CONTEXT
Medical experts, health care professionals and research institutions in Latin America and the Caribbean have long been sounding alarm bells about the number of deaths caused by chronic diseases. In 2004 this region recorded 3,200,000 deaths caused by diabetes, cancer, cardiovascular, respiratory illnesses and other chronic diseases. For the future, patients will face huge costs for treatm
ent. Health-care systems and national economies will encounter greater financial burdens and, even more disturbing, the number of deaths from chronic diseases will increase. High blood pressure and tobacco use are still the region’s major risk factors, but obesity and overweight represent huge additional problems for one-quarter of the region’s population over the age of 15 years. Just five years ago 139,000,000 persons in this cohort were considered as obese. Today, this figure has sky-rocketed to 289,000,000 persons, or just over one-third of the population. BACKGROUND
Obesity and overweight are known to be powerful indicators of the tendency to develop diabetes, an illness that is amplified by family history. Diabetes is also the primary cause of illnesses suffered by nearly one-half of all Guyanese patients who experience severe kidney failure. In 2000, WHO studied the prevalence of diabetes and found 19,000 cases, or just over 3% of the population. At that time, projections were that this number would increase to 36,000 cases by the year 2030 and represent a figure that would double in the years between 2005 and 2025. This survey also found that for Guyana’s 30-year-old population, one of every four women and one of every twelve men, was either obese or overweight. This disturbing reality has led medical practitioners, health professionals and special-interest groups to conclude that establishment of a Kidney Foundation could assist efforts aimed at mitigating the effects of this crisis. In the form of a project, the Foundation’s work will focus on obesity, diabetes, hypertension and kidney-failure and related illnesses that cannot be effectively attended to by the health-care system without significant increases in human, technical and financial resources. The Government of Guyana, the Ministry of Health, medical practitioners, international agencies and professional organizations have long been concerned about these trends. Their ongoing work is directed at reducing the incidence of chronic diseases by continuing support for the health infrastructure comprised of over 200 health centres staffed by nurses and health aides who provide preventive, curative, promotion and rehabilitative care in urban, rural and hinterland communities. The Georgetown Public Hospital spearheads
these efforts by providing specialist in-patient and out-patient referral services, specialized treatment and sophisticated diagnostic tests. Six private hospitals in Georgetown and five company hospitals in rural areas complement these activities. THE PROBLEM TO BE ADDRESSED
This project will address the specific problems of widespread public ignorance about susceptibility to obesity, diabetes, hypertension and kidney failure; the lack of understanding about the causative factors of these diseases; and the absence of awareness about the economic impact of these diseases on the lives and livelihoods of citizens. TERMS-OF-REFERENCE
The Committee dealing with EDUCATED CITIZENS will develop a public awareness programme that informs citizens about the kidney, its functions and the consequences of obesity, diabetes, hypertension and kidney-failure so that they can make choices about changes in life-styles and options for treatment that reduce the effects of these diseases. Through consultations and workshops, this Committee will engage policymakers, health-care professionals, public and private sector partners and public relations specialists in order to conduct a review of successful and failed approaches to sensitize the public about health-care issues. Experiences in selected Caribbean countries, research institutions and Universities will add value to this work. A coherent communications strategy will be designed; specific audiences will be identified and the messages to be communicated will be developed and pre-tested; and, time-lines and costs for this programme will be calculated. The Committee dealing with INFORMED POLICYMAKERS will develop a database that contains a Register with medical profiles of vulnerable persons in selected urban, rural and hinterland communities. This Register will assist policymakers to identify trends, facilitate design, formulate programmes and implement projects aimed at reducing the incidence of obesity, diabetes, hypertension, kidney-failure and related diseases. By examining existing systems for collecting, storing and maintaining electronic and health-care records and statistics and discussing conditions with medical authorities, this committee will evaluate the usefulness of the Register that will contain confidential medical profiles of vulnerable persons. Data on residents in selected communities in Georgetown, Bartica, Diamond, Enmore, Leonora, Lethem, Mabaruma, New Amsterdam, Skeldon and Suddie will be collected during medical outreaches that will be conducted during field work. The Committee dealing with ASSISTED PATIENTS will develop a draft Protocol aimed at improving conditions for patients suffering from renal failure. The Protocol will contain the results of negotiations with agencies delivering hemodialysis, peritoneal dialysis and related services in order to establish criteria for assisting patients unable to access treatment because of financial constraints. It will describe performance and other treatment standards and facilitate independent, professional evaluation of the quality of these services. Through consultations with selected patients and discussions with concerned agencies, the committee will become aware of the financial burdens that restrict access to these services. It will determine the charges for these services; mobilize financial resources from donors and study opportunities for accessing medical insurance. The resulting Protocol will articulate the process for identifying patients in need, transparent criteria for applications for assistance by patients suffering from renal failure and payment for services to be provided by participating agencies. OTHER CONSIDERATIONS
At the end of its first year then, it is envisaged that project activities would have helped to create a new situation. The circumstances for persons suffering from, or, vulnerable to, obesity, hypertension, diabetes and kidney-failure would have improved through increased knowledge about the causes and effects of these diseases. The work of health-care authorities, officials in hospitals, health centres and other organizations in urban, rural and hinterland communities would have been enhanced. Disadvantaged persons suffering from renal failure would have been provided with opportunities to apply for financial assistance. PROJECT MANAGEMENT
A Project Management Committee (PMC) that includes the President, Secretary, Treasurer and two other members of the Foundation will be responsible for all aspects of administering this project. The PMC will submit regular reports about progress being made to accomplish the Foundation’s objectives. It will undertake regular consultations with patients, health authorities, donors and special-interested groups and issue periodic public statements. Three (3) inter-disciplinary Committees will be responsible for producing the outputs necessary to achieve the project’s objectives. Each of these committees will be headed by a chairperson who is an experienced medical practitioner and a member of the Foundation and will include other Foundation members and also invited professionals who volunteer their skills and experience to support the work of the established committees. Each committee will prepare and cost a work-plan that lists the activities required to produce the related outputs.
