#414 Durban Shirley

December 2, 2020Scott Benner

South Africa Represent

Shirley is a T1 from South Africa and she's here to talk about type 1 diabetes care.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:07
Hello, friends, and welcome to Episode 414 of the Juicebox Podcast. On today's show, Shirley, who is a type one herself also works in the healthcare industry, helping people with type one diabetes in South Africa. We'll find out about Shirley, her type one, and what care looks like in South Africa. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan. are becoming bold with insulin.

I'm delighted by your accent, we're gonna have a great time. This is going to be the highlight of my day off. Well, you don't hear yourself right you sound you just think I sound fun.

Unknown Speaker 1:07
Yeah, no, I sound normal.

Scott Benner 1:09
We all do. This show is sponsored today by the glucagon that my daughter carries. g Volk hype open. Find out more at G Vogue glucagon.com forward slash juice box. This episode is also sponsored by the Contour Next One blood glucose meter. And you can find out more about that amazing meter at Contour Next one.com forward slash juicebox. And don't forget to add your name to the T one D exchange at T one d exchange.org. forward slash juicebox.

Shirley 1:58
Hi there. My name is Shirley. I am a South African. I live in Durban. And I'm a type one diabetic. I've been diabetic for 17 years.

Scott Benner 2:09
17

Unknown Speaker 2:10
Yes.

Scott Benner 2:11
Wow. How old are you now? I'm sorry.

Shirley 2:14
I'm 37

Scott Benner 2:15
Oh, I just did the math. And I know how old you are when you were diagnosed?

Shirley 2:20
I was older 2020

Scott Benner 2:23
were you in school at that time? Or were you finished?

Shirley 2:27
I was finished school. I was in university. So I was in second year of university.

Scott Benner 2:33
Big surprise far from home.

Shirley 2:36
Not too far from home. I went to university about 45 minutes from home. So I didn't stay at home. But yeah, not too far.

Scott Benner 2:44
And when you're diagnosed, what's the is it classic signs? Or did you have a strange finding?

Shirley 2:51
Um, yeah, to be honest, I had all the classic signs, but kind of didn't really even think I would be diabetic. So I didn't think about it at all. But yeah, like when I look back on it pretty much all the classic, or the classic sides?

Scott Benner 3:07
Yeah. Did you go to like a physician on campus? Or did you tell your parents and go to a private position? How'd you handle that?

Shirley 3:17
No, I went to my private GP so that our general practitioners family doctor, so yeah, came home and went there. But I went about two weeks into having all the symptoms.

Scott Benner 3:32
South Africa is interesting because living in America, the only thing I can tell you about South Africa is that Charlize Theron is from their tree, that is literally my only pull for that at all. I'm interested in, in understanding a little more about the breakdown of the country. Is it? Like? Is Africa, like, three different places? on one continent? Or how does? How do you feel when you when if you had to describe it to me, how would you describe the whole continent to me?

Shirley 4:05
So the whole continent, I mean, we're like, South Africa is like the bottom of the continent, the southernmost tip. And I mean, there's plenty other African countries on the continent, we're just one of them. Yeah, so I mean, I personally haven't traveled to any other African countries, but South Africa Yeah, we, we like the southernmost tip of Africa.

Scott Benner 4:31
Which is it's, you know, not that it's crazy that there are countries within a continent, but you understand the naming system throws me off. Because because there's Africa, like it would be like if if I lived in South North America, that's how it feels to me. And yeah, I suppose Yeah, you suppose you're like, shut up read a book.

Shirley 4:54
I mean, cuz I suppose you guys yeah. I don't know. Yeah, I'm not very Good with geography. So

Scott Benner 5:01
no. And I don't want to turn this into a geography lesson either I just want to, you know, kind of suss it out for people listening, that South Africa is unto itself its own place. It's it's just the Yes. Right? And

Shirley 5:14
yeah, own country, just part of Africa.

Scott Benner 5:17
Right. Right. And there are a ton of countries within Africa that, and it's a huge continent, it really is. Yes, I've now come to believe the map might not be correct. Scale wise, when you look at it, it's possible that land masses are much larger and smaller than I think they are. So I try not to wrap my head around that too much. Unless that's wrong. But anyway. So you're off at school diagnosed, you come home to your parents, they take you to your GP. And it's 20 years ago, so or excuse me, 17 years ago? What's management like? And is the technology much different in South Africa than I would find in America? Other places?

Shirley 5:59
Um, okay, well, I suppose like on diagnosis, our I started on insulin pins, and just your normal basic glucometer. Um, I've been on an insulin pump for about nine years now. And then I started a CGM end of last year, so about six to eight months on a CGM. So we have technology, I mean, we have stuff available. But it's not easily accessible due to funding. Yeah, so most people don't access technology. As much as you see in other countries, just due to funding privately, our what we call our medical aids, they don't actually fund technology, you have to fight quite hard to get it funded. And then in our public health system, you can barely even get a glucometer. So there's no technology in the public health system.

Scott Benner 6:58
So for a person living there that's not financially able to just run out and buy something for cash, and maybe is on the lower part of the of the spectrum. They maybe can't even get a glucometer

Shirley 7:12
Yes, so I work in public health. So I work as a dietitian in a in our public health setting. And your access for diabetics in that setting is it's like shopping to be very honestly, also, it's very difficult to access, if you comment, if they do get one, there's only one top that you can use, because they only will provide strips for one type of glucometer. And if they get that they get a maximum of 50 strips a month, which really is not helpful to anybody. So yeah,

Scott Benner 7:46
that's really something. How do those people manage them? You're taking me back to a number of years ago, I spoke in the Dominican Republic. And when I was when I was asked to come down and talk they, you know, they said to me, like, can you, you know, take what you do and bring it down here and translate it for people who are living, you know, at the poverty line. And you know, and I was like, Yeah, sure. So I put this whole kind of, I don't know, talk together where I was, yeah. And then I got there and saw what they meant by poverty. And I realized that even what I was saying, didn't imagine what was actually going on. You know, 50 strips, like, what do I do with 50 strips take really good care of myself, like, seven days a month,

Shirley 8:31
or? Yeah, so I mean, like, so 50 strips equates maybe to one maximum two tests a day. Yeah. So if you work it out, or they could do peer testing over certain periods of time. But I mean, to be honest, so like, what I listened to you on you listen to on your podcast, it would be very difficult to translate that back to my patients that I see as a dietitian. And yeah, so in our public health system, there's also like really no diabetic education at all. So they see a doctor, they get given something, whether they talk to they get put onto medication, if they tap one, they might go to a higher level hospital for if they're, especially if their child, and they'll have some sort of education there, and they'll have insulin. And then yeah, so And yeah, it is just the lack of education is the biggest. I mean, it's, I think, a bigger problem than even getting the 50 test strips because most of the patients we interact with, they don't really actually even understand what they have or what diabetes is or what's happening inside their bodies. So for them to control their diabetes is it's very difficult.

