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Helen

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One-Mom

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Half Marathon

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Lucia

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Don andres

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Program Update: Nutrition

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Our child nutrition programs have always had three basic pillars:

  1. The provision of nutritional supplements to children, to help prevent malnutrition and provide as a “safety net” in times of food insecurity.
  2. The provision of excellent medical care, to help identify and treat the diseases–both common and rare– that contribution to child malnutrition.
  3. Education of caregivers and community leaders about child health and nutrition, to help provide communities with the tools they themselves need to be engaged in protecting the health of their children.

Of these three pillars, by far education is the most challenging. This may sound counter-intuitive at first. However, if you think about all the different barriers that exists to a good educational program–such as low rates of literacy, or the inherent resistance there always is to changing infant rearing practices (which are time-honored and passed down from generation to generation in every culture)–then it is becomes easier to understand why educational programs are numerous but quality educational programs (that produce real change at the community level) are few indeed.

With this mind, I’m happy to report that Wuqu’ Kawoq | Maya Health Alliance has just finished the initial stages of a massive program evaluation designed to improve our nutrition education programming. To accomplish this, we assembled a highly skilled team of community health workers, anthropologists, and nutritionists, who spent most of July and August conducting dozens of focus groups and hundreds of interviews with community leaders, parents, and other stakeholders in our communities.

This evaluation was wide-ranging and designed to help us understand better what parents think about the health of their children and the causes of malnutrition. It will also give us deeper insight into dietary diversity, breastfeeding and weaning practices, and competing nutritional messages from other groups (such as companies which market infant foods).

Right now our team is evaluating the data that was collected during this evaluation. Within the next month or two, we will have a formal report from the team which will identify the areas where our current nutrition education programming might be deficient or not exactly in line with the needs of our communities and give us recommendations for improvement. We’re very excited about this great opportunity we have to continue to improve our programs so that we can better serve the children of Guatemala!

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Justin

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Understanding Health Holistically– An Update from Intern, Jillian Moore

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This summer, Anita Chary, Kelley Brown, and I spent two weeks in the Bocacosta, in Chocola, conducting research in nearby aldeas where our organization provides lipid-based supplements to young children. Kelley talked with mothers about their conceptualizations of malnutrition and good feeding practices. Anita led focus groups with the mothers and fathers. We also interviewed local community leaders and health promoters. For a market analysis of available food, I interviewed owners of pharmacies and shops in the rural aldeas and urban centers of Chocolá and San Antonio about the products they sell and what their customers purchase.

With these data, we hope to better understand what rural families know about nutrition, what food options are available to families, how parents choose what to feed their children, and how socioeconomic factors influence chronic childhood malnutrition. Currently, we are analyzing the data to identify ways we can ensure that more children benefit from the nutrition program.

My intern year focuses on environmental health concerns, so I spend most of my time finding and understanding how factors like wood smoke, unclean water, and pesticides affect health. Working with the nutrition project provided me a refreshed, holistic perspective of health. For instance, chronic childhood malnutrition can be exacerbated by illnesses caused by environmental factors like a diarrhea l disease from drinking unclean water or a respiratory infection influenced by breathing in wood smoke every day.

I am proud to work with an organization that seeks to improve health from diverse angles and recognizes that in order to improve the health of children in rural communities we should not only provide nutrition supplements but also understand the many different social, environmental, and economic aspects that seriously impact their health. By promoting other basic rights such as access to clean water, primary medical care, and health education we are doing more than just addressing the symptoms, but pushing to make change to the system. Hopefully in the future, after the research on environmental health is completed, we can approach other barriers to good health such as clean air in the home.

Spotlight on Students: Heather Wehr

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Here is another interview with one of our great language students!  The study of an indigenous language can serve to compliment a wide range of career paths!

Heather (center) with her teacher, Magda

Tell us a little bit about your background and interests

I graduated from Temple University in May 2011 with my B.A. in Spanish and Latin American Studies. I first started learning Kaqchikel when I studied abroad in Guatemala in 2010, and after graduating I went back to keep working on my Kaqchikel. I worked as an intern with Population Council and their program for rural, indigenous girls called Abriendo Oportunidades for the past 9 months. Just last week I started as an M.A. student in anthropology at the University of Kansas where I am continuing to study Kaqchikel!

Why did you decide to enroll in the Kaqchikel immersion school, Kab’lajuj Ey?

I decided to enroll in KE because it seemed like perfect timing for me to intensively study Kaqchikel in preparation for heading back to graduate school this fall. I had been studying with a private teacher in Comalapa and speaking some Kaqchikel in the field, but the opportunity to dedicate myself 100% to Kaqchikel for two entire weeks was just what I needed to solidify everything I had been hearing during field work over the past year.

Describe the experience of learning from KE’s native Kaqchikel teachers

KE only picks the best teachers to work with us! It was also really great to hear accents from three different Kaqchikel towns. I am used to hearing Kaqchikel the way it is spoken in Comalapa, so this was an opportunity for me to practice understanding Kaqchikel from different places. The accent from Tecpan, the town where the course was held, sounded very different for me! I am so happy that I had the experience though because now I can recognize when someone is from there.

It was also great to hear the different stories the teachers had to share. One of my favorite class times was the stories the teachers told us. Also, I loved talking with the teachers and doing mock medical consultations. It was an opportunity to learn and practice very focused Kaqchikel vocabulary in real life situations.

Any funny or meaningful anecdotes you’d like to share from your summer of language learning?

The best moments were in the random conversations we had with the teachers during talk time. I remember one day that a fellow student and I were talking with Ixkamey and trying to explain different sorts of body piercings that people get in the U.S. It was fun to experiment with all the new Kaqchikel vocabulary we had learned, but even more fun to see her reaction when we talked about facial piercings!

Another great KE memory was getting to talk about my internship with the teachers in Kaqchikel. The program tries to provide rural Mayan girls with the life skills they need to be able to make their own decisions about when to get married, if they want to have children, if they want to stay in school, etc. The teachers were really intrigued by this idea and wanted to talk about it–even the difficult topics like teen pregnancy! It was wonderful for me to hear what they thought and also to show them how much I cared and had learned from working in small towns for the past year.

Why do you think it’s so important for people who want to work in Kaqchikel communities to learn to speak Kaqchikel?

Even if there are bilingual people in a Kaqchikel community it is so important to learn the language because it says something about your participation in Kaqchikel life as an outsider. So many tourists love visiting Kaqchikel areas to see beautiful weavings and people. Some may even ask to be taught a few Kaqchikel words. But it is rare that someone actually takes the time to study the language, which makes it even more important. These are communities that have been marginalized for hundreds of years, so learning Kaqchikel in a way says, “I want to listen to what you have to say.” It’s more than a language; it’s another form of communication and a way to share with people.

What would you say to someone who is thinking about learning to speak Kaqchikel?

If there is someone thinking about learning Kaqchikel, I would say to do it, and to go to Guatemala and do a school like KE! Learning Kaqchikel isn’t like learning any other language– it’s a journey that connects you with people both here and in Guatemala in ways that you cannot really describe until you have experienced them. It is a humbling but always rewarding process, where for a good chunk of the time you end up looking silly and like you don’t know anything (because you don’t!) But in the end it is an investment of time that will keep rewarding you forever by allowing you to communicate and share experiences with people you would’ve never been able to know before, while also learning about a rich and interesting culture that was for so long ignored. Learning Kaqchikel helped me find a passion that will guide the rest of my life’s work. So you never know. Just try it!

Spotlight on Students: Cris Wibby

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Cris Wibby is an MS candidate at Yale University, and a graduate of our language class, Kab’lajuj Ey.

