Diabetics Doing Activism with Elizabeth Rowley

[00:00:00] Rob Howe: Welcome to the Diabetics Doing Things podcast, where we explore the amazing stories of type 1 diabetics around the world. I'm your host, Rob Howe, Diabetics Doing Things founder and 11-year type 1 diabetic. Help raise awareness for Diabetics Doing Things by sharing this with your diabetic friends. We're also on Facebook and Instagram. Tag a type 1 friend today. This week's guest is Elizabeth Rowley, founder and director of T1 International, an organization working towards adequate access to insulin, diabetes supplies, medical care, and education for all people living with type 1 diabetes. Welcome to Diabetics Doing Things. This is episode 9, Diabetics Doing Activism. And my guest today is Elizabeth Rowley of T1 International. Thanks for joining me.

[00:00:47] Elizabeth Rowley: Thanks for having me. I'm really excited to be here.

[00:00:49] Rob Howe: and this is one of the things that I really like about doing these podcasts is you're actually over in the UK so we're able to just connect via Skype so that's super cool yeah and Elizabeth tell us a little bit about yourself you are the founder and director of T1 internationals give us a little bit

[00:01:06] Elizabeth Rowley: of a background yeah sure so I was diagnosed with type 1 diabetes when I was four years old so I don't really remember life before it it was back when I was diagnosed I was hospitalized for about two weeks and I understand that it's changed a lot since then in the U.S. and in the U.K. And you can be overnight or not even overnight at all when you're diagnosed. So it was a pretty intense experience at the time, but I've managed and I'm really, really lucky to have access to everything I need to sort of be able to manage my type 1 diabetes. Yeah, I mean, I guess about me really is about T1 International as well. I studied international studies as an undergraduate, and that's kind of when I started thinking about, I guess from a selfish perspective, well, what if I was caught in a natural disaster? Or what if I lived somewhere where the healthcare system wasn't great? And just thinking about that made me realize there's lots and lots of people around the world who do live in places either that are affected by natural disasters or war zones. Of course, Syria is a big one right now. We've been doing a bit of coverage on that at T1 International. Or just, like I said, places where health care systems aren't great, the structures aren't there, or the support isn't there for people with diabetes. So those thoughts really led me to just question that more and look more into the situation for people with diabetes, I found myself in London in the United Kingdom doing a master's degree in international development. So during that time, I kind of learned more about not only global issues, but I continually applied it to what this would be like for people with diabetes in conflict and things like that. So that really led me to start T1 International, which started just as a blog and I really from there it's just grown hugely it was meant to be a place to put together all of the content about global diabetes and I realized there actually wasn't too much content out there there's some there's a few organizations doing doing things for people with type 1 around the world and there's a lot of local initiatives um so it became kind of a hub of information and it also became um a place where I realized that I wanted to do more. I wanted to find, uh, with people around the world, I wanted to work with them to find kind of more sustainable solutions rather than just, um, donating insulin or supplies or things like that. Um, so, you know, it's grown to a small charity and that's kind of where we are today. And, um, I've put a lot of my, you know, it's, it really means a lot to me, um, because I have type 1 and because I know how lucky I am. So, uh, I'm definitely very closely tied and that's, um, That it's kind of become my my diabetes passion really is to try to change the situation and make sure that everybody's on equal footing.

[00:04:09] Rob Howe: Absolutely. And I think I mean, you touched on some amazing points that I want to kind of go back a little bit. Sure. You know, talking about, you know, being selfish is where this started from and then to grow into something that's ultimately so selfless for all of our diabetic listeners out there. obviously understand the, you know, what the cost of healthcare, either in the United States or in the UK or Australia. But then, you know, thinking about a situation like in Syria, like, I can't imagine how difficult it is, you know, to not have access to a pharmacy or to, you know, healthcare costs being exorbitant. What kind of things are you guys seeing over there with, you know, some of