Scott Benner 9:50
Well, okay, so let's talk about that for a little while. Is Is it like that for other disease states? Diabetes particularly ignored.

Unknown Speaker 10:04
I'm

Shirley 10:06
sorry, I mean, so like from South Africa, so we do have a high rate of HIV positive patients, they have a different sort of access. I mean, they do have access to medications. And then they go through like a sort of simple education process as well, before they are initiated onto their abs. So there's a lot of focus in our country on things like HIV and TB, because we have a high population group that are both HIV positive NTP. So it does kind of fall by the wayside. There's also quite a big focus, like on maternal health, things like breastfeeding, where they are like programs in place. But yeah, I do. Like personally, for me, I find diabetes is sort of neglected, was a fine patients often playing because they uncontrolled, they've got all these complications. But nobody ever took the time to actually educate them and help them to control their diabetes.

Scott Benner 11:08
So from an institutional perspective, not from where you work, but from, I guess, government down is the idea. People get sick, and that's it, they're lost. And then the rest of their life is just dying faster than they would have.

Shirley 11:27
I just think there's, yeah, I mean, I just think there's just a lack of understanding, there's just a lack of, yeah, I mean, I think there needs to be some sort of definite program put into place to help with it. And it's not like necessarily that everyone is going to be dying, but they would probably have a shorter lifespan due to complications if they do become diabetic, right?

Scott Benner 11:54
Okay, I think I have my head wrapped around this pretty well. And so there's no educate the education piece is probably First, if you stop and think about leaving people who are diagnosed here who don't know, the first thing about type one or diabetes in general, they can run back to the internet and find out but that's not lacking in South Africa, right? People could go online and learn is there just no person or entity there with a voice that they can go to?

Shirley 12:26
Now we do have organizations. So I mean, we have like a diabetes, South Africa, there's a few different organizations. So I mean, there are resources, people could go on to the internet to learn for themselves. But also a lot of our patients Can't I mean, they may not be financially able to access internet, it's gotta pay for it. And also, sometimes literacy and education levels are low. So yeah, they may not really take that initiative to access education, because it's just not a priority, I suppose.

Scott Benner 13:00
And then their bodies become accustomed to the higher blood sugars, and they don't feel badly at first, and then they don't know they're really in trouble until they are and then that that whole cycle begins.

Shirley 13:10
Yeah, so I mean, for me, like in my institution, I'm seeing mainly older, like more type two diabetics, we do have like a sort of an age group of a younger adults type one diabetics. But pediatrics, so the younger children, so under the age of 16, they will go up to a higher, like a tertiary facility. So I don't see a lot of young top ones, but we, we do deal more with our top two diabetics, and just the common, mostly obese, high blood pressure, diabetes, often high cholesterol. So it's like a whole host of problems that they already have. Yeah, so we we deal mainly with type two diabetics, I suppose. And messaging. Okay.

Scott Benner 13:57
When you do that, just let's talk about the type two for a second, where do you start when you're trying to help them? Like, where's what's step one?

Shirley 14:06
Yeah, it's very hard. I mean, we tried to give them sort of a brief explanation on what diabetes is what's happening, you know, why they need to see a dietitian, okay. Like, for me, like they get referred to us as a dietician. But they've had no prior education. So the prior education, if they had that, they might see the value of a dietitian. But without having that. The I don't suppose there's not always that link between the value of seeing a dietitian because they don't really understand why they need to be there. So I think it's more starting off with just brief explanations on what diabetes is, what's happening inside the body, why our food is important, how it works inside the body, and then giving week I mean, we really do give basic dietary information at the level. We always With I mean, I wouldn't I don't do things like carb counting, etc, unless I have a more motivated patient who has some prior knowledge and wants that extra information. But a lot of them. It's very basic, basic dietary information, small changes that we can make to try and help them out. Do you see? Do people return for fall? And by the way, do

Scott Benner 15:23
you have a Star Wars droid in your home? That's it. There's a very like, electronic sound that that what is that? Is that?

Unknown Speaker 15:30
It's not fine. Oh, okay. I'm

Shirley 15:32
silent.

Scott Benner 15:33
Don't be sorry. I was like, she's got a robot. She's pretending that it's not great. But she has one now. My question was, do people continue to come back for help? Or do you see them once and then they disappear? And then my follow up to that is, how many people do you think you get through to in a way that changes their thinking and focuses them on what they need to do, and how many people are just trying to get by?

Shirley 16:01
Um, in terms of follow up, they don't always have follow up with us. It really depends on the dietician that sees them if they feel necessary for a follow up. Sometimes it's one self cancelling, and then a lack. Like, depending if the doctors see them, when the doctors see them, again, if the blood sugars are still high, because it's always blamed on the diet. They may be referred to us. But yeah, that's just dependent on who's seeing them what the situation is. So they may or may not have follow up with us. And then you're in terms of getting through to the patience. I mean, there's plenty that you do get through to the contrary, put it number two, it is plenty that you'll see a little light bulb click. And that I mean, I'm not saying they're going to have perfect HBA when sees results, but it might help them in some way.

Scott Benner 16:53
Sure. So your days mostly and with you feeling like you use your days and and you feel like you've you've accomplished something for people, mostly

Shirley 17:03
some days, some days not. So see. So that I mean, think in the states is very different for dietitians, they kind of specialize in certain areas. So we don't specialize we literally go to work and see anything that walks through the door. And we spend time in the woods as well. So we do both in and our patients. So I mean, I can have a day seeing diabetic patients overweight, we know. It really just depends what comes to us on that day. So my sole focus is not only diabetes, right?

Scott Benner 17:36
Well, how did you say you said you have an insulin pump? How did you find your way to it? Do you have some sort of assistance or coverage or the finances to be able to do it?

Shirley 17:47
As a dietitian?

Scott Benner 17:49
No, I just mean is that as a type one, like when you said you have an insulin pump is I'm trying to understand like here, people have insurance or don't have insurance.

