Margaritas

Helping out the Margaritas fundraising event was one of the last ways that I helped out the non-profit CASA. I published the following article in the local ex-pat weekly newspaper of San Miguel de Allende. My goal was to talk a little about the inadequate attention focused on chronic diseases such as obesity, and juxtapose chronic disease against the hysteria for H1N1. With that focus of attention, encourage people to support CASA by attending the fundraising event that was planned for the following week.

Without further ado...

Health and Perceptions
By Daniel Madrigal
Obesity and the influenza pandemic are two of the most serious health threats in Mexico today. One of these has the whole world on edge waiting to see what will happen next. The other affects 60 percent of the population and is a primary factor in the leading causes of death in the country (diabetes and cardiovascular diseases.) They both have had wide coverage in the media, but lately the importance of obesity has taken a back seat to the H1N1 virus. The influenza pandemic has captivated our attention primarily because nobody really knows how serious the epidemic will be. Some fear that the second year of the flu will be more lethal, as was the case with the Spanish Flu of 1918.

Understandably, public health organizations are devoting energy and resources to ensure that mortality related to the H1N1 virus doen not far surpass the 119 deaths already confirmed (as of July 6). At the same time, the obesity epidemic continues in Mexico with the trends not showing signs of change. National surveys have found six out of ten Mexicans are either overweight or obeses. The statistic has profound implications when considering a study from the Mexican secretary of health, which found that 12.2 percent of deaths in the county have "high body mass index (BMI)" as a primary risk factor. That works out to approximately 57,000 deaths a year, or about 150 deaths a day attributable to high BMIs. With such dramatic figures, one might expect to hear more about the obesity issue rather than the H1N1 virus.

The attention on influenza has produced prevention messages that focus on the use of anti-bacterial gel and facemasks, but what is the solution for the obesity problem? Though a pill doesn't exist for high BMI, the solution is simple: people need to eat healthier and get more exercise. Unfortunately, like many other chronic diseases, the underlying economic, social and political causes are more convoluted. The tangled web of causes complicates the creation of an effective intervention to the simple solution. A comprehensive approach is needed that accounts for all these causes.

In San Miguel de Allende, one organization already is preparing a program to effectively deliver healthy messages about nutrition in the community- CASA (Centro de Adolesceentes de San Miguel de Allende.) Together with community members and health professionals, CASAs experienced theater and radio groups are developing an educational play about nutrition to be performed for local children and youth, and a 12-part radio series to address issues including early good nutrition, breast-feeding, and nutrition and exercise during pregnancy. Increased awareness of how nutrition affects obesity is one component of the comprehensive approach. With the efforts of CASA, more people with understand that dietary choice is as importanas covering your mouth when you cough.

You can help support this work by attending CASA's second annual Margarita Contest on the CASA roof terrace in Colonia Santa Julia. Nearly 30 local restaurants are participating in this enjoyable evening that includes music as well as hors d'oeuvres created by local chef Kristen West.

Tickets are available at La Conexión, La Victoriana and Vía Orgánica as well as the Biblioteca Pública on Sunday 11am- noon. For more information, contact Margo at 154-6060 or cast-interns@hotmail.com

Throughout the writing of this piece, I was very conscious of the inherent contradictions proposed. On the one hand, I suggest greater attention to obesity prevention and at the end I suggest people should go spend some money on a Margarita contest to reach that end. If the "ends" justify the "means" right?

In any case, the event went off spectacularly, and there were was money and awareness raised to the nutrition programs of CASA.

Hors d'ouevre offered by the coordinator of the sexual health education program, Miguel

Mixing among the patron. The "catch" of the fun of the event was to try Margarita's from restaurants around town and judge the best one.

An example of an entry, little taster cups of the margaritas, and then little stickers for the people that voted. This one was of the chocolate variety and was boosted by a spicy little kick.

More mixing and mingling between tastings.

View from the event. The space used was the roof of the CASA building, which happens to have quite the breath taking view.

End of the night, the sun set, and patrons left as CASA employee's busily packed everything away. A few weeks later, word got back from the event coordinator that the event garnered $34,000. For me, the means have been justified.

Intership Notes: Finishing Up

Week 8

Data entry

Also this week, I had the opportunity to speak to the HIV coordintor for the municipal health dept. of SMA. I was able to get another perspective on the HIV services and learn what patients with HIV did in this jurisdiction. A little more difficult for these folks because they have to travel over an hour or more by bus to get to the CAPASITS clinic in Celaya.

Week 9

Data Analysis, umm, but I must say it feels a little disingenuous to call it "analysis" if I don't have a regression or even a p-value anywhere near the report. Nonetheless, data was analyzed and summarized using my second favorite statistical program, STATA.

I had the chance to speak with Dr. Meza (state HIV coordinator), it turns out that the health insurance system in México is way complicated. There are several different systems, like PEMEX, SEDENA, IMSS, IMSTEE, who each have their own networks. It's like if each gov't dept had its own veterans style health insurance system. PEMEX is the one for the Mexican owned petroleum company (I wish we had one of those!). SEDENA I believe if for the military, and IMSS and IMSTEE are for other groups of people defined by their occupation. He was commenting about the complications that arise from these fragmented systems.

Also, I learned more useful information about why CAPASITS Celaya had a hard time participating. Apparently, they are still under the management of the general hospital, so that is who they needed approval from to collaborate with us. As I have mentioned in past posts, the Celaya General Hospital has been less than helpful with the HIV related projects.

Week 10

In the last week, I wrapped all my tables and graphs into a report to be turned in the state health dept. All written in Spanish with some necessary grammar help from Juan and María. With the report I was careful to describe "issues" and recommendations with sensitivity, and in a way that they could perhaps be incorporated. One of the big problems that we noticed was that the budget the HIV programs operated on weren't enough to cover everything that we would've liked to have seen. With that in mind, I tried to aim the recommendations to the most pertinent issues such as providers not having the materials to follow universal precautions or the majority of participants not knowing what CAPASITS (HIV clinic) is.