[00:04:51] Elizabeth Rowley: the conflicts and things with diabetics? Yeah, I mean, it's, it's really, really tough, that one, especially because we're doing what we can to kind of raise awareness about that situation and get people to think about people with type 1 in Syria or refugees who are now finding themselves in you know Lebanon or Turkey and we're just hearing from people who either have children most it's mostly we're getting parents who reach out who have children with type 1 and they're just finding it harder and harder to get insulin. And often when they do get it, it's expired, which is a whole other problem. You don't know how effective it's going to be. Sometimes it gives you a rash. So there's all of those things. Test strips, again, are getting to be near impossible to get. And if you can get them, they're exorbitantly expensive. So I mean, that's really the main issue, we also have heard that electricity is not regular, even in Damascus especially, and then in rural areas. That's just a huge problem. So for storage of insulin, it's really, really tricky because if you can't keep it cool, as we know, then it can lose its effectiveness or expire earlier. So there's just a whole host of really tragic and terrible things that people are facing, not just because of the war, but also if you have the condition of type 1 and you don't know when you're going to get your next vial of insulin, it's pretty terrifying. So it's really hard for us because we aren't able to reach those people directly. You know, sending something in the post isn't really an option. We try to connect with organizations that are already there working on the ground and working in the refugee camps, one to encourage them to consider diabetes and we We offer them, you know, diabetes resources because we have connections in other parts of the world where they've established diabetes centers. So it's educational materials and that type of thing. And we're also trying to encourage, you know, bigger NGOs to make sure that they have insulin in their emergency stock. so that's kind of the way that we're trying our best to help and just connecting with those groups that are already doing great things for people to try to make sure that people with type 1 and all types of diabetes aren't forgotten.

[00:07:12] Rob Howe: Talk a little bit about what we don't know as diabetics here in the United States and in Europe and in those sort of first world countries about what our diabetic brothers and sisters are going through overseas.

[00:07:25] Elizabeth Rowley: Yeah, I mean that's a huge one I think. I've talked about it before but just having type 1 diabetes it's really easy to kind of think about yourself in your own management and it's a struggle for anyone no matter where you are so it's a really obviously a self-managed condition and we are the doctors or nurses of ourselves all the time so it's not always the first thought to kind of think outside yourself and what's going on in the rest of the world. So that's what we really try to do is just let people know what's going on by telling stories, letting other people's voices be heard and amplified. So we do things like just try to highlight that there isn't data. So, for example, the International Diabetes Federation, who do great work, they come out with an atlas every couple of years that looks at numbers of people with type 1 and type 2 and all sorts of different statistics. but actually they kind of repeat year after year that there is a huge lack of data for Africa as a whole, especially Southeast Asia, other parts of the world, and there's nobody really trying to fill those gaps. So, you know, you can't really tackle this problem of lack of access to insulin supplies, education, health care, if you don't really have a full grasp of what's going on. So we know that people are definitely dying in parts of Africa because they can't get insulin. But the numbers and the stats to back it up just aren't there. So we're already advocating because we know it's an issue. But the kind of the bigger picture that we can get, and that's one of our kind of four streams of our strategy, is to try to push for more data collection, support anything that's going on, and hopefully do some research ourselves. There's some great groups in Africa at the moment that I was connected with through the Young Leaders in Diabetes program. And they're doing some registries. They're trying to get registries set up for people with type 1, which is a great place to start in collecting data. Once you can get the names of people and just kind of start to track who they are and a bit about them. So we're working with them to support that work and trying to encourage as many registries as possible as kind of a starting point. And then as we grow, we hope to do, like I said, some of our own research as well. But there, yeah, there's no doubt about it. There is just a big gap in the stories, and we're trying to fill that gap as much as possible.

[00:09:54] Rob Howe: Well, I think it's a super worthwhile conversation because even in the United States and the research that is being done, it's more on the numbers of diagnosis that you see every year and the number of it's obviously very very publicized the number of type 2 diabetes cases that are rising every year as well as type 1 but we don't really know anything beyond the numbers of people that are getting diagnosed and some of it is HIPAA but you know just learning about who these people are and you know where they're from and you know there's there's a lot of things a lot of sentiment around there's more diabetes now than there ever has been. And part of that is that people are living longer with diabetes and they're catching it earlier and there are better treatment options available. And so, you know, trying to make sure that that extends worldwide so that we all have