Shirley 17:59
So basically, in our country, you we have private health care which you can pay for, or if you cannot afford to pay for private health care or choose not to then you access public health care. And so with my job, they do subsidize some of my private health care coverage. So like you guys have medical insurance, we call it medical aid, I suppose it's it's similar, but it is different. And yeah, so from my brief understanding of how yours guys works, I think it's linked more to who you work for, and what kind of insurance they offer. Yeah,

Scott Benner 18:40
so private insurance, your you get through your employer. Normally, you can buy it in cash, but most people get it through their employer, their employer subsidizes some of the cost and you pay the rest. I don't know what people pay in general. I do know what RS is. And it's, you know, for for people, I think we probably pay. I'm guessing here, but I bet you it's about $6,000 a year for

Shirley 19:08
that. Yeah, so as it's similar, the medical aid is a similar concept. employers don't have to subsidize it, just to get subsidized. And because I'm subsidized, I use the medical aid that they recommend. But if I do have the choice to use any medical aid I want, I can use any one I want. But they will only subsidize the one that they recommend. And then within the medical aid, there's like different options. So you can pay for different sorts of coverage. And I pay about five and a half 1000 Rand a month. So I don't know what that equates to in a year. I have no idea. Yeah. But your monthly pay about five and a half 1000 Rand. Yeah. All right.

Scott Benner 19:57
Well, I'm going to tell you while I figure out how Much Aranda is worth.

Unknown Speaker 20:02
It's not worth very much at the moment.

Scott Benner 20:04
But what I was, what I was gonna say is that is that, aside from the money that we pay out of, you know our check every month that comes from the company that gets held back for the insurance. The first $3,000 we spend on healthcare a year is what they call out of pocket. We have to pay that through. So I guess if I'm being honest, if nothing goes oddly wrong in a year, gee Volk, hypo Penn has no visible needle, and it's the first premixed auto injector of glucagon for very low blood sugar and adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about, all you have to do is go to G Vogue glucagon.com forward slash juicebox g vo shouldn't be used in patients with insulinoma or pheochromocytoma. Visit Jeeva glucagon.com slash risk. People with diabetes need an accurate and reliable blood glucose meter. It's a staple of your care. And the Contour Next One is easily the most accurate, easy to use, easy to handle meter that my daughter has ever used. It's small, but not too small, has a bright light for nighttime checks. And of course, the test strips allow you a second chance. So if you should not get quite enough of your blood sample and need a little more, you can go right back and get it without messing up the accuracy of the test. It's very handy, super easy to hold easy to use, fits well on your pocket or your purse, or wherever you carry your supplies. Contour Next one.com forward slash juicebox. Go there find out more about the Contour Next One meter, and a host of other things that contour has for you. There's test trip programs, and you may even be eligible for a free meter. This website is worth your time to pick around. For many people the Contour Next One meter is cheaper when bought with cash than when it's purchased through insurance. You should look into that too. And you can do that right at the link. Don't let your blood glucose meter be that thing that the doctor gave you because they had one in a drawer where a salesperson left one in their closet. Get a good one, get an accurate one, get one that's a pleasure to use Contour Next one.com forward slash juicebox. The T one D exchange is looking for type one adults and type one caregivers who are us residents to participate in a quick survey that can be completed in just a few minutes from your phone or computer. After you finish the questions. They are simple. I did them in about seven minutes. You will be contacted annually to update your information and to be asked further questions. This is 100% anonymous. HIPAA compliant does not require you to ever see a doctor or go to a remote site. This is your chance to add to Type One Diabetes Research right there from your sofa super easy to do. Go to T one d exchange.org. forward slash juicebox and click on join our registry now. After that simply complete the survey. Past participants like you have helped to bring increased coverage for test trips, Medicare coverage for CGM, and changes to the ADA guidelines for pediatric a one segals it's exciting to imagine what your participation may lead to T one d exchange.org. forward slash juicebox there are links to all of the sponsors right there. In your podcast player shownotes. We're at Juicebox Podcast comm when you click on the links, you're supporting the show. Thank you very much. And I want to get you back to Shirley now. I think we're all grateful that I haven't made any surely surely jokes so far. And let me just give you a little teaser right now. I'm not going to that's pretty proud of myself, as you may imagine.

And it's pretty regular year, it must cost us about $9,000 in cash to to have health care and for context. That is 152,120 Rand.

Shirley 24:38
So our like our medical aid works differently. So like the medical aid I'm on I'm on the highest option, and then it's within the option they break down so you have like in hospital care and they pay X amount for different things and then you're out of hospital care like you'll have a chronic benefit. I have like an optometry benefit. So, paying out of pocket more comes for things that they don't cover. So with your diabetes under your chronic, or the medical aids, we'll have what we call a chronic disease list where they cover certain chronic illnesses. And within those chronic illnesses, they have what are called prescribed minimum benefits. And those prescribed minimum benefits are what they have to cover. So for example, for diabetes or type one, they have to cover my insulin and my test strips. And then they'll also have a essential drug list and specific insolence and etc, will be covered. If you go for incident that's maybe not on that drug list, then you'll probably have a co payments. And then in terms of insulin pump CGM, they are not readily covered at all. There's no sort of funding for them within the medical aid, you have to try and fight for it.

Scott Benner 25:59
If if they were. Do people generally have cell phones to use as receivers for a CGM, or would they need a receiver from the CGM?

Shirley 26:10
No, there's access to cell phones.

Scott Benner 26:13
And before I'm just gonna blurt this out before I keep moving just for context, one US dollar is just about 17. Okay, so just so people have context. So if I had a CGM, I might have a cell phone to use it with and what kind of pump do you use? I'm sorry.

Shirley 26:31
So I currently use an accucheck pump. I don't think you guys have it in the States. It's a it's a combo. It's quite accucheck combo. And yeah, it's, well, my pump is now four years old, so it's just out of warranty. So hopefully, I will be able to upgrade to a newer system. It's just basically, the one I'm using is just a pump. It comes with a glucometer, which connects to the pump via Bluetooth so I can control the pump with the glucometer as well. Okay,

Scott Benner 27:00
so you take a blood test and it shows up on your pump. And do you do you have a CGM yourself? I'm sorry.

Shirley 27:06
So yes, I have started using a CGM. At the end of last year I'm using the at the moment the Medtronic Guardian Connect, because it's what I was able to get funded via medical aid at the time.

Scott Benner 27:19
Okay. Wow. All right. So how about insulin? Is everyone that we've talked about this, despite their financial situation? Is insulin available to all of them who need it?

Shirley 27:33
So yes, insulins available. So in private? Well, let's start. So in our public health care system, it's your your older insolence are like atrophy and profane the human insolence. They really only have access to those. I think you guys like and I've seen it termed as the insulin you get from Walmart. Okay. It's the same. It's the same.

Scott Benner 28:00
Feel good to hear that we're

Shirley 28:01
having a healthcare system. Geez.

