Sunday, May 11, 2014

El Problema es.........

-->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.

1 comment:

Scott Bolhack, MD said...

Great Post Pat! Welcome back stateside! The issues are worldwide with diabetes and the consequences. Looking forward to making a difference...