Cris (right) works 1:1 with her Kaqchikel teacher

Tell us a little bit about your background and interests

I recently started the MS in Nursing/Family Nurse Practitioner program at Yale University so that I can work with under-served populations in the United States and abroad. As an undergraduate, I studied anthropology of Latin American cultures while my graduate studies focused more on medical anthropology and healthcare of the indigenous in Guatemala. During my research and fieldwork, I realized how dire Guatemala’s healthcare situation was and that being a scholar was not enough–I needed to do something to help these people! After learning of the work of Dr. Paul Farmer, Anthropologist/Physician known for his successful innovative programs that serve the poorest of the poor, I realized that being an Anthropologist/Healthcare provider was the path for me. I have chosen to become a nurse practitioner because of all the time and care that nurses give to their patients. I look forward to returning to Guatemala and being able to treat patients.

Why did you decide to enroll in the Kaqchikel immersion school, Kab’lajuj Ey?

This is my second year at KE. As an Anthropologist and traveler who feels that Guatemala is a second home, I know the value of linguistics. I chose Kaqchikel because it’s the most common indigenous language and I plan to work in the highlands where it is spoken. Many of Guatemala’s indigenous live in rural areas and do not speak Spanish. There are numerous medical missions that come to Guatemala, however much is lost in translation as the consult goes from Kaqchikel to Spanish to English. Indigenous cultures have their own unique concepts of health, illness, and disease, so the only way to deliver high quality healthcare is to treat indigenous people in their language and be respectful of their healthcare beliefs. Also I am happy to be a part of a language revitalization movement, as foreign students like us seek to learn Kaqchikel then return to Guatemala to speak it.

Describe the experience of learning from KE’s native Kaqchikel teachers

Many of KE’s Kaqchikel teachers have worked as a dynamic team for years, and you can tell. They start each class with games or skits–never a dull moment! It is a fun atmosphere, but also fast-paced and very intensive. They love to teach and share stories about Kaqchikel culture and their lives, and they were also very interested to hear stories about our lives. We had lots of small group time with each teacher to really get to know them, so I felt that we all really bonded. That’s why I knew I had to come back.

Why do you think it’s so important for people who want to work in Kaqchikel communities to learn to speak Kaqchikel?

If you want to become a part of a Kaqchikel community, learning their language shows your interest and commitment. Language helps you learn more about the culture, how they think about things and see the world so you can truly gain an understanding of the people around you. Kaqchikel speakers are also interested in how you would describe things in English so you both learn a lot about your own and someone else’s culture.

What would you say to someone who is thinking about learning to speak Kaqchikel?

People with an interest in indigenous languages, healthcare, and Guatemala end up finding their way to KE. As for myself and the people I’ve met, we were looking for something exactly like KE then everything fell into place to get us there. We all either had strong connections to Guatemala or immediately developed them. Although I’m still just a beginner, the advanced students tell me how much the indigenous love when a foreigner speaks to them in Kaqchikel and I think if you want to spend time in with the indigenous in Guatemala then it’s a great starting off point.

Anything else you would like to add?

Aside from the intensive language study, there were fun field trips and we got to eat great food. KE includes a trip to the local archaeological site of Iximche where we took part in a Maya ceremony. We also learned to shop in Kaqchikel on market day. We got to sample Guatemalan cuisine as our meals were full of fresh local fruits and vegetables. You will have so many amazing experiences over two weeks!

Allying with Kaqchikel Maya Midwives

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Women’s Health Education – First Graduating Class

Throughout rural indigenous Guatemala, there is a severe lack of access to physicians and hospital-based services. As a result lay indigenous midwives remain the most important primary care providers in many rural communities; they are widely respected by their patients, and they are trusted because they share cultural values and speak Mayan languages. However, indigenous midwives are typically minimally supported by the medical community in Guatemala, and they are simultaneously charged with “covering the gap” in service provision and at the same time blamed for any shortfalls that occur. Furthermore, educational opportunities provided to midwives are typically of low quality and are not sensitive to their adult learning styles, low literacy rates, and limited fluency in Spanish (most speak Mayan languages instead).

Since 2008, Wuqu’ Kawoq and ACOTCHI have pioneered a midwife training program that overcomes these barriers. The program utilizes a “continuing education” model and is delivered in Kaqchikel, the native language of participants. Since 2009, the program has also included a track for novice midwifery students. In 2011, a women’s health education track for the general public was added. In 2012, our second group of novice midwives was enrolled, and the program expanded to include midwives from 5 municipalities, covering 183,000 people.

In 2013 the training program is planned to have four tracks. Track 1 will deliver monthly sessions on advanced themes in midwifery to experienced member midwives. Track 2 will be a “midwifery school” for midwives in training, where didactic sessions are coupled with supervised clinical rotations. Track 3 will be a women’s sexual health education track, open to the general public. Track 4 will be an intensive skills training curriculum for ACOTCHI’s core staff on the use of obstetrical ultrasound.

We are proud to report that, through 5 cycles of this program, our midwifery training program has emerged as a model for the region. It has encouraged tremendous professional growth in the membership, and has sparked several important achievements, such as growth in clinical coverage for women and their health needs (the training cooperative now covers a population of ~183,000 persons), the opening of a school for midwives in training, and the opening of a midwife-run birthing center. Another exciting expansion in the last two years has been the development of a sexual health training track for women in the general public; this track provides direct education to women other than midwives, thereby broadening the scope and reach of the initiative.

With the midwife members leading the way, Wuqu’ Kawoq | Maya Health Alliance will continue to support and develop this important healthcare resource for the Kaqchikel Maya of Guatemala.

This program is a partnership with the Conservation, Food & Health Foundation.

 

Cody’s Flying Monkey Marathon!

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Cody Bowers, a long-time supporter of our work, will be running the Harpeth Hills Flying Monkey Marathon in Nashville, TN this November!  He is dedicating his race to a very special pair of sisters, Sulmi and Amada, who are fighting Type I Diabetes.  Cody, “These sisters are great and very committed to maintaining their health through diligent self-care. I hope to give them the tools to continue their healthy habits.”

Please help Cody to help these sisters by donating to their care.  Just $21 provides a week’s worth of care and insulin to both women!

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Welcome to Language Month!

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Jillian Moore (right) practices Kaqchikel with her teacher Magda Sotz Mux (left.)

Language is a big part of the work that Wuqu’ Kawoq | Maya Health Alliance does, but it doesn’t often play center stage in our public outreach. This isn’t because studying, teaching, and using Mayan languages isn’t as important as our work improving healthcare for Mayas, in fact, the former makes the latter possible. No, the reason is that language tends to float out of focus unless something calls your attention to it.

Just think about what we’re doing right now. I’m producing English, you’re comprehending it, and feels so natural that you wouldn’t have even noticed had I not brought it to your attention. Even after you finish reading this blog and go about your day, you won’t be conscious of the fact that language underlies almost everything you do. This is the privilege of speaking a majority language like English or Spanish.

Native speakers of Mayan languages only get to feel this way at home or among friends. Going to school, or going to court, or going to the doctor are alien and alienating experiences. Imagine you’re a speaker of a language threatened with extinction by the end of the century. Now imagine you’re sick and have to be in the hospital. You long for the comfort of home, but this world is at its heart uncomfortable because the language is foreign. What did that doctor say again about the medicine you’re supposed to take? You heard your diagnoses, but who knows that that means! Ah, you’re supposed to come back for a follow up . . . but do you really want to come back to this place? This is the lived experience of many of our patients, and it’s something Wuqu’ Kawoq | Mayan Health Alliance is trying to change.

