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Daniel Elias Zoughbie (Urban Studies major/Middle Eastern Studies minor)
“The Diabetes Micro-Clinic Project: Community Awareness and Ownership in the Developing World"
Sponsor: Professor Ananya Roy, City and Regional Planning
Project Description
During a recent stay in the West Bank, Daniel identified a staggering diabetes problem with serious gaps in treatment delivery and diabetes education. Consequently, he intends to establish and document approximately twenty “micro-clinics” composed of small groups of Palestinian diabetics meeting in designated houses or businesses for the purpose of diabetes education, screening, treatment, and monitoring. The main innovation is that each micro-clinic will share the prohibitive cost of maintaining a glucose monitoring device -- an instrument readily available in the U.S. but rarely used in underdeveloped areas. This will provide a first line of defense against the lethal complications of diabetes through shared access to frequent testing. Also using lectures, workshops, and group activities, the diabetes micro-clinics will be vehicles of empowerment, utilizing community support and creating public ownership so that the affected population can move toward improving health care.
Scholar's Photo
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Daniel tries to harvest cactus fruit near Bethlehem without being pricked by thorns.
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Scholar's Journal
In one micro-clinic, a volunteer helper and I are greeted by a very nice older woman in her sixties who is very grateful to receive the machine and will be sharing it with her neighbors. She lives in an old stone house with an arched ceiling and well-worn furniture, and in her living room her husband lies in a bed that he has not left for 15 years. His body has completely atrophied so that his neck hangs off the pillow. But despite his condition, he still asks what we are doing inside his home. His wife was diagnosed with diabetes two years ago and has been complaining about a loss of vision and problems with her legs -- both are symptoms of diabetes complications. After a test shows her sugar at 221 (it was this high even though she had previously taken some medicine), I explain that the sugar in her body is acting like a poison and is destroying her bodily functions. I tell her that by keeping her blood sugar levels under control, she will save her vision and her legs, and avoid the tremendous cost and grief associated with such complications.
As the conversation strays away from diabetes, again I get asked the question as to whether Palestine or America is better. Again, I give the prepared answer about the advantages and disadvantages of each, having answered the question so many times before. I am also instructed to marry a girl from Bethlehem. This mother is pretty low key; some others have told me about how their nieces or daughters are doing great in school and are wonderful girls. I find that the best way to deal with such comments is with the words inshalla, or "God willing." This way, I do not insult people by saying no, but it leaves the possibility open that maybe God is not willing. This expression also works if someone invites you to his house and you know you don't really have time to go, or for hopeful statements about the future such as "inshalla I will finish high school next year."
Having visited another micro-clinic, I am thanked profusely by the participants, who insist that I finish my hand-squeezed lemonade and who are not insulted when I tell them it is too sweet for them -- a possible indication that the message is getting through. After a few more comments, I get up to leave and see the hostess's son testing his crippled father's blood sugar -- a very encouraging sign. Then, his mother brings out a hand-carved piece of olive wood, which her relatives and many other Bethlehemites sell. I immediately refuse the gift and explain that this is a project for school, and that I really would not feel right about accepting a gift. But with her and her neighbors surrounding me and insistently pushing it toward me, I looked helplessly at my friend, and finally relent. She says she wants me to know that she is generous. But as I say goodbye for the third time now, she says to her friends that I look skinny. It's funny that I still get this a lot here, and I'm starting to wonder if I have been starving myself for years. She tells me to wait and disappears into the kitchen. Knowing what she is doing, I try to excuse myself, but the other ladies will not let me go. She returns with 20 fresh eggs in a plastic bag. Again, this time trying not to laugh, I refuse the eggs, but then figure that it is no use. And besides, if I stay any longer, resisting, who knows what will be next? She and her son then insist on walking with us down the dirt path and steps that lead to the main road. Although I know her leg must be hurting, I'm glad she gets a chance to walk as it will help to lower her sugar before she sleeps. I leave her home humbled by her generous spirit yet saddened at seeing another group of Palestinians suffering from diabetes and the terrible economic situation.
I have been observing that some of the people I visit have "nurses" in their families -- nurses in the sense that they work as health care professionals or that they are simply caregivers who have learned how to do simple tasks related to health care. I find these nurses to be a very interesting development in the micro-clinic model, as now not only will homes and businesses become health-care facilities, but a family member or friend can help "staff" the micro-clinics as a volunteer. In other cases, I have sought the help of youth volunteers, most often a granddaughter, son or other relatives of the micro-clinic participants, to watch as I test the blood sugar. I see the low volume of requests for further assistance as an indication of the success of the model in training these volunteer staff members. So far, I have received only one repeat call to help a micro-clinic learn again how to use the machine. However, I recall that a blind woman's grandson was present when I visited and delivered that machine, so I will find out whether he can remember how to test. This group participation and staff support is essential, as often the diabetics I have been dealing with find it hard to work the machines themselves.
Click here to read Daniel's summer 2005 dispatches from the West Bank to the UC Berkeley web page.
Click here to go the the home page for the International Micro-Clinic Project.
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