HHI News & Updates: May 2017
A Stronger Heart: Francisca's Story

"Before meeting HHI, I was in difficult shape. I was worried because I had chest pain, I was always tired and dizzy, and had so much trouble breathing I could barely walk," remembers Francisca. It was 2012, and at 38 years old, Francisca knew these symptoms were not normal. HHI had been serving the community of Pancho Mateo for only two years, but Francisca spoke with a community health worker, who referred her to our primary care clinic. It would be the start of a long journey.

After being examined by our volunteer physicians and discussing  treatment options, Francisca entered our Referral Program to receive an echocardiogram and follow up with a cardiologist. Eventually, she was diagnosed with rheumatic heart disease, a chronic heart condition caused by rheumatic fever. RHD affects more than 15 million people around th e world  and kills 233,000 each year, mostly in low and middle income countries. HHI connected Francisca to the United Hearts Clinic in the capital of Santo Domingo, where in May 2013 she underwent surgery to repair two valves in heart.

Now, Francisca is an active participant in HHI's Sano y Feliz group in Pancho Mateo, and continues to receive treatment through our Chronic Care Program. She decided to start walking and paying attention to her diet after recovering from her surgery, so jumped right in to our healthy lifestyle group program. She continues to receive monthly visits from her community health worker, Dania Balbuena, who helps her manage her medication and counsels her on healthy eating and activity. Francisca says, "I encourage my neighbors and friends to come walking with me every morning. And my husband will wake me up early if I feel like sleeping in!"

Francisca says, "Thanks to Horizontes de Salud, my heart is better. Before, I could hardly walk, but now I love to walk every day because I know it is important for my health. And, now I know to eat less salt and more vegetables. Whenever the trucks come by selling vegetables, that's what I buy."
Primary Care Clinics & Community-Based Care

From May 8-12, our clinical staff, community health workers, and volunteer physicians were hard at work for our spring series of primary care clinics. In partnership with Hospital Maternidad Dolores de la Cruz in Montellano, our team consulted with patients from the surrounding com munities, including from HHI's Chronic Care Program (CCP). 

Working closely with each CC P patient's community health worker, our physicians evaluated each patient, discussed their treatment plan to ensure their hypertension or diabetes was well managed, and connected them to follow-up care if needed. The team also conducted home visits for patients who were unable to travel from the bateyes and countryside to the clinic.

Thank you to our volunteers -- Dr. Charlene Li, Dr. Chris Ahern, Dr. Ticco Robinson, and Dr. Brad Wilkinson and Dr. Ayaz Madraswalla of HHI's Board of Directors -- for giving so generously of your time and expertise.

In the weeks to come, our clinical team will be conducting a comprehensive chart review of all our CCP patients to identify trends and progress over time. Stay tuned for the results!

Spotlight On: Diabetes Training for Health Professionals

This month, HHI held a continuing education session for physicians participating in our World Diabetes Foundation project. Dr. Franklin Gonzales, an endocrinologist who specializes in medical complications due to diabetes, led the interactive training. In a lively session with 50 front-line physicians, he focused on diabetic foot care, including practical exam, prevention, and treatment. The doctors discussed how to assess patients' stress levels, and adapt their approach and consultation style to meet the patient's educational level and understanding of their own condition. Importantly, the training emphasized the emotional and economic cost on the patient's family, and discussed how to support family members as caregivers.
Sheila Calderón, HHI Project Coordinator, says, "We can see that due to these trainings, the doctors feel more confident in providing high quality care to diabetic patients, in prescribing laboratory analyses on correct schedules, in administering emergency insulin, and making the right call on referring to specialists. We have a lot of work left to do, but we can already see improvements through our follow-up supervisions."

In partnership with PSI/SFH of Santo Domingo, the Ministry of Public Health, and the World Diabetes Foundation, since 2014 HHI has:
  • Trained over 50 physicians, 20 nurses, and 60 community health workers on diabetes risk factor identification, prevention, and clinical management
  • Screened over 4,000 individuals for diabetes risk factors and connected nearly 2,500 to follow-up care
  • Reached over 14,000 people through diabetes education & awareness campaigns
  • Implemented monitoring and supervision processes in 12 primary health care centers and 3 hospitals across the Puerto Plata province to enhance quality of care. 
NCD Facts: Did you know...?

In the Dominican Republic, non-communicable diseases such as cancer, diabetes, cardiovascular disease, and respiratory illnesses are the leading cause of death, accounting for 70% of deaths each year. In a country where nearly one-third of the population lives below the national poverty line (approximately US$3.20 per day), the burden of chronic diseases can quickly exhaust a family's resources and reinforce cycles of poverty.

In 2012, the landmark EFRICARD II study reported that 9.9% of the population had diabetes, 34.7% had high blood pressure, and 26.6% were obese. But, only about half of these people were receiving treatment for their condition. EFRICARD II remains one of the only comprehensive studies of cardiovascular health and metabolic syndrome risk factors in the Dominican Republic, and trends suggest these numbers have only increased since 2012. In comparison, the CDC reports that in the United States, about 9.3% of the population has diabetes, 33.5% have high blood pressure, and 36.5% are obese.

The Dominican Republic is working to strengthen primary health care as a key strategy to address the problem of chronic disease -- and that is where HHI comes in. We believe in building the capacity of the Dominican health system to provide high quality health care and to prevent illness through public health measures. We believe that empowering community members is an essential part of any sustainable health intervention. By providing direct, community-based patient care, and focusing on education and partnership with local health care providers, we believe we can change the way patients, communities, and the health system work together to give everyone the opportunity of a healthy life.

Learn more about the global burden of chronic disease at the NCD Alliance website. For more information on the Dominican Republic's response, check out the country's NCD Global Scorecard profile. See how the United States and other countries compare! 
Now Recruiting: Executive Director

The search for our next Executive Director is under way! Excellent candidates will have a passion for global health and community development, expertise in partnering with communities and institutions, and the leadership skills to drive growth as a community-based, nationally influential organization. Check out the job description and help us spread the word!
Our mission is to improve community health in the Dominican Republic. Through building local capacity for public health and strengthening the primary health care system, we work to promote well-being and access to quality health care.
Health Horizons International Foundation, Inc. |   www.hhidr.org