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Third World Diabetes Care

Feb 26, 2013

I’m writing this from a cheap plastic chair while viewing a mountain village in Honduras.  Today I checked blood pressures on over 275 people and checked blood sugars on over 150. The lines were long, seeing over 550 patients today as part of a medical team of 5 physicians, 1 dentist, 5 nurses, 1 pharmacist, Red Cross volunteers, interpreters from Honduras, and various other support staff.  The office is complete with a wooden bench and table, piece of paper and pen, glucometer, and blood pressure cuff.  The drugs are simplified. The dentistry includes only removing offending teeth.   Everyone walks to the clinic, not one car arrives.  There is one piece of paper as the record.  This is medicine in its simplest form.

Today, there was NOT ONE case of type 2 diabetes and hypertension was infrequent.  This is in contrast to a village on the coast that we visited last week where diabetes was present in approximately 6-8 percent of all the patients, where some patients arrived with BG values between 350 and 600mg/dl or higher; and to the city where diabetes and hypertension were even more prevalent.

So of course, in my non-scientific study, I was intrigued at the contrast.  In the village by the sea, the primary diet was of fresh fish, plantain, rice, beans, bananas, avocados, and corn or flour tortillas.  Many people walked to the clinic. Being overweight was common, but obesity was nonexistent.  Fresh vegetables were minimal, and fruit was not in season at this time (much will be ripe in August). Little stores that sell sugary foods and beverages frequently dot the landscape. In the mountain village, the food supply is rice, beans and corn.  They also have greens and peppers (sweet and hot).  Chickens and turkeys roam everywhere.  There is a small shack which has soda pop and candy.  The people are thin, but do not appear visibly malnourished, and few cars are evident.  Some of the boys rode their old, rusty bikes to clinic.  There are narrow dirt paths to each hut. People work in the fields or the coffee plantations. 

Perhaps, the daily exercise routine and the lack of surplus food are the answers to the lack of diabetes and hypertension.  Or perhaps, it is due to the few older people that were apparent in the village.  But it was a strong contrast within a homogeneous population in which lifestyles are different (though not vastly so). 

I will return to the US on Friday, wishing I had less documentation to do and could talk to patients without a computer in hand. However, I am grateful that we have the variety of medications available to treat patients, glucose strips to make sure the medication is working and refrigeration to keep medications, such as insulin, safe and potent.   Going to a  third world country is a reality check that reaffirms how “spoiled” we are, and how grateful we should be for medical care in the US.  But, also a dose of reality on how exercise and eating simply can reduce our risks of developing type 2 diabetes.  If you have had the opportunity to visit a third world country, share your experiences with us!  And if not, I suggest you all include it on your bucket list, at least once-in-a-lifetime.

4 comments

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  1. Mar 26, 2013

    Thanks for sharing. We are truely blessed here in the states. Less sometimes can be more.
  2. Mar 07, 2013

    Thank you for this wonderful post Carla (and for your service!). What a great reminder of the wide variations in medical care, and the cultural and and community factors influencing diabetes risk. Hope you had a safe return home.
  3. Mar 06, 2013

    Carla, thank you for sharing! Can you recommend any organizations for an RD,CDE who is interested in serving (short term) in third world countries?
  4. Mar 05, 2013

    Carla! What a wonderful "time out!" I returned 1 year ago today from Guyana, South America after a 2 year service in the Peace Corps. I did a lot with diabetes education and self-management while there. On the coast, I believe something like 11-13% had DM2 and another 12-14% were considered "pre-diabetic." Our clinics often didn't have enough strips to even test BG on patients coming in concerned about their BG, only recieved a couple of minutes with a physician, and generally had very little idea WHAT diabetes was. Another Volunteer and I created a 15 week course which we facilitated with several groups of people about diabetes pathophysiology, medications, complications, self-management techniques, how to navigate their own healthcare system to get the care they needed... all based on availability of resources in the area. It was hugely rewarding and challenging! I think many of the participants knew more about their condition than their healthcare providers by the time they were done with the course! Definitely reminds us how fortunate we are in the States! ...also, opens the eyes to the detriments that diabetes will have on the rest of the world- especially in places where they do not even have the most basic healthcare resources.

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