[00:10:42] Elizabeth Rowley: the same opportunities is super important. Exactly. And actually, we've just been working on a survey kind of, again, it's not, you know, super highly scientific, but we do have some researchers on our team. So we've done just this survey that has gone around and kind of asking people, how do they administer their insulin? What type is it? How much do they pay out of pocket? So we're just looking at out of pocket costs, not like cost to governments, because there's a couple of people looking into that a little bit right now. But I'm also asking, you know, how much does it cost for their test strips? Do they have access to ketone testing and glucagon? How much their overall costs, including, you know, healthcare visits, doctor visits, those kind of things. And it's just been really interesting. We got over a hundred responses from about 40 different countries, which is just, you know, really useful just for the world to see, which we're going to be sharing some of this data on World Health Day, which the theme this year is diabetes. And that's on April 7th. So look out for that. But yeah, just to kind of give you a small taste, even things like costs for diabetes in the U.S., as you know, we were shown the range that, you know, people pay anything from zero dollars a month to $1,700 a month. So things like that are just really, just to kind of, to put those numbers on it is also, I think, really important. We work a lot on telling the stories and sharing voices, which is hugely important, But also just getting kind of some of this data really shows, you know, for the same brand of insulin, people in the States and in other parts of the world in the same countries, like we had several respondents from India who take a certain type of insulin, for example, and they pay a completely different price, maybe because of their location or because of the health care system or because the companies decide that they want to charge certain people a certain amount. So it's a really powerful stuff. And it's just the start, hopefully, of getting that bigger picture. But we hope it's going to be powerful in terms of advocacy in country for people to kind of show that there's a big disparity here. And why are people paying such huge percentages of their monthly income? I mean, even outside of this survey, you know, there's places around the world where people are paying 75% of their family's income. That percentage of income is growing in the States and it varies hugely. But we have a friend in Kenya who's one of our global advocates. And he says that, you know, proper diabetes management would cost about $120 a month for everything. but the minimum wage as far as I can tell in Kenya is about $106 a month. So just looking at that math, it's pretty crazy that to properly manage your type 1, you would be running at a deficit. And so people just miss out on management practices. They're unable to test their blood sugar. They don't get to go to the doctor or get their HbA1c tested very often, if at all, which is just kind of astounding when you really stop and think about it and hear about it. And that takes into account, obviously, the monetary strain that it puts on a family.

[00:14:06] Rob Howe: Obviously, you can't live operating in the red, much less live with diabetes. And I think it brings up a bigger picture, too, in some of those countries, discrimination against people with diabetes. What types of things are you guys seeing?

[00:14:21] Elizabeth Rowley: yeah I mean that's that's a big one as well I mean yeah not only are you having to worry about how much it costs but you're you're looking at in some some countries um I mean both men and women face this but um I think women get it especially bad around the world oftentimes people can view them as unmarriable or they're not they think they're not able to have kids or, you know, they're not fit for much at all is what we've heard, which is just, again, you know, not really acceptable. And as we know, people with type 1 are completely capable of doing all of those things. So that's really hard. We had a global advocate who recently did a blog post, and he's from Kuwait, and he has a lot of discrimination. He faces it, and he knows a lot of other people who have faced it in terms of just getting a job. If they find out before you, you know, have an interview, for example, then they can reject you on that premises. They cannot promote you because you have type 1 diabetes, or they think that you won't be able to go, you know, work in the field or do field visits and all sorts of kind of assumptions that, for example, that Global Advocate's working really hard to kind of break down those myths and barriers and get the government involved, hopefully, to try to pass some sort of law that would outrightly prohibit discrimination. But it's definitely something that I think we can all relate to in terms of the stigma of just diabetes in general. But there's varying degrees of discrimination in countries everywhere.

[00:16:02] Rob Howe: Yeah. And I think for me personally, I never really viewed it as discrimination, But I think it was just when I was trying to play basketball on the professional level, I wasn't from a skills and athleticism standpoint, not really didn't really stand out from the pack much. So I had to do a lot of little things to get noticed. So I could not let any coaches or scouts or agents know that I was a type 1 diabetic because that would just be something that in this player selection process would immediately rule me out as, you know, being willing to take a risk on and pay to come over. there. So I had to keep that very under wraps and like really focus super hard on my management. And, you know, for the first time that was, you know, hey, I'm going to hide this. And I'm, you know, for me, I took that as a personal challenge and sort of bowed up a little bit internally. But, you know, that's a challenge. It's a super challenge for everybody overseas. And, you know, not to even remotely put that in the same category as, you know, being denied employment, especially with, you know, the rising health care costs. But I think awareness, I think, is in general for people without diabetes is just such a huge part of that because, you know, they're potentially missing out on some really great, prepared, organized, mathematically