If you think that patients are more likely to put their confidence in a doctor that speaks their language, you should care about language.
If you think that indigenous people have a right to sustain their living cultures, you should care about language.
If you think that NGOs should do their work in ways that do not undermine the communities in which they work, you should care about language.
If you think that community disintegration is a barrier to development, you should care about language.

This month is language month for Wuqu’ Kawoq | Maya Health Alliance. All of these issues and more will be on our mind. We’ll be blogging, and tweeting, and talking about language issues in Guatemala. We’ll be showing you how our language work is important in its own right, but also how it supports what we do improving health and alleviating poverty in indigenous communities.

Insulin for My Birthday!

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Have you ever given someone insulin as a birthday gift?  For my birthday on September 15, I am hoping to raise enough money to give two special sisters six months worth of insulin!

These delightful and resilient young women with type 1 diabetes are Sulmi & Amada. Thanks to previous funding, we were able to provide them with their own glucometers and blood sugar testing supplies.  As a result, we were able to get their blood sugar numbers under unusually good control. They are now on adequate doses of insulin, and they are feeling better than they have in years. What we need now is continued support, so we provide uninterrupted services for them. Although WK has many patients on insulin therapy, we need special support for these two women, because the amount of insulin and the intensity of monitoring that they require is much higher than the typical type 2 diabetic patient that we see.

If you want to make my birthday extra special, please consider purchasing some insulin for Sulmi & Amada!  Each week’s worth of insulin costs about $10.50 per woman.  Check out the selections below, and decide how many weeks you would like to sponsor!

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Spotlight on Language: Meet Jillian

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Today we are kicking off a weekly rotating spotlight on our Kaqchikel language students.  Six people attended Kab’lajuj Ey, (KE) our Kaqchikel Maya intensive language immersion course, this summer.   This week we asked Jillian Moore about her experience.

Jillian Moore (right) practices Kaqchikel with her teacher Magda Sotz Mux (left.)

Tell us a little bit about your background and interests.

I studied biology and Latin American Studies at the University of Arizona in Tucson. My interests are in rural and indigenous health, particularly in how environmental factors affect women and children through anthropological and epidemiological lenses.

Why did you decide to enroll in the Kaqchikel immersion school, Kab’lajuj Ey?

While searching for a way to become involved in promoting indigenous health in Latin America, I came across the organization Wuqu’ Kawoq. To work in these Mayan communities, I consider it essential to speak the local language. Kab’lajuj Ey provided an affordable and unique environment in which to learn.

Describe the experience of learning from KE’s native Kaqchikel teachers.

Our teachers were patient and regularly expressed they were grateful that foreigners were learning their language. It was eye-opening to be taught by teachers from different communities. They often shared words or phrases unique to each of their homes, evidence that Kaqchikel is not confined to the standardized rules outlined in our books.

For example, when reviewing phrases commonly used in medical consultations, our teacher, Magda, emphasized it is proper to ask patients not about specific diseases, but rather about how they are suffering. Patients may understand illnesses differently than medical professionals do, not necessarily attributing certain distress to a disease. Language is integral to how we conceptualize the world. At KE, in addition to learning words and phrases, we were acquiring a new perspective.

Why do you think it’s so important for people who want to work in Kaqchikel communities to learn to speak Kaqchikel?

I believe that all people have the right to receive social services in their native languages, especially in the domain of health. A patient is already in her most vulnerable state, and to use her own words to describe her condition can only bring comfort and improve the outcome of the consultation. Furthermore, for professionals like physician, researchers, or nurses to use a language like Kaqchikel commonly considered to be used only by those in need helps to promote the use of the language (and culture) in the community. Finally, to understand deep cultural meanings and nuances that shape the lives and worldviews of our patients, it is essential to learn their language.

What would you say to someone who is thinking about learning to speak Kaqchikel?

In addition to recommending KE, I would advise them to spend time in a home where Kaqchikel is spoken. For me, though more difficult at first, it is essential to learn a language from participating in daily life and conversation. I plan to use Kaqchikel principally for interviews and medical consultations. It is important to me that I learn to speak Kaqchikel as the people do.

 

Diabetes in our Rural Communities

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Diabetes Information for Rural Communities

Last month I wrote about the emerging global burden of diabetes and gave some specific reflections on the case of Guatemala, where we have been working to develop diabetes programs for indigenous and rural communities.

At that time, I remarked that one of the challenges of this kind of work is that we know very little about the actual prevalence or profile of diabetes and diabetes patients in these marginalized geographic and social spaces. What we do know, at least, is that diabetes is not just a disease of urban environments where sedentary lifestyles and dietary changes are most rampant. For example, we know that worldwide the prevalence of diabetes has gone up five-fold in rural communities over the last 25 years (1).

Understanding more about diabetes in these rural settings is important, because it will help us develop more effective educational and clinical programs for prevention and treatment. Recently, we’ve been trying to flesh out the story a bit in the communities we work for in rural Guatemala. What we’ve been able to do, thanks to the recent implementation of an electronic medical record system, is go back and closely analyze some of the basic characteristics of our patient population. This is by no means hard-hitting science, since all of the data that emerge are heavily skewed by the type of patients we attract to our clinics, who tend to have more diabetes-related complications than the general population.

Nevertheless, as a first approximation to understanding the health of this rural population, we think that the experience has been very instructive. What has been particularly helpful has been the recent publication of a great public health study of diabetes in urban Guatemala by our colleagues at INCAP (2) which has allowed us to make some comparisons between the “typical” urban diabetic patient in Guatemala and the our rural diabetic patients.

For example, in our communities, the average diabetic patient is around 55 years of age and is diagnosed with diabetes in their late 40s. This is similar to findings from urban Guatemala, and it suggests that in both settings the bulk of our effort at screening for diabetes likely needs to be focused somewhere in the fourth decade of life.  On the other hand, one of the ways in which the rural population is very different from the urban population is in terms of educational achievement. Nearly three quarters of our patients have three years of primary school or less. This is a very important finding, even though it is not particularly surprising, because it underscores how strategies to educate about diabetes in this population need to be appropriate for the educational level.

Another very interesting finding for us was the very low rates of tobacco use (0%) in the rural population – much lower than the urban population (~40%). We had always suspected this number was low, but these rates were even lower than we had thought. The fact that there is basically no tobacco use at all in the rural population is excellent news, as this helps to reduce the overall burden of cardiovascular disease.  Guatemala became a signatory of the WHO Convention on Tobacco Control in 2005, and implemented comprehensive tobacco control legislation in 2008 (3). I wonder if (and hope that) rural Guatemala may have been able to dodge the tobacco bullet through the implementation of comprehensive tobacco legislation before tobacco ever managed to “catch on.” Indeed, in lower income countries around the world, where the WHO Convention on Tobacco Control has been adopted, the early implementation of anti-tobacco legislation (prior to growth in actual consumer demand for tobacco) may be one of the great global health triumphs of the coming decades.

One final interesting detail from our small study was the fact that obesity rates in the rural population were some 15% higher than in the urban population. At first glance this seems very counterintuitive. How can obesity be higher in a population that is less sedentary and has more traditional foodstuffs in the diet?  This finding has led us to reflect on the large body of emerging literature that demonstrates a close association between chronic childhood malnutrition and adiposity in adult life (4). Since Guatemalan rural populations have one of the highest rates of child malnutrition in the world (5), could this be what is driving the emerging diabetes epidemic (more than, say dietary change or sedentary lifestyles)? It seems like a hypothesis worth investigating closely because it would mean that, from a public health perspective, preventing diabetes in Guatemala (and similar marginalized settings) would require also and simultaneously fixing the problem of childhood under-nutrition.

