed well, it can be life-threatening.  Diabetes is now the leading cause of natural death in South Africa, but patients do not always receive sufficient hands-on training or practical instructions on how to use their medication safely – or what to do in an emergency. As community journalist Tholakele Mbonani discovered, the consequences can be frightening for patients and their families. For many people living with diabetes, insulin is a lifeline. But for my father, Sipho Mhlanga, a 63-year-old resident of Duduza on Gauteng’s East Rand, managing his insulin is the most frightening part of living with the disease. He has never been given training or ongoing education on how to administer his medication correctly.  “When we go to the clinic, they give us medication and tell us how much to inject and how many times a day. But nobody really sits down with us to teach us how to inject ourselves properly. They just give us the medication and expect us to know what to do,” he says. After a seizure that led to hospitalisation in 2023, a doctor asked how he measured and administered his insulin. My father explained that whenever he had a seizure or felt dizzy, he would inject himself with insulin. The doctor explained that he was overdosing on insulin and advised him to stick to his prescribed schedule of injecting in the mornings and at night. “I thought I was doing the right thing because I was taking my insulin the way I understood I was supposed to. It was only when I ended up in hospital that I realised I did not understand everything about the dosage and how dangerous it could be.” My father believed he was helping himself when he felt unwell, but he did not understand the risks of taking additional insulin. Like many other diabetes patients we know, he felt inadequately equipped to manage his condition safely once he left the clinic. Living with a lifelong condition He was diagnosed with Type 2 diabetes in 2020, and life has not been the same since. What started as a condition requiring medication and lifestyle changes has become a daily struggle, not only for him but for our entire family.  There are things we often take for granted, like taking a bath, walking around the house or going about our day without worrying about what could go wrong. For my father, these are no longer things he can do without caution. Last year, he had a seizure while bathing. Since then, he has stopped using the bathtub and washes himself using a basin. It might seem like a small adjustment, but it shows how much independence he has lost. He injects insulin twice a day, in the morning and at night. His blood sugar levels sometimes rise too high or drop dangerously low. We have watched him experience seizures, become disoriented and struggle to communicate. At times, his body stiffens, leaving him seemingly unaware of what is happening around him. My dad used to get seizures a few times a year. Lately he has had one almost once a month. When he has a seizure, I call an ambulance and he is taken to the hospital, where they monitor him for 24 hours. Sometimes they monitor him for longer. After that he is discharged and sent home. We are never advised what to do when seizures occur or how to recognise the warning signs. We are also never advised what to do while waiting for the ambulance.  My father also lives with hypertension. His seizures started before doctors discovered a brain tumour in March this year, but the cause of the seizures has not yet been established. Watching someone you love go through that is frightening. You never know how serious the next episode will be. What should happen at the clinic? His experience raised a question for us: how many patients are expected to manage insulin at home without fully understanding the risks? Pamela Jwili, a registered nurse working at a nurse-led diabetes education and wellness practice in Boksburg, says patients need practical training, not simply instructions about how many units of insulin to inject. “Prescribing insulin is only one part of treatment. Preparing the person to use it safely at home is equally important,” she says. Jwili says healthcare workers should demonstrate the injection process and ask patients to show it back to them – a technique called the Teach-Back Method. Mistakes should not automatically be blamed on patients, she adds, because unclear instructions and inadequate follow-up can contribute to errors. Community lifelines When my father has a seizure, there are moments when I genuinely do not know what to do. During these frightening episodes, I turn to his friends and our neighbours, particularly Refiloe Mabuza, his longtime friend and our neighbour, who has become an important part of our support system. During one such incident in 2023, Refiloe helped me position him safely while we called an ambulance. She also shared what she knew about his medication and daily routine, things I was still learning to understand. His other friends, some of whom also live with diabetes, often step in to help too. However, despite being someone we rely on during emergencies, Refiloe admits that she, too, has never formally learnt how to administer medication or respond to diabetes-related emergencies. “I never received any formal training on how to administer diabetes medication. Everything I know, I learned from my mother, who later died from diabetes. Even at the clinic, nobody showed me how to administer the medication properly. They only told

