Researching the growing prevalence of diabetes and hypertension in rural Bolivia

Hola desde Bolivia!

We are Annsa, Danielle, and Gabby, and the three of us are recent Northwestern graduates, moving (perhaps a little too) quickly into the start of our M1 year at Feinberg. We are currently wrapping up our summer abroad in rural Bolivia, where we have been working with Centro Medico Humberto Parra (CMHP), a free primary-care clinic situated in the country’s eastern rainforest. CMHP is located in the small village of Palacios, about a 2 hour’s drive outside of the city of Santa Cruz.

To address the growing prevalence of diabetes and hypertension in the region, CMHP has recently established its own diabetes prevention and management program, which utilizes community health leaders to facilitate diabetes and hypertension support groups in their respective villages. However, the clinic faces a severe lack of data regarding the burden of diabetes in each individual community that it serves. After contacting health professionals at CMHP, the three of us identified a need for research on the prevalence of diabetes, hypertension, and other relevant risk factors in the clinic’s surrounding villages.

For this reason, the three of us have spent these past two months in Palacios, screening for diabetes and hypertension in four communities surrounding the clinic: La Arboleda, Buena Vista, Yapacani, and Warnes. With this research, we hope to provide CMHP with a broader, more comprehensive body of knowledge relating to the health demographics of its surrounding villages.

Our method consisted of conducting a brief interview with participants about their medical history, diet, general health and exercise habits, in addition to measuring height, weight, blood pressure and blood glucose levels. Because we had to measure participants’ fasting blood glucose levels (before they had consumed any food), most of our work was done in the early morning. We would wake up between 5:30 am and 6 am, always before sunrise, gather our materials and supplies, and head out in the clinic’s SUV. We spent about six mornings in each community, interviewing participants and collecting data.

We would arrive at our designated location within each community, which ranged from someone’s house to the sidewalk in the main market to the local health post. Our location changed every few days to increase exposure and reach a different group of participants. Sometimes, we would arrive at our spot and there would already be people waiting in line and other times, people would trickle in after reading our sign or seeing the crowd.  It was really astounding how people would wait in line for over an hour just to have their blood pressure and glucose levels measured!

We learned to work efficiently, with what resources and space we had. One table, a few chairs, one balance, a stadiometer to measure height, three sphygmomanometers, three glucometers, and a few boxes of lancets and test trips. Each of us would take one participant, explain the purpose of our study and start with the interview, ask our questions, measure weight, height, blood pressure and blood glucose levels.

Although all three of us speak Spanish, at times, it was still difficult to communicate with participants either because they did not exactly understand our questions (specifically related to the concept of chronic disease and exercise) or would use Bolivian slang and special words that needed further explanation, especially when it came to talking about diet and work. For example, a lot of our participants were amas de casas, or housewives, making it difficult for both them and us to judge how truly active their lifestyles were. After all, we’ll agree that running after small children and doing laundry by hand every day can be tiresome, but is it the same thing as playing fútbol or going for a run? That’s something for us to work out as we start analyzing our data. As a whole, however, it was great to talk to these people about their daily lives and habits, and we definitely became very familiar with the Bolivian lifestyle.

We talked to over 450 people and made lots of new friends, to the point where we would recognize people who had participated in our study. In La Arboleda, one of the women made us breakfast after we finished with our study (coffee, cuñapes, and quinoa cake). In Buena Vista, participants would return on the following days just to chat with us and see how we were doing. The local community health leaders in Warnes would treat us to salteñas, a typical Bolivian breakfast pastry. Meanwhile in Yapacani, the health leader’s adorable 2-year-old daughter, Sari, would come play with us when we were done working. We were even interviewed in two different communities by reporters and showcased on the nightly news, speaking our finest Spanish of course! Every place we went, we were welcomed by the community and graced with willing and friendly participants.

One of the early difficulties we faced while conducting our study was trying to explain the concept of chronic disease with our participants. For the most part, Bolivian understanding of health tends to be more immediate in nature, influenced by the belief that chronic diseases like diabetes can be cured with a single doctor’s visit. Even those participants who had been previously diagnosed with diabetes had trouble grasping the importance of consistently taking their medication as prescribed.

We encountered many patients who told us that they had diabetes and/or only took their medication when they “felt bad.” Many did not realize that diabetes is chronic, meaning it occurs from one year to the next and necessitated constant monitoring. We had to explain that it was not a disease that could be controlled sporadically but required taking medication daily to maintain a normal blood glucose level. If anything at all, our study served as an educational campaign in these four communities, as we were able to teach hundreds of people not only important steps to diabetes prevention and management, but the basic tenets of living a healthy and active lifestyle.

As we wrap up our time here in Bolivia, we can say with absolute conviction that this has been an incredible verano – an unparalleled learning experience that we will surely continue to draw from for the rest of our lives.

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