 

(1) Hwang CK, Han PV, Zabetian A, Ali MK, Venkat Narayan KM. Rural diabetes prevalence quintuples over twenty-five years in low- and middle-income countries: A systematic review and meta-analysis. Diab Res Clin Pract 2012, doi:10.1016/j.diabres.2011.12.001.

(2) Central America Diabetes Initiative: Survey of Diabetes, Hypertension and Chronic Disease Risk Factors: Villa Nueva, Guatemala 2006. Washington: Pan American Health Organization; 2007.

(3) Gobierno de Guatemala (2008). Decreto 74-2008: Creacion de los Ambientes Libres de Humo de Tabaco.

(4) Vieira VCR, Fransceschini SdCC, Fisberg M, Priore SE: Stunting: its relation to overweight, global or localized adiposity and risk factors for chronic non-communicable diseases. Rev Bras Saude Mater Infant 2007, 7:365-372.

(5) De Onis M, Blössner M: The World Health Organization global database on child growth and malnutrition: Methodology and applications. Int J Epidemiol 2003, 32:518-526.

New Midwifery Clinic!

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We are happy to announce that one of our partner organizations, the midwives cooperative of ACOTCHI (Asociacion de Comadronas Tradicionales de Chimaltenango), recently opened up its own clinic in Chiq’a'l/San Juan Comalapa.

We have been collaborating with ACOTCHI for nearly a decade to support midwife training programs delivered in Kaqchikel, to assist with adult literacy classes, and to hold primary health care clinics.  Our relationships with many of ACOTCHI’s midwives have facilitated not only improvement of prenatal care to many Kaqchikel women, but also nutrition and diabetes programming  in several rural communities of the Kaqchikel highlands.

During the inauguration of the new clinic, ACOTCHI’s Director, Erika Yax, commented, “It has been very difficult to reach this point. We began on the ground…no one has ever made sure that midwives have had an adequate or dignified space in which to work.  This is a dream, and it is just the beginning.”

As Wuqu’ Kawoq continues to collaborate with ACOTCHI in this beautiful new clinical space, we will contribute to ACOTCHI’s admirable efforts in lowering maternal mortality rates and providing high quality prenatal and post-partum care to Kaqchikel women.

Facebook in Kaqchikel!

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Languages around the world are disappearing at an alarming rate, about one every two weeks. And because most of these languages are non-written languages, once they are gone, they are gone forever, even from memory. Without a doubt, however, the greatest tool out there for combating this trend is the internet. The internet provides many methods for empowering speakers of minority languages. People can create indigenous language websites, archives of oral recordings, or online language lessons for non-speakers who may want to learn a minority language, as well as many other things. These sites are not only practical, but impactful as communities realize that their often-ignored language is just as useful for modern online communication as more dominant languages are.

That is why Wuqu’Kawoq | Maya Health Alliance is proud to help promote the launch of Wachwuj!  Wachwuj simply means ‘Facebook’ in Kaqchikel, the indigenous Mayan language spoken by most of the communities we work with. By going to www.wachwuj.com, anyone can download and install a program that provides a Kaqchikel interface for Facebook. The program is free and easy to install. With this product, thousands of native-speakers of Kaqchikel who do not speak English or Spanish will be able to access the world’s most popular social network!

Wuqu’ Kawoq | Maya Health Alliance has always thought of ‘Health’ very broadly. We want our communities to have healthy culture and language as well as healthy bodies. This is why we have strived to engage communities in linguistically and culturally responsible ways. Keep an eye on our blog over the coming week for more language-related announcements, including highlights from our neologisms projects and new health-related radio announcements we have been producing! You can also follow us on facebook or twitter for the latest news on these topics!

Partnering with NAPA/OT Field School

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Florencio translating Margarita’s story.

For the second year running, we were proud to work with the students of the NAPA-OT (National Association for the Practice of Anthropology-Occupational Therapy) Field School in Antigua. The students visited our clinical facilities in Santiago, Sacatepequez, and listened to Margarita, an elderly diabetic woman, discuss her experiences with diabetes.

NAPA Students with Kaqchikel patients.

Staff members Florencio and Anita translated Margarita’s story from her native language, Kaqchikel, and the group shared an appreciation of the difficulties Margarita faced, including various misdiagnoses, patient abandonment by numerous doctors, and bankruptcy from selling her land possessions to obtain costly medications. Margarita’s ill health improved soon after enrolling in our diabetes program, which provides home visits and medications free of cost. Florencio and Anita also described the challenges that indigenous people face in accessing quality health care in Guatemala and explained how our programs seek to address the problems that our patients like Margarita face.

To learn more about treating non-communicable diseases like diabetes in Guatemala, click here.

 

Team Billy!

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Hi everyone! Our team is running a 5K, and we have decided to dedicate our race to a very special patient in Guatemala: Billy.

Billy

Billy has Down Syndrome, as well as a serious heart condition. He is scheduled to have heart surgery in Guatemala City this month. We are raising money to fund this desperately-needed surgery. That includes costs for transportation, lodging for his parents, medicine and recovery time for Billy. Medical care for little Billy is going to end up costing somewhere in the neighborhood of $2,000.

Our staff on the ground have dedicated about 30 days in the last 3 months exclusively to Billy’s needs for many trips to doctors, and for medication. With this race, our team hopes raise the funds for a portion of what will be required to continue giving excellent care to Billy. We stand in solidarity with Billy and his family as they deal with these challenging medical problems, supported by Wuqu’ Kawoq | Maya Health Alliance.

And we are excited to watch his new life unfold after he receives this life-saving surgery.  Please consider a donation to help this cause!  We will keep you updated on his progress, so that you can watch his life unfold, too!

Sincerely, Team Billy:  Brad Nelson, Heather Wehr, Kate Moneymaker, Emily Tummons, Brian Longfellow and Emily Bullard.

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August 1 Update: After much struggle to optimize Billy’s nutrition and heart medication regimens, we are happy to say that he is now growing and stable, and ready for surgery. He has now had all of his pre surgical workup and blood work completed, and he has a date for entering the hospital this month. We hope that he will do well with the surgery and will go on to live a healthy and productive life. Billy’s parents are very grateful for all the help with their child who would have died without our intervention and advocacy.

August 20 Update: From our Medical Director:  “Billy was scheduled to have surgery last Thursday, but he had a fever and some viral symptoms, so I canceled the surgery. We hope to try again this week.”

Patient Updates: August 1

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Some very positive developments for our patients!  To continue their support, please click on the patients’ names.   Remember, even $10 can make a big difference in Guatemala!

1. Sulmi and Amada :  These delightful and resilient young women with type 1 diabetes are doing extremely well. Thanks to your funding, we were able to provide them with their own glucometer and blood sugar testing supplies. This allowed us to obtain many blood sugar readings over a period of a few weeks and intensively manage their insulin dosing.  As a result, we were able to get their blood sugar numbers under unusually good control. They are now on adequate doses of insulin, and they are feeling better than they have in years. What we need now is continued support, so we provide uninterrupted services for them. Although WK has many patients on insulin therapy, we have been asking for special support for these two women, because the amount of insulin and the intensity of monitoring that they require is much higher than the typical type 2 diabetic patient that we see. Insulin for these women runs about $1/day.