A 60-year-old woman from Meriting informal settlement in Lenasia South fears losing her remaining eyesight after developing eye complications associated with diabetes. Ayanda Ndlovu*, who has Type 2 diabetes, lost sight in her right eye after her vision deteriorated while waiting for specialist care between 2022 and 2024. Her vision in her left eye continues to worsen while she waits for cataract surgery at St John’s Eye Hospital at Chris Hani Baragwanath Academic Hospital. “It has been two years since I have waited for surgery to save my left eye. The right eye has lost vision completely. I wish the processes from the hospital can be quicker before I lose my remaining sight,” she says. Ndlovu* was diagnosed with bilateral diabetic retinopathy in 2022, a complication of diabetes  that weakens the blood vessels in the retina and can lead to vision loss in both eyes. In 2024, doctors also discovered a cataract affecting the vision in her left eye, a condition more common in people with diabetes.  High blood sugar during pregnancy Ndlovu was first diagnosed with high blood sugar in 2002 at Mayibuye Clinic in Tembisa while she was pregnant.  “I found out that I was diabetic in 2002 during my antenatal check-ups. Nurses who were treating me at the time said it might be because of pregnancy and continued to monitor the diabetes as I attended antenatal treatment.” Her blood sugar remained high after giving birth in 2003, and she continued receiving diabetes treatment. By 2013, healthcare workers prescribed insulin and metformin, medicines prescribed to treat Type 2 diabetes.  In 2019, Ndlovu* was hospitalised for three weeks at Tembisa Hospital after healthcare workers struggled to control her blood sugar levels. She says her eyesight began deteriorating around this period. Losing sight in her right eye while waiting for treatment Ndlovu* says she returned to Mayibuye Clinic in early 2020 because of her worsening eyesight. She was referred back to Tembisa Hospital for specialist eye treatment.  She says she attended numerous hospital appointments over two years without receiving a diagnosis. “I went to a private doctor to consult because the waiting at Tembisa Hospital was getting too long and I was racing against [losing] my vision. I consulted with the ophthalmologist twice in April 2022 and I was diagnosed with bilateral diabetic retinopathy.” Ndlovu* was unable to afford private healthcare and returned to Tembisa Hospital.   She was referred to Steve Biko Academic Hospital in 2023, where she attended several appointments, but the facility was unable to perform specialised eye surgery. In 2024, she was referred to St John’s Eye Hospital at Chris Hani Baragwanath Academic Hospital for surgery. “It was already too late for my right eye because I lost sight completely.” Waiting for cataract surgery Ndlovu has been waiting for cataract surgery on her left eye at St John’s Eye Hospital since 2024. The procedure involves removing the eye’s cloudy natural lens and replacing it with an artificial intraocular lens. “Every time I have to go for my surgery there’s always something, from waiting for the correct lens size, lenses being unavailable, or no theatre equipment. I cannot see, I am not even sure if my remaining sight will be restored,” she says.  Vision loss caused by cataracts can be reversed with cataract surgery but will not reverse vision loss caused by other underlying eye diseases. Ndlovu’s* next follow-up appointment for cataract surgery is scheduled for March next year, but no date has been confirmed for the procedure yet. In October, the Gauteng Department of Health conducted a cataract surgery drive to reduce waiting lists for patients needing operations. It is unclear why Ndlovu*, who has been waiting for surgery since 2024, was not included in the initiative. Ndlovu* says her right eye remains painful even after she lost sight in that eye. “At times I get painkillers from the hospital but it’s usually not enough to cover until the next hospital visit. So we just buy over-the-counter painkillers.” Losing her independence Ndlovu* now relies on her son and caregiver, Nomsa Mbatha*, to help with everyday chores at home and to accompany her to hospital appointments. “She tries to do her laundry, clean the yard and cook, but she is failing. She is dependent on us, and I try my level best to support her,” Mbatha says. “Her son is unemployed, but he is discouraged to find work far from home, just to support her and extend his help.” “The only help I need is the outstanding surgery so I can at least see with my left eye,” says Ndlovu.* Importance of eyecare in diabetes patients Dr Wezi Gloria Maphenduka, an ophthalmologist and head of the clinical unit at Charlotte Maxeke Academic Hospital and the University of Witwatersrand, says bilateral diabetic retinopathy can develop without noticeable symptoms and eventually cause permanent vision loss. She adds that pregnant women with diabetes should be closely monitored and treated because retinopathy can worsen during this period.  “More than 90% of diabetes-related vision loss can be prevented or delayed through early detection, timely treatment, and good control of blood glucose, blood pressure, and cholesterol levels.” The Gauteng Department of Health was approached for comment on delays in accessing specialised eye treatment and surgery in public hospitals in the province. The department acknowledged receiving the questions but was unable to respond by the time of publication.  Warning signs of diabetes-related eye problems *Ayanda Ndlovu requested that her real name and that of her caregiver be withheld out of fear of stigma within the Meriting community. Author Lerato Kodisang Lerato Kodisang is a journalist with experience engaging communities through civil society and local platforms at district and provincial level. She is passionate about health and people-centred reporting that centres lived experiences and gives voice to issues that matter to communities. View all posts