Scott Benner 28:04
Gotcha. All right. So what we consider here to be older insulin. Yeah, is what's common there. And

Shirley 28:11
available to everyone your private sector. I mean, you can access Lantus levemir you're Pedro, you're Nova rapids you're humalog I think we have a tour Seba is available now as well. Yeah, so in private you can access I suppose your newer insolence if you wanted to have them as that

Scott Benner 28:39
right and what do you use?

Shirley 28:41
I'm using in my pump I use Nova rapid but I mean since diagnosis when I was diagnosed, I used Lantus and I used I've used a p drive us to Malaga, and I've used Nova rapid as my rapid acting. And then yeah, am I longer acting? I used land just when I was diagnosed.

Scott Benner 28:57
Okay. So, um, for your care, like what are your What are your goals? A one C, is that how you measured you measure more like your variability your up and down? Do you just shooting for what your finger stick says? How do you go day to day?

Shirley 29:15
So yeah, I mean, I do use HB one C, since I've had a CGM. I have been able to look more at like my time and range and those things as well. Um, yeah, I mean, my agency has ranged a think it generally was in the sixes last year, clammed up into the sevens. And then since I bought the CGM, I have reduced it down to 5.8%. By Yeah, just by having all that extra data, it really does help to make changes and to just see what's happening throughout the day, not etc.

Scott Benner 29:54
What changes did you make did you start with food or were you pretty comfortable with your diet and it was more about insulin?

Shirley 30:01
More about insulin Amina. I don't really follow a diet, but I'm pretty comfortable with my so called diets. I kind of eat all the food, but more just about insulin. I've been able to just tweak my basil a little bit as well. So that's helped as well. And then yeah, I do exercise quite a bit. I still kind of battle with that with dropping low during exercise. And but yeah, also playing around with like your extended Bolus is on your pump, which you can see better when when you've got a CGM. You can see how they're affected. And then, yes, Pre-Bolus Singh. I've been much better at that as well, since I've had a CGM. It's a big deal.

Scott Benner 30:43
That's probably where you got the point out of your a one C was the Pre-Bolus. Yeah. Oh, wow. That's so it's very interesting, because I have the feeling that I have talking to you about what's happening in South Africa around care is how I feel when I'm doing the podcast. And I think this podcast really is reaching just people. You know, I mean, fully reaching just people who have the technology to take advantage of the data. And for everyone else listening, it's probably feels like, I don't know, like something they can't it's out of their reach? And is there a way since you've been listening? Is there a way to take the the conversations on the podcast and what you've taken out of it? And give it to people who don't have the technology? Or is it just not? Is it not possible in your point, in your opinion?

Shirley 31:36
Um, I think it could be possible. It's a little bit difficult. So I mean, like, the patients, I see a lot of them also like English is not their first language. So sometimes, the context might be difficult for them back not having English as their first language. And yeah, and then I just yeah, I think they also saw, I mean, most of my patients, if they're on incident, they unset doses, nobody teaches them to adjust doses or anything like that. And if they're not testing, it's very difficult for them to adjust doses and make changes in their doses themselves. So they're not really given that kind of freedom, which in a private setting, it's completely different. Because we do have, I mean, most of the patients in private setting will be doing things like carb counting, they'll be able to adjust their doses themselves, they have access to better sorts of insulin. But in the public setting, it's a little bit difficult. I mean, I can give basic messages across but not Yeah, there's not a lot of I don't think a lot of the information would translate very easily for them.

Scott Benner 32:52
So many people there are managing type one, in a way that is more reminiscent of 40 or 50 years ago, in America, the idea of just I'm going to get up in the morning, give myself some insulin, make sure I eat at the right times, if I get dizzy, I'll eat something like it's it's that simple.

Shirley 33:12
Yeah, so I mean, like in my patients that we see, so a lot of top twos is also a bit hesitant to put patients on insulin. So there'll be sitting with her HB, one sees there are knock the oral dose of Metformin and maybe one other oral medication. And they probably really need insulin, but they there's a resistance that doctors don't seem to want to stop the insulin, and then also patients resistant as well. So because a lot of patients won't want the incident. Yeah,

Scott Benner 33:44
yeah. Is there trouble with refrigeration, that the two people have that concern that they can't keep the insulin?

Shirley 33:51
And I think like, that's not one of the major concerns. I just, I think it's fear sometimes as well. So I mean, because they often they're gonna say, oh, you're going to get an injection to take home, there's no like education around it. Or you take it, what do you do? They're kind of just given the stuff. And then they go home. And a lot of them, even if they're given the insulin, and they go home, they don't take it because they don't really know what to do with it. And nobody's taught them.

Unknown Speaker 34:19
Wow, that's sad, isn't it? So yeah, I

Shirley 34:23
mean, there's like, there's really as two different levels of care is that the public health care, but in privates, it is completely different. It's more along the lines of what you guys would experience in America, just with a little bit less access to the technology that's available.

Scott Benner 34:40
I you know, I don't you know, from my limited interaction with type twos and I do have some, I don't know that that sounds that much different than what a lot of people with type two diabetes here experience either it's, it's limited education, a small understanding. A feeling like you don't want to use insulin. I've heard people say insulin felt like giving up. A lot of people say that here, you know, like, like they have it in their head that they can diet their way out of there type two diabetes. And if they're going to use insulin, it feels like they've given up on trying, which is, of course, you can dye it and use insulin at the same time. It's not a one doesn't preclude the other. But I get the idea. I understand it, it is such a strange. I mean, honestly, most health issues that require more than take this pill in the morning and take this pill at night, comes down to can you get the patient to put themselves in the doctor's shoes and make the the kind of the bold idea that I'm going to be in charge, now I'm going to take care of this, I'm not going to lean on the doctor, the doctor has given me you know what he's got, I'm going to go find out the rest, I'm going to start paying attention to my body, seeing what happens making adjustments on my own being a little, you know, aggressive and not scared. I don't know that it's, I don't know that it's a fixable thing that you just, you know, turn a dial or, you know, send some instructions out to every dietitian in South Africa. And suddenly it's, it's fixed. It's, it really does live with the person who has the disease, but it's got to be someone's job to impress upon them beyond a shadow of a doubt that this is the only thing they should be focused on until they figure it out. Because otherwise it's just gonna it's just going to impact the rest of their life.

Shirley 36:27
Yeah, I think so. Like in our setting. There's also like, a lot of misinformation given. I mean, I do also understand some of us, like in our clinics, and even in our hospitals, that doctors nurses are really short staffed, they don't always have the time to sit with a patient. I do understand that. But I mean, as like, patients get told they can't eat red apples, they can only eat green apples. They mustn't eat a banana ever again. And it is an illness Jakob diabetes that's very much related to sugar. So they a lot of patients will feel well, they'll tell me they don't need any sugar. But they don't understand

Unknown Speaker 37:11
that hydrates

Shirley 37:12
and how they impact the blood sugar levels. So they kind of get this sort of like brief, like, don't eat sugar kind of message and take this pool and you're going to be fun. And that's it. Yeah, that's Yeah, it doesn't go further. The education part doesn't really go further than that.

