Introduction According to the WHO 9% of the world population is suffering from diabetes type II. On the ABC islands it is almost 20%. Diabetes type II is a disease in which the hormone insulin is not sufficient or cannot be made. Treatment is important because untreated diabetes can lead to serious complications, such as heart damage and problems with the kidneys and vessels, it even can be fatal. This folder is meant for Dutch dieticians who will start working on the ABCislands. It provides information that is necessary in the treatment of diabetes on the ABC- islands. It also offers tips and recommendations that can be made to improve treatment on the islands.
- It is important to share knowledge. Explain that there is evidence that a healthy weight has to do with healthy food and that overweight and obesity entail health risks. - Give clients the confidence that they are able to adopt progressively healthy habits in their daily routine. - Try to think along with the client how healthy eating can be fun and enjoyable. For example, make ready-made recipes for healthier versions of traditional dishes. - Convince the client that exercise is important for a healthy lifestyle. Explain that this does not mean that the client should immediately go to the gym Also, walking, cycling and dancing is exercise.
Food habits
Demographics for diabetes Although the ABC-islands have a great independence of each other in the field of diabetes prevention, the prevalence of diabetes type II is high on all three islands. An unhealthy lifestyle such as obesity and lack of exercise, common on the islands, is often the main reason for getting this illness. Besides the problem of obesity, medical organizations and governments have long been unable to address prevention of diabetes II. The size of the problem is seen in, for instance, the number of diabetes cases in Curacao. More than 18% of the population of Curacao has diabetes. Ranking number two in the world, after the USA. More then 17% of the population of Aruba has to deal with diabetes. These days it is aware of the seriousness of the problem and trying to reduce the incidence of diabetes. With a diabetes plan it is aiming for a healthier lifestyle with less overweight and more physical activity. Bonaire is sparsely populated in comparison with the other two islands and data about diabetes is hard to find. When it comes to health problems such as obesity and diabetes Bonaire is often mentioned together with Curacao and Aruba.
Although there is an abundance of healthy nutritional resources, the dietary pattern of most people on the Antilles is characterized by high intakes of fat, fast-food, low-fibre sources of carbohydrates, and soft drinks. At the same time consumption of fresh fruit and vegetables is mostly inadequate. These food habits and customs can cause an increased risk of diabetes mellitus type II. In general the population of the ABC islands is indifferent towards adapting a healthier lifestyle. This indifference is partly caused by the limited knowledge about food and the risks that are involved with unhealthy dietary choices. Because healthy nutrition is widely regarded as less tasty than foods rich in fat, sugar and salt, people often make unhealthy nutritional choices. Besides this lack of knowledge there are other determinants that affect the food habits on the Antilles. Food and eating perform an important social and cultural function. On the ABC islands food equals sociability. Because the refusal of food is seen as a rude gesture, people feel obligated to accept the food offered to them despite possible health risks. Wealth also plays a role in choice of food. Because the costs of fresh fruit and vegetables are high compared to the prices of fastfood, the less wealthy part of the population will easily resort to unhealthy food habits.
Level of education
The educational system on Aruba, Bonaire and Curacao is similar to the system of the Netherlands. After primary education pupils can go on to secondary education and then on to post-secondary education. In primary school the language of instruction is one of the official languages of the island, namely, English, Dutch and Papiamento. The prevalence of diseases is higher among inhabitants with a low education level than among high educated people. Also people who are economically inactive indicate more often having a disease compared to those working or looking for a job. Poverty On the Antilles big income differences exist between wealthy and poor households. For example, in Curacao the group of wealthy households has 9.5 times as much income as the group of poor households. In comparison with the Netherlands, this factor is 5.1. A quarter of the households in Curacao is living below the poverty line.
For more information see the report Colophon: The Hague University of Applied Sciences Faculty of Health, Nutrition and Sports Nutrition and Dietetics Januari 2015
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Anita Hellemons, Diaan Vroegh, Dirk van Stiphout, ElĂŠonore de Merode, Evelien van der Heiden, Floor Hendriks, Maartje Hommeles, Mabel Ouwerkerk, Martina de Haan, Sabrina Pater, Susanne Drienhuizen, Suzanne Oomen
Diabetes awareness on the ABC Islands a startersguide for dieticians
How diseases are perceived on the Antilles
Recommendations Promotion of sport activities/ physical activity An active lifestyle not only reduces the risk for diabetes, it also prevents the risk for other lifestyle diseases such as heart disease, stroke, high blood pressure and obesity. Campaigns to promote sports in primary and secondary schools are needed. These could also include afterschool activities.
