Mayan Medical Aid
We at Mayan Medical Aid (MMA) face six major problems in the provision of health care to
our population. In each of these areas, MMA has defined - or will define - the exact nature of these problems, using evidence-based research, and use this same research to design and implement a plan of curative action.

1) Chronic Malnutrition

Nearly 60% of children in our area of influence, who are under the age of five years, suffer from chronic malnutrition. Two issues accompany this problem: a) first is to determine the scope of the nutritional deficits in terms of total calories, as well as in terms of the specific caloric deficits of carbohydrates, proteins, and fats; and b) second is to determine both which foods practically and economically can be used to correct the defined deficits and which foods these undernourished children and their mothers will find acceptable and palatable.

Because of our research projects, we now know which children are malnourished, the types of foods they currently eat, and the amounts, kinds, and distribution of calories and micronutrients their present diets encompass. We also know which mothers employ good feeding practices and which mothers do not. And finally, we know which mothers breastfeed too little or for too long, which mothers correctly implement complementary feeding, when their children reach six months of age, and how diarrheal illnesses affect a child's ability to thrive.

As a result, MMA now is prepared to advance its interventions in a manner, which objectifies the process: collecting data, monitoring progress, and measuring outcomes. The result will be that Mayan Medical Aid will know exactly which interventions work, why they work, and with which interventions the program should embrace or reject.

2) Sexually Transmitted Infections (STIs)

Among men and women from the ages of 15 to 50 years, STIs are rampant. The problems are legion: a) a lack of educational resources regarding STIs, b) an inability of the population at risk to establish cause-and-effect relationships between sexual activity and the acquisition of infection, c) cultural limitations on the ability of women to protect themselves from being infected by their husbands and/or sexual partners, and d) a dearth of information on which kinds of preventative and educational interventions patients will accept.

As such, we find ourselves at a clear disadvantage to stem the tide of this ever increasing health care disaster. It only has been with research that MMA has been able to begin to make strides in developing an evidence-based, therapeutic and educational program for patients, who have acquired STIs. We now know about four aspects of this issue: 1) that which patients understand about STIs, 2) which myths patients embrace, 3) how patients perceive their options for prevention, and 4) in whom affected patients have the most trust – their spouse or their medical provider – to provide them with the best therapeutic and preventative information and options.

3) Contaminated Water

Contaminated water is a fact of daily life in all of the pueblos MMA serves. Occasionally, the Municipal government intervenes by adding chlorine to the water. However, this effort is inconstant, and there are large questions as to whether their method of adding chlorine to the water really has any beneficial effect. Moreover, because our adult population never has received a proper education or hygiene training, they often employ maladaptive practices, which either contaminate uncontaminated water or fail to protect themselves and their families from ingesting non-potable water.

To implement corrective plans, Mayan Medical Aid, first, must define the various behaviors in which the population is exposed to or ingests contaminated water. Without such knowledge, we cannot know where or how to intervene.

Fortunately, recent research has included defining in which ways our patients become victims of the infectious and parasitic diseases passed on to them by exposure to water contamination. Additionally, we now understand the role of the Municipality, the impact of the poor handling of water, and how the lack of knowledge and dearth of good practices our patients employ make both avoiding and not creating contaminated water a challenging goal.

4) Poor Dental Hygiene

The only kind of dental hygiene our patients have is poor hygiene. The reasons are legion: lack of dental education in the schools, no toothbrushes or toothpaste, parents who do not have enough understanding of dental hygiene to train their children in good dental practices, no dentist in the community, and the epidemic use of hard candies and sugar-laden drinks (both carbonated and non-carbonated).

For three summers, research students have developed and implemented a dental hygiene program for five of the pueblos, which are a part of the Municipality of Santa Cruz La Laguna. Three of these pueblos are considered by health authorities and the municipal government to fall into the category of being "abandoned" by the federal government in terms of receiving adequate health and other governmental services.

This dental program has received the support and accolades of both the school authorities and the teachers. In fact, several teachers have come to the MMA office for the express purpose of letting us know that they are thankful for the dental program. The reasons they are pleased are that the schools are unable to teach dental hygiene due to a lack of both curriculum and resources.

The research students have filled both of these gaps by presenting a well-considered educational program, as well as toothbrushes and toothpaste. Each year, the children in each of the schools in these pueblos have received instruction in dental health twice weekly for eight weeks, in conjunction with utilizing the toothbrushes and toothpaste that the student groups have supplied.

5) Air Contamination

In all of the villages of Santa Cruz La Laguna, air contamination also is a normal part of daily life. Villagers use wood for cooking and for their twice weekly bathing ritual, which involves the use of water and rocks heated by wood in a small, sauna-like structure, known as a "temescal". Because of the common use of wood for cooking, some people keep a fire going all day long. The result of these culturally engrained food preparation and bathing practices is that the villagers appear to have a significant exposure to air contaminants.

During the months of June and July, 2016, researchers placed air-contamination sensors, with permission from the homeowners, in a variety of rooms in local houses in the aforementioned pueblos in the Santa Cruz La Laguna municipality. The results were impressive from the standpoint of significant air contamination being found in all venues tested.

These results help us to document that exposure to air contamination is problematic for our patients. The results also serve as a springboard for further research and subsequent interventions. For example, although the research has documented that exposure is an issue, the next step is to test our patients to determine the actual physiologic effects of this exposure. With that information at hand, we, then, will be able to determine which interventions and treatments will be necessary, beneficial, and practical for our patient populations to receive.

6) Sinusitis Causes

Acute sinusitis affects approximately 60% of patients in our area of influence at any given time. And most of those suffering from this malady experience multiple episodes annually. The high prevalence likely is due to poor hygienic practices and the close quarters in which this population lives.

Although guidelines in the US blame viral pathogens as causative in 80-90% of acute sinusitis cases, amazingly, there is no data to support this contention. Studies in other parts of the world actually show that bacteria are causative in over 60% of cases. And one study suggests that viruses isolated from patients with acute sinusitis might not be pathogenic. Moreover, different populations likely have differing causative agents, based on their unique ways of living, including the health practices characteristic of their culture and living conditions.

As a result, we plan to culture all patients of all ages to determine the prevalence of bacterial sinusitis in our community. This study will be accomplished using pharyngeal, bacterial cultures, including antibiotic sensitivities, when bacteria are determined to be the causative agent.
Photo: Charlotte Raymond
Research Projects
Copyright:
Craig A. Sinkinson 2016
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