Peruvian diabetes project wins praise and improves lives

On a recent November afternoon in northern Peru, the atmosphere at the Centro Salud Bellavista was festive. A military band played brassy versions of Latin favourites, while children in school uniforms and adults in mototaxis gathered to watch. Under a tent, a line of men and women waited for the chance to receive a free screening for diabetes.

“Today, we’ll screen about 100 people, and it’s likely that 10 to 15 of them will have diabetes,” Dr Jose Huaman, the centre’s leader, said to visitors from the WDF. “We’re so thankful for your support, and proud to show you our daily work.”

He led the group inside, where a group of diabetes patients were learning about how the body processes sugar. Then, he took them to a room where a woman was receiving a foot examination. She showed the visitors plum-sized ulcers on both ankles of her right foot, and said they were healing quickly thanks to her doctor’s expert help.

That doctor, a general practitioner named Teobaldo Fiestas Cherres, received his diabetes training through Basic units for diabetes care in Peru (CUIDATE), a project run by the Peruvian Diabetes Association (ADIPER) and funded via a WDF fundraiser project. Asked what he did before the training, he thought a moment before answering.

“We did offer diabetes care before, but it was not ideal,” he said. “It is much better, more organised now. Since we as GPs don’t get much diabetes training, we really need this project.”

Born of need

Basic Units for Diabetes Care is now rolled out in eight primary care clinics in Piura and Lima - twice the original target - where it has trained more than 100 healthcare professionals, screened more than 1000 people and provided counselling and footcare services to nearly 1000 since its launch in June 2015.

“A basic unit is a group of at least three healthcare providers – a doctor, a nurse and a nutritionist – who all are trained in diabetes care,” said Dr Jorge Calderon, the project’s coordinator. They may also include a diabetes educator, a lab, and other resources. 

These small, coordinated groups are proving adept at improving diabetes care in the clinics where they have been introduced, winning praise from healthcare professionals, patients, and regional authorities. 

“Peru has very few specialists and an overburdened hospital system. Yet 2 million people in Peru have diabetes – we all know someone affected. So this project was born of the need of doctors, nurses from the first level of diabetes care,” Dr Calderon said.

Diabetes drugs are often expensive or inaccessible in Peru, appointments with endocrinologists can take months and awareness of the disease is still inadequate, he added. For this reason, advocacy is a second priority of the project. To date, the project has produced more than 3000 posters on prevention of diabetes and complications, and contributed to a high profile World Diabetes Day event and Peru’s first national diabetes patient congress.

“We’re saying that health is a right, and that asking for drugs shouldn’t be like asking for a favour,” he said. “Peruvian diabetes patients deserve better treatment.”

Ambitious plans

Regional governments are listening. On Nov. 11, during a meeting between the Basic Care project partners and the Piura regional health authority, an expansion of the project to more Piura clinics was discussed.

“Your training helps us improve the quality of care for our citizens,” Dr Eduardo Alvarez-Delgado, vice director of the regional health authority said. He added that they would offer extra support to the clinics involved in order to extend the project’s impact.

The national government is listening as well. In 2015, Peru’s Ministry of Health and the Pan-American Health Organisation (PAHO, the WHO Regional Office for the Americas) signed an agreement for a national level programme with the WDF. Called Diabetes Network Action (DIANA Peru), its key element is the creation of a new, 1-year diabetes diploma course that will train more than 800 healthcare professionals across the country. 

”Diabetes rates in Peru are unfortunately increasing, as is the case in most low- and middle income countries,” says Jakob Yigen Madsen, WDF programme manager. “So a strengthened response is needed.”

For that reason, it’s encouraging to see how the WDF project portfolio in Peru has grown in recent years, he says. The WDF’s collaboration with ADIPER began in 2010 and has expanded over the years, he notes, benefitting many Peruvians with diabetes.

“We expect that the ADIPER partnership, together with the large scale programme with the Ministry of Health and PAHO, will generate more measurable improvements in diabetes management in the near future.”