Pilot project set to attack diabetes epidemic in the Caribbean

[dropcap]P[/dropcap]revention, awareness and change. Three fundamentals driving the Tenacia Global Initiative that provides an unprecedented collaboration of research, clinical and commercial expertise in an effort to combat major health crises including diabetes and obesity. Globally, diabetes is recognized as a full-blown epidemic, particularly in places such as India, China, and throughout many emerging economies. The barrier in being able to effect meaningful change lies in the stigma associated with the disease, as well as ignorance, and improper management on the part of patients themselves. The STAR sat down with Kevin Hanville, a partner at Tenacia Global, who was in Saint Lucia this week conducting research and setting in motion the wheels for a pilot project expected to be rolled out early next year. The initiative is aimed at reducing the high cost of diabetes related complications through innovative technologies, education, and community outreach programs.

What makes this initiative especially important at this time?
Hanville: There is the realization that current strategies for combating diabetes don’t work. The American Diabetes Association is one of our partners in this. They’ve determined that 70 percent of the cost of diabetes is due to the mismanagement and non-compliance of the patient. There’s this story I heard from the housekeeper of the resort I’m staying at. She’s got a friend who just was diagnosed with Type 2. She was given the diagnosis, started crying, kind of depressed about it, but that’s all she’s doing. She’s not changing anything. She feels alone. She doesn’t know what to do. So we’re helping the Saint Lucia Diabetic and Hypertensive Association (SLDHA) build the infrastructure by partnering with the entire community.

Why was Saint Lucia chosen for this project?
Hanville: My company was initially designed to bring technology and these products to the Middle East. In July I came here on vacation. I’m a bit of a workaholic, and I did research into what was going on with diabetes in St Lucia. I reached out to George Eugene, the executive director of the SLDHA, who shared with me his vision and business plan and totally changed my perspective. We then started working with Dr. Stephen King and Dr. Martin Didier to come up with a different way to bring in the American Diabetes Association to effect change in emerging countries. I was back here a month ago, and I’m back here again getting all of our partners in place. This wasn’t a situation in which we started out to do something in Saint Lucia. It’s actually been serendipitous that it’s happened this way, much to the benefit of Saint Lucia.

Who are some of the local partners in the pilot project?
Hanville: M&C is going to be our partner pharmacy chain, as well as the M&C Group. We’re bringing together government, business, and the medical community. The Saint Lucia Medical and Dental Association is behind this. We’ve got NIC on board, also Sagicor, and we’re meeting with the Tourist Board and the Chamber of Commerce. We want to get the OECS involved. We’ll be bringing the ADA in to certify not only the clinicians and the doctors under ADA guidelines, but community healthcare workers, because that’s the key. If we can get in front of the patient more often with a less expensive asset, we can help reduce that 70 percent. Someone told us that the reason people don’t like going to get diagnosed with diabetes is because they assume their foot is going to be cut off. People wait too long, for whatever reasons, to go to a doctor.

What are some of the problems with the way diseases like diabetes are dealt with?
Hanville: Globally we spend billions of dollars annually and the results have been abysmal. Between 1988 and 2014 there’s been a 291 percent increase around the world in diabetes patients. In the United States, we spend one out of every three Medicare dollars on diabetes patients, and one out of five health-care dollars. You take all of the frightening statistics about diabetes and all of the associated problems and you put it on a population like Saint Lucia, which is 90 percent African ancestry, and you almost double those statistics. People of African ancestry have a one and a half to two times propensity for diabetes and hypertension.

What are some of the impediments to progress in Saint Lucia?
Hanville: The SLDHA’s problem has been they don’t have the resources to get to the people, to touch the people outside of Castries. What we’re doing is partnering; bringing in product and technologies from the United States that would not otherwise get to Saint Lucia, with world-class scientists, researchers, academia, the American Diabetes Association, to develop for the first time this pilot project that has never been done anywhere before. Once we execute it here we’re taking it to the other islands. We’re starting here. My company is involved in the Middle East. We’ve got Egypt, Pakistan, Morocco, Saudi Arabia watching this. The goal is, once we launch this project and we take it to emerging countries worldwide, that it becomes known as the Saint Lucia model. It gives this country the opportunity to be at the forefront of battling diabetes for emerging countries, in a much more simple and cost effective way. If current strategies keep being utilized, frankly the national treasury will go broke.

