Starting in January 2011, work began in earnest on our new diabetes training manual. The idea for this manual came out of a collaboration we have with INCAP (Institute of Nutrition in Central America and Panama) and APRECOR (Guatemalan Association for Prevention of Heart Disease) to develop better educational resources for Kaqchikel speaking diabetic patients. Starting with resources originally developed for an urban, non indigenous Guatemalan population, Wuqu' Kawoq is embarking on an extensive cultural and linguistic revision of these materials to make them more appropriate for our target population. The end result will be a training manual, consisting of seven interactive sessions, which can be used to teach health promoters to lead group-based sessions with diabetic patients in their communities. As part of the revision, new handouts and patient education illustrations, especially designed for low-literate populations, are being developed.
Work on this manual is now well underway. Linguists from Kaqchikel Cholchi', the Kaqchikel linguistics organization, are collaborating with Wuqu' Kawoq staff to produce the adaptation, which will then be field tested on select groups of volunteer patients and health promoters prior to release to the general public. Staff from both organizations are meeting weekly at the offices of Kaqchikel Cholchi' in Chimaltenango to move this project forward.
At the same time as this exciting new work is going on, we continue to provide the same high quality diabetes care to patients as always!
“If you have money you can get treatment, if not the best thing to do is die.” Arminia explained her hopelessness in battling diabetes. Diabetics in the rural communities of Guatemala express similar hopelessness with the severity of type 2 diabetes mellitus. Collaborative research on these perspectives associated with diabetes was recently conducted in multiple rural communities within Guatemala by Wuqu’ Kawoq staff. Along with the primary treatment costs of diabetes, the long-term conditions and complications resulting from poor management of this disease compound the economic burden. Wuqu' Kawoq recognizes this economic burden can weigh heavier on those residing in the rural communities. All health services are therefore maintained without any costs to the patients. The hopelessness of the diabetic patients has been directly lessened by the presence of Wuqu' Kawoq. Arminia now states, “Without the Wuqu' Kawoq physician, I would have let my life end.”
Aside from the economic burdens associated with chronic illness, “Diabetes is a social disease.” The debilitating effects of this chronic illness can threaten a person’s employment and thus the overall well-being of an entire family. Furthermore, adherence to treatment is not only dependent on the individual patient but also their family and social groups. Knowledge of diabetes varies greatly and is affected by medical pluralism, which is the often contradictory medical advice stemming from various sources such as pharmacists, natural healers, market vendors, nurses, family members, friends, and casual acquaintances. One patient Abraham explained his predicament in receiving various advice, “With diabetes I was alone and didn't know where to go, and I couldn't know because so many people were giving me advice.” His son recommended seeking treatment through Wuqu' Kawoq. With consults conducted in his primary Mayan language, a greater level of trust was created which helped to overcome the confusion created by multiple outside sources.
Wuqu Kawoq' is extending the availability of high-quality medical services and diabetes educational and support groups. Partnering with the Institution of Nutrition in Central America and Panama (INCAP) and APRECOR (Guatemalan Organization for Prevention of Heart Disease), Wuqu' Kawoq is implementing these high-quality services in the rural communities of Guatemala. In the coming year, medication and diagnostic supplies are being expanded, educational and support groups developed, and culturally appropriate educational materials provided. The social implications and immediate biomedical aspects of diabetes mellitus are inseparable and Wuqu' Kawoq therefore implements programs designed to address all of these obstacles to chronic illness management.
“Poverty entered my house because of diabetes,” said Doña Dominga, a 55-year-old woman of Santiago Sacatepéquez. During a recent survey we conducted among our diabetic patients, Dominga related to us the story of her diagnosis and initial treatments with a series of health care providers, which drained her life savings without improving her health. Diabetes had debilitated Dominga to the point that she no longer had the strength to leave her house. A concerned friend mentioned that she ought to try Wuqu’ Kawoq’s diabetes program, through which, to Dominga’s surprise and relief, a Wuqu’ Kawoq physician visited her in her own home and spoke with her in her first language--Kaqchikel. After her first visit, she received regular follow-up consultations, medicines, blood tests, and one-on-one counseling with a nutritionist at no charge. “I trust in the doctor because he has a great love in his heart for us sick people,” she described her physician. “I am poor. There is so much poverty here. Without this help, I would have never gotten good medicine.”