[00:17:18] Elizabeth Rowley: inclined employees. Oh, yeah, totally. Yeah, we have to do so much and multitask and yeah, loads of math, as you said. But yeah, I mean, I think that's the kind of the great thing and why we think our cause is so important, because you can, you can always find a way to relate, even if it feels like, you know, some of the people on our who are sharing their stories are, you know, so far away, you actually just feel a lot closer, because a lot of what they say, you can find, you can either relate to it directly, or there's a piece of it that you can think, oh, wow, yeah, I've experienced something like that or you know I even had my own kind of scare for example where I left my I was traveling and I left my insulin um at at my friend's house but it was many hours away and we'd you know driven all day to to another place so I was kind of going through what what the options were for me and it really helped put into perspective you know what other people have to to go through where they actually can't you know it's a very very tiny degree of that but there's always things that kind of help us just want to band together and make sure that we're doing something about these issues.

[00:18:30] Rob Howe: Absolutely. And you mentioned in foreign countries where there is a disparity between the monthly income and monthly diabetes costs. You mentioned Ethiopia as an example. What's treating type 1 like for the average person in Ethiopia? How does that differ from maybe what we're used to in the United States?

[00:18:54] Elizabeth Rowley: Yeah, well, so we have a map tool, which we can talk about more later, but you can click on different countries and read about what it's like to live with diabetes in those countries. So I encourage anyone who's listening to go and check that out. Ethiopia in particular, it's a new edition that we have. And we try to cover general things like an overview of the health system and kind of what happens if you need to go to the doctor and that sort of thing. And then we always ask just kind of practically, what is it like to live with type 1 there? And some of the things that were shared with us are just really tough to imagine. I mean, kind of similar to what I was talking about in Kenya, really. Nobody really tests their blood sugar regularly, let alone understands or has had the education of carb counting. So that's kind of a very novel idea, I think, in general in Ethiopia and in certain other parts of Africa. Again, not because they don't want to, but also, you know, carb counting is different when you're taking different types of insulin. So you more have set meals if you're taking kind of the NPH or mixed insulins. So it gets really, really complicated. but as we know, I don't know about you, but I test my blood sugar. I can test my blood sugar 10 times a day sometimes. So it's kind of terrifying to imagine not knowing what your blood sugar is and on a day-to-day basis not knowing that. So kind of the health outcomes or complications come sooner and I would say that's kind of the biggest challenge. Awareness across the board is an issue that comes up again and again, But hopefully with more awareness will come more realization that these things are the basics and everybody should have those.

[00:20:44] Rob Howe: Absolutely. And I think, you know, one thing that we are as diabetics doing things are trying to help and push for is, you know, if we can improve here in the United States specifically, if we can improve the experience around diagnosis and the conversations that are taking place between doctors and, you know, people who have just been diagnosed with diabetes and given proper education, how many more great diabetes success stories can we have? And I think part of that too is, you know, when not only are you in Ethiopia with no access to the supplies that you need, but also the education. So I, you know, I often will test my blood sugar, you know, on a regular basis four or five times a day. And if I'm having a weird off day, like you said, maybe 10. But the most important thing is that I know how I feel at each phase of the test. And so some days when I maybe run out of strips halfway through the day or something, I just hate not knowing where I stand. And so I think, you know, for that to be your life day in and day out is something that we need to really rally around and try to, you know, continue to spread awareness about, especially in the United States, because I think that's where we have the resources to actually, you know, put, you know, put our time and efforts and energy and money somewhere where it can make a difference for somebody who is suffering from the same thing as us.

[00:22:06] Elizabeth Rowley: Definitely. And another thing from our survey showed that I think it was, you know, more than half of the respondents don't keep ketone testing or glucagon with them, which, you know, I know there are a lot of people that don't, but there was a good percentage of those people that don't do that because they don't have access to it or they've actually never heard of it before. So just thinking about that is intense because the glucagon has saved my life several times. So to imagine that there's people that just don't know about it or the governments don't provide it or, you know, there's just no provision in general, whether it's government or just availability.

[00:22:52] Rob Howe: Absolutely. So I think I definitely want to focus in on the map for a bit. What else, you know, on the site and on the map, what are some things that stood out across the world that maybe surprised you that came back from your surveys or from your global ambassadors?

