Our Chief Medical Office, Dr. Peter Rohloff, spends two weeks per month in Guatemala and the rest of his days teaching at Harvard Medical School, working the night shift at the Brigham and Women’s Hospital and Boston Children’s Hospital, writing articles and reading books. Busy? We think not! We asked him for a little reflection every time he leaves Guatemala, and so ‘Peter from the Plane’ was born.
Entry #1: August 2015.
After much preparation, we have launched a new big initiative around chronic child malnutrition, or stunting. Guatemala’s Maya population has one of the highest rates of stunting in the world. Stunting has a wide variety of effects on life-long health and wellbeing for affected individuals. We’ve been especially concerned about its effects on cognition and general development in small children. Stunting happens often within the first year of life, when the brain is still developing at a rapid pace, and so the consequences can be devastating. We commonly see two-year-old children, for example, who don’t walk and have no language development.
For years, we’ve been running and evaluating programs to prevent and treat stunting. What is exciting about this new initiative is that we’re partnering with the Applied Psychology program at the Universidad del Valle de Guatemala to formally measure development in these children.
So, for the first time we are going to have the data that documents the effects of stunting on brain development for this population.
The goal, of course, isn’t just to document the bad effects of stunting on the brain. It is rather to collect the preliminary evidence we need to begin building targeted interventions to help parents of at-risk children foster a better socioemotional and neuropsychological development.
This is a big challenge obviously, there are so many factors that need to be taken into account – cultural differences in parenting and in child learning, a multi linguistic learning environment (many of these children are learning Spanish and two Mayan languages simultaneously), and adaptation of our testing materials, which are so skewed towards literate populations in economically stable environments. But we’re excited to get started.
This month we also launched our new collaboration with Puente de Amistad, a large micro-finance organization in Guatemala. We’re providing several health packages to their clients, such as diabetes and hypertension management, cervical cancer screening, and so on, in a pilot feasibility study in the department of Sololá. We are trying to be really intentional about evaluating the implementation, not just so that we can provide excellent care, but also so that we can better understand the health care needs of middle-aged indigenous women, who are the typical profile of client we are serving in this project. So much women’s health care in Guatemala is really just pregnancy care, and so the health needs of women outside of pregnancy are pushed to one side. As a result we really lack basic data, like obesity, diabetes, hypertension prevalence rates. We’re hoping to fill that gap through this and other similar projects.
My role on this project is mostly helping the implementation team think about data structure and collection, which in practice meant about 60 hours working through customization and optimization of the electronic medical record system we are using for this project. We’re using an instance of OpenMRS (www.openmrs.org). We’ve been using OpenMRS for years now as our primary EMR, but this will be our first project where we have also build all of the monitoring and evaluation into the EMR, so there will not be any need for parallel data management tools in order to track the project.
From Seat 5B, Peter