Over the past few months, we have spoken with many patients like Dominga to evaluate our diabetes programs. We are pleased that many of our patients are happy with the care they are receiving and that many of them have their diabetes under control. However, we are constantly searching for ways to improve our projects. Earlier in the year, a team of Wuqu’ Kawoq physicians, nutritionists, and medical students started brainstorming about improving our diabetes educational classes. Fortuitously, at almost the same time, several of our collaborators--a midwives’ association and various community health promoters--approached us about the possibility of forming diabetes support groups. After two months of assessing our patients’ knowledge, attitudes, and practices about diabetes through surveys and interviews, we are beginning to develop plans for this diabetes curriculum. With the energy and enthusiasm of our community collaborators and patients, as well as the support of our donors, we are excited to move forward with this endeavor in the coming months.
We have gained many insights from this research so far. First, the family plays a significant role in patients' abilities to follow a diet, and few patients are aware that diabetes is often a hereditary condition. Therefore, nutritional education targeted at the families of diabetics will be beneficial. Second, many diabetics feel isolated and would like to hear about others' experiences with the disease. Furthermore, every single patient we have talked to has interpreted the onset of the disease as the result of stress, poverty, and poor mental health. We hope to coordinate support groups about these themes in the near future.
Did you know that, by contributing to Wuqu' Kawoq's adult diabetes treatment programs in Guatemala, you are participating in a paradigm shift? Previously in Guatemala, there has been very little attention to the treatment of chronic diseases, such as diabetes, high blood pressure, and kidney disease. However, as antibiotics and other lifesaving technologies now prevent most deaths from infectious disease, Guatemalans are living longer and the rates of chronic diseases are rising rapidly. These chronic diseases, although they do not kill immediately, cause disability and impact the financial and emotional security of families.
Wuqu' Kawoq is pioneering a model of health care delivery in Guatemala that includes the comprehensive treatment of chronic diseases, and you all are a part of it!
This month, one of our physicians was in Guatemala to perform a review of the diabetes program and see patients. He reports that things are going well. The program is now functioning in three highland Kaqchikel towns and we are regularly seeing over 60 diabetics, which is more than our goal of 50 patients for this Global Giving Project. This may small like a small number of patients, but in fact is an impressive logistical and financial committment to the wellbeing of these patients, who will need to be followed for their entire lives.
Thank your continued support of the project. As we move into the summer months, we would like to expand the number of patients we are able to serve, however this depends on the generousity of supporters like you! We ask that you consider continuing to support this project, either through a one-time gift or by registering to make a small regular monthly donation.
Even if you cannot support this project financially at this time, we ask that you support us in other important ways, such as forwarding project information to friends and family, posting links to the project on Facebook or your personal website, etc.
As always, we welcome your comments and suggestions.
Dear friends, I have just returned from Guatemala, where I had the chance to interact with many of the diabetics enrolled in our program.
I am happy to report that all are content with the program and most are achieving great diabetes control. The last several months have seen great success in improving the dietary and nutritional aspects of the program. As a result our patients state that they feel healthy and well, with renewed energy for work and family life.
Recently we have accepted several new diabetic patients into the program with long-standing disease. Although they have had diabetes for decades, with us they are experiencing for the first time having their blood sugars in a normal range. For most, they failed to achieve blood sugar control previously due to the high cost of the medication.
Now, however, through the generous support of you, our program sponsors, we are able to offer these medications free of charge -- in effect, cutting the direct link between poverty and poor health outcomes for diabetics here in Guatemala. We are deeply grateful to you all, and we hope that you will continue to support our work in the coming months.
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