Scott Benner 37:33
It's interesting. Do you have water ice there be like, slushy ice that's got flavors in it.

Unknown Speaker 37:41
Yeah, yeah. So there's a piece a giant

Scott Benner 37:43
organization here. You know, I don't know how far across the country but on the East Coast, it's a massive and they sell water ice at these little stands. And part of their sales pitches. It's fat free. And I always I'm like, Yeah, I mean, right? Until you put it in your body and your body goes, Oh, sugar, what should I do with it? Hmm, I'll turn it into fat. And it's the same idea with like, Oh, I don't need any sugar. You know, there's barely any sugar and bread. Okay, you know, and then the carbs, of course have, you know, they don't understand is really difficult to I don't know where that understanding has to happen. Like, as you're talking. there's part of me that always thinks, what if you just draw a line and start over, and everyone who's above a certain age, you're just gonna miss them. And there's nothing you can do about it, but at least you could fix how it happens. Moving forward, like, do you spend more time in, you know, lower level schooling, you know, with younger children, explain that to them. But don't just say, hey, sugar turns into fat or, you know, bread could be carbs, like you don't just do that you say, and 10 years from now, when a friend of yours or you develop type two diabetes, this is going to be really important information to remember like, do you give them a little extra honesty? And, and so that it sticks in their head? Because you know, I'm watching my daughter downstairs this morning doing geometry. And you know, she's thinking, when am I ever going to use this to my life? But if somebody said, Listen, this geometry you're learning today, this is going to save your health. 10 years from now, really remember what you're being told here. Remember to come back to it. I this is I don't know if this is gonna sound connected or not. Do you have children?

Unknown Speaker 39:29
I don't have any children. Okay, first of

Scott Benner 39:31
all, good job. Kids, dogs. It's a lot of problems. But I find myself thinking I should have started a diary. When my kid was born, and every time I thought of something, wow, he's gonna need to know this one day. I should have written it down. Yeah, because I find myself learning things about life. Sometimes it's medical, and sometimes it's not. And I think well, now I know this He should get to stand on the shoulders of this idea, not have to figure it out for himself. And you know, sometimes when it's not medically, you know, related, you think, Well, you know, it's good to figure things out on your own a little bit. But if you're really going to make a leap in something, you can't start in a hole, you have to start, you know, someone's going to prop you up a little bit. And with medicine, it's just, it's super important. It's what I see with the podcast, you know, people come in completely lost, and the podcast supercharges, their idea of what's going on, and it does it quickly, so that they suddenly are lifted up, and then they can, they can start, you know, at least they're playing on a level playing field all of a sudden. But if you give someone diabetes, and then give them all of the physical problems that come with it, especially, you know, mental tiredness that your body feeling wrong, like you know, all the stuff that you could be dizzy, all the stuff that could come with it. And then on top of them, tell them now live through this every day. And don't forget to pull the pearls of wisdom out and don't forget them and don't forget how to, you know, apply them. It's, it really seems impossible, without, without help without somebody to stand, you know, someone's shoulders to stand on. I don't know, it makes me I really I keep thinking about it. Like there's a way to handle it. I've been having type two conversations with people privately recently. And I just think there has to be a way to do for people with type two diabetes, what the podcast does for people with type one diabetes. And I think it's doable. It just

Shirley 41:31
yeah, I think it is. I mean, I mean, if I look at our context, and like the patients I work with, so a lot of its low income patients, and in terms of diets, they tend to eat a high starch, high carb diet, just because it's your foods that are easily available, accessible, that cheaper. And so I think, like from my side with the information I give, if I can relate, because they only feel like sugar affects their blood sugar levels, and they're not adding sugar, or, you know, they're not eating cakes, or sweets or whatever. But often, yeah, just to try and relate to them, that starch will also affect their blood sugar levels, and they will eat very big portions of starch. So I think it's little things like we get them to cut down on their starch portions, and trying to include more vegetables in their diet. So I mean, it really is like, basic, healthy eating, and I will for myself, I never apply it just to the patient, and encourage them to apply it to their whole family, because it's beneficial for everybody in the family, and it's not specific information. And then on the other spectrum, and our private health care. I mean, you do also get people's perceptions that a lot of people only low carb or no carb. Yeah. So it really just depends where you are in society as opposed if you're low income, middle income, high income, and what your perception on diet is, as well. So yes, it's, it is a little bit difficult, even in private, because those patients have more access to information technology, stuff on the internet, and they don't really see a value of a dietitian sometimes as well, because they just gonna follow whatever. fad diets or etc. that's out there at the time and what works for them, right?

Scott Benner 43:27
Whatever, Google and Instagram, tell them to do. Yeah. Oh, my goodness. Well, that's

Shirley 43:33
for myself. I mean, I've never eaten a low carb diet, I eat carbs, I eat everything. And a lot of people like try and push that onto me. And I'm like, Well, I don't really see the need for it.

Scott Benner 43:44
You're, you're doing difficult, you're doing terrific. What was do you know, back in when you were younger, what your agencies were like in your early 20s.

Shirley 43:56
Um, I think they were relatively fun. I think the highest agency I had was about a 9%. And I was battling and after that. That was when I started. Well, I was interested in getting insulin pump. And I think after that I've got an insulin pump. So like, I think they've mostly ranged in the six senses and sevens, maybe blow eights and luck from what are the one I can remember is b 9%, which was the highest it had been and then you're just I needed to refocus and look at something different to help with the management.

Scott Benner 44:35
He used the word a second ago, I didn't hear you said you were battling something. What were you battling?

Shirley 44:45
I can't remember. He said

Scott Benner 44:47
I was battling. And then it sounded like you said like, when a spider man's like photos or something like that. I couldn't tell what you said. Like you swallowed a couple of letters and I couldn't hear them and I was like, Oh, Okay, nevermind, I thought you're gonna be like, oh, That was just this, but I don't know if it was, um, I really don't know.

Shirley 45:04
I'll listen to what I said, I sorry, I can't even remember.