When 54-year-old Themba Sepeng developed a second sore on his foot in the space of a year, he followed the advice of his friends and consulted a traditional healer, who attributed it to witchcraft.  In 2021, Sepeng, who lives in Klipgat near Mabopane, North West Province, developed a blister beneath his left foot. He immediately sought medical care at Dr George Mukhari Academic Hospital. He says doctors did not explain to him what had caused the blister.  A year later, he developed a similar blister. “The same type of wound reappeared in 2022, and this time it was on my toe. People around me advised it was not a good omen to have the same sores in a very short space of time, they suggested it was sefola, so I decided that I should not consult for Western or medical help but went the traditional way,” says Sepeng. In Setswana and Sepedi culture, sefola refers to a severe, non-healing skin wound or swelling traditionally believed to be caused by a bad spell or supernatural forces.  Sarah Mahasha, who’s worked as a traditional healer for 35 years in Refentse, Hammanskraal, says how a wound looks determines how it’s treated.  “We can tell if it is serunya or sefola, there are signs of wounds that cannot be addressed with herbal balms as a traditional healer, and I will refer such patients for western treatment immediately.”  A study in Tshwane found that traditional health practitioners associated sefola with a sore that doesn’t heal, and expressed interest in being trained on certain skills used within the biomedical system.   Misdiagnosis delayed critical medical care “The traditional healer did not disappoint, he said that it was witchcraft, there are neighbours who cast a bad spell through sefola. That was exactly what I wanted to hear. He gave me some herbal balms and concoctions to drink and defend myself from my enemies,” says Sepeng.  After three months of traditional treatment, his condition worsened and Sepeng was in unbearable pain. “I had nightmares, I couldn’t sleep. What started as a swelling became a sore. My belief that traditional healing will give me my spark back was not working. The only option left was professional medical treatment.” By the time Sepeng sought medical advice in 2022, he was diagnosed with diabetes. He says following the recommended diet was difficult because of the associated costs.  “I wish the government could have special provision of the food recommended for the diabetics, though they have tried their best by providing social grants. But one should look after your diet.” Had he sought professional medical advice earlier, Sepeng would have learnt that he had a diabetic ulcer. High blood sugar caused by diabetes can damage nerves in the feet and restrict blood circulation so that small injuries, blisters, or scratches often go unnoticed, don’t heal properly, and can quickly become serious ulcers or turn into gangrene.  One study shows 28% of diabetic patients present to primary healthcare clinics with diabetic foot ulcers (DFUs), often presenting in advanced stages of ulcer severity. In early 2023 Sepeng was referred to a specialist, but by then the wound on his foot was so infected that his leg had to be amputated to save his life.  “I lost weight dismally, my left foot toe was now rotten, pus was spouting out of my affected toe. The doctors at Legae Private hospital advised that it will affect my body if it mixed up with blood and I could lose my life as a result. The social worker gave me counselling and advised amputation. There was no other solution but scissors”, says Sepeng.  After spending six months in hospital, Sepeng received assistance with wound care and rehabilitation. With support from his wife, Naomi, and his late mother, Fredah, he has learned to adapt to life without his leg. Life as an amputee Sepeng was fitted with a prosthetic limb and despite the amputation, manages to live an active life. He drives, does household chores, and manages a local soccer club. Following his experience, he encourages people, especially men, to visit clinics for regular health check-ups and to seek medical assistance early when they notice unusual wounds. “Had I taken a decision to go for medical help at first, I believe I wouldn’t have gone this far,” says Sepeng, pointing to his amputated leg.  According to diabetes clinical guidelines, any foot sore that is deep, weeping, or showing signs of infection needs immediate medical attention. Applying non-sterile balms or home remedies can trap bacteria and worsen tissue damage.  Primary health clinics are equipped to clean and dress these wounds safely, and getting to a clinic early is often the single most important factor in saving a limb. “I live a healthy life now, despite my condition,” says Sepeng. “I am active and can spread the word that diabetes is not a death sentence to its patients, you only need to consult at your local clinic.” Author Lucas Phelwane View all posts

