From Itabuna to the world: a task force model for diabetic retinopathy screening in a public health care scenario
Dr. Rafael Andrade is a retina specialist in Itabuna, a countryside city from state of Bahia, located in the northeast of Brazil. In 2004, he pioneered a project with the goal of raising awareness about diabetic retinopathy in his city. What apparently started as a humble diabetic retinopathy screening task force for 200 patients reached a national proportion and gained international repercussion 16 years later. Dr. Andrade himself never expected that his project would grow to the extent it has today, as 2,200 patients are screened by multiple professionals in a one-day task force. His initiative now serves as a benchmark for dozens of cities throughout Brazil interested in carrying out similar joint efforts.
by Natasha Cruz MD
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 of their diabetic retinopathy screening task force, I went back to Itabuna, my hometown, 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 feedbacks 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 the disease in more advanced stages 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 presented 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 poorests 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 is to screen more diabetic patients using artificial intelligence to identify fundus alterations.
What can we expect for the future of your project?
In the 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.
For further information, please visit the website: www.unidospelodiabetes.com.br
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