Clinical practice dilemmas: Managing diabetes and hypertension on medical missions

December 14, 2018 | Christopher Dainton

Our series of clinical protocols for medical missions continues with our recently published article on diabetes and hypertension. Nowhere are the stakes higher for patients and communities than in the care of these increasingly common chronic conditions.

Mother with prescription for diabetes and hypertension

Medical missions are far from perfect. They’re often criticized as a band-aid solution for the problems with healthcare access for the rural poor. But unlike episodic care for minor aches and colds, patients with diabetes and hypertension require ongoing follow-up. Untreated, these conditions can lead to heart disease and strokes. They also frequently require long-term treatment with medication. What’s more, in large parts of Latin America, the prevalence of these conditions is only increasing.

But in places with limited resources, how can volunteer doctors choose safe and appropriate medications – ones that are both inexpensive and available locally? How do patients obtain proper follow-up? Furthermore, how do we decide who needs referral to a specialist outside the community?

Predeparture training for doctors managing diabetes and hypertension on medical missions

Fortunately, some short-term medical missions have clinical protocols for these dilemmas. They provide them to their volunteer doctors as part of a predeparture training package. But how good are these protocols? Likewise, are their suggestions similar to the guidelines that come from international bodies like the World Health Organization?

In our clinical protocols series, we analysed training documents collected by contacting 225 organizations operating short term medical missions in Latin America and the Caribbean.

Unfortunately, most of the NGOs that responded denies having any protocols at all. Others only had literature that they routinely recommended to volunteers. In the end, just twenty organizations were willing to share their protocols for analysis.

You can find summaries of the most common recommendations for the management of diabetes and hypertension in the full article.

Old man with diabetes and hypertension
How do these protocols for diabetes and hypertension on medical missions compare to international guidelines?

On one hand, World Health Organization and other large bodies publish guidelines that generally reflect the best evidence available. They’re lengthy and broad. But as we’ve said before, locally developed protocols may better reflect local realities, including medication availability and resources.

Of course, this depends on how they were developed. For example, such clinical protocols can only work when locals participate in their creation. The care provided by volunteers should never compete with that provided by host clinicians. Furthermore, we identified many gaps in the protocols we analysed, meaning that there is still plenty of room for quality improvement on short-term medical missions.

Learn more about clinical guidelines for medical missions

Preparation and predeparture training by medical mission volunteers is a hot topic for medical mission research, but international guidelines for care in low resource settings are hard to find and access. So, we pulled out the most common evidence based recommendations, condensed them to make them more accessible, and then put them all in one place.

Read our published article on protocols for diabetes and hypertension in the Annals of Global Health. We’ve also previously published reviews of clinical protocols for gastrointestinal illness, respiratory illnesses, and dermatologic disease.




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