In 2015, a WDF programme manager visited Amazonas, Brazil to see the progress of Educating Educators in Diabetes Without Borders – an ambitious effort to train hundreds of healthcare professionals in some of Brazil’s most remote areas.
In Manacapuru, a lush provincial city on the banks of the Amazon, Bent Lautrup-Nielsen met with Michel Tayrone, a coordinator from the local indigenous health district (DSEI).
“He explained, among other things, that deteriorating patterns of diet and exercise were resulting in increases in obesity and diabetes in the local indigenous populations,” Mr Lautrup-Nielsen, now Head of Global Development and Advocacy at WDF, recalls.
The two discussed the many overlapping health challenges in Amazonas, and how the Educating Educators project fits in.
“We shared the view that this project should support district efforts to strengthen community health workers and their interactions with the local indigenous communities. He said our project was welcome and needed.”
Training, screening and care
Educating Educators is a partnership between WDF and the Brazilian Diabetes Society (SBD). In 2008, SBD rolled out a 40-hour Diabetes Educator course covering diabetes risk factors, diagnostics, prevention and care. The course quickly reached hundreds of health professionals in the country’s southern regions, but SBD found it difficult to reach health professionals in the less-developed north.
SBD approached WDF with a proposal. Staff would identify several northern cities or states interested in the course, and then adapt it to the contexts of these areas. Each course would end with an event for the local population, where the students could put their new educational and diagnostic skills to work. WDF agreed to support the initiative, and Educating Educators in Diabetes Without Borders, WDF12-722 launched in 2013.
The states of Roraima, Paraíba and Amazonas were chosen for roll-out. Staff at primary health care posts in Roraima and Paraiba would be trained, while in Amazonas, the focus would be on indigenous communities and health care services.
The project would train 240 health professionals across the three states, roll out screening and awareness raising campaigns for local residents, and improve care for at least 4,500 people with diabetes.
Adjusting to local conditions
With these ambitious goals in place, the project team got to work adapting and developing educational material, identifying motivated and available HCPs, and connecting with the most marginalised groups in the three target states.
Inevitably, challenges arose. In Roraima, the first focus for the project, local leadership changed three times in just one year. In Amazonas, several health professionals struggled to reach the course, which required several days of travel by boat.
By 2015, however, follow-up visits were showing encouraging, even remarkable results.
Participating health professionals were very motivated by the course, says Dr Claudia Mauricio Pieper, an endocrinologist at Pontifical Catholic University of Rio de Janeiro and WDF’s partner on the project. She recalls one nurse who set about training all the healthcare staff in her clinic, then arranged for home health visits to 100 local diabetes patients. Another trained educator “completely changed” how he evaluated the feet of his patients with diabetes.
“In the visits and follow-up reports after the courses, our team was able to see improvement in patient care by health professionals who took the course,” she says. “The municipal and state secretariats of each state, the primary health care posts and the indigenous health services all showed interest in continuing the project - including multiplying knowledge through other courses.”
HCPs at the Educating Educators Manaus Health Fair in 2015.
Early results also suggested that increasing the project’s focus on one of the three states would be beneficial. In response, SBD and WDF agreed to extend the project in Amazonas.
“Amazonas was the obvious choice,” Dr Pieper says. “The situation of indigenous communities and their very high risk of diabetes was something we knew would be a special challenge. We realised that additional efforts were needed here to achieve more sustainable results.”
The extension allowed extra time to adjust to local conditions and changing health system priorities in the state. It also provided training for 89 additional HCPs, and an extra health fair for local residents.
In 2017, the International Diabetes Federation Congress in Abu Dhabi featured an oral poster and presentation about Educating Educators, citing the project’s innovative scope and approach. The SBD team completed project implementation the following year and closed the project in 2019.
“SBD did an impressive job,” Mr Lautrup-Nielsen says. “A project such as this, in such a demanding and remote context, requires a very committed partner and a protracted effort to succeed.”
Educating Educators trained more than 300 HCPs, and improved care for at least 15,000 people with diabetes – triple the original target. HCP participants also gave very positive feedback to the project, and pre/post knowledge tests indicated a notable improvement in their knowledge.
“The need for improved access to diabetes care, especially in Brazil’s less-developed northern and north-eastern regions, remains high,” Mr Lautrup-Nielsen notes. “But this project offers many relevant learnings for those working with indigenous peoples and other populations at high risk of obesity and diabetes.”