California State University Fullerton + Universidad Autónoma de Tlaxcala

In Tlaxcala, Mexico, obesity has reached a crisis state and it is contributing to increased cases of diabetes, which has become one of the top three causes of death in the country. Nutritionist Maria Elena Madrigal, a resident of the area and professor at Universidad Autónoma de Tlaxcala, is faced with the impact in terms of her patients and students, as well as personally. Like thousands of others in the region, her husband is living with the disease. But a USAID-funded, HED-managed Training, Internships and Exchanges and Scholarship (TIES) partnership between California State University, Fullerton (CSU Fullerton) and the Universidad Autónoma de Tlaxcala (UAT) has begun to help address the problem through an innovative combination of research and hands-on education for students and practitioners at many levels.

To reach and engage nurses, nutritionists like Madrigal and other health practitioners at CSU Fullerton and UAT worked together to develop a series of courses delivered by CSU faculty through video conferencing and in a traditional classroom setting. These classes combined scientific information, such as how human bodies experience molecular changes from exercising, with on-the-ground advice on promoting public health in the community. The CSU Fullerton team assisted not only in developing the course work, but also in building the technological capacity of UAT, providing IT support as they developed their video conferencing capabilities. Project Director Dr. Chris Latham noted, “We overcame many technological and cultural hurdles, including some language barriers, to deliver a holistic and practical set of information that, if incorporated in a systematic way, will ultimately have a major impact on the lives of many Tlaxcalans.”

There were 18 UAT faculty participants in Healthy Lifestyles and Diabetes Prevention courses—nurses, practitioners, physicians and nutritionists—who visited Fullerton and received hands-on experience in learning about healthy lifestyles. Beyond traditional classes and activities, the group visited the gym of a university (where they underwent physical fitness testing), a surfing camp, and a community play day for children hosted in a Santa Anna parking lot. They were exposed to a social/ecological model for improving outcomes that could not only save lives, but was also fun. When the faculty returned to Mexico, the health care professionals formed study groups that involved staff and student wellness groups at UAT, as well as school-based health promotion programs for adolescents and pre-school children.

As one of the UAT faculty members who wanted to incorporate better self-awareness of students’ nutrition, Madrigal stated, “Participating in the Cal State University, Fullerton educational program has been a life-changing experience for me, as an instructor and as a person. I have learned to see diabetes as a multi-factorial problem, where social conditions of the individual and the community play an important role in shaping the outcomes of the disease.” As she shared information with her students, they reflected on the availability and cost of healthier foods, how their eating behaviors were impacted by stress, and the prevalence of diabetes in their families.

In addition to her work at the university, Madrigal acknowledged an increased level of awareness and personal responsibility. “I too became much more conscientious of my role as the wife of a person with diabetes. Even my husband’s boss learned about my training and invited me to give a presentation at his job where six co-workers are diabetics.” Initially, Madrigal was scared of insulin. Now, she and her husband have become more confident with the insulin treatment because of her experiences at Fullerton.

“I entered my Master of Public Health program with a different vision to see if one could impact prevention to promote health,” she said, now in her third semester of the program. Madrigal anticipates working as a coordinator of social service at UAT and plans to coordinate an improved nutrition program with parents of malnourished children in Tepetomayo. Further, the partnership developed a research component to focus on how the unique issues of diabetes in Mexico could be tackled on a public health scale. As part of a community assessment, 109 Tlaxacalans recently diagnosed with diabetes were surveyed and interviewed. As a result, researchers became familiar with the health hurdles in Mexican infrastructure—for example, clean drinking water isn’t available in most Mexican schools. The findings of this research were shared at a bi-national conference in Tlaxcala on September 25, 2009, and a manuscript is under review for publication in the Journal of Nursing Scholarship. Dr. Latham said, “This project is incredibly valuable not only because we’re helping Tlaxcalans improve and lead more full and healthy lives—but we’re also gaining further insight to fighting diabetes here in local communities in the U.S.”

With USAID support, more than 20 active TIES partnerships throughout Mexico are collaboratively addressing common concerns and advancing Mexico’s competitiveness in the global market.

Combating Obesity and Diabetes in Tlaxcala

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