EMORY University School of Medicine is providing an educational session in SPANISH for the multitudes of Health Care Providers in Latin America about OBESITY.
I listened to it today as my friend from Panama, Dr. Abouganem was one of the speakers.
All over the world, the rate of obesity is increasing. Instead of looking at the root causes of OBESITY, many of the workers have MEDICALIZED the phenomenon into a DISEASE and trying to treat each and every one of the complications.
The fact that this method of mediclization has failed is evident in the results.
Despite the number of Doctors and para medical and auxillay people devoting their professional efforts at this medicalized view, the RATES OF OBESITY AND DIABETES continued to CLIMB. Not a single state in the USA has lost collective weight or average weight or median weight since 1980!
We are obviously barking at the wrong tree..
Even if they medical establishment is compartmentalising the outcomes and treating them with medications, the outcomes and the results are not encouraging. The control of Diabetes continues to be poor, ALL ACROSS THE WORLD.
The BEST RESULTS that I have seen is among the slum dwellers of Cambodia where a non-medical PEER EDUCATOR helps people combat with the disease and illness. The programme is run by an NGO MoPoTsyo.org and its energetic director, Maurits van Pelt, is a lawyer by training with experience with Medicins Sans Frontieres and a lifelong commitment to Humanitarian Medicine.
A recent article by Rao (and her colleagues at UWashington at Seattle) at PLOS One,
Utilization of diabetes management health care services and its association with glycemic control among patients participating in a peer educator-based program in Cambodia
had these conclusions:
This study demonstrates a positive association between peer educator utilization and glycemic control incremental to other elements of diabetes management. These results suggest that peer educators may be a valuable addition to comprehensive diabetes management programs in low- and middle-income countries even when other health care services are accessible.
Another observation stands out and I can collaborate that since I have been associated with the programme in the capacity as a friend of Maurits.
Number of physician consultations was not associated with glycemic control after adjustment.
As my friend, Daniel Abouganem MD from Panama said in his talk: Somos pocos, we endocrinologists are very few. Most of the places that I visit as part of my humanitarian medical efforts have never had an Endocrinologist and no serious interest in Diabetes, I can think of Leticia in Colombia where I go to visit Ticuna Indians upstream Amazon River.
In the USA, every single Primary Care Provider, every single paramedical person, Nurse Practitioner and Physician Assistant (these two class of workers do not exist in most countries) think they can manage Type 2 Diabetes and Obesity.
As Daniel said: we should educate the people who are at the end of medicalizing this epidemic or attending to just one aspect of this Illness/Disease/Dysfunction process which has deep social roots.
I admire this MoPoTsyo concept of Peer Educator where a non-medical person with knowledge of Diabetes enables the patient to cope with the Illness while coping with poverty, crowded slums and medications (the last time I met Maurits, we calculated the entire expense for ONE year of Peer Education, medications, occasional lab tests including A1C, PER PATIENT, could be brought down to 110 USD ... ). In a poor country like Cambodia, where the salaries of workers hover around 150-200 dollars a month, this lay out is well within their budgets and Maurits does not have to go begging money in European capitals.
When I try to bring this concept to other developing countries, let alone affluent countries, there is tremendous opposition from the Medical and Nursing professions.
Now working with two excellent professionals of Native descent, I realize that in the affluent society, the concept of Peer Educator of Maurits is the concern my two colleagues show. Their objectives are qualitative and not quantitative. The minute you begin to pay attention to the number of patients you see rather than the quality of human touch you imparte, your role as a healer vanishes. You have just become a technician, albeit a good one. and a well paid one.
I still remember very clearly, one of my first visits to an Indian Reservation, and discussing the possibilities of Diabetes Prevention. Of course the discourse was strictly on technical terms: low fat food, more exercise, such as is continued to this day. An elderly Lakota man got up and said: Outsiders think Diabetes and Alcoholism are our main problems, but for us, the main problem is lack of employment. Give us jobs and you would see how quickly Diabetes and alcoholism disappears. At that time, I was also working with Alabama-Coushatta tribe of Texas, an anomalous cultural entity in that, they are deeply Presbyterian but they never lost their language. Also they had one of the highest rates of employment among the Indian tribes and one of the lowest rates of alcoholism. The connection did not go unnoticed by me but to this day, the linear thinking of the western mind, look for cause and effect, and expect correction of deficits and deficiencies, with money put into mechanical projects which produces very little result.
Doctors see the DIsease and look at the organs and numbers and Peer Educators see the patient ..
Let us take our eyes off from the sterile visions of epidemiology and smell the accoutrements of the society they bring with them...
A disease which is SOCIAL in nature, needs a SOCIAL solution.
Thank you , Daniel in Panama and Maurits in Phnom Penh, nice to have you as friends.
The appropriate name for the Peer to Peer Educator in the West would be LIFESTYLE GUIDE..
