Project Restauración's Fellow, Amy VanderStoep, takes over the FIMRC Blog for International Diabetes Day!
While May 9th represents everyone’s favorite international recognition day, World Migratory Bird Day, another important date to remember is November 14th, International Diabetes Day. With the prevalence of chronic illness on the rise in the developing world, the local and international health sectors are fighting a whole new set of battles against diseases such as diabetes. However, hearing about diabetes doesn’t tend to spark the reaction that it merits. High blood sugar, controllable by medications doesn’t seem that horrible on the surface. Digging deeper, however, we find an illness that turns the life of the patient around and, if left untreated, can lead to very serious consequences.
FIMRC is seeing this trend of increasing chronic illness, especially with diabetes and hypertension. Creating appropriate programs for these long-term, lifestyle-changing illnesses requires lots of planning and continued work through the lives of the patients. While programming varies from country to country, I have observed FIMRC’s approach to developing these programs to be in seven primary steps.
To properly start non-profit programming, it is important to IDENTIFY the issues present. This seems simple and obvious, however, it is incredibly critical and not always done. One of the easiest ways for a non-profit, or any service organization to fail is to ignore the true needs of a community. Entering a community, especially one that is not yours, it is important to seek out what is actually needed and not imagine problems that you want to fix or that are easy to fix. Each of the FIMRC sites is different and has its individual problems, so with the beginning of each new site, the primary health issues need to be identified. For this reason, upon the launch of the FIMRC site in Restauración, as is custom with all of FIMRC’s sites, a very thorough analysis of the needs of the communities was performed. After surveying Restauración and the surrounding campos, three main areas of need were identified: dental health, personal hygiene, and chronic, non-communicable illnesses. Diabetes and hypertension were two of the top ten most common illnesses. This was the start of programming in diabetes and hypertension in Restauración.
After identifying an issue for programming, it is important for you, as an organization to UNDERSTAND the disease. In this informative age, gaining basic information on a topic is only a few clicks away. Diabetes, for example, includes two different forms of the same ailment. Type I Diabetes, at its simplest form, is the body’s inability to produce insulin because the insulin-producing cells are destroyed. It is often early-onset and is not preventable. Type II Diabetes, on the other hand, is the body’s inability to use insulin correctly and is often due to poor dietary or lifestyle choices. Type II is far more common, especially in areas where poor diet is a chronic issue for the population. The normal Dominican diet consists of a high percentage of carbohydrates (rice, yucca, potatoes, bread) and a high percentage of the food being fried. Not only is the presence of these diseases an incredible strain on lifestyle, it can also lead to consequences such as blindness from diabetic retinopathy, loss of feeling in hands and feet from diabetic neuropathy, kidney failure, and many other life-threatening side-effects of the disease. Understanding the problem gives the organization a basis for building its programs.
Now that the organization has a handle on the basics of the disease, the information and knowledge needs to be spread. The next step is to EDUCATE about the issue. This can be in a community charla (community health lecture) format, a formal class, regular club meetings, or another creative method. The diabetes/hypertension programming in the Dominican Republic began as a formal education class to teach community members suffering from diabetes, hypertension, or both about their disease(s) and what lifestyle choices are affecting its progression. In the DR, this class has now been held in three of the communities and a fourth will be started in January. In the sites in Peru, an education program teaching community members to manage their sugar levels by improving their diets and increasing their exercise has also been added to the existing programs. Giving the patients the information makes disease management much more successful because they understand how their actions impact their disease and how their disease needs to impact their actions.
Parts of the community are now educated. Now what? To just let the information sit percolating in the minds of the community is irresponsible. It is important to MONITOR the issue and hold the patients accountable. Those who have gone through the education program in the DR (and a few more patients who joined afterwards) have been a part of a Diabetes/Hypertension Club that meets once a week for blood sugar and blood pressure checks. In Restauración, this is facilitated by FIMRC and offers a great opportunity for interns and volunteers to have direct patient interaction. In the other two communities, El Carrizal and Mariano Cestero, the patients get their checks done at the local clinics. Constantly being aware of blood sugar and blood pressure values is important for staying focused on improving your nutrition and also monitoring the effectiveness of medications. Nicaragua’s site also does weekly checks, facilitated by community leaders trained to take blood pressure and sugar.
If the organization is not made up of medical professionals, it is important to INVOLVE professionals, preferably locals for sustainability’s sake. The DR site has a diabetes specialist from Santiago who comes in once a month. He is able to look at the weekly sugar/pressure checks, as well as talk with the patient face-to-face about their diet and medications. FIMRC travels with the doctor to all three sites so that the two communities who use the clinics for the checks still receive the same professional medical care as those in Restauración.
Even while the patients are being closely monitored, it is important to CONTINUE the education. There are new diagnoses every day and it is easy to forget the specifics of your disease if you aren’t repeatedly reminded. Part of this education is the checks and meetings with the diabetes specialist, but it is also important for continued education that is more formal in nature. At the site in Nicaragua, local community leaders teach monthly charlas about specific issues that pertain to diabetes and hypertension. These FIMRC-trained volunteers receive classes from FIRMC and then pass the information on to other members of their communities.
The final step in international programming is to TRANSFORM the program into one that is entirely local and self-sustaining. The work of international non-profits is good and helpful when done correctly, but the end goal should be for the programs to continue, even if the organization were to leave. The use of local community members in programming, as in the Nicaragua site, really helps this sustainability. The involvement of local professionals, such as the diabetes specialist in the DR, is important as well.
The issues of diabetes, hypertension, and other chronic illnesses are on the rise. And while there’s currently no vaccine or pill that will completely cure these ailments, there are things that can be done. Appropriate programming to address prevalent issues is one way to work to improve the lifestyles of those affected by these diseases. The assistance of volunteers and donors is HUGE in helping make these programs possible and will continue to be critical as FIMRC continues in the battle against chronic illnesses such as diabetes.