2. Billy: After much struggle to optimize Billy’s nutrition and heart medication regimens, we are happy to say that he is now growing and stable, and ready for surgery. He has now had all of his pre surgical workup and blood work completed, and he has a date for entering the hospital this month. We hope that he will do well with the surgery and will go on to live a healthy and productive life. Billy’s parents are very grateful for all the help with their child who would have died without our intervention and advocacy.

3. Emily: Is doing amazingly well. She just finished her third round of chemotherapy, which she has tolerated very well. She has regained much of her strength, and all of the swollen glands and other symptoms she had from her lymphoma are completely resolved. We are hoping for a complete recovery!

4. Ashley and Scarlet: This two little girls are doing fine. In particular we are happy with how Scarlet has been doing. With adequate nutritional therapy, provided through the generosity of our donors, she is growing well and is beginning to show some signs of improved neurological development. As we have said before, the condition that these two children have, proprionic acidemia, is extremely rare and it requires a special medical milk product that is not available in Guatemla. In order to keep these children alive and healthy, we need to import the product into Guatemala. This is very expensive, and we rely on your support to make it happen. It is worth it, though, because with this product the children can lead relatively healthy and symptom-free lives! $42 will sponsor one child for an entire month!

5. Maria: This strong woman it tolerating her treatment for cervical cancer very well. The cancer doctors decided that she did not need surgery but rather would do better with a combination of chemotherapy and radiation treatments. She has had two rounds of chemotherapy treatment now, and she is set to begin radiation therapy later in the month. We will keep you posted on how things go!

Chronic Disease Epidemic

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The developing world is experiencing a massive, growing epidemic of noncommunicable diseases, a fact which is still largely overshadowed in the popular media by conversations about infections diseases like HIV, malaria, and tuberculosis. The majority of deaths in the world are caused by noncommunicable diseases, and over 80% of people living with conditions like diabetes or heart disease now live in lower income countries. The World Health Organization predicts that the number of global deaths from these disease will rise 20% over the next decade or so (1).

Developing policies and programs to target noncommunicable diseases is trickier, in some ways, than developing policies or programs for infectious diseases. Mostly this is related to the fact that almost none of the noncommunicable diseases are “curable” in the traditional sense of the word. A condition like diabetes, for example, can be controlled with diet, education, exercise, and medications – but not cured. This means that treating noncommunicable diseases raises all sorts of questions about long-term financial costs, which explains in part why many countries still lack clear policies for tackling these diseases head on.

In Guatemala, where I work with {Wuqu’ Kawoq | Maya Health Alliance}, we’ve been involved in developing programs for rural indigenous patients with type 2 diabetes for about 6 years. Guatemala has followed the global trends towards diabetes prevalence. Recently for example, it was estimated that diabetes affects as many as 14% of the adult female population in the country, which is a rate higher than that in many developed countries (2) Importantly, although we know quite a bit about diabetes in Guatemala’s urban population, we have almost no appreciation of diabetes epidemiology in the country’s rural indigenous population. This is a pressing issue, because the indigenous sector is a majority of the country’s population and because we know that, worldwide, diabetes rates are rising rapidly everywhere—not just in urban areas, but also in rural, agricultural communities. For example, one recent report estimates that the rate of diabetes in rural communities globally has gone up five-fold in the last 25 years (3). In other words, heart disease and diabetes are affecting everyone, everywhere—not just those with the most sedentary lifestyles, or the easiest access to fast food restaurants.

Recently, we finished completing an evaluation of our diabetes programming, complete both with a chart review as well as an ethnographic study of patient perceptions of their condition. One of the major findings of this study was that patients almost universally felt that the major barrier to good health was the cost of diabetic medications and care. Most of our patients self-referred to our clinic after exhausting their financial options in other health care venues. We’ve known this for a while actually, that cost was a major barrier to quality diabetes care, and this was a major reason why we have always provided all necessary medications and testing free of charge.

In fact, we’ve always felt pretty strongly on this point, that medical services should be free of charge. The neoliberal point of view that clients need to “buy-in” by paying nominal fees and that this also contributes to financial sustainability of the project ignores two important facts. First, in an impoverished setting, user fees are never likely to be a meaningful source of revenue, because the price point at which your target population will no longer be able to pay will always be well below the actual cost of the services delivered. If an institution raises its user fees to the level at which they become a significant source of revenue, then they are almost certainly no longer providing services to the poorest members of their target population. Second, the “buy-in” argument ignores the fact that the patient has already “bought-in.” It is not at all atypical for one of our patients to get up at 3 in the morning and spend 3 or 4 hours on a bus to get to the clinic, then spend several hours waiting in line to be seen by a physician, all in all spending $5-8 on food and transportation for the day (which is, in most cases, at least a day’s wages if not more), to say nothing of lost wages (no “sick days” in Guatemala). “User fees” seem to us just to add insult to injury in this scenario.

Anyway, it has been good to hear our clients echoing and reaffirming something that has always been a central belief of ours – in the treatment of chronic noncommunicable disease, cost is the issue. You can’t separate the cost issue for the adherence issue in most cases, because in most cases patients don’t take their medications simply because they can’t afford them.

I’m going to write a few more entries about other aspects of what we have learned about treating diabetes in Guatemala over the next few weeks or so—so stay tuned.

 

 

 

  1. World Health Organization (WHO): Global Status Report on Noncommunicable Diseases 2010: Description of the Global Burden of NCDs, Their Risk Factors and Determinants. Geneva: WHO; 2011.
  2.  Danaei G, Finucane M, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang Y-H, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet2011, 378:31-40.
    1. Hwang CK, Han PV, Zabetian A, Ali MK, Venkat Narayan KM. Rural diabetes prevalence quintuples over twenty-five years in low- and middle-income countries: A systematic review and meta-analysis. Diab Res Clin Pract 2012, doi:10.1016/j.diabres.2011.12.001.

 

Olga’s Story

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Our medical director, Dr. Peter Rohloff recently visited one of our patients who is in the last days of her cancer battle.  His report follows:

Yesterday I had the opportunity to spend a half hour visiting the home of one of our patients, Olga–who is dying of widely metastatic breast cancer.

Olga is in her mid fifties, has lived her entire life in an average-sized Guatemalan town, a few hours west away from Guatemala City down the Pan-American highway. She first noticed a lump in her breast about 5 years ago. She ignored it for several months. When the lump “broke through” the skin and turned into a weeping, non healing ulcer on the side of her breast she got nervous and decided to seek medical attention.

For her first consultation, she saw a local doctor, who told her this was probably breast cancer and recommended that she go to the national cancer hospital. After a few weeks of delays, she finally got an appointment for a breast biopsy, which confirmed the diagnosis of breast cancer. She was told that she would need a mastectomy as well as chemotherapy to treat the tumor. However, the surgeon told her that the hospital was quite full and it would be three or four weeks before surgery could be scheduled. However, he confided, he could perform the surgery tomorrow in his private clinic. He could even take care of the chemotherapy for her, without the need for her to wait in line at the hospital.

Desperate to “get it over with” she agreed. Her mastectomy went off without a hitch and she was halfway through her first round of chemotherapy when the bills started coming in. The cost of the surgery emptied her bank account, and she had no resources left to pay for the chemotherapy. Since becoming ill with the cancer, she had been unable to work.  Furthermore, her marriage had always been relatively unhappy, and her husband had moved away permanently when she became ill. Her children lived far away and tended to side with her husband. Therefore, she decided to suspend treatment. She simply stopped going to appointments and she ignored the bills. She felt well enough, and the mastectomy had healed.

Life continued routinely for 4 years. Then she noticed that the intermittent aching pain over the mastectomy scar that she had had since the surgery was getting gradually worse and more persistent. She also felt “run down” and couldn’t sleep at night. One morning, looking in the mirror, she noticed a small ulcer growing in the scar on her chest.