The three islands of the Antilles, Curacao, Bonaire and Aruba, differ each in size, population, language and culture, and therefore, also in healthcare development. Many different nationalities live on these small islands. Arubans Curacaos and Bonaire’s are a mixture of original Indian inhabitants, Europeans (mainly Dutch), African slaves and to a lesser extent Sephardic Jews. Other nationalities on the ABC islands are Dutch, South and Central Americans and other Europeans. Obesity is a major health issue on the three islands. As a consequence, there is a significant risk of diabetes type II, eye disease, hypertension and heart failure. The underlying causes of these problems are unhealthy eating habits and lack of exercise. Many people on the islands are poor and low educated. The lower their education, the lower they consider themselves in good health. The causes of obesity are multifactorial: bad food habits, a lack of exercise, a voluptuous beauty image and not seeing a relation between lifestyle and health. They doubt quite often if there is a relationship between eating healthier and losing weight and between obesity and health risks. Most Antillean patients find their way to Western medicine easily, but some of them tend to attribute (mental) illness to Brua, a folk religion. Typical for healthcare on the Antilles is sending out patients for medical care and examinations to other islands or countries if there is no adequate medical care available on their own island. Preventing illnesses and its complications is very important. Here, the practitioner can play an important role in specialized care such as diabetes.
The way diabetes is being treated on the ABC Islands On the ABC islands the same medication is available as in the Netherlands. However, American units for blood glucose levels are used. In the Netherlands mmol/l is used and on the ABC-islands mg%. Medication is available at the pharmacy (Botica’s). Including blood glucose measuring instruments, insulin pens, insulin pumps and all the requisites. A health care team helps the diabetes patients with their treatment and medications. Dieticians work in different places as independent practitioners. They are all educated in the Netherlands. Patients usually visit a general practitioner or a medical specialist on referral. But a standard referral is not common. Different information sessions and exercise programs are accessible on the islands.
Promotion of cycling Cooperation with the Dutch government is recommended. The export of bikes, which are stored in the depots of the municipality, can serve the people of the ABC-islands. A lot of Dutch students go abroad to do an internship on the ABC-islands, these Dutch students could initiate a program to teach biking to Antilleans.
Dietician-patient communication in relation to compliance of treatment Good communication with the patient is the key to ensure more compliance with the treatment. By paying attention to the following factors, the dietician can enhance the quality of the dietician/patient interaction: -Adopt a friendly and approachable attitude, i.e. by showing interest in their personal situation; - Give clear explanations to increase the patient’s understanding of the disease, its causes and the treatment; - Address and respect the patient’s unresolved concerns, i.e. side-effects of medication; - Gain a good understanding of patients’ health beliefs, experience of the illness and associated feelings and expectations; - Be based on the accurate recognition of the patient’s problem by the doctor; - Demonstrate active listening and empathy; - Be respectful of the patient’s priorities and viewpoints even when they differ from your ideals and expectations; - Consider the patient as the primary actor in defining goals of treatment and developing a treatment plan that is tailored to their own beliefs, life-style and personal circumstances; - Check the patient’s attention to compliance; - Take into account and familiarise yourself with spiritual and cultural dimensions that may be important to patients, as for example Bruah. - Encourage family support; - Present treatment instructions in a clear and simple manner: use concrete and specific advice, repeat and stress critical components of the advice, check understanding and provide feedback; - Make an effort to master as much Papiamento as you can; - Be aware, that the locals are not pleased of the Dutch superciliousness. They see this as a form of disrespect.
More cooperation between the ABC-islands Campaigns about food, physical activity and lifestyle diseases should be the same on every island. This is cost reductive. Maybe it would even be possible to import healthy foods together, to lower the costs. This would make healthy foods cheaper for the inhabitants. This could result in more variation in diet and a healthier lifestyle. Broadening knowledge and understanding of a healthy lifestyle Community classes for woman, the caretakers of the family and health care classes in primary and secondary schools are necessary. Different ways of communication and interaction with the population: - A board of health professionals from every island who discusses healthcare, health promotion and develops events and strategies to improve a healthy lifestyle. - Information to parents through the school of their children about healthy living and sports. Schools could also involve parents in afterschool activities. - Yearly health promotion plus sport events on every island, on the same day, in the same format. - Promotion of cycling in cooperation with the Dutch government. - Import of vegetables and fruits in cooperation with all the islands.
Means and ideas for a smooth transition of Dutch dieticians To facilitate the transition as a Dutch dietician working on the ABC islands, you should be aware of the fact that clients have a different attitude towards healthy habits. It is important that your first aim is to understand how you can help the client. Some tips: - Try to understand the beliefs and mentality of your client. - Ask how the client sees his or her own health status. Use the figure rating scale to determine the self-image and the ideal of beauty of the client. - Discuss the importance of the social environment and the expectations regarding their reactions. - Build a good relationship with the client.