At the IPS Salud Social, a bustling primary care centre in central Barranquilla, dozens of women listen intently as a doctor explains the risks of HIP and the importance of controlling the blood sugar during and after pregnancy.
Each has her own reason for being here. Audris Celin, 28, is among the pregnant women present – she was diagnosed with gestational diabetes seven weeks ago, and after her diagnosis she was encouraged to join the programme activities and come for regular checkups.
She now visits the clinic every 15th day to receive medication and follow-up care, check her blood sugar, and attend the information sessions.
“I have learned that the way you behave and nutrition are very important, and also to show up for check-ups and do what the doctors ask you to do to prevent something serious from happening. I now eat a healthy breakfast and also lunch and, in the evening, I only eat green vegetables and eggs and similar,” she says.
A woman in her neighbourhood died from high sugar levels, she adds. “So you have to be careful.”
Keily Quintero, 18, has also battled gestational diabetes. She was pregnant before, three years ago, but lost the baby to diabetes, she says. Four months ago, she delivered a healthy daughter, with the health centre’s help.
“I was in the hospital almost every day because it was the same with [my second child], she also wanted to come out in week 26. So they treated me here, and I had her in week 30,” she says. “We are doing fine today, thanks to the treatment at the clinic and thanks to God.”
Audris Celin (left) and Keily Quintero.
IPS Salud Social is one of 125 health centres targeted by Generación Vida Nueva: Hyperglycemia in Pregnancy (Phase 3), a project working to integrate HIP screening and care into the health system to ensure healthier pregnancies and positive pregnancy outcomes along Colombia’s Caribbean coast and the city of Cali.
It aims to:
• Update and adapt clinical guidelines and protocols for HIP detection and management incl. post-partum activities/diabetes care and prevention
• Build capacity of health centres across the eight targeted departments
• Roll out of universal screening of pregnant women across all communities within catchment areas, combined with education and referral for cases detected.
• Roll out large-scale awareness and mass media campaigns concerning diabetes and other NCDs, targeting pregnant women for HIP detection
WDF began its partnership with Vida Nueva in 2010. At that time, the knowledge about HIP was limited in Colombia, says Line Bechmann, WDF Programme Manager. Data collected during Phase 1 and Phase 2 of the project indicated a high prevalence of HIP in the country – and spurred a recommendation for universal screening for pregnant women in clinical guidance published in 2016.
Two years later, when Colombia passed a resolution establishing a Comprehensive Health Care Pathway for pregnant women, a recommendation for universal screening was included.
After Vida Nueva confirmed the need for universal HIP screening in Colombia, it helped roll out HIP services in Barranquilla, Montería, Valledupar, Sincelejo, Cartagena, Santa Marta, Cali, Riohacha, the Archipiélago of San Andrés as well as the capital city Bogotá.
“The national policy recommendation was a tremendous milestone and an important first step,” Ms Bechmann says. “WDF is proud to have been part of the journey, and we hope that in the future, the Vida Nueva partnership will support the Colombian authorities in extending pre- and post-natal HIP services and at the same time improve diabetes care services nationwide.”
During a recent visit to Colombia, Ms Bechmann met with the project’s Regional Scientific Committee, which includes authorities, scientific societies, universities, and health service providers. Project implementation is proceeding well and meeting its targets, she says.
Meeting of Regional Scientific Committee February, 2023.
“The participation of the authorities, academia and associations of endocrinologists and obstetricians, which support the health personnel, has been decisive for the adoption of knowledge. An organisational structure has been created that works through a Local Committee, with representatives from various institutions, which coordinates implementation and provides follow-up,” says Humberto Mendoza Charris, Vida Nueva Project Responsible and District Secretary of Health in Barranquilla.
Ms Bechmann also met with Jaime Urrego, Vice-Minister of Public Health, PAHO, and other relevant stakeholders to explore how WDF can broaden and continue its support of projects combatting diabetes and other NCDs in Colombia.
During visits to several health centres participating in the project, Ms Bechmann met health professionals and beneficiaries such as Ms Celin and Ms Quintero.
By the time it the project finalises later this year, it will have trained more than 1200 doctors, nurses and HCPs in HIP care, and 125 health centres across Colombia’s Caribbean coast will be better equipped to serve pregnant and postpartum women.
“There’s good momentum, and strong interest from relevant stakeholders,” Ms Bechmann says. “Other countries, including Mexico and Ecuador, have expressed interest in implementing the ‘Barranquilla model’.”
From seed to garden
Valledupar, the capital of Caesar Department, is one of new health centres joining the Vida Nueva project. Dr Miguel Jose Soto Ruiz is working to integrate the project’s learnings at Hospital Eduardo Arredondo Daza, where he works as an ontologist and hospital director.
Dr Miguel Jose Soto Ruiz (right) with WDF’s Line Bechmann.
Inspired by the ‘Barranquilla model’, he and his team have launched new services in the hospital and in the wider community. They range from a glycaemia satellite centre to prevent and control gestational diabetes and diabetes type 2 prevention to new outreach, support and services for the city’s more remote residents.
“I am proud to be a pioneer. We have left the clinics and gone to areas where there is almost no accessibility for many of our users - we are reaching every corner of the municipality,” he says. “We started with this seed, and we hope to leave a fruitful garden behind.”