She panicked, knowing exactly what that small ulcer represented. This is when we met her, because she came to our clinic for a first-time evaluation. Collecting her history, it was fairly obvious that this was likely recurrent local breast cancer and that she needed urgent evaluation to decide what treatments might be available to her. However, it took several months to collect all of the necessary records–biopsy samples, chemotherapy treatment logs–that were filed away in the office of the private clinic where she had initially received treatment. Her outstanding debt complicated obtaining these records considerably, of course, but we were able to resolve that eventually. In the end, she returned once again to the national cancer hospital to begin a course of chemotherapy – now however, just palliative not curative.

After two rounds of palliative chemotherapy, the tumor size had regressed a bit, and Olga was feeling well, with a bit more energy and a bit less pain than usual. Of course, this didn’t last long, three months perhaps. After three months, she began to feel short of breath and her ability to move around without being winded decreased dramatically. We repeated x-rays, which showed that the tumor had invaded through the chest wall into the right lung and was also spreading around the chest to the left side.

At this point, the absentee husband and children reappeared, for the first time in four years, essentially to lecture us about how Olga was “weak in the head” and that we should not, under circumstances, tell her that she was dying–because telling her that she was dying would “kill her”. Meanwhile, bankrupt and without any local support, Olga had moved in to the home of a very distant cousin , who had been providing most of her care. We never saw the family members again.

The tumor has now spread across the chest and invaded into her thorax. Her breathing is labored and rapid. She cannot swallow because the tumor has invaded her esophagus.

When I sat down next to her last night, she reached out and squeezed my hand – almost as if I were the one who needed comforting.

I said, “Olga, this cancer is killing you. You only have a few days left.”  She said, “I’m not afraid to die, I just want a drink of water.”

Then she fell asleep.

Patient Updates

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Here is a report from our Medical Director, Dr. Peter Rohloff on some of our complex patient cases.  In all of these cases, we are still raising funds to cover treatment costs, so please consider clicking the links, and helping out with a small donation!

Sulmi and Amada 

Both of these sisters with type 1 diabetes are now on good insulin regimens. They are having regular checkups with one of our nurses, and we have sent them home with glucose meters. Using these meters they have been able to check their blood sugars very regularly, which has allowed us to more rapidly get them into good control. Both are very motivated, and are very happy to be receiving much needed medications and supplies, which they previously could not afford. We hope that, now that their diabetes is finally under control for the first time since diagnosis 10 years ago, they can get on with their lives! Of course, we will need your ongoing support to be able to continue supplying them with the medicines they need!  Click here to read more about these sisters, and to consider helping!

Billy

It has taken quite a bit of work to get Billy ready for heart surgery. The parents were quite reluctant to have this done, not understanding exactly what it entailed. However, after several meetings with them to explain the procedure and how much healthier Billy will be after it is done, they have agreed. We’ve also had to work on arranging lodging, food, and transportation for the family so that they can stay with Billy while he undergoes surgery and recovers in the city. Finally, we’ve had to work on his heart failure symptoms with medications and his very poor nutritional status. All of those tasks are just about done now, and Billy has his heart surgery date in mid July! We’ll keep you posted on how things go.  Click here to support Billy and his brave parents!

Emily

Emily is doing extraordinarily well! She has now undergone two rounds of chemotherapy for her lymphoma. After the first round, all of the swollen glands that she had disappeared completely. We did have a bit of a scare after the first round of chemotherapy, because with her weakened immune system she caught an infection. However, we were able to catch this quickly and hospitalize her for treatment of the infection. She is in good spirits and looking forward to finishing the next round of chemotherapy.  Click here to help fund Emily’s next round of chemo!

Maria

Maria required additional radiological and pathological studies to define the stage of her cervical cancer. Fortunately, it is a relatively early stage, and she has a good chance with a combination of chemotherapy and radiation therapy. She had her first round of chemotherapy last week, and her first appointment for radiation therapy is in mid July.  Can you help Maria be healthy for her family?

Ashely and Scarlet

Thanks to one of our supportive runners, we were able to raise money to provide Scarlet with the necessary medical milk formula to keep her growing and healthy for the next several months. Her family is extremely grateful for the help! We still need help raising more money so that we can provide the same service to Ashley.  Click here if you can help!  $21 will cover Ashley for a month!

Happy Mother’s Day!

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Thanks for checking in here for an update on our little girl! The video below is the latest update on Deysi! Let us know if you have any questions.

One-year-old Deysi (‘Daisy’) was born with multiple congenital defects including displaced hips and club feet. Her family lives in rural Guatemala and is very poor. Deysi needs multiple surgeries to give her the chance to ever take her first steps.

Fortunately, we provide healthcare services for patients just like Deysi. Our physicians have connections to the broader healthcare community in Guatemala, and will get Daisy the best care available. We will provide all of Deysi’s medical care free of charge, and will accompany her and her mom throughout her entire process.

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Introducing Doctora Waleska

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One of the tenets of our organization is to develop and employ local Guatemalan healthcare workers.  We are incredibly proud to announce that we have added a new doctor to our local staff.  Here is a (translated) note from Dra Waleska:

My full name is Maxbeny Waleska Marlene López Canú, originally from Patzun, Chimaltenango and proudly Kaqchikel. I graduated as a Medical Doctor and Surgeon from the  Universidad Autónoma del Estado de México, and the University of San Carlos de Guatemala.

My work in Mexico and Guatemala has been exclusively in rural clinics for the Coverage Extension Program by the Ministry of Public Health, while also participating in the creation of projects focused on the development of communities in the municipalities Tecpán, Patzún, Santa Apolonia and Patzicía, all in the department of Chimaltenango.

I think in Guatemala, we need many more professionals to be involved with people in rural areas and that true development lies in education and providing all my countrymen with the conditions and the rights to opportunities to succeed as individuals and as people.

Currently I am working with with Wuqu Kawoq bringing education, nutritional supplements and health care to children under two years in communities of Solola and Chimaltenango.

Coins for a Cause GRAND Total…

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The preschool kids at Villa Academy have finished their coin drive – and did they ever do a great job!  They completely funded Juan & Juan’s care, with over $500 to spare.  With the extra money, we will be able to respond quickly to the next child who needs urgent medical care!

The final total was as follows:

You can still help their cause, by clicking here to adding to their total!

An Update on our Nutrition Project

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Our medical director, Peter Rohloff recently returned from Guatemala, and gave us this update on our nutrition program.  To learn more about our work in nutrition, click here.

I just got back from Guatemala two days ago.  I once again had the opportunity to interact with mothers from two of our communities. In both communities, I am happy to report that more than 85% of mothers say their children are readily consuming the Plumpydoz supplement as directed.

Virtually all the mothers have a positive regard for the product, and more than three-quarters say they have noticed improvements in their children’s appetites and energy levels since starting the program. Most importantly, we are also seeing results in terms of growth. For example, in once community, among the children who have been regularly taking the supplements since the program started, the rate of underweight children has dropped by 50% and the rate of stunted children has dropped by 20%.

We are very excited by these excellent preliminary results, which of course would not have been possible without your continuing support! Indeed, we rely almost exclusively on recurring donations from individuals like yourself to keep projects like this one afloat.

I invite you to share in the excitement by taking taking a look at some of the photos and videos of these programs that we have recently uploaded. For example check out this video as well as many others on our Youtube channel. Similarly, this photo set on Facebook has several new pictures from our nutritional program site visits.

As always, I welcome your direct personal input or comments:  you can email me at any time at peter@mayahealth.org.

