Research Project Description: How to Prevent and Mitigate the Effects of Diabetes in Nicaragua Site: Ciudad Sandino, Nicaragua (Project located in Masaya, Nicaragua) Research Topic: Public Health Partner Organization: Foundation for Sustainable Development and Centro de Salud Davila Bolaños Description of FSD: Foundation for Sustainable Development is an international development organization that seeks to support communities in achieving their goals through asset-based development and international exchange in Africa, Asia, and Latin America. FSD provides opportunities for students and professionals to engage in real community development work--instead of a typical study abroad or drop-in service project program. FSD’s program sites are in six countries and eight cities, where for more than two decades it has supported more than 300 community partner organizations and trained more than 3,000 volunteers. Its community development efforts have maintained an ongoing project sustainability rate of nearly 80 percent, addressing health, social, environmental, and economic issues by responding to community priorities and offering training, grants, and volunteer support to community partners. Description of community partner: Centro de Salud1 Davila Bolaños, located in northern Masaya, is one of the city’s two major health centers. Its sister site, which is located at the south end of Masaya, is named Centro de Salud Monimbo. The smaller health clinic next to the town’s boardwalk, Puesto de Salud2 Roberto Clemente, houses the region’s only mental health staff. These health centers are all directly governed by Sistemas Locales de Atención Integral en Salud (SILAIS3), the state health system for Nicaragua’s 17 departments. The health centers receive funding, staff pay, and medical supplies from the federal Ministerio de Salud (Health Ministry)4. Overall, SILAIS in Masaya has six agencies—three rural and three urban. Each one has a permanent staff that visits communities in the surrounding areas of Masaya to conduct outreach health visits and checkups. The health system is organized on a national platform, so other cities in Nicaragua possess the same institutional hierarchy. Centro de Salud (CS) Davila Bolaños provides services that include pap smears and cervical cancer referral, pregnancy and newborn care, family planning, children’s health services, vaccinations and immunizations. Other programs available include dental care, tuberculosis assistance, epidemiology, vector diseases, STD diagnosis and treatments, chronic health ailments (such as diabetes, hypertension, arthritis, and asthma), and general triage for minor wounds and fevers. Health workers from CS Davila Bolaños travel to rural communities surrounding Masaya to educate campesinos on thematic topics (e.g.

1

Centro de Salud (Health Center) Puesto de Salud (Smaller health clinics, usually rural) 3 SILAIS (Local Integrated Health Care Systems) 4 Ministerio de Salud (Health Ministry) 2

sanitation, disease and diarrhea, child nutrition, cervical cancer) and to undertake vaccination campaigns. Current health campaigns at CS Davila Bolaños include:  Promotion of and education about breastfeeding: a highly visible national campaign that has been in place since 2005 and extends to every health center and clinic  Cervical cancer prevention, awareness, and treatment: drop-in pap smear exams are offered daily; although, so far the high incidence and death rates have not dropped  Diarrhea, dehydration, and dengue fever prevention  Healthy nutrition (a recent FSD intern completed a successful “moveable mural” project to educate patients about nutrition)  HIV/AIDS testing and referrals: problems with this area include a lack of education and counseling to accompany the tests, insufficient resources (such as condoms) offered due to funding constraints, and no campaign to combat STDs  A center for traditional medicine has just been opened to use for treatment of chronic illnesses, primarily Diabetes and co-occurring conditions. The CS Davila Bolaños strives to improve community members’ quality of life by providing medical services and health education with a focus on women’s and children’s health. It offers a full range of free and low-cost health services—from vaccinations to dental care—and integrates educational workshops into its daily schedule to increase the knowledge base of the community. Its goals are to: 1. Offer a wide range of free and low-cost preventive and curative medical care 2. Provide compassionate attention and counseling for health care concerns 3. Educate patients and community members about Nicaragua’s major illnesses and mortality areas, prevention techniques, and healthy practices Social issue: Health needs in Nicaragua are the result of poverty, geographical positioning, and a disorganized health care system. A high prevalence of malaria and parasitic diseases, gender inequity, large numbers of children, and periodic natural disasters all contribute to a portrait of suffering and need. Infant mortality and maternal mortality remain high, especially in disadvantaged groups – rural areas, indigenous populations, the poor, adolescents, and women with low levels of schooling. To add to all of these concerns, only about six percent of the population is insured and government spending, already low, has been steadily decreasing since the eighties. This has created a situation where out-ofpocket health expenditures constitute a serious barrier for the majority of Nicaraguans. All of these issues are present in the local community of Masaya as well as a high number of patients with chronic diseases, such as hypertension and diabetes. Impact of project on the community (Community engagement): CS Davila Bolaños staff, in addition to attending to patients, undertakes a series of health promotion activities in the local community, including working with schools as well as community health leaders, distributing information on different health-related matters, forming community groups focused on specific conditions such as diabetes, and has recently opened a traditional medicine clinic to offer an alternative means of treatment and care for patients with diabetes and other chronic illnesses and ailments.

As much as these activities can be quantified, their impact on community´s health remains unknown due to the lack of cohesive and updated information; both qualitative and quantitative. The aim of the investigation would be to find out the level of knowledge that patients have about their diabetic status and contributing factors. Building from a previous intern’s research which focused on the perceptions of care delivery to diabetic patients who received diagnosis and care at the Centro; findings indicated that further research is needed to assess and address diabetic patients who live in rural regions, elderly diabetic patients, and any other cohorts which are both underrepresented in existing data and have greater limitations in seeking diagnosis, treatment, and education. Research project description: The goal of this research is to expand previous research efforts to assess the level and quality of knowledge of diabetic patients surrounding their diagnosis and selfmanagement. This research should expand on previous methods to include a larger population, specifically those who have limited access to the services provided at the Center itself. The scope of the research may be expanded to include an objective aimed at providing baseline data on patients using the traditional medicine clinic (caveats for treatment include recent diagnosis and no former treatment methods) to provide a foundation from which to measure efficacy of this concurrent service delivery method. Methodology: The research would combine quantitative and qualitative methods. Data collected by the CS and community leaders would provide quantitative results that can be analyzed by the intern. Following this, semi-structured interviews, surveys, and/or focus groups can be used to qualitatively assess the health status knowledge, contributing factors, limiting factors, and enabling factors to the elevated level of diabetes in the Department of Masaya while identifying methods for building capacity in the existing service delivery model and community education resources to modify outreach and education activities to better promote and increase quality knowledge at the individual, community, and family level. Student profiles: Ideally this research would be conducted by a pair of students with complementary backgrounds. Student 1:  Student of Public Health, Epidemiology, Psychology, Pre-med or similar  Minimum intermediate Spanish  Experience with quantitative analysis methods  Dedication and motivation to support the organization Student 2:  Student studying community/public health, sociology, education, with a strong interest in the community and socio-cultural aspects of health and health behaviors  Advanced Spanish preferred, with intermediate minimum  Experience with qualitative research methods



Dedication and motivation to support the organization