Scott Benner 45:07
Don't, don't worry, listen, right here, when I'm editing the show, I'm gonna go back and play it again and again for people, and we'll figure it out together instead of it instead of, you know, it'll be fun. It'll be fun, you'll listen back one day and think, oh, that's what I was talking about. It's really, it's very interesting that you have been through so many different insulin types. And that you're kind of, you know, you have to mishmash your, your technology around like, you have to get a Medtronic, you know, CGM, because it's what's available that you're using a pump that, you know, obviously, we don't have here any longer. Is there a way to attract companies to South Africa? Like, is there just not enough of a patient population there? Is it a distribution issue? Do you ever do know why some companies don't exist? In some places, they're their products.

Shirley 45:56
Um, so we have access to so obviously, electronic is here, that is the main company. The accucheck pump is still available here. And then we do have access to tandem and Dexcom as well. So that is available now as well. Okay.

Scott Benner 46:14
It's just not it's just not financially reasonable, and nobody will back it up with coverage.

Shirley 46:18
And no, there's people. Yeah, I mean, I'm sure that people using it, the Dexcom. The sensors are a lot more expensive than your Medtronic sensors. So yeah, but there are people that definitely use it.

Scott Benner 46:32
Gotcha. Okay. I just, I mean, it's, it's one of those ideas, like, I don't know how many, you know, what percentage of people you end up, pulling out of the out of the hole. But if you threw a Dexcom on everybody, they have at least a chance to figure out what was happening to them. Even you know, especially type twos, honestly, the way you describe them, I know that more and more type twos are using glucose sensing technology, but that's for them, you know, to see what a banana does, and not just and not just have somebody tell you, you can't have a banana anymore. You know, to see what how, what impacts medications have and where insulin would be helpful for them. If you know dieting is not working for them. Hmm. Yeah, I don't know. It's a problem, obviously.

Shirley 47:22
Yeah, I mean, the other thing we do have access to as the freestyle libri. And there was talk of people trying to motivate for that to be brought into the public healthcare facilities for the diabetics. But I think it's a very long shot to get that into our system, but it is available properly.

Scott Benner 47:45
If you wanted to, do you know the political ramifications? Like if you wanted to petition someone to consider something like that? How do you How would you do that they're

Shirley 47:59
not 100% short in public, but at the moment, in our private sector, there is a group of people and I have participated where we've started a CGM for all campaign. And we are trying to engage with the medical aids to fund CGM for type one diabetics,

Scott Benner 48:20
that would be wonderful if you could do that. I, I don't know. Like it's, it's, I've lived as a parent of a child with type one in both worlds I've used not the really old insulin, but I've been, you know, just fast acting, slow acting and needles and me and a little meter. I've done that for a number of years. I lived through the beginning of CGM, where it was, you know, they were definitely finding their way in the first, the first year, or the first iteration of it was, I mean, still better than anything I'd ever seen. But nowhere near what it is now. And what I'm assuming it's going to be as the generations keep pushing forward. And this is the way to do it. There's there's no doubt like this is this technology is is the gold standard for understanding what's happening inside of your body and making great decisions that keep you healthy and, and and let you live, you know, the the life you're supposed to say it's really devastating to hear, especially with the you know, there's going to continue to be an explosion of type two diabetes, and to know that for most people in in place in a lot of places, not just there, but here in other countries, that it's going to be, you know, that's what their life's gonna turn into is either an uphill battle or, you know, an exercise and ignoring things and hoping it doesn't hurt them, which is of course, not going to be the answer.

Shirley 49:45
Yeah, I mean, it definitely. It's a very hard thing because I mean, it is a lot of diabetes is a patient responsibility. I mean, you don't live with your doctor 24 hours a day. So a lot of your management is Your responsibility and what you put into it. But yeah, I think the starting point to get there is to have a good solid education given to you by the health care workers or whoever gives the education. I think that's the starting point to motivate people. Because if you don't understand anything about diabetes, or what's happening, you don't really have that motivation to do anything about it.

Scott Benner 50:29
Yeah. Now let's even that, as you're saying that I'm thinking, then you have to have a life that you that you want to be healthy to go live, generally mean? And if you're if you're already struggling in other ways, what's the you only mean? Like, what's the excitement for you like, Oh, I'm gonna be healthier. So I can go, you know, do my do my job over and over again, that I don't enjoy that. I feel like it's just, you know, a task and I don't know, it's a it's a bigger idea, like, how do you motivate yourself? In that scenario?

Shirley 51:02
I suppose everybody has their own motivation? Yeah. Something that must keep them going. Whether It's Your family, your job? I don't know. I'm sure everybody must have some sort of motivation in them to keep going.

Scott Benner 51:18
I think so I just I think sometimes it doesn't feel when it doesn't feel doable, then, you know, you know, we talked about this the other day. When you don't, when you can't retreat into your mind and come up with an answer for something, and you don't know who to go ask, then there's that feeling that the answer doesn't exist. Which is, which isn't true. It's somewhere it just you don't know how to get to it. And not knowing how to get to it is about the same as it not existing sometimes? Surely, you're a bummer. Is there anything you're not just kidding? What What made you reach out? Well, first of all, how did you find the podcast?

Shirley 52:01
Think on Instagram, through Instagram, and then I started listening to it.

Scott Benner 52:07
It helped me Was it valuable for you? Or is it just interesting to hear about people with diabetes?

Shirley 52:13
It is very valuable. I mean, the pro tip series that you do, that's really great. And it's also just interesting to hear other people's stories.

Scott Benner 52:22
I'm glad. That's excellent. I Instagram is a is what I was guessing I just wasn't, it wasn't 100% certain out and now you've got me looking. I'm now interested to see how many people listen from South Africa. So I'm going to look real quick, right? While you're here, because that doesn't that can't be that many as what I'm thinking. Because you found it. But yeah. There's a couple of 1000 downloads this year. I guess that's not crazy. Yeah. But that's some people. It's a it's interesting when I see it pop up, because I do look at at the downloads in Africa. And it's interesting, where it'll pop up, moving up into other countries is very sparse. But they're just some countries right through the center that don't even have one download. Did they have no internet access? In that Central African? In that maybe not? Maybe not. Look at you. You're like, I don't know. I'm not leaving South Africa. It's

Shirley 53:19
possible that they don't mean, I don't know what's in Central Africa. Is that like the Congo?

Scott Benner 53:26
Yeah, a little Congo little? Listen, let's talk about something real for a second. How many great white sharks have you seen? And how many people do you know who have been eaten by one? And none? out here?

Shirley 53:38
I've never seen one. I've never gotten shark cage diving to see one. And I don't know anybody who's been eaten bow and I would never

Scott Benner 53:47
go in the water in South Africa. Although it looks beautiful. It's beautiful. Right?

Shirley 53:52
Yeah, I mean, it depends where you go in South Africa. So I mean, if you went to Cape Town, and there was really freezing cold but in Durban we have a much more warmer climates, our waters much nicer and warmer.

