Across Tanzania, Medical Refrigerators Preserve Life and Health for Kids with Diabetes

The technology Tanzania's children with diabetes needed most urgently wasn't a cutting-edge treatment. It was refrigeration.

Local public health clinics across Tanzania provide monthly checkups for children with Type 1 diabetes, as well as free insulin and equipment for monitoring blood glucose. Children and their parents learn what the disease is and how it works. Despairing parents, who may assume their children won't survive, receive the needed tools to help them live happy and healthy lives.

"It's very difficult, but you don't give up because the aim is to help," said Dr. Renatus Nyarubamba, a physician, program manager, and public health research coordinator at the Tanzania Diabetes Association, or TDA.

These clinics, which operate out of area hospitals or medical centers, are a lifeline for the poorest families. Conversations with a doctor at a diabetes clinic are often what change parents' minds about their children's future - along with free medicines and supplies for managing diabetes.

Insulin, which people with Type 1 diabetes depend on throughout their lives to maintain healthy levels of blood glucose, must be kept within a narrow range of refrigerated temperatures to be safe and effectiv e.

But medications must be readily available, at no cost, at these clinics - because otherwise children from vulnerable families likely won't receive lifesaving care, Dr. Nyarubamba explained.

Direct Relief, which funded and sourced the initiative, partnered with the Tanzania Diabetes Association and the International Diabetes Federation to place 128 pharmaceutical-grade refrigerators at 78 public clinics across the East African nation - enough to store and allocate insulin for more than 6,200 children and youth with Type 1 diabetes - in late 2025.

Through Direct Relief's support, the Tanzanian Diabetes Association also placed 128 universal power sources in public clinics, because power loss poses an especially high risk to insulin's safety and effectiveness.

This installation was part of a larger Direct Relief project designed to increase medical capacity in low- and middle-income countries. Thus far, Direct Relief has worked with in-country partner organizations to install medical refrigerators in 18 countries, with more support across Africa, Latin America, the Caribbean, the Middle East, and Asia in progress.

"That was a game changer," Dr. Nyarubamba said. "People are very happy…[Clinicians] can order insulin based on the need, without fear of being unable to find a place to store insulin."

TDA staff first identified the need for refrigerated infrastructure support in 2023. "We started observing that we had challenges with insulin storage at the clinics," Dr. Nyarubamba explained.

Staff members, responding to increased demand as more children sought care, decided to expand the insulin support they provided to clinics in 2024. From providing insulin and supplies to about 4,000 children, they began to support more than 8,000 children at dozens of clinics.

That's when refrigeration became a much bigger concern, he said.

Doctors began complaining that there wasn't enough room in their existing refrigerators to store the insulin their patients needed. Often, the refrigerators were shared across a clinical facility, with different specialties needing room for their cold-chain medicines.

Insulin is a precious resource, and Dr. Nyarubamba and his colleagues work closely with clinics to determine precisely how much will be needed at each facility for the number of registered patients.

"Most importantly, we ensure access" to the medications and supplies that children with diabetes need, he said. "We as local implementers are given the opportunity to determine the demand."

Dr. Nyarubamba has seen firsthand the difference local care, education, and free insulin can make. His interest in pediatric diabetes goes back to the days of his medical residency at Haydom Lutheran Hospital in Tanzania's Manyara Region. He was assigned to the hospital's diabetes unit, but wasn't as deeply interested in diabetes care at that point.

However, what he saw worried him: Patients were frequently misinformed about diabetes, thinking people with the disease were cursed, that they were going to die quickly regardless of treatment, that they "don't have any value to society," Dr. Nyarubamba recalled.

In addition, it was hard for many families who had children with diabetes to reach a doctor.

"Someone would spend an entire day just traveling to a Type 1 diabetes clinic," Dr. Nyarubamba said. What that meant was that families who needed to work and care for other children often simply couldn't.

One day, he encountered a man picking up insulin for his three children with Type 1 diabetes. It was clear to Dr. Nyarubamba that this father felt ashamed of his children's diabetes, that he didn't want to be seen visiting a clinic with them, and that he "had no hope" they would survive.

The family members were part of the Hadzabe, a hunter-gatherer tribe that still lives a traditional lifestyle near Lake Eyasi in Tanzania. Because the father only spoke the Hadza language, which has no known related languages and is characterized by a unique system of clicks and breaths, Dr. Nyarubamba couldn't communicate well with him.

But he was determined to make sure this man understood what diabetes was, and that his children could still live healthy and fulfilling lives. He made a number of phone calls and found a translator. Then he sat down for a series of conversations with his patients' father.

"I loved the challenge," Dr. Nyarubamba recalled. "It made me also have a different perspective about…diabetes and the way people perceive diabetes."

Soon after, the father began bringing his children to the clinic for regular appointments.

"He was confident," Dr. Nyarubamba said, summing up the man's changed perspective this way: "'These are my children. They have diabetes, but it's not the end of the world. They can still achieve their dreams.'"

From then on, Dr. Nyarubamba had an abiding, profound investment in treating diabetes, and in supporting the local clinics that educate families, make healthcare accessible, and provide the medicines and testing materials that keep children with diabetes alive.

When he sits down to design programs or research, to allocate medicine, or to place a powered medical refrigerator, he keeps these children in mind.

"I imagine a child in a rural setting somewhere far from Dar es Salaam," Tanzania's largest city, said Dr. Nyarubamba. "Every decision I make here, I know it's going to affect that child who is living 100 miles away."

The installation of medical refrigerators in diabetes clinics across Tanzania was made possible by donors Eli Lilly & Company and Moderna.

Since 2018, Direct Relief has provided $26 million in material medical aid to the Tanzania Diabetes Association, including insulin and insulin devices. Medical material aid was provided directly as well as through Life for a Child, an organization that supplies lifesaving medicine and equipment to children and youth with Type 1 diabetes in 70 countries.