[00:23:08] Elizabeth Rowley: yeah well um i guess just to yeah just to talk about the map and kind of some of the other things on our website um it's just been a really good experience with this map because we kind of imagined it a couple years ago and um started making connections with people who are keen to share about life in their country so um it's it's been really really interesting to see how many similarities there are in terms of people being frustrated about the lack of general awareness in the public and about stigma and discrimination as we were talking about just commonalities with kind of generally living with it day in and day out as a strain but then to see the places where there weren't commonalities and where those were the difference was just so great between a place like I'm so lucky here in the UK because I have I pay my taxes but then for the national health system they provide me with insulin and supplies and every time I go to the pharmacy I'm so grateful because I I'm picking up you know what saves my life and I don't have to pay exorbitant costs for it and when I was in the United States I definitely felt like I was paying exorbitant costs. So just as we've already said, seeing those other examples of other countries. In Pakistan, there's a huge discrimination issue, but there's also lack of access to insulin. And there's a lot of kind of, it's led by the culture and in just kind of misinformation of like herbal remedies and these kind of things that people turn to either because they're taught to believe that it might work and cure their diabetes or because they actually have no other alternative and they can't afford, you know, insulin and supplies. So they turn to these remedies which don't work and obviously cause death and other complications. so it's been great to just learn and as we've said try to kind of collect more information so that we can start to build our advocacy efforts to change situations so one of the things that we do at T1 International is just really work to connect people with either other people, individuals in their country who they can get together with and support each other and start to fight these things or with groups that exist So that's something that we're quite proud of is just sort of being a hub for people to be able to come together and connect because we all know that just, you know, there's strength in numbers. And when you have that support system, it usually leads to you wanting to kind of do more and be more engaged. We also kind of from some of what we've learned, we decided to create this Rights of the Child resource. and it just looks at the United Nations Convention of the Rights of the Child, but it applies the rights of someone with type 1 diabetes to this document. And it's just a really clear, it's fairly easy to read resource that outlines what families and children have the right to. And we've been sharing it with different groups around the world and it just can be quite powerful to let people be informed about that they should really and truly have access to these things to be able to start advocating for themselves. So we're working on those types of things, and we're working on a kind of more involved advocacy toolkit right now and collecting some case studies from the map and from other connections to help just impact and show people that, okay, so we've learned about these issues, and now here's what we can do about them And some really great examples are coming out of that to show people that you can take the next step and you can be an activist or you can call it advocacy, whatever you want to call it. You know, you can do something. And it's really important that we all kind of share those stories with each other.

[00:27:13] Rob Howe: absolutely and I I mean you guys are doing so many great things you know all over the world with all of your different global ambassadors and and outreach and programs and how let's take a step back how did you how did you go from this being a just a blog a passion project to growing T1 International to what it is today?

[00:27:40] Elizabeth Rowley: Yeah, that's a good question. I mean, I think once I realized that kind of there was a space for this and it wasn't being done, and as I said, I was quite outraged that more wasn't being done, I would say I kind of dove in, but I also just it gradually grew into, okay, this needs to be more than just a blog or just a website and now we're you know a small charity um which is just it yeah it feels like you're growing a business so it's it can be overwhelming but it's just it's something that I do feel so strongly about and it's I would say um yeah it's just grown it's grown in some ways it seems slowly in some ways it seems really quickly actually uh it's T1 International's third birthday today. So we've, you know, kind of officially existed as an organization for three years, which is, which is pretty cool. And, you know, to see how far we've come from, from that beginning point is pretty special really to, to imagine that it's come this far in three years. So, you know, who knows what will happen in the next three years, but I think it's going to be doing more and supporting more people and making more connections and, you know, just hopefully uniting the diabetes community behind this sort of movement that we're trying to to get going to to fight for the rights of people with type 1 all around the world

[00:29:10] Rob Howe: that's fantastic and first of all congratulations thanks three years and i think i agree with you you know uh you've come so far in three years and i think that should certainly be celebrated but also just as the potential of you know what this could grow into and um how far the reach can really stretch and how many people you can get involved. And, you know, really, I just want to encourage you and continue, you know, we're really, all the diabetics that are out here, I think are really hungry to be united and to make a difference for each other worldwide. So the fact that you guys are really doing that and doing it well is super encouraging for the future. Yeah, thanks. So talk about your global ambassador program. You have ambassadors all over the world. what are they doing in those different places to kind of further the cause?

