-->May 11, 2014
The same in the United States
but at different levels: lack of
nutritional and health education, public health services, reasonable access to
healthcare with cultural awareness, and in San Cristobal, adequate resources
for healthcare professionals to deliver optimum healthcare.
These statements are my
personal observations while working
intermittently with Don Sergio over the last 6 years. Seeing the consequences of
these deficiencies brings me to these conclusions.
Lack of nutritional education.
Sweets are hard to find in
nature so our bodies have not evolved to handle consuming large amounts of
sugar. This early and chronic consumption can result in type 2 diabetes (T2DM) at
an early age as the pancreas’ ability to produce insulin wears out in keeping
up with elevated blood sugar…hence the term ‘impaired glucose tolerance’, aka
IGT. We often see many 30-somethings with out-of-control diabetes and horrific
foot ulcers are their first obvious signs of this disease - they are unaware they have diabetes. Interestingly, these people are not obese, as
in the US, some may carry 2-10 kg too
much, but not all.
|Typical aborrotes packed with soft drinks.|
It is not unusual to see a
mother pouring a refresco in her baby
or toddler’s drinking bottle, or just letting them drink straight from the soda
bottle (I see this in the Hispanic US population too). The sugar content in these 400ml/~12 oz
drinks is about 46 grams. There are 4 grams of sugar in a sugar packet. That
means there are 11 packets of sugar in one bottle. When this starts early in
life, the taste of water does not ‘taste good’, therefore continued consumption
of sugary drinks seem normal.
It is not unusual to see a 3
year-old child with deciduous (baby) rotten teeth. The acid in the soda breaks
down the enamel and the oral bacteria feed off the sugar creating an
imbalance of oral flora and therefore damaging the teeth. I saw this clearly with our 3 y/o boy that
was burned with hot liquid on his chest, abdomen, and hand. He had a dark brown
nub of one of his front teeth and a few others were beginning to rot. His
parents fed him soda to try to distract him during these wound-dressing
changes. Pain medication would have been ideal but it is not available.
|In some places you have to ask the staff to unlock a door to buy toothpaste, or it's behind the counters in the pharmacy.|
For some reason in Mexico
(this is in the north and the south) for the poor population, oral hygiene is
not advocated. In Tucson, many of our Mexican immigrant patients need emergency dental care
due to tooth abscesses, sinus tract development and grotesque caries due to
lack of basic dental care and oral hygiene. Poor oral hygiene and early soda
consumption appear to be a bad mix.
Lack of health education, aka PREVENTION, ¡por favor!
Diabetes is at ~11 % in
Mexico and at ~7% in the US; these stats reflect the number of those actually ‘diagnosed’! There are numerous people
with IGT in which 30% of these people will go on to develop T2DM if they are
not educated and informed on how to prevent the progression.
Global T2DM is increasing in
mid- to low-income nations but high-income nations have their burden too. If we
don’t educate our youth (and all for that matter), we will exhaust an enormous
amount of resources.
Diabetes puts in motion the
following problems: heart and vascular disease, kidney and eye disease, and
neuropathy. This can lead to high blood pressure which increases the risk of
stroke; kidney failure resulting the need for dialysis; eye disease leads to blindness.
Neuropathy (burning, tingling, numbness of lower legs and feet) results in
inability to feel a pebble in a shoe which can lead to a small ulcer, then infected ulcer, then
amputation, etc. Complications from diabetic neuropathy is the main reason so many wound care
centers have popped up in the US over last 15 years. Don Sergio tries to fill the local wound care void; hence the 120 + patient visits per week.
Public health promotion.
I have not lived in Mexico
long enough to comment with complete understanding of the public health (PH) system.
However, Bruce and I were living in Oaxaca for 3 months in 2009 during the ‘Swine
Flu Epidemic’ and it appeared the public health system rose to the occasion as
did the government. PH vans roamed the neighborhoods knocking on doors asking
specific questions about symptoms of illness. Well-publicized professional soccer games in
large stadiums cancelled, as were schools and offices to contain the spread. It was quite impressive how Mexico responded. I don't think we in the US would cancel any professional sporting event to contain an infectious disease.
|Common cooking stove. |
|Some people can't afford a stove and wood burning to cook is their only option.|
This being said, in the San
Cristóbal region, education on preventing common burns and diabetes
seems non-existent. Small children frequently get burned with hot water or oil,
the ubiquitous fire crackers use can cause serious damage, and neurocysticercosis can cause epilepsy and those
centrally located, non-enclosed fire blocks in the home seem to be a magnet for one
experiencing an epileptic seizure. Public service announcements, posters,
television blurbs could make a huge impact. The US population can benefit from these public service announcements as well and we have resources to do so, but for some reason don't implement.
|Don Sergio finds remnants of feugos artificiales.|
Cultural awareness is so important.
This is one place in the
world, in the Americas, that still has a heavily populated Mayan/indigenous culture
with their own style, beliefs, dress, language and ways. These cultural identities
can vary from town to town. It is a pleasure to be able to experience the diversity. However, with
healthcare, there must be a bridge and understanding their culture as to yield
the best results when caring for these unique groups.
Resources for the healthcare system.
I often hear the Mexican physicians
and nurses go on strike not for money, but for resources to provide better
care. These physicians and staff want to help and do their job well, but resources are limited which can result in bad outcomes.
So what is the solution?
Do what we can within our
abilities to improve these flaws. It has to come from within a community and we
(wherever we are) must have the desire to be part of the solution. However, this is difficult when the infrastructure to support these ideas is not in place. As with every visit here, I ask Don Sergio,
“Why do you do what you do?”. His response this visit is, “I don’t want to be
closed in and think about myself, I want to think of others and be part of the
help and solution”….”people need help”.
Okay, I’m stepping off my
soap-box. To reduce the suffering and needless life/limp/game changing
ailments we must invest in education: not just in Mexico but in the US as we
are no better. We have our own burden of T2DM and it appears to be taking the
globe by storm…..we’ll soon match Mexico’s 11% of diagnosed diabetics if we
don’t do something.
Posted by Patricia Ferrer.