Priya Larson stars in our blog this week:
For my first week at Wuqu Kawoq, I took some time to get oriented, then planned a sampling of field visits with their team. I saw complex care coordination, diabetes clinic, and nutrition monitoring project in action. This allowed me to see part of what WK does, and I got to visit 3 new places!
On Wednesday, I went to diabetes clinic in San Juan Comalapa. Comalapa is a nearby town (45 minutes away) that looks like a smaller Tecpán, with more art, and it’s higher in the mountains. It’s named after the traditional surface on which they toast tortillas, the comal (a flat metal or clay pan). Anne showed me the huipiles (the classic female blouses) typical of Comalapa – with red stripes down the shoulder. On our way in, I saw murals of animals on the buildings entering town – these same animals are typical of the designs woven in the Comalapa huipiles. I also learned of a famous artist from Comalapa, whose “disciples” have preserved his style of painting, called “naif,” for centuries.
I travelled with Carol, a WK nurse who kindly changed her commute to join me for my first camioneta bus ride in Guatemala. Camionetas are very crowded because they are under pressure by gangs to earn a lot of money, so they try to maximize the number of customers. In order to attract more customers, they have to get places very fast. This meant that they literally pushed us out the bus at our stop, so they could accelerate as soon as possible!
Diabetes clinic was a lot like diabetes clinic back in the United States, but with fewer medications on formulary due to access. Carol and Sandy, the two nurses, both Guatemalan, run diabetes clinic there each month. They are amazing and know as much as any provider doing the same job in the US. They see about 20 patients per day. The clinic is a house with no current inhabitants, nor much furniture. It’s a nice clean space, though. We brought some boxes of materials and medications, and laptops with small wifi modems which pull signal from cell towers, since there is no wifi service in the clinic.
Anne, the Executive Director, joined us with her uncle, Steve, who is a retired family practice doc visiting for a week of field visits. This helped me, because it required everything be translated from Kaqchikel to Spanish to English. The nurses could have – and do – run the clinic themselves, but it’s good for the patients to also see a doctor or someone with new perspective for their care.
We nicknamed the most common drug regimen “GEM”- glimeprimida (one of the sulfonylureas), enalapril, and metformina. Many people were on insulin NPH. One person was on the fast acting regular insulin. They don’t have insulin 70/30 or Levemir/Detemir. Just like in the US, a lot of people take their insulin or meds whenever, at whatever amount, and many don’t want to start insulin.
I saw that many patients have pretty good control of their A1c! The point-of-care A1c tests that WK uses are “like gold,” in Anne’s words because of cost and availability. Besides A1c, the WK team does have access to labs, so the patients have to go visit the lab for periodic urine samples, creatinines, and cholesterols.
There were several people with complaints of fever. I learned it’s very common to get a fever here. One was a case of pneumonia, diagnosed by stethoscope and treated empirically with IM ceftriaxone and 5 days of azithromycin. It was the last azithromycin pack we had to distribute.
This day was a great introduction to Wuqu’ Kawoq’s work. I was so impressed with the organized and effective care they provide. With this day’s experience in hand, I’m excited to start with the diabetes and hypertension education project they are developing!