Over the last week, we've been working on a “proyecto” (project) that we created to help improve the management of four major chronic illnesses that is commonly seen in the clinic such as diabetes, hypertension, obesity and asthma. Our group was asked to develop a plan during which we would produce a volunteer handbook that would help guide future volunteers in managing these illnesses when they come through the door.
For each of the chronic illnesses, we provided basic disease pathophysiology and specific socio-cultural-economic factors that are unique to the patient population here in Alajuelita that further complicates chronic disease management that goes beyond access to resources and medical attention. Next, we created step-by-step instructions on how patients with know history of chronic disease or demonstrate risk factors that would indicate screening and identify scenarios in which the physician or clinical staff should be notified emergently i.e. a child struggling to talk in full sentences during an acute asthma exacerbation or an adult having a blood pressure above 180/110. Our goals for these step-by-step instructions is to help streamline patient check in, provide appropriate medical care (urgent in certain cases) and allow time for health promotion and education. This leads us to the other component of our project, and arguably the most important component: health education and disease prevention. Through health education and empowering patients to take ownership of their own medical care, we hope that this would translate into creating long lasting change in people’s lifestyle habits, behaviors that would ultimately lead to better physical and mental well being.
Our completed binder!
Our focus for health education was primarily based upon providing basic medical knowledge that would be comprehensible at the population's general level of education (often is limited to grade school), discuss about risk factors for developing these chronic illnesses (tailoring these to the environmental/social/cultural practices that may contribute as a risk). We also wanted to focus on the importance of disease prevention and provide patients with tangible ways to prevent or control their chronic illnesses.
This portion actually required a lot of thought and insight into the living circumstances of the patients that we see in clinic. Having lived and worked in this community for an extended period of time, we gained an understanding of the limitations of treatment of these diseases necessary to give realistic advice and guidance. While we can argue that hypertension is shown to be most effective controlled by at least 2 anti-hypertensives, the reality is within our clinic that is situated in the slums of Alajuelita is that this treatment method is close to impossible to sustain over time due to limited resources. Instead, we tried tailored our treatment through non-pharmacological methods such as encouraging a low sodium high fruits and vegetable diet, 20-30 min of exercise on most days of the week, weight control etc. As this is our last week in Costa Rica, we also started brainstorming ideas for how to best disseminate health education, through activities that would cater to the local community. We discussed about hosting cooking classes during which patients can swap recipes and learn about healthy eating, exercise classes with yoga or simple exercise that patients can replicate at home or going into the schools to talk about asthma and incorporate the use of games and interactive workbooks. Our hope is that future volunteers can use this binder to identify patients with chronic diseases and use the educational materials that we made to educate patients on their disease, prevention, and treatment that is catered to unique challenges this population faces. We hope that the program is sustainable and will eventually help patients better control their chronic diseases in ways that make sense to them. We are planning to work with FIMRC to send some of this information to volunteers before they arrive in Costa Rica so they can jump right in and educate patients on day 1 and perhaps even use our posters and other educational materials to hold a charla (lecture) or a support group meeting!
Our patient learning about diabetes complications from Diego, diabetes man!
Serena giving a diabetes charla with brochures she made for future volunteers to distribute!
Too cute not to share! These kids were so interested in learning about how to use my stethoscope... he even asked me to turn around and breath so he could hear my lungs like I did to him!
For our last weekend, we were able to enjoy the beautiful coastal city of Montezuma and Santa Teresa with our adopted group member Luke and captured some of the most beautiful sunsets over the Pacific Ocean! We also visited Montezuma Falls, which consists of three sets of waterfalls emptying into freshwater swimming holes, one of which even had a rope swing!
Montezuma Falls
Playa del Carmen
Beautiful sunrise!
It has been such a pleasure to have had the opportunity to work with the clinic staff and the patients here FIMRC Alajuelita. We are grateful for the help and guidance that we received from Tatiana, Dayon and Dr. Natalia during our time here. It has truly been a once in a lifetime experience and we have all learned so much about the practice of medicine in Costa Rica, international medicine, public health, and the beautiful language, culture and people of Costa Rica. Thank you so much for all your support and for following our blog!! Muchas Gracias y Ciao from Costa Rica Team 2015 “Las Chicas”!! Ya Vengo, which means be back soon!
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