Guatemala Health Initiative: Health related research in the Guatemalan Western Highlands

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Faculty

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Medicine

Project Summary

Over the summer, I worked on a research project for Hospitalito Atitlán in Santiago Atitlán, Guatemala. The project was to evaluate the effectiveness of a community health intervention for diabetes, called Manejando la Diabetes en el Departamento de Sololá. This program started as a pilot project in 2012 and has since expanded to serve more of the department of Sololá, where Santiago Atitlán is located. One component of this program consists of diabetes clubs, where participants receive screenings, medications, and information about how to manage their diabetes, all for free. The aim of this summer’s work was to evaluate the extent to which the clubs provide standardized care to Sololá’s diabetic population and the extent to which the clubs help participants control their diabetes. Because this project involved evaluating clubs throughout Sololá, my research partner and I got to travel frequently, which was both a blessing and a curse. It was a blessing because we got to explore some of the most beautiful places we had ever seen and meet interesting people along the way. It was a curse because we were constantly adjusting to new places and had to plan several steps ahead all the time. However, these challenges were fantastic learning opportunities. My partner and I got much better at getting around places we had never been, we got very good at asking for directions, and we became expert planners, always prepared for whatever the day might throw our way. And, we did all of this in Spanish. Through our research, we found that there is significant heterogeneity in the care provided by clubs; we found that patients reported financial difficulty with managing their condition while some providers reported that patients do not always prioritize their healthcare expenses; we found that men are underrepresented in the clubs; and we found that measuring blood glucose monthly does not inform type 2 diabetes control. We came to the first three conclusions quickly after analyzing our data. However, to arrive at the last conclusion, we stared for hours at a graph of our blood glucose data, which turned out to be meaningless. The graph does not show any patterns and cannot be used to determine whether patients have their diabetes under control. Instead, we recommended that the program measure HbA1C, which is the percentage of hemoglobin in the blood that has been damaged by glucose. Unlike blood glucose--which, even for a healthy person, varies widely during the day--HbA1C is stable and does not require patients to fast for an accurate measurement. Also, the damaged hemoglobin is what causes harm to the organs and tissues of diabetic patients, so by measuring it directly, we get a clearer picture of the patient’s health and what treatment they need to be as healthy as possible. Ultimately, we learned that health and healthcare cannot be defined absolutely--using strict measurements, defined by a culture of science and a tradition of research--but must take into account the needs, desires, and culture of the patients receiving help.