Dr. Manzi struggled with diabetes in childhood. Now, he teaches children to thrive after diagnosis.
When children with type 1 diabetes arrive for the first time to the Rwanda Diabetes Association clinic, in Kigali, Rwanda, many believe their lives are over. Dr. Manzi understands that fear – he has lived it himself. Diagnosed at 11 years old, he spent years struggling with diabetes. Through incredible strength, he not only learned how to manage it, but he also found meaning in helping others do the same.
“Someone who has come in with no hope can leave with hope,” he said.
Some of his young patients have been misdiagnosed, sometimes repeatedly. Others have faced rejection. Some have overheard their parents question whether it is worth paying for medication or schooling for a child who will never be cured.
These are all experiences Dr. Manzi knows, he confronted them during his own childhood.
Now 27, he works for the Rwanda Diabetes Association, the very organization that once supported him. They provided him with free insulin and monitoring supplies, taught him the ins and outs of managing his glucose levels, and showed him that his own life was just beginning. It’s also where he grew into a dedicated educator and advocate for others living with diabetes.
“Trust me”
In 2008, at age 11, Aime Manzi became suddenly unwell. Within a few weeks, he lost more than 30 pounds. He needed to use the bathroom so frequently that his brother complained about sharing a room with him. His teachers assumed he was looking for excuses to leave the classroom. He often fell asleep during class, compounding their frustration.
A local hospital thought he might have malaria or tuberculosis – both common and highly visible infectious diseases in Rwanda. “I think they didn’t think a young person could have diabetes,” Aime recalled.
Eventually, doctors decided he was dehydrated, and instructed him to leave school temporarily, and try to eat and drink more.
That didn’t work, so his parents took him to a traditional healer, who said he had been poisoned and provided a medicine that made him vomit uncontrollably. Then, thinking his illness might be spiritual, they took him to a Catholic priest, hoping for a miracle.
“I started to believe this was a punishment from God.” Aime said.
When he collapsed, nonresponsive, in the middle of doing chores around the house, his uncle carried him in his arms for three hours to a hospital in Kigali, where he was diagnosed with type 1 diabetes. Doctors explained that the disease was lifelong and would require daily injections. Aime’s parents were skeptical.
Aime had trouble managing his injections. No one had properly explained the protocols, and his parents assumed he’d probably been cured and no longer needed to buy insulin.
But, of course, that wasn’t possible.
Eventually, Aime was referred to Life for a Child’s local partner, the Rwanda Diabetes Association where doctors showed him how to manage his blood sugar and provided him with a blood glucose meter, strips, and insulin, all free of cost. Without the support they provided, he said, his parents would not have been able to manage the expense: “It was a lot.”
Aime’s parents were upset to learn that their son would always have diabetes. The expense and difficulty of providing separate, appropriate meals disturbed them, and they assumed he’d contracted the disease by eating too much sugar – “If you eat too much sugar, you’re going to be like Manzi,” Aime recalled other parents telling their kids.
School in Rwanda requires tuition fees, and Aime’s parents didn’t want to pay them. Dr. Manzi said they felt that “instead of spending money on this one, we can just spend money on the other kids who are healthy.”
“There aren’t many old pictures of me because during that time my family had really given up on me.”
At a time of heightened concern about AIDS and tuberculosis, two diseases that spread through person-to-person transmission, other parents didn’t want their kids to spend time with him assuming he might transmit his diabetes to them.
“I was left with no friends to play with.” Aime said.
It was around this time that the Rwanda Diabetes Association invited him to an overnight camp session – an invitation that marked a turning point in his life.
The other kids at the camp “…were young kids, very joyful, doing well at school,” he explained. “They were OK with insulin, they could inject themselves well. I was like, ‘How did you do it?’”
Equally important were the staff members focused on teaching the campers that their diabetes was completely manageable – that they could live great lives and achieve long-term dreams.
When Aime arrived home from camp, he told his parents, “You don’t believe in me, you think I’m going to die, but trust me: Let me go back to school.’”
This marked a pivotal shift for him. He was so inspired that he began volunteering with the Rwanda Diabetes Association, encouraging other kids with new diagnoses to see their diabetes as manageable and their future as bright.
“Change the Whole Narrative”
The last piece fell into place when Aime asked a science teacher what he knew about diabetes. “I was testing him a little bit,” Aime cheekily admits. The teacher’s answer was full of misinformation. He claimed diabetes could only be passed on genetically, and those who had it were always “one step from death.”
A natural advocate, Aime corrected his teacher, who then invited him to speak to his whole class about diabetes – a daunting prospect for a child “But I wanted to play with my friends again,” he said.
That experience taught him to love science and to seek out chemistry and biology classes, where he frequently asked teachers what they knew about diabetes. “Teachers didn’t really know how diabetes worked, they had a negative image,” he recalled. “I liked to challenge them and change their minds.”
Against all odds, and everything he had been told about the limitations of living with diabetes, Aime went onto medical school. He continued volunteering with Rwanda Diabetes Association (RDA), leading camps and peer support groups.
Being a doctor makes it possible for him to “change the whole narrative” surrounding diabetes in Rwanda.
Advocate. Camp leader. Researcher. Dr. Manzi is someone young people with type 1 diabetes in Rwanda can count on.
Today, Dr. Manzi is a general physician who works with children with diabetes at the RDA’s clinic in Kigali. One day he hopes to specialize in endocrinology. He’s also a committed advocate for his patients, working with their families so they can offer effective support and educating larger communities about how diabetes actually works.
The Kigali clinic cares for about 500 young patients, he said, and the RDA serves approximately 1,300 across Rwanda.
Rwanda has strengthened its health system for type 1 diabetes over the past few decades. While some children with diabetes have access to private clinics, some still choose to receive care through the RDA, Dr. Manzi observed. It may not be as fancy, he said, but it offers something more important, “a family of people with the same condition.” It brings Dr. Manzi the greatest joy, telling his young patients that he, too, has type 1 diabetes. It’s often the first step of teaching them how much they have to look forward to.
For many of them, managing diabetes would be financially impossible without support from the RDA. Their family incomes are simply too low to pay for insulin, testing strips, a blood glucose meter and strips, and regular blood panels, as Dr. Manzi’s was during his childhood.
“A Happy Man”
Just recently, Dr. Manzi began treating a 14-year-old boy diagnosed with diabetes. The teenager, a bright student, reminded Dr. Manzi of himself – “I think I wasn’t as bright,” he said drily – and this boy, too, was in danger of going without an education.
The boy’s mother was distressed that he was having difficulty managing his blood sugar levels at school, where the food provided wasn’t enough to counter the level of insulin he needed to take. Fearing the painful symptoms of low blood sugar, he was even refusing to administer insulin while at school – and beginning to develop complications. His mother had begun to wonder whether keeping him in school was worth the money.
“I’m still working to make his glycemia [a medical term for blood sugar levels] fall in the right range,” Dr. Manzi said. “If it all works out, I’ll be a happy man.”
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