The Star (St. Lucia) - - LOCAL - By Kayra Wil­liams

P 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?

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.

Kevin Hanville, Part­ner at Te­na­cia Global (left) with Ge­orge Eu­gene Ex­ec­u­tive Di­rec­tor of the St Lu­cia Di­a­betic and Hyper­ten­sive As­so­ci­a­tion.

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