[00:30:00] Elizabeth Rowley: Yeah, so it's our global advocates program, and I believe we have eight advocates now who are a great resource for us, and hopefully we're a good resource for them. It's just a really neat initiative that we invite people from anywhere in the world to apply for their role, And what they do really is they help us understand living with type 1 in their country. So, for example, helping us with the map or just giving us kind of more specifics about what's going on in their country and how maybe some of the successes that they've had can apply to other countries. They also just really kind of continually give feedback on our campaigns and our work in general so that we can be very hopefully fully engaging with the kind of the people that we want to support. So we're not just out there sort of saying this is what we think should be changed. This should be different. And here's how we're going to go about it. We really want to involve as many people from as many parts of the world as possible so that we're getting, again, that fuller picture. and they kind of also just shout about T1 International to their communities and let them know about the resources we have, about the things that we can do to hopefully build their communities. So it's a nice two-way street where we're supporting them and they're supporting us and it's just really, really great. We try to get together and have Skype meetings now and then And it's awesome to have people living with diabetes from, you know, eight different countries all on the same call. And that's a really powerful thing as well. From that, actually, we've kind of spun off and working with an organization called Diabetes Sisters who do online meetups. So we're doing like a global ladies meetup every couple of months. And we had our first one recently. And it's just so huge for camaraderie, sharing best practice, and just, you know, support in general. Seeing people, again, being able to, I guess, bond and share similar stories and find ways to look out for each other. and opening people's eyes to situations in other places because we do have commonalities, but there are very diverse situations in different countries. So getting people to kind of stop and think, okay, so I'm advocating for access to CGM, continuous glucose monitoring, but actually, and that's great. That's great to be advocating for that, but actually there are people who still don't have insulin. So just kind of, yeah, just opening people's worlds up a little bit.

[00:32:41] Rob Howe: And like you said before, kind of all about perspective.

[00:32:44] Elizabeth Rowley: Yeah.

[00:32:45] Rob Howe: You know, everybody's going through that struggle as a type 1 diabetic, but when you think about it from a different perspective, it can kind of change everything for you.

[00:32:53] Elizabeth Rowley: Definitely.

[00:32:54] Rob Howe: So, you know, from your perspective, what is one thing that all diabetics around the world, across the globe, sort of need to know? What, you know, what's your one takeaway? What's the simplest message that you would give to diabetics?

[00:33:12] Elizabeth Rowley: From myself or about T1 International or?

[00:33:16] Rob Howe: Either way, I think. Something either from your experience and your experience from T1 International. You know, what do we need to do together?

[00:33:26] Elizabeth Rowley: Yeah, well, I think together, that's a big word, isn't it? I mean, we are all in this together. We are a community and there are communities growing and being built out there. And that's amazing. And I think I just think that this community is starting to think about these things. But the more we truly make sure that we understand what's going on, we learn, we open our minds, we just ask questions. And then we really just need to be together as a global community. When we're together and we're supporting each other, I think that there's so much we can do. I mean, we saw with the HIV and AIDS movement in the late 80s when there were just activists who were really, really changing the way that access to medicine was happening for people with HIV and AIDS. There's other people and places in history that show that it's possible to make the kind of changes that we want to make. But within countries and as a whole, you know, the price of insulin in general in every single country is increasing. And that's one example of something that we all have in common and that we can all, you know, the more of us that speak out about it, the more impact it's going to make. And I'm very confident that this is a tackleable issue, even though it may seem complex. So, yeah, together, I mean, that's the word. And together we're stronger. and we will be able to change things.

[00:34:59] Rob Howe: Totally agree. I think getting aligned and just talking to each other and communicating and supporting each other is just a huge part of how we're going to be successful.

[00:35:09] Elizabeth Rowley: Definitely.

[00:35:11] Rob Howe: So I know you're about to go on a trip, and I'm sure you travel a whole lot. I mean, your organization is called T1 International, so you're all over the world. That's a challenge for type 1 diabetics. That's a question that I get a lot. I did a lot of traveling in 2015 when I was playing basketball. How do you manage your supplies on the road when you're going to be gone for maybe more than two weeks?

