Project HOPE Mexico: Educating Communities

Project HOPE Mexico provides something that every patient needs – a community. Led by Courtney Guthreau and Abraham Castañeda Chávez, Program Director and Medical Director team (y esposos), Project HOPE and their local partner SerBien are demonstrating the personal impact of diabetes educational programs in the community – and perhaps more importantly, real outcomes. Working with a larger team of dynamic professionals and volunteers, Project HOPE is making a difference in the lives of so many families struggling with diabetes in Mexico.

Diabetes is a serious health threat in Mexico; the lifestyle and “comida típica” or traditional eating habits in Mexico don’t help. Large consumption of fried foods, meat fats, dairy fats, and carbohydrates make almost 2 in every 3 Mexicans overweight or obese. As a result, diabetes affects nearly 12% of the population with growing prevalence among the youth. Unlike the proactive “Programa Saúde Familia” primary care teams in Brazil, little is done in the public health system in Mexico to reach out to patients to detect their diabetes before major complications arise.

Abraham describes his experience speaking with a primary care physician to demonstrate a sense of urgency. “How many patients do you have in your district?” he asks. The physician responds that the clinic is responsible for 35,000 patients. Conservatively, that means that at least 3,500 patients have diabetes. Then he asks, “how many patients do you have enrolled that you are treating for diabetes today?” The physician replies, “200 patients.” Where are those 3,300 patients? How far along have their conditions progressed? It is clear that the primary care and specialty care systems are not capable of scaling capacity (quickly and effectively) to address the needs of these patients.

Since 2003, Project HOPE Mexico has demonstrated a successful patient education model as a mechanism to (1) expand capacity for detecting and educating patients with diabetes and (2) PREVENT the progression of diabetes within communities. Working with a number of local partner physicians and providers, including Dr. Fernando (to the right), Project HOPE has benefited thousands of individuals in the Mexico City region. The current program portfolio includes a patient-centered approach with diabetes educator, peer-educator, and hybrid educator programs to achieve its goals.

Diabetes Education: Elementary School Approach

It’s never too early to start practicing healthy habits

Project HOPE currently works with a number of schools in and around Mexico City to educate students (and their families) that “3 Habits” are required for a healthy lifestyle: ear 4-5 servings of fruits and vegetables, drink 2 liters of water or “agua pura”, and exercise 60min each day. Through four “cuentos” or stories about the impact of overweight / obesity on long-term health, Project HOPE teaches children what they can’t control (race, heredity) and can control (food selection, sedentary inactivity).

The program is also careful with its messaging: this is a lifestyle aimed to revive the healthy person within each individual, not a “diet” program which implies a temporary or self-limiting process (and unattainable results). Project HOPE Mexico rewards children who achieve each of the 3 healthy habits by providing buttons for them to wear on their school uniforms to publicly pronounce their accomplishments. More amazing, Project HOPE collects and tracks information from each student on their progress over time and the outcomes associated with their BMI.

The impact? Children in the class I visited spoke up about talking with their families about these healthy habits and how everyone in the house should be eating healthy, exercising and drinking pure water (not soda). Project HOPE has empowered these children to pass on the education to their families. One testimony of a mother indicated that the “cuentos” empowered her to talk to her husband about healthy eating and justify serving salads instead of fat-rich meat or fried foods every meal.

Peer Education: Diabetes Promotores

Taking diabetes diagnosis and monitoring to the community

So how else do you reach those 3,200 patients not touched in the current health system? You literally, go out on the street and find them. Project HOPE’s diabetes education “promotores” are working magic one person at a time. Using a hand-held glucose monitor and test trips, they provide both diagnosis and monitoring services to the community in a surprisingly personal way. And, they’ve earned quite a reputation!

Berta and Consuelo uplift patients who don't know they have diabetes, have become hesitant of being associated with a medical facility or labeled as “not well” – and demonstrate exciting results. Berta shows me a card from a 25-year old patient who came in for the first time with a glucose level of 572 mg/dL only 8 days ago. Today his levels were down to 260 mg/dL (still high but a remarkable improvement!). She exclaims “and without a doctor!” It’s true, going through the basics of healthy living through nutrition and exercise can do a lot. While most of her clients see a physician on a regular basis, she inspires them through her own personal story. She has Type 2 diabetes, but through her own changes in nutrition and exercise has her A1c 100% in control with absolutely no medications. Since the far majority of diabetes cases in Mexico are Type 2 driven by heredity and obesity, a physician may treat their conditions, but Berta gives them hope.

I had my glucose tested to “experience” the impact of the community outreach myself. It was quick, easy, and painless!

Hybrid Education: “5 Pasos” or 5 Steps to Self-Care

Community mobilization in diabetes through clinical and peer-education

The “5 Pasos” experience was perhaps the most moving in Mexico; this is where the community impact really comes together in a beautiful way. Originating from the first Project HOPE assessment in 2001, J&J led the funding effort to design, test, and implement this progressive approach to diabetes care. Today the program has grown substantially and in some communities, is self-sustaining through continued donations, Project HOPE support, and volunteer staff.

Classrooms of mostly women and children with families affected by diabetes actively learn, re-learn, and then teach the physical, mental and emotional components of diabetes. This is true patient and community empowerment! The extensive course is 12 2-hour sessions with a final examination to receive a certification from Project HOPE for completing the 5 Steps to Self-Care. Course topics include evolution, decision-making, physiology, continuing education, self-care, nutrition, exercise, and health services. See below as a student describes to the group the physiology of Type 1 diabetes:

So how does education empower this community? It would be impossible to account for the testimonies of the 600+ certified students of this program. In the session I attended two were among the most powerful:

A young, thin, 22-year old woman came up at the end of the course to introduce herself; as she got closer it was easy to tell that she had substantial vision loss. Although she did not look like she should be screened, her family heredity made her a victim without many of the symptoms; most of her family had diabetes. As a result, her diabetes started affecting her microvascular function. Through 5 Pasos, she is working to control her A1c levels and preserve her vision.

Another woman described the emotional devastation that diabetes put on her and her family when she was diagnosed. At first, she wasn’t aware of her options. She had started visiting funeral homes because she believed her life would end until she realized, through the 5 Pasos community, that she could live a full and healthy life. She and many other women came up after the session to hug me and give me their thanks and blessings for my journey with Project HOPE to help those with diabetes globally.

Honestly, nothing could be more meaningful to me. These women will always be in my heart. This isn’t about theorizing a perfect system or protocol – this is about helping people. This is about changing lives. This is about empowering people to help themselves, their families, and their communities. This is Project HOPE Mexico!

Sources

Helping people help themselves in Mexico (DAWN Initiative Highlight)

Project HOPE Mexico: empowering people to care (IDF paper)

Project HOPE Global Diabetes Portfolio (presentation) – Courtney Guthreau