Learning to Count in Kaqchikel

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We visited the kids at Villa Academy today.  In addition to presenting us with a $466 worth of coins for Juan and Juan, they also had a little Kaqchikel lesson with our medical director, Peter Rohloff!

 

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Update from our Medical Director – March, 2012

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I am writing you again from Guatemala, where I have spent the last several days visiting our projects. This is just a short update, whose purpose is mostly to post a few pictures of our staff hard at work!

In most of the updates we have made to this project so far we have talked about the needs of the children we are serving and about the nutritional product, Plumpydoz, that we are using. However, I wanted to take a moment to celebrate the hard work of our staff, whose compassion, commitment, and dedication make our programs a success.

Community based nutritional programs like ours require multiple levels of staff in order to run smoothly. At the most local level, we work with women’s cooperatives, who coordinate most of the program logistics, such as distributing nutritional products and medications, measuring children’s heights and weights, and noting down data in medical records. These women’s groups are closely supported by our nursing staff, who help with triaging patients and who also lead educational sessions about nutrition and other health topics.

In the first picture, you can see Cristalina, one of our community leaders hard at work; she has just finished weighing and measuring children and she is recording their data for the medical team to review. In the second picture, you can see Herlinda, one of our nurses, together with Carolina, another community leader; they are just about to take off to make some house calls on some of our most malnourished children.

Finally, all children in our programs receive medical attention directly from our physician staff. This is done collaboratively with our nursing staff and with the community leaders, who always know the child’s individual situation very well and provide expert advice on how to achieve our nutritional goals for each child. In the final picture, you can see our nurse Herlinda together with Dr. Cesar and myself carefully reviewing the growth of a particularly complicated case, trying to figure out how best to help the child out.

Thanks for listening!

New Directions – Better Patient Care Through Research

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The following is an excerpt from the Wuqu’ Kawoq | Maya Health Alliance 2011 Annual Report. To read more about our projects, click here.

In order to make sustainable improve­ments in community healthcare we must do more than just simply treat patients. Careful research is required to identify the true causes of health deficits and the most effective ways to make a real, lasting difference. This is par­ticularly true when it comes to chronic diseas­es like diabetes or malnutrition, two of WK’s main areas of focus.

This year we published a paper on breastfeed­ing habits, completed a pilot study for using the micronutrient powder Chispitas to fight iron deficiency and anemia in Guatemala, and sponsored the ‘Collective Futures’ conference, a meeting that focuses on converting research results into effective development solutions for Guatemala.

We have also begun working with the INCAP Chronic Disease Division to further address the issue of diabetes. Diabetes is a prevalent health issue amongst the rural poor in Guate­mala since its chronic nature requires ongoing treatment for a population with little access to health care. In our partnership with INCAP, we explore the most effective ways to deliver high-quality care to rural diabetic patients.

We have also begun consolidating our evi­dence on the use of new nutritional supple­ments like Plumpy’doz® and Nutributter® in the treatment of childhood malnutrition. At the end of 2011, we completed a midpoint survey of caregivers, which demonstrated their overall satisfaction with these products, but also showed us areas where our educational programming needs improvement. In 2012, funding from USAID will allow us to apply these findings to some 5,000 new children. We anticipate that the data from this initia­tive will be compelling enough to influence the way other nonprofits and governmental programs approach nutrition.

How to Make Milk Carton Coin Collectors

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The Villa Academy preschoolers are doing a great job collecting coins to help Juan & Juan get better!  Click here to read about and support their project!

Told hold their coins, they are using homemade coin banks.  In case you would like to create your own project to support a patient, I thought I would share the process to make the banks.  If you would like a patient for your family or group to sponsor, please email contact@mayahealth.org (or click on Contact Us in the top menu).  For general sticker templates, see the end of this post.

 

Click on the link to download templates for milk carton stickers:

Tikal (2″ x 4″ stickers – fits on the back of the carton).  This template works with Office Depot 2″ x 4″ shipping labels (or Avery #8163)

Toucan, Howler Monkey, Jaguar, Quetzal (the national bird) or the Guatemalan flag.  These templates work with 3M #4200M, 1 1/2″ diameter round labels (or Avery #8293).

Electronic Medical Records – Improving Data Management

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The following is an excerpt from the Wuqu’ Kawoq | Maya Health Alliance 2011 Annual Report. To read more about our projects, click here

This year we began using a powerful new tool for primary care, called OpenMRS. This free, open-source electronic medical records system can be tailored to fit specific needs. OpenMRS has already been widely used in many other developing countries for a diverse range of applications. However, it has never been used in Guatemala.

Using an electronic medical record like OpenMRS means that we can better track patient care. It also gives us tools to more accurately identify health trends and statistics, and it increases our ability to collaborate with other institutions through the sharing of medical data. We installed OpenMRS this year, and have since embarked on an extensive training process for our staff. We are happy to report that all of our providers and program managers are now using OpenMRS directly to enter patient data. We now have more than 3,000 of our patients entered in the system, and we are adding more every day.

Currently we are exploring collaborations with other members of the OpenMRS community to make the system even better suited for work in Guatemala. These will include ways to alert patients about their upcoming appointments by cell phone, and a more robust system for tracking data associated with some of our largest programs, such as our child malnutrition program. Our vision is to have an easy-to-use system that can be implemented widely in Guatemala.

For more information about OpenMRS, visit their website.

Chispitas – Treating Anemia in Children

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The following is an excerpt from the Wuqu’ Kawoq | Maya Health Alliance 2011 Annual Report.   To read more about our projects, click here.

Anemia is one of the major contributors to poor child growth and development in communities where we work and can affect up to 75 percent of children under the age of five. In 2010 we set out to reduce rates of anemia in our communities using a product called Chispitas or “Sprinkles”.   Sprinkles are a flavorless, odorless, white powder iron supplement that can be added to food or beverages each day.

We started pilot programs in two different communities where local health organizers were educated about the causes of anemia and how to administer Sprinkles as a treatment.  Results from these pilot studies have been very encouraging. In one of the communities, we reduced the rate of anemia by 50 percent and, in the other, by an astonishing 80 percent in just six months.

Based on these preliminary findings, in late 2010, we began using Sprinkles more widely in our programs, with the goal of reducing the burden of anemia throughout all the communities where we work. Parents continue to be happy about the quality of the product, and they report sustained improvements in the health of their children due to its use.

Nutributter Arrives

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Several weeks ago, our giant shipment of Nutributter arrived in Guatemala.  We thought you might like to see what it looks like to transfer 38 tons of it across Guatemala!  To check out our kick-off meeting, click here.  To learn more about lipid based nutritional supplements, click here.

 

Thoughts on Dietary Diversity, Junk Food, and Child Nutrition

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Lately, I’ve been giving a lot of talks about child malnutrition. In large part, this is because we have been working on a project to deliver Nutributter, a lipid based nutrient supplement, to children less than two years of age across a good-sized geographic chunk of Guatemala. Simultaneously, we’ve been using Plumpy’doz, another lipid based nutrient supplement, in more intensive community-based nutrition venues. In short, we have been doing a lot of talking up these new products, as well as continuing to raise awareness about chronic child malnutrition in general to other development and policy groups. When I give these talks, there are two questions that almost always come up, and so I’d like to take a few minutes to address them here in this forum.

The first question goes something like this: “Although nutrition programming and supplementation is important, isn’t the real problem in indigenous communities that they all have access to junk food now?” “Isn’t processed food displacing traditional dietary substances, resulting in diets that are less healthy and predisposing to more malnutrition?”