When Minenhle Mofokeng was 4 years old, her mother became worried about her daughter’s poor health, as she was constantly losing weight and had no appetite. She took her to several doctors before she finally got a diagnosis. Tests confirmed Minenhle had type 1 diabetes, an autoimmune condition that leaves the body unable to produce insulin, and there’s no cure. Now 12 years old, Minenhle continues to manage her diabetes with the help of her mother. “It was painful when I found out, and it is still painful,” says Minenhle’s mother, Busisiwe Maseko, who lives in Vila Rosa, Boksburg, on Gauteng’s East Rand. “She has to go through so much at such a young age.” What is Type 1 Diabetes? Type 1 diabetes is an autoimmune condition where the body’s immune system mistakenly attacks insulin-producing cells in the pancreas. Without insulin, glucose cannot enter cells to provide energy, leading to dangerous blood sugar spikes. It is unrelated to diet or lifestyle, can affect anyone at any age, and requires lifelong daily insulin treatment and blood sugar monitoring. Busisiwe says healthcare workers taught her how to manage Minenhle’s condition, including how to administer insulin correctly and rotating injection sites rather than repeatedly injecting into the same area. She was given a glucose testing machine and testing strips when they visited the hospital for their three-monthly check-ups.  Although they are armed with the knowledge they need, managing the condition has not been easy for the family. Minenhle’s blood sugar levels remain high, often hovering around 14 mmol/L, well above the recommended healthy target of 4 to 7 mmol/L. “When she gets sick, she becomes weak and loses weight very quickly. She vomits, becomes weak and sometimes struggles to recover.” The family tries to stick to the diet recommended by their healthcare providers. Busisiwe says they’ve also changed their eating habits to ensure Minenhle does not feel different from the rest of the family. “We try to eat the same food so that she doesn’t feel discriminated against. I have even stopped using cooking oil altogether because her sugar levels are always so high.” Ensuring children’s dreams don’t die Journalist Pitso Molemane knows all about the psychological toll of being diagnosed with type 1 diabetes as a child; at a very young age he was told he wouldn’t live long. Now, over four decades later, Molemane is an active ambassador for diabetes care and education. “Having lived with type 1 diabetes for 43 years, I want young people to know that diabetes does not mean the end of their dreams. I have experienced life-threatening complications, including a minor stroke and eye challenges, but my life changed when I improved my knowledge of diabetes and adopted a healthier lifestyle alongside my medical treatment,” he says. Molemane uses his lived experience to educate, encourage and support others through his Fighting Diabetes initiative and the podcast he hosts, Fighting Diabetes with Pitso Molemane. “When a newly diagnosed child meets someone who has lived with type 1 diabetes for more than four decades, it can challenge the belief that their future is limited. A diagnosis should not destroy a child’s dreams.” Healthy eating and physical activity are important for management, he adds, but they do not replace the insulin someone with type 1 needs to survive. “We must stop blaming children or their parents for the condition. Blame creates shame, while accurate information encourages early diagnosis, appropriate treatment and better support.” Recognising the warning signs Molemane outlines the 4 warning signs using the “4Ts”: “Other symptoms may include increased hunger, irritability, vomiting, abdominal pain, deep or rapid breathing and unusual drowsiness which may indicate diabetic ketoacidosis (DKA).  These signs can develop quickly in children with type 1 diabetes and can cause a life-threatening emergency that requires immediate hospital care,” he said. He urges parents to seek urgent medical assessment and to tell healthcare professionals they are concerned about possible type 1 diabetes and request an immediate blood glucose test. “Early recognition and treatment can save lives. Trust your concerns, act quickly and never ignore the warning signs.” Navigating school, stigma and self-care Molemane says school life can present challenges. “Children face the fear of being different at school, among friends and in social settings. Some may feel embarrassed about injecting insulin, checking their blood glucose or explaining why they need to eat at certain times.”  “They may fear being teased, judged, rejected or treated as though they are weak. Worst case scenario, others may even hide their condition because they want to fit in with their peers.” He says it is particularly worrying when embarrassment leads a young person to skip insulin injections. “Insulin is not optional for someone living with type 1 diabetes, it saves their lives.“ “Missing an insulin dose can cause dangerously high blood glucose and, in some cases, diabetic ketoacidosis, a life-threatening emergency. At school, children may struggle to find a private, clean and safe place to administer insulin, store their supplies or manage their condition during lessons, sports and examinations,” said Molemane. He suggests that schools should work with families and healthcare professionals to develop an individual diabetes care plan. School staff should learn how to respond to low or high blood glucose and help diabetic children access their prescribed supplies, food and medical care when needed. “Privacy should be offered when a child wants it, but no child should be made to feel that diabetes is something dirty or shameful. Unfortunately, this pressure can lead some young people to hide their condition or skip treatment, which can be dangerous,” he said. He says peer support should complement, not replace, professional medical care. “If we empower young people with knowledge, positive role models and supportive communities, we can help them move from fear and secrecy towards confidence and responsible self-management.” Authors Tholakele Mbonani Tholakele Mbonani is a seasoned journalist with over 10 years of experience in community-centered storytelling, currently focusing on health, development, and social impact reporting. View all posts Keletso