On June 22^nd, the day began early… like 5am early. Today was Dia Diabetica (Diabetes Day) and me, Nikhil, many pharmacy and nutrition students and a team of AME doctors, nurses and pharmacists had to be in the small town of Terra Roxa by seven in the morning. With diabetic foot model in hand, we arrived bright and early to one of the local, primary health clinics, which was already packed with the day’s patients.

In the waiting room, decoration took the form of a small diabetes information wall, with a description of the disease, its types and its symptoms.

Nikhil and I had already heard a lot about the diabetes situation in Brazil and here is what I came in today knowing…

1. Brazilian people love their sweets so to many diabetes seems like a curse
2. Insulin is often ill-viewed by many in the diabetic population as it is associated with loss of hope
3. Few people understand the serious complications (such as not coagulating well, retinopathy and neuropathy) associated with the disease when not managed well

After almost a month here in Brazil, we have experienced small things that may validate the aforementioned points. For example, coffee with sugar truly does mean coffee WITH sugar, no jokes, no holding back. However hearing all these things and having super sweet coffee is very different than spending a whole day with the diabetic population of Brazil, and we were very excited to see how it all played out.

If you are interested, in my past post (To Be Defined) I talked about the big Matriciamento project behind Dia Diabetica and how AME is reaching out into the 18 cities surrounding Barretos to strengthen ties between primary and secondary care centers. As for Dia Diabetica here is the flow of the day (my writing brain is really getting a kick out of these numbered lists…)

1. Patients are asked a comprehensive list of questions about their lifestyles, medical history, diet, etc.
2. Nutritionists measure the patients’ height and weight
3. Pharmacists talk to patients about medications they are currently using and any issues they are having
4. Patients meet with the doctor
5. Patients go to a follow up meeting with the pharmacist to discuss any changes in medications prescribed by the doctor
6. Patients attend a personal orientation with the nutritionist

Lucky for us, in between each meeting with the doctor or pharmacist or nutritionist patients were waiting. With the help of the one of the nurses organizing the event, Marilene, we successfully recruited a group of about 10 patients and some caregivers to join us in a classroom setting. Although we had prepared our foot model presentation, we very quickly ran out of things to say but lucky enough Nathalia is trained in orienting diabetic patients and naturally took over, using the foot model as a tool to emphasize her points. She would involve her audience with simple questions like “What happens when you are washing your driveway and you bend the hose?” Most people answer that the water stops running. Nathalia then ties in the fact that with diabetes nutrients also stop flowing to the sites of small cuts on your feet and they cannot heal. She then proceeds to use the toe wound progression to demonstrate how bad one little cut can become.

After taking it all in I have a few more things to add to my list of mental facts. Firstly, patients do not wrap their own wounds. This is a service provided by the local health clinics and apparently the system works pretty smoothly. Nathalia described that the bigger issue with diabetic foot ulcers is patients not knowing to acknowledge a small cut as a problem worth seeing the doctor about. That is why the wound progression aspect of the model is so valuable. Thirdly, detailed, scientific descriptions and telling statistics do little to make an impression on these patients. Nathalia’s strategy to relate the processes of the disease to daily activities that everyone has to perform elicited an impressive response with many nods of understanding. As our mentor Dr. Leautaud likes to say… We’re on the ground. It is with these observations and experiences that we can work collaboratively with our friends in Brazil to find, design and refine solutions to the challenging health issues of the nation.