| Diabetes Spectrum Volume 12 Number 3, 1999, Page 146
Diabetes Education: A Global Perspective Preface Betty P. Brackenridge, MS, RD, CDE Diabetes presents unique challenges to health care providers and patients alike. Because of the chronic nature of the disease and the important role daily activities play in its management, patients are, indeed, the most active and powerful providers of diabetes care. Even the most skillfully devised regimen of care is of absolutely no use in achieving metabolic control unless it is appropriately put into action by a patient. This makes the education and training of people with diabetes extremely important. Recognition of this fact has fueled the growth and development of formalized diabetes education throughout the world, although the developmental timetable varies significantly around the globe. About 6 years ago, I was first given the opportunity to work with educators and other clinicians outside of the United States. The prospect at first seemed daunting. I could not imagine how my U.S. experience would translate to other settings that seemed, at first glance, to be so different from my own. I could see only the things that were different: language, food, politics, health care organization and payment systems, even the training of health care providers. In many countries I was preparing to visit, there were, in fact, no words in the local language for what I am: a diabetes educator. Although I was sure the work would be fascinating and enjoyable, I was not prepared for the deeply engaging growth experience that awaited me. For although many things were different, I found two factors to be universal in their presence and importance. In 25 countries over 5 years, these two factors formed a common ground on which productive sharing and collaboration could be carried out. These common factors are diabetes itself and the humanity of those touched by it. I soon found that wherever humans try to manage diabetes with imperfect tools and limited resources, predictable themes and challenges emerge. It matters little whether the people and their providers speak English or Hungarian, whether their insulin is beautifully clear or disturbingly brown, whether their staple food is potatoes or rice. The problems are the same everywhere. But because of the very differences that first held my attention, people around the globe come to those common problems from unique perspectives: their values, skills, training, and resources often shape different approaches and solutions to the same problems. And that was the gift of my experience: to find the richness of ideas and solutions from around the world that have been developed to address the all-too-common challenges of diabetes. In this issue of Diabetes Spectrum, authors from around the world share a broad range of experiences and approaches. The issues are ones of importance to every professional working in diabetes: how to appropriately promote and support health behavior change, how to teach those of a different language more effectively, how to help patients reframe thought processes that may be interfering with care or quality of life, how to upgrade or intensify therapy safely and effectively within the constraints of available resources, how to organize care to meet the needs of particular groups, such as children affected by diabetes, how to best assure the competence of those who specialize in the education of people with diabetes. The discipline of diabetes education is now recognized as having a unique knowledge and skill set, separate from clinical understanding of the disease's pathophysiology and treatment. The growing global acceptance of this reality is revealed by the fact that educational and psychosocial issues will, for the first time, have their own complete track within the next International Diabetes Federation Congress, to be held in November 2000 in Mexico City. However, the fact remains that very few doctors, nurses, or dietitians are exposed in their professional education to this independent set of skills. Without that training, health professionals understandably tend to approach the education and training of people with diabetes in a straightforward fashion—they simply tell patients what to do, based on their clinical understanding of the disease. This seldom works. But the papers in this From Research to Practice section reveal that thoughtful professionals from throughout the world are expanding both the theoretical and practical knowledge to which clinicians can turn as they seek to improve their own practice and effectiveness in this important area. While educators in developed countries pursue roads to enhancing specialized practice, those in developing countries face the daunting challenge of providing even the most basic information and skill to vast numbers of patients with few resources and precious little manpower. But creativity can enhance even this difficult task, as evidenced by Baumer's Letter to the Editor (p. 185) describing a hand-teaching method developed for use with tribal people in Africa. That we have much to learn from each other is underscored by Baumer's description of how she and her colleagues have adapted this method for use with urban Austrians. The skills of diabetes education—like the skills of diabetes self-management—cannot be mastered quickly. At best, a few new concepts can be discovered periodically, and first attempts at applying them can be undertaken. Mastery will only come with practice. Mastery of any skill emerges over time, as learners apply their new knowledge to various circumstances. Experimentation and practice build our teaching skills, in the same way our patients' self-management skills are built. And learning is not limited to beginners. Even those among us who have been doing education for many years can benefit from the explorations of our colleagues—even when they come from settings quite different from our own. Continued development and refinement is always possible, regardless of the level of mastery already achieved. Concert violinists, regardless of their homeland, don't stop practicing! Copyright © 1999 American Diabetes Association Last updated: 9/99 |