Matriciamento (pronounced ma-tri-see-ah-men-to). This word stuck out to me in the several conversations Nikhil and I had with the medical staff at the Ambulátorio Médico de Especialidades (AME). AME is a hospital of specialist doctors who only treat patients referred to them by the patients’ regional health clinic. The idea of many, widely spread out primary care units feeding complicated cases to one central location sounds great, but becomes quite messy in practice. AME is having difficulty seeing all the patients referred to them in a timely manner, so they are working with the referring health units to ensure only the patients that truly need more specialized care are sent to AME. This is where our new friend Matriciamento comes in. Matriciamento (for which I have yet to find a cohesive definition) is an initiative to strengthen the ties and communication between primary and secondary health units and revitalize the population’s connection with their regional, primary care centers.
We were meeting with our friends, Dr. Guilherme and the pharmacist Nathalia, at AME to discuss Diabetic Day, one of the manifestations of the Matriciamento project. Type II Diabetes is a widespread problem in Brazil which is ranked 4th among countries with highest rates (De Almeida-Pititto). AME decided to focus on the treatment of this specific patient population within the healthcare network to implement Matriciamento’s goals. Diabetic Day first consists of AME training the medical staff of a primary care unit of a small city in the region. Then 100 diabetic patients that had been recently referred to AME were instead invited to receive their doctor consultation at their local health clinic with both the local and AME doctors present. Additionally, the patients would go through pre- and post-consultation orientations with pharmacists and nutritionists to discuss the medication and dieting aspects of diabetes.
On July 22nd we were going to have the opportunity to participate in one of these days in the city of Terra Roxa (direct translation: Purple Land). Although being able to see and experience a piece of Matriciamento instead of just trying to google a definition is a huge reason for my excitement, what I am most looking forward to is being able to see the diabetic foot model in action! In my first post, I was still painting toes and during week 4 here in Brazil, I will be able to see how patients react and learn from this educational intervention tool. I think the only people more excited than I am have to be Dr. Guilherme and Nathalia.
The foot mounted on our display… Note the toe wound progression!
Currently, Nathalia uses conversation maps to visually guide diabetic patients through their disease. They are actually pretty elaborate, eye-catching and in conjunction with some narration by Nathalia or a trained nurse, very simply explain diabetes. She was excited to allow patients to see a realistic model of how bad things can get from not caring for one little cut. Communicating this to patients renders the depiction of the progression of wounds a very important and useful part of the model.
One of Nathalia’s conversation maps about diabetic foot care
I suppose it is no coincidence that the other technology we brought from Rice was also envisioned as a tool to help diabetic patients. A Rice engineering design team developed DoseRight clips to ensure patients and caregivers can accurately dose liquid medication. The doctors at AME were instantly fascinated by the idea applied to insulin dosing. They explained that they do many things to ensure patients can treat themselves safely at home, but insulin dosing is one of the things they cannot regulate.
BD 5mL syringe with a 2mL DoseRight clip
Because DoseRight is currently only able to fit in 5mL syringes, the design would need to be modified. Every part of my engineering self wants to sit down, design out the modifications, have it 3D printed and shipped to us in Brazil. Sadly my engineering self also knows better than to discard the value of the complete design process and its potential to come up with an even better solution. Instead of designing, I will focus on collecting information about the types of syringes in use, how patients describe their dosing, and all the facts needed to develop a solution that best fits the problems at hand and the context in which it is found. Here is to Diabetes Day, finding definitions and further defining problems.
Work Cited
De Almeida-Pititto, Bianca et al. “Type 2 Diabetes in Brazil: Epidemiology and Management.” Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 8 (2015): 17–28. PMC. Web. 30 June 2016.