Offering Culturally Appropriate Solutions to Global Problems: Northwestern SCS Students Conduct Diabetes Research in Palacios, Bolivia

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Ashley, Marc, and Brooke outside of Centro Médico Humberto Parra (CMHP)

Brooke Bachelor, Ashley Thorne, and Marc Deheeger embarked on a research trip to Palacios, Bolivia this past spring break to study diabetes. Their research took place at the Centro Médico Humberto Parra (CMHP), a primary care clinic created by Northwestern University physician Dr. Mark Molitch and his wife, Dr. Susan Hou of Loyola University Medical Center. The clinic provides free health care, medication, and health education to about 40,000 residents of communities surrounding Palacios, Bolivia, located about 75 miles outside of Santa Cruz. CMHP is funded entirely by private donations and is the only free clinic in the region.

Q: Why diabetes?

We chose to target diabetes because it is a major public health concern around the world. When left untreated, the condition carries risks of serious complications like heart disease, stroke, blindness, kidney failure, foot amputation, and nerve damage. These partially preventable complications contribute greatly to the morbidity and mortality rates resulting from diabetes.

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The community gathered at CMHP to be educated on diabetes

Q: Why did you choose Bolivia?

We chose Bolivia as a place to work with educating patients on diabetes because the incidence of diabetes is growing rapidly in Bolivia, where the estimated number of diabetes cases is expected to double by 2025. A previous study done by NU students showed that this population would benefit greatly from additional education and identified in their time at the clinic that about 11% of the CMHP’s patients have been diagnosed with diabetes in the past.

Additionally, Bolivia is one of the most resource-poor countries in South America and has one of the smallest expenditures of all South American countries on diabetes prevention and care.  As we found during our time at the clinic, many patients at the clinic were not aware of the symptoms and consequences of diabetes, and therefore, some did not know they were affected by it.

We learned at the clinic that a diagnosis of diabetes generally occurs when the disease is in its later stages. Of the lucky few that have been diagnosed, only a small amount actually received treatment before they received care from the clinic. The clinic has been instrumental in helping much of the local population be even well controlled.

Our aim was to help patients be more vigilant and aware of symptoms before this chronic disease progresses to its more detrimental later stages.

Q: How did you conduct your research?

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Surveying community members & staff

We surveyed 20 CMHP patients over 5 full clinical days. Our goal was to evaluate their knowledge of diabetes and diabetes treatment, to see what current treatment strategies were being employed by patients, and evaluating their educational levels. We found many people could not read and some were nearly blind due to poorly controlled blood sugar levels, making the current diabetes education supplies difficult for some to understand. With many patients, including some newly diagnosed patients with diabetes, we reviewed when, how, and why they were taking certain medications and reviewed potential side effects of these prescribed medications. During these private education/interview sessions with 20 CMHP patients, we found a system that used colored stickers to identify medications made it easier for patients to know what to take at what time.

Q: What are the outcomes of your work?

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Brooke giving a powerpoint presentation on diabetes at CMHP

Our final project is an improved medication sheet and general healthy living guide on the back with images promoting healthy eating, exercise, and consequences of diabetes. We included a “how- to” video in Spanish to help educate the clinic staff on this new, more efficient system. We kept in mind efficiency for staff, as they see many patients, but we wanted to make sure all needs of patients were being met. Our idea was to help make a more efficient process for the staff and simultaneously have the material easier to understand for the patients.

Additionally, we did 2 days of group education at the clinic via Powerpoint, complete with samples of a diabetic-friendly version of a traditional dish called “sopa de mani”, or peanut soup. We created the soup using low cost, locally sourced ingredients purchased from a market near the clinic to ensure audience accessibility to these ingredients. We would call our own sopa de mani a success because all the patients ate it all during our presentations! We were so happy to offer this using local and cost-conscious ingredients.

We found it helpful to be at the clinic itself to gain a better understanding of the cultural implications of diabetes as part of the eventual goal of creating a sustainable, effective, and culturally sensitive program to increase prevention and improve outcomes.

Q: Do you have any closing thoughts?

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Making friends at the clinic

Our trip came to an end way too quickly. It flew. We had just started to feel comfortable in our new work environment, and we hope to come back to pick up where future volunteers will have built on our projects. We hope that further endeavors at CMHP will involve and continue our work in diabetes education and that the clinic continues to be an educational site for Northwestern University Pre-health Professionals, as this is a mutually beneficial experience for the clinics with which we work and for the patients involved.

[Of note, the clinic is looking for some of the following supplies to be donated. We can collect them locally and send them down with future volunteers. Please contact Brooke at brookebachelor2012@u.northwestern.edu if you or anyone you know would like to contribute these supplies or donate funds for the following materials: otoscopes, pen lights, laptop computer for very busy social worker, lancets, alcohol swabs, blood glucose machines, toothbrushes, condoms, prenatal or general multivitamins, funds for: photocopy machine, new roof for clinic and attached house for staff. ]

For more details on our adventures:

http://centromedicohumbertoparranupp.blogspot.com/

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