It has been a great time this week as we have just finished the training in which me and Waheed were able to demonstrate how the cervix models we made with Karen are used in training medicals personals. Am so happy getting to see how people liked the models. they were so pleased in such a way that they wanted us leave the models with them.
We also had a chance to attend different kinds of training on cervical cancer diagnosis, such as how LEEP ( Loop Electrosurgical Excision Procedure) is used to cut abnormal tissues.
More thanks to OEDK, Dr schmeler and Sonia for the support and their time in the whole training session.
A Lamborghini whizzed past a rusted trailer home, swaying the overgrowth of tall yellowed grass that framed the decaying home. Gray roads studded with potholes required tense, sharp steering but they eventually led to beautifully paved, smooth roads with white curves that swayed you, comforted you. You could enjoy the scenic Spanish columns of tall fenced houses before the horizon fell to abandoned furniture protected by sickly, angry stray dogs and their fleas.
I marched in with our bulky intervention or as we liked to call it, a three-pronged solution: a foot model, an educational flip-book and a quiz-based website. We quickly learned that most of our population did not have consistent access to the Internet, so the website became irrelevant. Next, we learned that our flip-book, even though we had specifically written it at a fifth-grade reading level, could not be mass-distributed to our target population because illiteracy was more common than we anticipated. We had underestimated the literacy barriers to health education. Next, we realized that the base we designed to hold our model was simply too cumbersome to be practical.
Those first three weeks, Brownsville’s unexpected anachronistic details taught me that I was ignorant.
I decided to step back. What were the main barriers that prevented individuals experiencing diabetes from taking necessary care of their feet? I wanted to make sure we were addressing the real issues. I wanted to make sure we weren’t just proposing a solution simply because it was the frame from which the problem was originally posited. They said teach wound care, we teach wound care.
Our bulky intervention – a foot model propped on a base, accompanied by a website and flipbook. (a) front view (b) top view to simulate, respectively, a caregiver looking at a foot and an individual looking at his/her own foot.
Su Clinica helped me set up a series of intensive, 30-minute interviews with a range of professionals involved in patient care. My team and I interviewed a Podiatrist, and his range of nurses and assistants. We interviewed head nurses. We interviewed diabetes educators, nutritionists and physicians between three different clinics, one clinic of which focused specifically on Diabetic Wound Care. We asked questions not only about the barriers patients face in taking care of their feet, but also about the education individuals experiencing diabetes receive about foot care. We wanted to know how our model could fit into and enrich this education, but we also wanted to know what the current challenges to diabetic education have been.
Su Clinica helped us set up interviews with a range of professionals in diabetic patient care.
Further, we sat down with over 50 individuals for feedback as to what worked in terms of our foot model design and what needed improvement. I was blown away, not only by individuals’ creativity but also by their commitment to envisioning how our model could be used and how it could be made more impactful. In talking to this variety of individuals, I realized that many were starting to notice how much of a burden diabetic foot problems had become. We weren’t alone in taking initiative and so we found many allies in these clinics and hospitals.
I was ignorant and presumptuous. And the challenges were more complex than we understood from our literature reviews.
John*, a loving father and grandfather, comes in for a checkup, reluctantly, at his daughter’s insistence. He feels good. Everything is fine. His eyesight is worsening but that’s a normal part of aging, right? He isn’t worried about his diabetes because he’s taking his insulin.
New policy in the doctor’s office:
If you have diabetes, you must take off your shoes.
John struggles but manages to pull off his shoes and socks. The doctor comes in. His A1C levels are out of control. Managing your diabetes isn’t just about taking your shots. Yada yada, John has heard this before. I feel fine, he insists. Exercise and diet. It’s about exercising and watching what you eat. Then the doctor kneels to check John’s bare feet.
The sudden urgency in the doctor’s voice takes John by surprise. John hears the word “infection”.
John had a small green toy soldier embedded in his foot. His grandson had accidentally dropped the small toy inside of John’s shoe. Unknowingly, John had stepped into the toy without feeling a thing and had been walking on the toy for almost a week. Now his foot is infected and there is no way to salvage it. John becomes another one of the amputation statistics.
This happens 185,000 times per year, nationwide.
Diabetes causes neuropathy. When you can’t feel your foot, it’s hard to know if you cut it or burned it or stepped on something that hurt you. Diabetes decreases blood flow to the extremities. Cuts and scrapes that you didn’t even know were there quickly deteriorate into gaping wounds that then subsequently become infected. The solution? An amputation so that the infection doesn’t reach the bone because osteomyelitis could kill you.
Dr. Marin narrated this incident to a meeting room that was silenced by shock. This is why we were here. Dr. Marin, the CEO of Su Clinica, Dr. Mccormick, the Dean of the UT School of Public Health, Dr. Fisher-Hoch, our mentor and Professor of Epidemiology, Dr. Prasad, Interventional Cardiologist and numerous others. I was humbled to be working with such an ambitious team. And I was humbled by how real the shocking statistics had become.
185,000 amputations annually in the United States. The Rio Grande Valley, including Brownsville where I was stationed, had the highest rates of both amputation and diabetes in the nation… in the nation.
Something had to be done.
The Rio Grande Valley has the highest rates of diabetes and amputations in the nation.
…or if we ignored my unbridled enthusiasm and challenged ourselves to be a tad more realistic – an educational intervention.
More importantly, my work seemed to be an obsession with the word “shocking”. I heard it over and over again. “These are incredibly shocking depictions of wounds.” or more commonly: “ugh that’s gross. It will shock patients.” These sentences formed the harmonies of my introduction to Brownsville, TX.
Now, I don’t imagine most people associate the word “shocking” with the city of Brownsville in any way. And I don’t blame them. Brownsville is a small city of about 200 thousand. Although palm trees line the breezy streets in an air of vacation, the most exciting part of this city is called Sunrise Mall and it has a movie theater showing The Jungle Book to satisfy all of your vacation needs.
Brownsville, TX looks like vacation. But I was here for the word “shocking”.
Don’t let my sarcasm suggest I was visiting Brownsville on vacation – I was, after all, here for the word shocking.