[00:35:36] Elizabeth Rowley: Yeah, I mean, it's always tricky. Before I was on the insulin pump, it was a bit easier because it's just less stuff that you have to take. But I do use an insulin pump now. And you have to take kind of more than you think you might use. And I really just have to sometimes pack lighter on other things so that I can include all of my diabetes supplies. But it's also making sure that I have a backup system. So because I am on a pump, I'll always make sure that I have injections in case something were to happen to the pump. Making sure that I have enough kind of supplies for low blood sugar in different countries. Different things are available. in the UK we have this awesome stuff called Lucozade which is basically like glucose tablets but in liquid form but it's it's a quite a sweet drink anyway it's like a really quick thing that helps your blood sugars come up and I don't know any other countries that have it so um if I'm able to take take those types of things that I know work well for me to at least have kind of a stash for backup or until I find something that works well in whatever country I'm going to to treat my blood sugars. And yeah, I mean, I'm going to Kenya in April, actually. And there's just a lot of things that you have to think about when going to those locations, regardless of if you have type 1 diabetes. But having type 1, I think, just makes me be extra diligent and organized about every aspect of travel. Yeah, so it's totally doable. And I, I moved here from the U.S. when I didn't fully understand the system here. But as long as you kind of take the time to learn as much as you can about the place you're going and you're prepared, then it's completely manageable.

[00:37:29] Rob Howe: Totally agree. I think my craziest trip, I went on a military tour when I was playing against the Globetrotters. And we were in Afghanistan and Kuwait.

[00:37:41] Elizabeth Rowley: Wow.

[00:37:42] Rob Howe: United Arab Emirates and we were gone for three weeks um and I brought way too much stuff but I was like well what if we get delayed and um I think you know it was just it was a challenge it was like hey like despite all this other stuff that I have to carry and have on me at all times I also have this you know the thing that's most important and so yeah I think I had to bring less socks or something for that yeah exactly um but um okay so how uh for our listeners who are like, man, this sounds great. You know, I want to do more in my community or online or help people. What are some ways that we can get involved with T1 International?

[00:38:23] Elizabeth Rowley: Yeah, well, I guess the first step is just check out our website if you want to kind of read more in detail about some of the things that you and I have touched on. From there, you can sign up to our newsletter. That comes every couple of months just with a few highlights about what's going on. You can click to read further. It won't clog up your inbox, but it'll definitely keep you in the loop about are there different actions that people can take and ways that they can support and get involved. Donating is a big way to help us. We did a little bit of a donation birthday party today for our third birthday, but people do events to raise funds for us or take on challenges. There's all sorts of things, and we offer a lot of support for anyone who wants to kind of actively fundraise, but even just making a donation, a one-off donation or a regular donation is hugely, hugely impactful. It allows us to do these kind of things like, you know, get communities together and helping people support each other, sending, physically sending these resources to people who can't, you know, access the internet, those types of things. So it just really, really does impact people with type 1 in every corner of the globe. And then people also volunteer for us. We have our global advocate volunteers, as we've discussed, and other people who not only raise funds, but people do research tasks for us. So we have all sorts of, you know, with all of our projects, we can always use an extra hand of people helping either, yeah, with research or getting the word out on social media, looking for, you know, higher profile supporters who can start a little buzz about us. So there's all kinds of things. And if people have, you know, we've had people with special skills like photography or web design or different things kind of approach us and say that they want to help. So we're, we're keen to talk to anybody who has an interest in helping. And if, if some of the options that I haven't given aren't appealing to you, but you have something else that you'd like to do to help. That's great. But yeah, the biggest thing is spreading the word. I mean, as we were saying, we've been sort of talking about this movement and getting the community together and we all have so much in common. So, you know, just tell people about the issues, have people read our blog posts. There's just some great stories from some amazing people on our blog and on other parts of our website. So, you know, start to read and get informed. And if you get outraged like me, then, you know, use that outrage to start being an activist and joining with us to speak out about what I feel are injustices for people with type 1 around the world.

[00:41:02] Rob Howe: Well, I can say for sure that the world needs more constructive outrage, like the work that you're doing with T1 International. So we are definitely going to post links on the podcast post in our social media to Facebook, Twitter, Instagram, and to the website, especially the map tool. So all of our listeners can easily find everything that we've talked about today. Great. Well, happy third anniversary. Seriously, that's super, super awesome. Really excited for you, not only for what you've done, but for what's to come. And thank you so much for joining us on the show. and for finding this time to do the makeup call.

[00:41:42] Elizabeth Rowley: Yeah, thanks for having us or me.

[00:41:47] Rob Howe: Want to get involved with Diabetics Doing Things but don't know where to start? How about sending an email to rob at diabeticsdoingthings.com. Thanks for listening to Diabetics Doing Things. Subscribe to our newsletter for weekly emails and behind-the-scenes content. And if you or someone you know has an amazing story to share, send an email to rob at diabeticsdoingthings.com.