When Humberto Mendoza Charris wanted to talk about diabetes in the late 1990s, it was often hard to find an audience.
“Diabetes was perceived as a second- or third-order challenge, a disease of the upper and middle classes. There was a lot of ignorance about the suffering caused by its complications and its high costs to the health system,” recalls Mr Charris, Medical advisor for Public Health in the Mayor’s office of Barranquilla, Colombia.
He and his team set about changing this. They submitted their first proposal to WDF in 2010, a plan to improve detection and care of hyperglycaemia in pregnancy (HIP) that became Vida Nueva, WDF10-572.
During this first project, they found that many women with HIP had a lifestyle with diabetes risk factors and relatives with type 2 diabetes. Their next project, Generación Vida Nueva, WDF15-955, followed up with these women and their families – especially their children - to educate and prevent them from developing diabetes at a later stage. A third phase, Generación Vida Nueva, WDF18-1617, began in 2018: it is rolling out the first stage of a national programme targeting HIP in eight departments of Colombia.
“We found that the focus of the problem was in the family, so our response was to make family the focus of our work,” Mr Charris explains.
To mark World Diabetes Day 2019 and its theme Family and Diabetes, WDF spoke with Mr Charris about diabetes, family and what others can learn from Vida Nueva’s experience.
Why are families important, and how do you approach them?
There is much evidence that a genetic component is strongly involved in the development of diabetes. But we are convinced that the problem goes beyond mere predisposition. In the family, habits are formed that function as triggers of the disease.
When you want to reach families, in Colombia you begin with women. The Colombian woman is linked to the family and dedicated to the care of its members, with a great impact on the choice of what food to consume and also in the formation of habits.
What challenges did you face?
The challenges faced were institutional, social and cultural.
The institutional challenges included a) high turnover of clinical staff, b) some clinicians resisting new care practices, for example because they perceived that the activities constituted additional workloads; c) absence of processes and limited availability of resources for prevention activities.
The social barriers included problems with a) security for the project advisory group, b) low availability of users' time, c) varying educational levels, mostly at a low level.
Cultural barriers included a) beneficiaries believing their health is more the state’s responsibility than their own, b) low perception of risk, c) the difficulty of modifying nutritional habits (which was greater than the difficulty of increasing physical activity), d) short-term thinking (immediate needs taking precedence over future health benefits) e) parents pressuring the younger women not to follow recommendations and f) women lacking time because of their responsibilities for family care.
What have you learned?
We learned many things – and continue to do so. Key learnings include:
• The active participation of the local health authority is very important, and the participation of other institutional actors (scientific societies, universities, research centers, NGOs) creates great potential resources for type 2 diabetes prevention programmes.
Awareness activities should not only be limited to beneficiaries - sessions with clinicians are also required, because training is not enough.
• People are even more motivated to remain in the programme when they find people they know in the screening and intervention groups.
• The risk of developing diabetes must be clear enough for people to change their attitudes and behavior, yet they should also perceive that short-term benefits are possible and healthy lifestyles do not have to be a boring habit.
• Information and communication technologies are effective in reaching large numbers of beneficiaries and motivating them.
What are you most proud of?
I am proud of a set of results that give a totally different picture of diabetes in Barranquilla than that seen before the process began.
The problem of diabetes is now high on the public agenda of the city, and in the community; universities and scientific societies participate enthusiastically in these projects; scales are used in our primary care centers and risk factors are being addressed and monitored; citizens are increasingly involved in the Global Diabetes Walk on 14 November each year; an increasing number of people have adopted healthy lifestyles; in the parks of our city more and more people are doing physical activity and demanding more fruits; the number of people who have stopped consuming sugary drinks and juices is growing, and many families have received our programme’s messages and are putting them into practice.
Our next challenge is to consolidate the achievements in Barranquilla and extend them – first in our Caribbean Region and then to the rest of the country, starting with women in their reproductive function and their role in promoting habits in the family. The recognition of the success of this experience in our city has led us to look at the rest of our country and ask ourselves: why not?
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