Wuqu' Kawoq

Wuqu' Kawoq's mission is to address the barriers to excellent health care that the majority of Guatemala's indigenous Maya population face, including principally the lack of access to health care in their own languages. As such, Wuqu' Kawoq develops primary care and health programs within a larger context of community vitality, family stability,and Mayan language revitalization.
May 8, 2014

Focused Care, One Patient at a Time

DIY Dialysis
DIY Dialysis

Hello Friends,

At times, life is difficult for all of us. There are days when we don't want to get out of bed or days we are not sure how to make the best of a difficult situation. We understand that, which enables our patients to confide in us and put their trust in us to help them get better. In rural Guatemala, our diabetic patients face extremely difficult sitautions, especially when diabetes is poorly understood by family members and friends. Often, they receive poor advice about diet and mediciation and when they are trying to following a good diabetic diet, often family are misinformed and make it difficult for the diabetic patient to eat the foods they should. 

We have worked together with our patients to understand their most difficult problems while batteling diabetes. Most often, it comes down to education and access to medications. We are thrilled that we can help our patients with both of these facets. 

One of our patients, a 62 year old woman named Paula, told me "I always try to eat the right thing. I have tried cutting out sugar in my coffee and I rarely eat fried plantains any more and in the afternoons I have been trying to cut out my sweet bread. However, the most difficult factor is my husband, he always wants me to sit with him and have sweet bread and he loves plantains in the morning. I know these aren't good for me, but with him and my children always wanting the foods I can't eat, well it's hard to make more than one meal every day 3 times a day."

We understand Paula's concerns and we are excited to be growing our education program. We have continued pilot testing our program and we believe we are going to be making some fundamental changes to our program. These changes will focus on home educational visits wtih the diabetic and the entire family in order to educate and hopefully prevent diabetes among other family members. 

The majority of our patients are able to control their diabetes through diet and some medication. However, we have several diabetics who need a lot more care, some needing insulin and even dialysis. 

Our patient Amada, has been an incredible warrior batteling diabetes and has been on dialysis for many years. She lives far away from a hospital that can dialysis, which made it difficult for her to work or take care of her young daugher. We wanted to change that! We helped Amada to do dialysis at home! Amada compelted dialysis training sessions and has been doing DIY at home dialysis for over a year now. It took time to find her a place to live, incuding the construction of a small room that was a dedicated space to do dialysis. But now she is doing fantastic.

Amada makes the best of an extremely difficult situation in life. Here is Amada visiting with our nurse, Sandy, and showing us how she does dalysis at home: http://vimeo.com/71350398

From DIY dialysis to educating the family, not only the patient, we are helping diabetics learn and live!

Links:

Dec 31, 2013

Graduation Day for the First Diabetes Class

First Diabetes Class on Graduation Day
First Diabetes Class on Graduation Day

Our research with rural diabetic patients in Guatemala has demonstrated that patients strongly prefer education classes and materials in the indigenous langauges. For example, many patients have explained that they fail to understand explinations in Spanish about diabetes control and diet modification. Most often, they return home after the consult with no resolution.

In order to provide the best care possible to our patients, we added an education course that incorporates indigenous knowledge and culture. The course is also taught in the indigenous langauge. We recently graduated the first class of adult, Kaqchikel Maya participants. The course was extremely successful! Participants explained that they not only learned how to control their diabetes with diet and medication in their own langauge, but for the first time ever they have found a strong social support in order to make the diet and liefstyle changes that are necessary to manage their diabetes.

One class participant explained that she struggled to follow the diet she was taught by us during consult, at home because no one else in her household understood her specific diet or its importance. But since we made family, friends, and the class particpants part of the learning process and key to supporting her and keeping her healthy, she now feels that now has the support at home and in the community to make better dietary decisions. 

We are excited with the outcome from the first class and we can't wait to start more in January! Stayed tuned for more updates. 

Thank you so much for your support in 2013!

Links:

Dec 31, 2013

Chronic Malnutrition and Impactful Interventions

Yoli, our health educator talking with a mom
Yoli, our health educator talking with a mom

We have launched a new intervention to aggressively intervene with home visits for severely malnourished children. 

As usual, we weigh and measure all the children under five years of age in our communities. We then chart  the children’s growth on World Health Organization curves for height and weight. When a child’s growth appears alarming, we then try to figure out what’s going on and how to fix it. 

Remember, stunting is diagnosed when a child is short for their age. When you see stunted children, they look like healthy, plump little kids until you realize that they are really short and look about 6 months younger than they should appear. Guatemala has one of the highest rates of stunting in world and the highest rate in the Western Hemisphere. 

Does it Matter is someone is a bit shorter?

You may think, “Does it matter if someone is a bit shorter?” Well, after fifty years of follow-up, the INCAP Nutrition Study has found that, as they grow up, children who were stunted have decreased school performance, reduced cognitive skills, higher probability of living in poverty, and some significantly worse health-related outcomes such as number of pregnancies in women. Think of this: A child whose height improves by one standard deviation at age three (e.g., going from from the 0.1 percentile to the 2.5 percentile) will earn on average 20% more money per year as an adult and will be 10% less  likely to be poor.

The New Intervention: In Home, One-on-One education and Food Supplementation

In this new intervention, we identify the kids under age two that are “severely falling off their growth curves.” We then make a visit to their homes, speak with their family, and conduct a medical work-up. We work to rule out things like hypothyroidism, congenital diseases, and parasites, and if children do have these–or any other–conditions we treat them. We send them for laboratory testing, imaging, and even surgery if they need it. We also give the child deworming medication and vitamins. We also focus heavily on one-on-one education with the family and mother on how to provide the best food and nutrition for their child.

We are particularly sensitive to the time when the child turns six months old, as this is the window when complementary foods should be given in addition to breastfeeding. Due to both economic considerations and education, many mothers delay the onset of complementary feeding or give foods that are very low in nutrients. Often, we see that children are growing just fine until they reach 6 months of age, at which point they basically stop growing. 

In the “small picture,” the intervention is exciting because we think we can really influence the individual children in our care.  We will evaluate this new program as we move forward and report back to you.

Our Harvard medical student David working with the program says, “I must also confess that I love visiting these children. They are so fragile, so small, so innocent. They have so much more living to do, but their future is at stake. Thankfully, we have some tools to help. I can’t think of anything that could be more worthwhile.”

Thank you friends for your amazing support. Together, we are saving lives and creating better futures!

Sheny, a child now growing in our program!
Sheny, a child now growing in our program!
Example of a growth curve for a malnourished child
Example of a growth curve for a malnourished child
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