Scott Benner 54:09
And, or am I right? Our seasons? Like what what time of year? Is it there for you right now?

Shirley 54:17
So we are I suppose winter. But yeah, I mean, so we are live in Durban. Winters very, very mild. So it's not like if it gets to 20 degrees, we're in Celsius. So if we get to like 20 degrees Celsius, we were all winter clothes because it doesn't get very cold. Yeah, that makes sense. But other areas of the country get colder than us.

Scott Benner 54:40
What about the summertime? Is it incredibly hot, or what's it Yeah,

Shirley 54:45
very humid and hot.

Scott Benner 54:47
humid? I hate the human humans my worst thing.

Shirley 54:51
So don't love the humidity. I actually like Durbin winters. Perfect.

Scott Benner 54:58
Yeah, it sounds like early spring.

Shirley 55:00
65 days of the year,

Scott Benner 55:01
you will take that ICS Have you ever traveled to other countries?

Shirley 55:07
Um, yes, I've been to America. So I've been to New York and Colorado. I've been to Italy, I've been to France, and I've been to the United Kingdom. Wow,

Scott Benner 55:18
that's a lot of traveling.

Unknown Speaker 55:20
Yeah, a little bit.

Scott Benner 55:21
I used to think a little bit you were you've been to four places I've never even considered. I've been places I'd like to be that I've never thought. I wonder if I know you said there's English isn't a first language. And you've heard the pro tip. So let me ask you this. And this isn't me trying to make something happen. I'm just generally interested. If you instead of like you said, it's hard to see patients, because it's so quick. If instead of if instead of a quick, 10 minutes, right, if you put 500 or 1000 people with type one diabetes from South Africa, in a room, and I jumped up on a stage and did a two hour talk about some of those prototypes and got people into the mindset and there was someone there translating for me. Do you think that would move them forward?

Shirley 56:12
I'm not sure. So like, I mean, in South Africa, we do actually have 11 official languages. Oh, dear God. And so we are live in Durban, or what's our provinces kwazulu Natal, our language. I mean, obviously, there's English, but there's also the main language spoken would also be Zulu. And direct translation is a very, there's no real direct translation really, between English and Zulu. So you can't translate word for word. So you're to our talk, take a very, very long time when somebody tries to translate into you, I understand to try to get it out. So I would need someone like you who understands what I'm saying somebody who's speaks the local language to almost have their own

Scott Benner 57:10
understanding of what I

Shirley 57:11
was able to listen to something, have their own understanding, and then disseminate that information.

Scott Benner 57:17
Gotcha. So it for example, if you spoke Zulu, which you didn't say you did, so I'm assuming you don't worry, you would totally be bragging and saying you did. And so if you did, and you really understood the protests, and I showed up and I said something, you could listen to what I said. And then put it into context. Because your brain Yeah, your brain would do the trick.

Shirley 57:34
Yeah. So I mean, I don't speak Zulu fluently. I speak very limited. So I mean, I wish I spoken more fluently. But yeah, so my limited words and things I can string together definitely wouldn't

Scott Benner 57:49
help. It wouldn't help. But But somebody I just I'm trying to imagine like, how do you talk to people like that, and then they'd have to have the technology. So So what I want to kind of finish up by asking you, what of the stuff that you heard in the pro tips. Have you been applying to people who don't have technology? What are you able to tell them?

Shirley 58:12
I haven't really used stack your pro tips much in my week. Okay. So I mean, something I do like to speak to them about if they are on insulin is maybe the timing that they taking the insulin, because it's not often discussed, sometimes they take the insulin home, and they don't actually get told when to take it, they might take it after they've eaten, they might take it just when they eat. So that's something I do discuss. The only other thing I really also discussed with patients is the injection sites, trying to make sure they rotating injection sites, because that's also something that's not really discussed with them, or they're not really told about and, but also in terms of the way we work and like professional regulating bodies. As a dietitian, we are technically only allowed to educate in terms of diets. Everything else is actually out of our scope of practice. So I mean, I do give brief information, but that's just mainly from my own knowledge. But

Scott Benner 59:20
it would have to be an actual physician who said, this is how you use the insulin no one else is.

Shirley 59:24
Yeah, so I don't really speak to them about dosing. I don't. I can't recommend adjusting dosing, I have to set out to go back to the doctor and ask the doctor to look at those things, even though I mean sometimes maybe I could see it for myself that they need to adjust the doses or change something. I can't really give them advice to do that. Gotcha.

Scott Benner 59:49
Wow. What's your favorite Charlize Theron movie quick.

Shirley 59:53
Oh, geez, I don't even know

Unknown Speaker 59:55
unbelievable. You're not following her. She's not watched with it and he's not like your bread. head or anything like that? You guys don't like she made it? I think all right. Oh,

Shirley 1:00:05
yeah, she made it. She seems so like far removed.

Scott Benner 1:00:09
Are all women in South Africa tall and blonde or no?

Shirley 1:00:15
Well, I don't think I'm very tool but I do have blonde hair. I

Scott Benner 1:00:17
don't think I'm very tall. What is not very tall?

Shirley 1:00:21
I'm like 1.6 meters.

Scott Benner 1:00:23
I have no context for that. That's hilarious

Shirley 1:00:26
in my mind now really tell you in feet because I have no context of I only know the metric system.

Scott Benner 1:00:33
I'm gonna find out. Because right now in my mind, right now in my mind, you're like, you're just as tall as like a baby in my mind. So you're like five feet a quarter inches? I gotcha. Okay. All right. You're right. You're not that tall.

Unknown Speaker 1:00:50
Yeah. Okay, so

Shirley 1:00:52
no, we're not all tall and blonde. I was just wondering,

Scott Benner 1:00:56
is there any type one in your family? Like, was this do you? Are there a lot of people who have type one? Are you the only one?

Shirley 1:01:03
Nice so when I was diagnosed? Yeah, I pretty much was the own. Yeah, well, I am still the only one and my dad's family. So my dad's actually Welsh, so he's from Wales. And, and then after my diagnosis when he spoke to one of his sisters back home, and she said she could remember their grandmother taking insulin. So possibly, it would, I think that would have been my great grandmother. So she's about 20 years older than my dad, but she remembers her dear grandmother taking insulin and back boiling the syringes and that kind of thing. Okay. Wow. But otherwise, no, there's

Scott Benner 1:01:47
no the only connection. So you really are on your own to, to do this and figure things out and extra because you're, you're living somewhere. Were you born in South Africa?

Unknown Speaker 1:01:56
Yes. Okay.

