The Chronic Care Program
Diabetes and hypertension are foremost health concerns in Bolivia, particularly in the department of Santa Cruz where Centro Medico is located. A striking 11% of the local population has diabetes compared to 8% of the population in US. 22% of the local population have high blood pressure. Centro Medico is trying to address this problem through our Diabetes and Hypertension Chronic Care Program.
Diabetes and hypertension are serious, chronic diseases that need constant maintenance. Poorly managed diabetes can lead to strokes, blindness, heart disease, kidney failure, foot amputations and nerve damage. Untreated hypertension puts patients at risk for heart attacks, strokes, and atherosclerosis. We are very aware of these problems and follow our diabetic and hypertensive patients every month to promote medication and lifestyle compliance. We also have our health promoters out in the communities regularly checking patient's blood sugars and pressures to help promote good control.
Unfortunately, many of the local villagers do not manage their diabetes or hypertension on a consistent and long-term basis. Villagers have undergone foot amputations, lost their sight and suffered heart attacks and strokes. Due to extreme poverty, poor diet and lack of health education, the morbidity of diabetes and hypertension among the local rural population is increasing. Families commonly live at a subsistence level with an average income of around $40 per month, and the typical diet consists of low-cost foods that are energy-dense but nutrient-poor. In addition, many patients suffering from diabetes or hypertension know little about their diseases and often believe that they can be cured with a single trip to the doctor or dose of medicine. As clinic founder, Dr. Susan Hou, says, 'We have found that people don't understand what it means to have a chronic disease. They tend to have very short-term concerns that make it difficult to think long-term.'
To address the growing prevalence of diabetes and hypertension and the resulting medical complications, Centro Medico implemented the Diabetes and Hypertension Chronic Care Program Pilot Program in July 2005. Now, three of the twelve Centro Medico communities have community-based support groups that emphasize self-monitoring of blood glucose and pressure, a healthy lifestyle, adherence to medication when applicable, and provide professional and peer support to participants.
The program has been very successful in improving health and is currently expanding to other local communities.