Realizing the Dream: Quality Diabetes Care Across Guatemala

“We have the dream that we can deliver the same level of care in a little building in Chichimuch or in a home in Santiago as they can give at a Harvard hospital. I don't think we always succeed, but we certainly try. And sometimes we work miracles.” - Dr. David Flood

As part of our changemakers series, we’re excited to introduce David Flood, M.D., M.S., M.Sc., an Assistant Professor of Medicine at the University of Michigan who leads our efforts to transform diabetes care in rural Guatemala. He currently supervises our diabetes care team and is co-leading a research initiative to integrate a practical, effective model of diabetes care into Guatemala’s Ministry of Health practices.

Read on to learn what brought him to Wuqu' Kawoq, what keeps him engaged, and his vision for the future. This interview has been edited for brevity and clarity.

How did you find Wuqu' Kawoq?

DF: I met [Wuqu' Kawoq co-founder] Dr. Peter Rohloff at the end of 2010 in the cafeteria of Children’s Hospital Boston. I was a first-year student at Harvard Medical School looking for a mentor. It was after he had worked a 24-hour shift. He was so grumpy! I realized years later when I was doing my own residency how generous it was for him to meet with me after being up all night! It turned out that Peter became my main mentor, and that initial meeting changed my entire life and career. 

Undeterred, and in fact inspired by their conversation, David moved to Guatemala in 2013 to work with Peter and some Maya diabetes nurses attending patients in rural communities. David’s wife-to-be, Nora, another doctor and Wuqu' Kawoq collaborator, came down to work in obstetrics and gynecology. They lived in the small village of San Juan Comalapa and studied the local Mayan language of Kaqchikel.

What do you remember about your first experience in Guatemala?

DF: It was striking how different medicine could be at a Harvard teaching hospital in the US and in rural Guatemala; it just was really shocking how challenging and almost impossible it seemed for sick people to get care. The barriers were myriad, but mostly social: people couldn't get care because they didn't have enough money to pay, or because the public health system was unable to provide them with care, or because they didn't speak Spanish, or because they lived in a rural area that was an hour from a clinic. Mainly because they were poor, basically.

It was really interesting to work with and learn from Peter and see how he delivered care in Mayan languages, in the home a lot of times. It was just really meaningful. A lot of patients got better. And so by the end of that first year, I decided I wanted to make my career providing care and doing research and trying to figure out ways to improve the system in Guatemala. Now it's been 15 years almost, and I'm still doing it.

What is the current situation with diabetes care in Guatemala?

DF: There are a lot of great diabetes specialists here but they tend to be clustered in Guatemala City. Once you get out of the capital area or Antigua area it's really almost impossible to get quality care for diabetes and related chronic diseases. So most patients in rural areas go untreated. In medicine, we have this phrase “the natural history of disease” that refers to what happens to a patient with a given disease if you don't do anything and you just watch it. And what we're experiencing in Guatemala is basically the natural history of these diseases, because there’s so little treatment. A person with diabetes who has good control of their glucose level, their sugar, their blood pressure, and has good checkups, adequate access to medicines and education, they can live a perfectly normal life. But in a place like this where you can't get access to those things, what you see is a lot of premature suffering. People who are in their thirties or forties whose kidneys fail, who go blind, who need a foot amputation because they get an infection.

How is Wuqu' Kawoq addressing these gaps?

DF: Our diabetes program is kind of a referral program. We accept the patients from the public health system who are very sick and we provide a lot of complicated care for diabetes. We have patients who've had strokes. We've had patients who have had foot amputations, and many other different kinds of complications. These patients do pretty well with us. We're very proud of their care. But it's a very small number, roughly 150 patients. In Guatemala, there are probably 500,000 patients with diabetes.

My main research interest right now is trying to improve the Ministry of Health’s diabetes care. I do different kinds of studies to try to take the lessons we've learned over the last 10 years and put them into the health system. That’s the dream. 

One of the main lessons is using trained nurses and providing mentorship and supervision so that they can provide care in rural clinics where maybe there isn't a doctor. We have clinical protocols the nurses can follow. For 90% of the patients, they can do a great job. When they have problems, they know what's out of their scope and they have my phone number; they can call me if they need me. Another big lesson is developing systems so that you can make sure that the logistics and procurement of medicines is adequate, and that there are patient charts. 

They're really simple things. We meet patients where they are and help them figure out how to manage their conditions with diet and care. That's not how things normally work here; patients get yelled at a lot. They're made to feel bad very often. And that's why patients who are sick would prefer just to die at home.

So I view our clinical work as a little bit of a laboratory where we can figure out what things work, how to do things that are really high quality, but maybe not so expensive, and to try to import those lessons into the Ministry of Health. 

What keeps you involved in the work?

DF: The very high quality of services. We have the dream that we can deliver the same level of care in a little building in Chichimuch or in a home in Santiago as they can give at a Harvard hospital. I don't think we always succeed, but we certainly try. And sometimes we make miracles, like this guy Edwin. He’s 22, has diabetes, and lost his sight due to cataracts. We got him in to see specialists in Guatemala City and helped arrange for him to have surgery for a discounted cost that we covered. He just got his surgery last Saturday. And he can see now. He actually came by my house last Friday and my family and I are going to his village for lunch next week. He's got his whole life ahead of him!

And then just how everybody at Wuqu’ Kawoq is so interested in indigenous culture and linguistically sensitive care. I find it really invigorating to be around that. The third thing is that many of my best friends are from the staff and, you know, I truly would trust them with my life. I think they also see that what we do is really special and they derive a lot of meaning from it, just like I do.

Give now to support quality care!

David not only dedicates his time to Wuqu’ Kawoq, he is a monthly donor. He describes some giving opportunities to transform the lives of patients with diabetes:

1) $85 a month provides medications (such as insulin or metformin), supplies (syringes, glucometer), and lab tests to help a patient with diabetes monitor and manage their condition. 

2) $1,000 covers vision-restoring cataract surgery and accompaniment and for a patient losing their sight due to diabetes.

Donate by midnight 12/31 to double your impact!

Help us reach our goal of raising $105,000 in donations so we can fully leverage our board match for a total of $210,000! 

Gifts received before midnight PT on 12/31 are eligible for 1:1 match!

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