The short answer to this question is, “No” – or, at least “No, probably not.”…read more.

Lipid Based Nutrient Supplements (i.e. “Nutributter”)

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Lipid based nutrient supplements (LNS) are perhaps one of the most exciting, and potentially transformational emerging technologies for the treatment of chronic malnutrition. LNS preparations are called ‘lipid-based’ because, unlike older nutritional formulations, they derive a much larger percentage of their calories from fats (typically from peanuts, milk, and vegetable oils). They also generally contain a full complement of vitamins and micro nutrients. Because they are fat-based, these micronutrients may be more easily absorbed by the body (they are not bound up by plant phytates which are abundant in grain-based nutritional supplements). They also provide essential fatty acids, whose importance for promoting healthy growth and brain development is more and more appreciated today.

Most people have heard of at least one type of LNS product, Plumpydoz®, which has revolutionized the treatment of severe acute malnutrition in many countries throughout the world. Plumpydoz® is classified as a therapeutic food, meaning that it is extremely dense in calories and is essentially meant to be used in a situation where aggressive ‘refeeding’ is necessary. Since the product has a long shelf life, does not require mixing or cooking, and is tasty, it has produced a paradigm shift in the treatment of severe malnutrition. Previously, most cases of severe malnutrition needed to be hospitalized, often simply because the mixing and preparation of re-feeding solutions was complex and required special tools and training. Plumpydoz® simplifies this process, which means that re-feeding can happen in the home and in rural communities.

What many people do not know, however…read more.

Cancer Treatment in Guatemala

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Collectively, I think we all have a common misperception of health and disease in developing countries. In particular, we tend to think of developing countries as places riddled by infectious disease like malaria, HIV, and tuberculosis.  Of course, these conditions and others like them are indeed very serious problems for many countries.

However, all developing countries are also experiencing growing burdens of what we in the medical profession call “noncommunicable diseases” (NCDs). NCDs are conditions like asthma, heart disease, diabetes, and cancer. Most of us think of these conditions as disease which affect primarily ‘richer’ countries, but this is not at all the case. For example, more than 60% of all deaths in the world last year were due to NCDs, and of those deaths more than 80% of them occurred in ‘poor’ countries. Of the 350 million people in the world who have diabetes, 280 million of them live in ‘poor’ countries. 70% of all deaths from cancer occur in ‘poor’ countries.

Combating NCDs in developing countries like Guatemala is difficult. Unlike most infectious diseases, it is not enough to provide a cocktail of medications to kill off or control the infection. Think about diabetes for example. Effectively treating diabetes requires intensive laboratory tests, nutrition counseling, regular medical checkups, and treatment of a whole host of complications that arise over the course of the patient’s life (blindness, kidney failure, foot ulcers, heart attacks, and the like). Or think about cancer: surgically removing a tumor is not usually enough; the patient also usually requires extremely toxic combinations of chemotherapy medications (which have severe side effects and are very expensive) as well as access to radiation therapy, pain medications, and hospice care (in cases that cannot be cured). Care of NCDs, in other words, strains the medical system to its breaking point in a setting where resources like specialist doctors and medications are already strained beyond comprehension. It also requires a degree of coordination that the health care system often cannot handle. For example, in Guatemala, it is not uncommon for more than 50% of all patients with cancer never to go back for their second appointment with the cancer doctor. There are financial considerations obviously that affect this number, but there are also the issues of fear of the medical system, lack of trust in physicians in general, and lack of an advocate who helps the patient negotiate the system and decide what treatments are best for them.

Over the last several years, Wuqu’ Kawoq | Maya Health Alliance has been focusing more and more on coordinating care for NCDs, and we have updated you periodically about our successes and failures in this area. In 2011, we had an unusually high number of cancer cases, and I wanted to take this opportunity to describe to you a few of these cases so that you can all appreciate the complexities and the soul-searching questions that arise in this context.

In the spring, we encountered a case of a young man with a rapidly growing tumor in the neck. The tumor made it difficult for him to breath and eat. Because we were concerned that he was running out of time, we hospitalized him to facilitate workup and treatment. A biopsy was performed, but the results were equivocal. It turned out that this was a rare form of a relatively undifferentiated tumor, and none of us had any experience with it, nor did any of our cancer colleagues in Guatemala. The tumor was extremely malignant and rapidly growing, and there were several weeks of delays in starting treatment as we tried to figure out what was going on and how best to treat it. The man was eventually started on a combination of chemotherapy and radiation, but these only extended his life a few months. He died in the hospital, surrounded by family members and our staff. Could we have sped up the diagnostic process? Would doing so have made a major difference? Should we have counseled the family to end (relatively futile) treatment earlier, so that the man could have died in the comfort of his own home?

This summer, we had a 40 year old woman who came to our central clinic with complaints of vaginal bleeding. Upon performing the vaginal exam, I immediately knew there was a major problem; the woman had a huge tumor growing off of the cervix, entirely filling the vagina. We performed a CT scan which showed invasive cervical cancer spreading up into her pelvis, invading the ovaries and other organs on both sides. Advanced cervical cancer is one of the most incurable of cancers, even in the United States with the best-possible care. We explained this to the patient, suggesting that we focus on palliative and hospice care including radiation therapy. However, obviously in despair over the diagnosis, the patient got a second opinion from a private surgeon (not a cancer doctor) who suggested to her that she should be operated on. He performed a surgical debunking of the tumor, and the family took out a bank loan to pay for the procedure. She died from complications of the surgery. How do we improve our process of guiding patients through a terminal diagnosis? How do we ‘protect’ patients and their families from bankrupting themselves in consultation with for-profit opportunistic medical practices?

Not all the cases have such bad outcome. For example, we currently have a 30 year old woman with a metastatic fibrosarcoma. This began as a tumor on her foot which she neglected (for fear, and also for lack of financial resources) but eventually spread to her lungs. The tumor has been removed surgically, and she has now completed 6 rounds of chemotherapy for the lung metastasis. She is doing well, and all of the lung tumors have gone away. Is she cured? Probably not. The lung tumors have a high likelihood of coming back at some point, or cropping up somewhere else in her body. However, she did well with the chemotherapy, she is in good spirits, and the treatment has unequivocally prolonged her life, potentially for some years to come. Going forward, however, how do we continue to provide support and guidance? How do we help this woman, with little previous exposure to the health care system, negotiate for herself the concept of ‘remission’ (as opposed to cure)?

This is a learning process for us all, and we any thoughts and insights from all of you.

Treating Diabetes

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As you know, for a number of years now we have focused on educational initiatives for our diabetic patients, coupled with intensive glucose-lowering strategies. One of the most rewarding parts of this initiative has been using glycosylated hemoglobin testing (“A1C” testing) to give us a better sense of how are patients are doing and how their medications should be adjusted. Using A1C as a target for treatment, about 50% of our patients now achieve a level of glucose control that we think is “excellent”, with another 25% achieving acceptable control (of course, with the other 25% still needing some work!)

Now, in the last few months, we have been working to identify other areas where we can improve care for our diabetic patients. For example, since people with diabetes have a higher-than-average risk of heart disease, blood pressure control is very important. Although we have always treated high blood pressure in our diabetics, we are now being more aggressive in treating patients with more borderline high blood pressure readings, to reduce their risk of complications even further. This has been very successful, with more than 75% of our diabetics now reaching our goal for blood pressure control…read more.

USAID / Nutributter Rollout

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Enjoy some photos from our kick-off meeting for the Nutributter project, which will reach 5,000 kids in 90+ communities around the Lake region. Stay tuned for more updates as the project progresses.