Scott Benner 1:01:58
So your dad was from some was your dad for somewhere else or?

Shirley 1:02:01
Yeah, my dad's from Wales,

Scott Benner 1:02:04
Wales. And he made it that to South Africa that started a family there. Which is why you're blonde, but short. Is that right? Is your mom from South Africa? Originally?

Shirley 1:02:15
I Yes. My mom's from South Africa.

Scott Benner 1:02:17
I figured it out already. That's right. You got the blonde from your mom, the short from your dad, am I wrong?

Shirley 1:02:22
No, my mom's actually got dark hair. My dad was the blond one.

Scott Benner 1:02:25
Have you ever considered just agreeing with me? Surely. So it seems like I know what I'm talking about. I mean, really wouldn't have been that way. At the end of the episode, you could have really made me seem like a genius and been like, Oh, my God, it's got you figured it out? It's amazing that I obviously, I'm, I don't know what the hell I'm talking about. But you have, you've painted a really interesting picture that I think people should, should wrap their minds around a little bit that, you know, I see people here. And there are certainly people in America who are in, you know, just similar situations financially and with their ability to get insulin, especially and, and technology for sure. And then there are people who, you know, like us are just, you know, we're able to get this stuff because we have the insurance. I mean, if we lost our insurance tomorrow, it would be out of reach. But it's interesting that the problems don't change from place to place, the idea of you know, not having the right education not having the right understanding, then the tools, it's, it's a, it's a worldwide problem, you would think it would be since it's such a similar problem from place to place, the place you would think it would be something that would be fixable, but I guess in the end, it just really does come down to money. And who's gonna pay for it? So

Shirley 1:03:46
Yeah, it does. I mean, I think every suppose every country in some way has the has similar situation, similar problems. Some people have access, some people don't. So it's not only one place in the world that has the problems. I think we all have similar problems. Right. Um, but yeah, I wish it could be fixable. And I mean, there's I think there's two ways it could be fixed, I think strengthening public health care services. Having programs in place because yeah, programs do actually work in public health care. We have other programs for other conditions and things that actually do work. And yeah, so having a specific program in place could be something that could work for the public health care as well.

Scott Benner 1:04:39
Yeah. I hear crickets in the background. It's very relaxing. Are you outside? No, I'm a Windows just open and just have it just I'm like it's just making me very happy. I'm like, Oh, it's lovely. In my mind, you're in the Serengeti. I know you're not but if you could just let that be like that. I would appreciate it. Thank you.

Shirley 1:04:56
Lions outside my door.

Scott Benner 1:04:58
I've been that you know of Say a bear walking through my town the other day and trust me, that's not something that normally happens,

Unknown Speaker 1:05:06
I think. Yeah,

Scott Benner 1:05:09
I think everybody stayed inside for so long because of COVID-19 that the bears were like, Huh, I wonder how far we could get. How? Let me finish by asking you has Coronavirus been very impactful there.

Shirley 1:05:20
Um, yeah, so we got our first case cases in March, which came from people that had traveled. Well, I mean, those are the cases that were tested and they came back from people that traveled in Italy. But I mean, for honestly, we actually don't, I don't think you know, when it actually into the country. Um, we were put on by the end of March we'll put on to it was meant to be a three week lockdown, very strict lockdown, just essential services. And then basically staying at home you couldn't go anywhere and except about food or access medical care. That was extended for a further two weeks so and then in the beginning of May, I think we went to what we've called level four lockdown, which then we're allowed to exercise between six and nine in the morning. And the our that was about it. And then from Monday, which was the first of June we now and what we calling level three, everybody's gone back to work. And basically they've asked us to stay home as much as possible only go up for essentials. In our strict lockdown. Alcohol was prohibited. So there were no sales of alcohol that opened on the first of June. So everybody flocked out but alcohol and cigarettes have still been prohibited. There's no sale of cigarettes. And yeah, that's that's where we are at the moment.

Scott Benner 1:06:47
I found it odd here that they we made we made alcohol an essential thing. So a liquor store was essential. And they stayed open, but they closed meetings. So like there was no a meeting. So Alcoholics Anonymous meeting sounds like that's not that doesn't seem balanced. And, but it does. It did really tell you like I think they're like oh, we're gonna lock all these people in their houses. We better at least give them booze because

Shirley 1:07:14
we got no booze at all. Well, what you stocked up and people thought it was only for three weeks. So yeah, weren't very happy. Most people have been home brewing their own beer. Um, but yeah, I think sustainability of the lockdown especially in our country financially, we couldn't sustain it. So they have allowed everyone to go back to work now but it's really created great job loss. Terrible major financial impacts on our country. So yeah, we're gonna have to try and recover from that. Yeah. And then in terms of like our numbers, I think we setting on 30 odd 1000 people at least 50% recovery rates so far and I think our death rate something about 2%

Scott Benner 1:07:58
I know I would the unemployment. I don't even think you people know the full extent of it yet. Like there are people right now in America who are home who are like, oh, when this all is over, I'm I'll go back to work except they're gonna go back and their jobs not gonna exist because the company

Shirley 1:08:13
exists. You know, unfortunate. I mean, it's not only for us. I don't think any country can sustain these lockdowns. Yeah, that's just really not sustainable. Like financially, it's not sustainable. And there's a lot of criticism about lockdowns should we be locking down? Shouldn't we is criticism about so we have to now wear masks if you're out in public, exercising anything like that? I'm supposedly supposed to practice social distancing. But that's just up to an individual if you do it or not, we still not allowed to, well, we're not supposed to visit family. So yeah,

Scott Benner 1:08:50
I haven't seen my mother things. I have not seen my mother in like, four months. And I was talking to her last night and she's in her mid 70s. And I started thinking like, you know, at what point are we protecting her body and breaking our mind? You know, like, I got to figure it out.

Shirley 1:09:06
Yeah, I mean, it's very difficult. And I do think for the elderly, it's actually not good for them to be isolated from people. Like it's just not just the elderly, for anybody to sit isolated by yourself, especially if you live alone or something like that. It's not good for you. It's the interaction with humans.

Scott Benner 1:09:26
100% I could use a hug once in a while. So all right, well, surely I know. It's what time is it there by the way?

Shirley 1:09:34
It is almost 20 past six in the evening.

Scott Benner 1:09:38
Wow, that's lovely. Sounds very nice. Well, I I am, I really appreciate your reaching out and doing this and taking the time and adding another perspective, to, you know, to the chorus of episodes. And, you know, I appreciate this very much thank you for, for finding the show and for and for wanting to add to it.

Shirley 1:09:58
Thanks. Thanks for having me as well. Always a

Scott Benner 1:10:00
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