Physical Health Guatemala Project #3477

Diabetes Care for Kaqchikel Maya

by Wuqu' Kawoq

Project Report | Aug 2, 2012
Individualized care = excellence!

By Peter Rohloff | Medical Director

Talking about problems diabetics face in Guatemala

Dear friends,

More than anything, I attribute the success of our diabetes programs to our amazing staff - nurses and health promoters - who every day advocate for patients and make sure that they have all the resources necessary to live healthy lives.

Let me just tell you one story by way of example. Several months ago, we had two new patients come to our diabetic clinic with type 1 diabetes. This is unusual, because the vast majority (99%) of patients that we take care of have type 2 diabetes. Type 1 diabetes is the kind of diabetes that develops earlier in life and is much more difficult to control because it requires earlier and more frequent insulin injections.

These two patients are young women, sisters, in their mid twenties, who were diagnosed with type 1 diabetes as teenagers. However, in the last 10 years since diagnosis, they had never found adequate treatment for their diabetes, mostly because other clinics were uncomfortable dealing with patients with the type 1 diagnosis or because the insulin treatments prescribed were too expensive.

These barriers, however, were no big deal for our staff. First, since the medications we provide are free of charge (thanks to all of you and your generous support!), we were immediately able to manage that concern. Next, the staff leaped into action, providing intensive in-home nutritional counseling and lifestyle advice to the women over the next two months. They also provided the women with blood sugar testing supplies (again, thanks to your generous support!), which allowed for intensive monitoring and rapid adjustment of insulin doses. The result: after three months, both women have blood sugars that are nearly normal, and they feel better than they have ever felt in the last decade! By controlling their diabetes, we are able not only to make them feel better but also prevent long term damage to their eyes, nerves, and kidneys.

Recently, some of our staff and patients had the opportunity to host a group of international visitors (see the pictures below). The visitors had the opportunity to learn about the challenges of treating diabetes in Guatemala and how Wuqu' Kawoq is attempting to take care of this problem, one patient at a time!

Visitors chat with diabetes patients and staff

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Apr 29, 2012
Home visits for diabetics

By Peter Rohloff | Medical Director

Dear friends,

We have been running diabetes programs in Guatemala now for nearly 7 years! Over that time, a guiding aspect of our philosophy and approach to patients has been accompaniment and home visits. As you probably know, diabetic patients often have a hard time meeting the strict guidelines set forth for medications, diet, and exercise. This is not a problem unique to Guatemala, of course, but it is especially difficult there, where low levels of education and literacy and high rates of poverty dramatically impact the ability of patients to keep up with their care plans.

Since the beginning, therefore, we have made a point to try to understand diabetes from the perspective of the patients. This means, quite simply, spending a lot of time with them. For example, one of our nurses regularly reviews the blood sugar results of our diabetic patient panel. Based on these numbers, she is able to identify patients who are having a hard time managing their condition. Subsequently, she sets up home visits, where she is able to spend an entire day with the patient and their family, observing them preparing meals and making suggestions about healthy food choices and portion sizes. In the case of patients who have trouble remembering to take their medications, she also uses these visits as opportunities to identify and implement effective strategies, which often involve enlisting the support of a husband or wife, son or daughter, who can help their loved one with their medications and other needs.

We are very proud of this unique, individualized approach, which has been successful at improving diabetes control and reinforcing key educational concepts to patients.

As always, thanks for your ongoing support. As a reminder, GlobalGiving is conducting a special Mother's Day campaign from May 1-13. All donations made to this project (or to our other projects, here or here) "in honor of" a loved one during this time will make us eligible for additional funds!

Also, if you are interested in signing up for more regular updates on our work in Guatemala, click here.

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Jan 26, 2012
Expanding treatment options for diabetics

By Peter Rohloff | Medical Director

Dear friends,

Over the last few months since I last wrote a project update for our diabetes program, a lot of great things have happened!

As you know, for a number of years now we have focused on educational initiatives for our diabetic patients, coupled with intensive glucose-lowering strategies. One of the most rewarding parts of this initiative has been using glycosylated hemoglobin testing ("A1C" testing) to give us a better sense of how are patients are doing and how their medications should be adjusted. Using A1C as a target for treatment, about 50% of our patients now achieve a level of glucose control that we think is "excellent", with another 25% achieving acceptable control (of course, with the other 25% still needing some work!

Now, in the last few months, we have been working to identify other areas where we can improve care for our diabetic patients. For example, since people with diabetes have a higher-than-average risk of heart disease, blood pressure control is very important. Although we have always treated high blood pressure in our diabetics, we are now being more aggressive in treating patients with more borderline high blood pressure readings, to reduce their risk of complications even further. This has been very successful, with more than 75% of our diabetics now reaching our goal for blood pressure control.

Finally, we have begun monitoring kidney function in our patients more aggressively. Long standing diabetes does permanent damage to the kidneys, and kidney disease in diabetes is a major cause of death and complications. Knowing whether a patient has kidney disease is tricky, because it means taking blood samples, often in very rural settings, and transporting them to a central laboratory for analysis. However, thanks to several highly motivated staff members, we have been able to begin offering this service to our patients! Fortunately, only 10% of our patients have significant kidney disease; knowing this information, however, allows us to tailor our treatment for them in ways that better help to protect their kidneys.

Well, those are the updates for now! Thanks so much for your continued support!

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