Who are you hoping to target?
Hanville: We’re looking at all the pillars of society so we can have an ecosystem, when we’re out doing screenings in Vieux Fort, once we identify that person we’ll have metrics, we’ll bring in technology that will help us talk to them, put them in peer groups, online coaching… just change the whole dynamic of it so they are not fighting this alone. We’re not going to be able to help the person who’s already in dialysis, that’s not the 70 percent. By the time you’re there, you don’t have a lot of options. But, Type Two diabetes if caught early enough can be reversed, or easily managed so you’re not getting all of the problems associated with it.

Other than health aspect, how does diabetes affect countries like Saint Lucia?
Hanville: You’ve heard of absenteeism. Well, there’s a new term and it’s presentism. That means the person’s at work but doesn’t feel good. So that person is literally not working; even though he is at his desk. Diabetics are very prone to that because it is such a debilitating disease if you’re not managing it. If you have one in four people in your work force who don’t feel good, or they’re sick all the time, you have an unproductive work force. And that affects the bottom line. Studies have shown that up to eight percent of the GDP of Saint Lucia is tied up just due to lack of productivity, cost of disease, and so on. Another statistic is for lower income people who have diabetes. Up to 48 percent of their income goes to the disease. That’s money out of the local economy. They’re not able to enhance their lifestyle because all of their money is eaten up by the disease, and that’s because it’s not being properly managed.

What is the long-term vision of your pilot project?
Hanville: Back in 2006 the OECS did a program for AIDS. They said it was a crisis of the Caribbean because less than one percent of the population had AIDS. That was less than five thousand people out of six or seven million. Depending on the statistics you look at, 15 percent is a very conservative estimate of the number of people here with diabetes. The executive director of SLDHA thinks it’s 20-25 percent. That’s just with diabetes. Those aren’t the ones who’re pre-diabetic. That could be an equal number. In Saudi Arabia, for example, 40 percent of the population has a problem. If for example you look at AIDS, the United States has done an amazing job at marketing and changing perspectives and the stigma attached to the disease. Also breast cancer. An amazing job has been done marketing it. We need to do the same for diabetes. If we can get everybody in the community talking about it and changing the stigma, making them aware of it; if we can have people communicating with each other better, we’ll not have the misunderstanding that if you get diagnosed with diabetes you’re going to lose your foot. You see that a lot in the rural areas. And the bad thing about it is that it’s a self-fulfilling prophecy. If you believe that and you come down with diabetes do nothing, you’re going to lose a foot. Or you could lose your vision, or all of the above.

What is the full scope of the pilot project?
Hanville: Part of what we would like is a voice to turn this into a national emergency. Once this program is in place we will launch it to the rest of the islands in the Caribbean. It’s not going to cost Saint Lucia any money because we fund this pilot through philanthropy. Hopefully we’ll start in the first quarter, and probably run a year. I think we’ll have results within six months because we’re going to be sitting down with each patient and giving each a small set of goals. Giving them simple goals to hit. Most diets don’t work because the person on the diet doesn’t see enough change. This is the reality of it. A patient goes to the doctor because he or she is not feeling well. They have diabetes, they get diagnosed with diabetes, they’re given some literature, then they’re told to stop drinking, stop smoking, start exercising, change your diet, lose weight. What the patient hears is, take this pill and I’ll be fine. They’re not going to stop smoking; they’re not going to lose weight; they’re not going to change their exercise routine; because as soon as they leave that doctor’s office they’re shell shocked. They go home and cry and don’t change a thing. We have developed a process so that as soon as that patient is found, through screening, the doctor’s office, or whatever, we pull them into our program; they now get support, they get education; we’re touching that patient to make sure we get them to a stable point.

How is this project different from similar initiatives?
Hanville: We have a very different way of doing this. One of the things we’re doing is bringing the entire community in. It’s going to create jobs in the community because we’re going to be training up to 60 workers. That way we can touch everywhere within the community. We’re looking at changing the way NIC and these companies reimburse the healthcare worker through the SLDHA instead of the doctor level, and part of the business plan is if that person comes across another person through our screening that can’t afford the doctor, they’re going to get the resources through the SLDHA. Nobody is going to be left behind. When we go out to the patients in the rural communities, for example, they may not have the ability to get to a doctor. We’re getting vehicles donated so we can take patients to the doctor. By doing this, we will change the Saint Lucian mindet. This is a major undertaking. It’s unique and it’s an unbelievable opportunity for Saint Lucia.