When retina specialist Dr. Rafael Andrade pioneered a diabetic retinopathy project to raise awareness in his Brazilian city of Itabuna in 2004, he never expected that his project would grow to the extent it has.
What started as a humble diabetic retinopathy screening task force for 200 patients in a rural city in the state of Bahia became a national program that has since been recreated internationally.
Today, about 2,200 patients can be screened by multiple professionals in a one-day event. His program now serves as a benchmark for dozens of cities interested in carrying out similar joint efforts throughout Brazil.
We talk with Dr. Andrade about his efforts.
Dr. Andrade, how did you come up with the idea of starting a diabetic retinopathy screening task force in Itabuna?
I was inspired by an experience I had while I was a retina fellow at the Department of Ophthalmology in the Federal University of São Paulo (UNIFESP) in 2002. After having participated in its diabetic retinopathy screening task force, I went back to my hometown Itabuna and decided to start a similar task force. In partnership with the secretary of health, the project focused primarily in the detection and treatment of diabetic retinopathy.
With the positive feedback that we received from the population and the lack of care the patients had, we realized that the project had to grow. Today, in addition to screening for diabetic retinopathy, patients are evaluated for nephropathy, heart diseases, and diabetic foot on the same day.
Which professionals are involved, and how does the campaign evaluate these patients?
Every year we rely on approximately 1,000 volunteers, including physicians ranging from ophthalmologists to cardiologists, as well as nurses, technicians, nutritionists, psychologists, physical educators, pharmacists, dentists, physiotherapists, lawyers and more than 400 medical students.
The project offers everything from blood glucose testing to diabetic foot evaluations to diabetic patients for free. Patients are guided from one evaluation to another as they undergo a complete health assessment including fundus evaluation, kidney exams, and diabetic foot.
It is a very intense day but also fun! They can take gymnastics classes, enjoy musical performances and also receive information from health professionals about various aspects of the disease through lectures addressing the correct use of medications, home monitoring of the disease, dental health care, hearing assessment, obesity and physical activities, among others.
Patients that present with more advanced disease are referred for additional evaluations including renal and biochemical evaluations, electrocardiogram, and echocardiogram. When patients need intervention such as cardiac catheterization, they are scheduled.
As for the diabetic retinopathy of patients, cases are managed according to the stage of the retinopathy. For instance, patients that need laser photocoagulation treatment have it initiated on the same day of the task force and receive a follow-up appointment. Those who end up requiring intravitreal injection or surgery are referred to an affiliated service.
Do you have any idea how many people have been assisted since you started the task force?
In these past 15 years, we have assisted about 27,000 patients with diabetes, and we estimate that 2,200 of them required treatment with laser photocoagulation for the severe stages of the disease.
What were the biggest challenges you faced?
Despite being considered a developing country, Brazil faces significant social and economic challenges because of its size. My city, Itabuna, is located in one of the poorest regions of Brazil, so we are constantly fighting social inequality, poor education, and inaccessibility to health care. It wasn’t easy at first to get everyone on board.
We went through a rough patch to find sponsors and other means of financial support. Advertising and reaching the population was another challenge, since social networks were still an incipient idea 15 years ago. Through the years our positive results proved our initiative to be solid and support from the media and other specialists followed.
What was the latest innovation of the diabetic retinopathy screening task force?
This past year we started a pilot study using a new portable fundus imaging device produced in Brazil. The goal was to screen more diabetic patients using artificial intelligence to identify fundus alterations.
What can we expect for the future of your project?
In upcoming years, our goal is to expand and increase the impact of diabetes campaigns, reaching as many cities across Brazil as possible. Currently, through our NGO, “Unidos Pelo Diabetes,” we have helped to transfer the know-how to more than 25 cities across the country strengthening the prevention concept and health education, as well as increasing access to early diagnosis and treatment of diabetes’ complications. In addition, we are aiming to increase assessment in remote areas by using telemedicine.
Further Resources
Visit the website unidospelodiabetes.com.br.
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About the author: Natasha Cruz, MD, is a vitreoretinal surgical fellow at Federal University of São Paulo, where she previously completed a Research Fellowship in Retina. She is a PhD student at the same institution researching silicone oil release from syringes in intravitreal injections. She is a delegate of the PAAO-YO and is a member of the Brazilian Society of Retina and Vitreous and the Brazilian Council of Ophthalmology. |