WATERLOO --- A new telemedicine program that utilizes an Argentina-based doctor is designed to lower the diabetes rate of Hispanics, especially Mexicans, living in the Cedar Valley. The project is being run out of El Centro Latinoamericano, and links patients to Dr. Elias Hofman in Buenos Aires, Argentina, via an Internet video conference.

"This program will help populations with less resources and money who suffer from diabetes," Hofman said. Due to a mix of genetic and environmental factors, diabetes has reached epidemic proportions in Hispanic populations in the U.S. and much of Latin America. About 25 percent of Mexican-American adults suffer from the disease, a rate about 1.7 more than white, non-Hispanic Americans.

Not all Latinos are equally predisposed to the disease. For example, Cuban-Americans are only slightly more likely than white, non-Hispanic Americans to develop diabetes because the country has a stronger European ancestry than most other Latin American countries. "You can take a look at it, and you can obviously see there's a genetic component that's huge. But there's also a cultural component, and that's just the really high amounts of sugar you tend to see used in Latin diets," said Nathan Nebbe, co-founder of Telemedica, the company operating the prevention program.>

Nebbe, a medical anthropologist from Cedar Falls, teamed up with Hofman, an endocrinologist, to start up the diabetes prevention program.

The program is designed to reach under-served Hispanic populations. Often Latinos don't receive adequate care in Iowa because they can't afford it, face language barriers or fear authorities due to their immigration status.

"In Iowa there's a major lack of medical personnel who speak Spanish," Nebbe said.

Hofman has patients fill out a 50-minute, Spanish-language questionnaire, essentially a medical interview, that reveals their symptoms and behavioral habits. Because 70 to 90 percent of proper diagnoses come from information the patient provides, a well-designed questionnaire is crucial, Nebbe said. For that they turned to PrimeCare, originally an English survey designed by doctors at the University of Iowa.

Yet even after painstakingly translating the complex questionnaire, problems can arise.

Petrona Lazaro Aguilar has lived all but one of her 59 years in Guatemala. Since moving to Waterloo last summer, her diabetes has worsened to the point where she was recently forced to the emergency room for treatment.

There was only one issue as she sat down at a computer, flanked by Nebbe and El Centro caseworker Alexandra Frazier, to answer questions --- she's fluent in Mayan, and speaks little Spanish.

"We haven't had many who don't speak Spanish," Nebbe said.

Another obstacle was education. Telemedica has been operating for a year in Argentina, where nearly everyone has benefited from a universal education system.

That isn't the case in Guatemala. Aguilar never attended school. Her daughter, who accompanied her to the appointment, said she has taught herself basic literacy skills, such as signing her name, since arriving in Waterloo 12 years ago.

So as Aguilar navigated the questionnaire, Frazier rephrased nearly every question in simpler, more concrete terms. Even a seemingly straight-forward question about her weight was asked again as, "Do you think you're too fat, or too skinny?"

"We found out later, she doesn't weigh herself, and may have never weighed herself," Nebbe said.

Besides being genetically predisposed to diabetes, it turned out Aguilar has unknowingly been worsening her condition by continuing her life-long habits of drinking sugared soda and whole milk.

Despite the many barriers, progress was made. Aguilar may not speak Spanish well, but she can understand it. Frazier instructs her to make a few minor changes to her diet as they answer the questionnaire.

"So when you go to the grocery store and you pick up your diet soda, pick up your gallon of milk with the pink top (skim milk)," she said.

After the interview, Concepcion Mendez said her mother learned a lot, and even plans to make some changes to her diet.

Even though Aguilar doesn't like the taste, "she said she's going to buy diet now."

Contact Jens Manuel Krogstad at (319) 291-1580 or jens.krogstad@wcfcourier.com.

Reprinted with the permission of the WCF Courier.