Integrating artistic programs in diabetes education and self management in Madagascar.

Author(s) Tojosoa Rajaonarison1, Haja Ramamonjisoa2, Tiziana Assal3, Jean-Philippe Assal4, Georges Ramahandridona5.
Affiliation(s) 1Art-therapy, Madagascar Diabetes Association, Antananarivo, Madagascar, 2Therapeutic Education, Madagascar Diabetes Association, Antananarivo, Madagascar, 3Art-therapy, Foundation for Research and Training in Patient Education, Geneva, Switzerland, 4Therapeutic Education, Foundation for Research and Training in Patient Education, Geneva,Switzerland, 5Medical, Madagascar Diabetes Association, Antananarivo, Madagascar.
Country - ies of focus Madagascar
Relevant to the conference tracks Chronic Diseases
Summary The Malagasy perception of diabetes is negative. Patient with diabetes often do not accept their treatment and their family members reject them. Heath caregivers need to be closer to patients and to promote a good collaboration with them.
Our Diabetic Association has organized up to 12 painting workshops from 2010 to 2013 with 141 patients. They are centered on patients’ problems and needs. Each workshop provides painting exercises associated with specific moments: blood sugar measurements, diet discussion, and hypoglycaemia. Health caregivers provide flashes of therapeutic education during this time. Workshops also provide psychological and social balance enabling patients to be more responsible for their health
What challenges does your project address and why is it of importance? Painting workshops are a tool to promote therapeutic patient education for all types of diabetics. Organized by A.MA.DIA. (Association Malgache contre le Diabète à Antananarivo), they have brought many changes in our participants’ lives: patients are finally able to express themselves more freely, they discover their personal creativity, they are more involved in social activity, they feel less isolated. This process has a strong effect on the coping ability of each patient. Adherence of treatment increases, medical appointments are better respected and the doctor–patient relationship improves. As a consequence, there is a general improvement of patients and care providers’ attitudes. They all feel more empowered in their daily activities. After the workshops patients feel that their family members understand them better.
How have you addressed these challenges? Do you see a solution? The A.MA.DIA has faced many problems over the years including crowded outpatient clinics, lack of enough fully trained personnel, difficulties in continuing education as well as being faced with false copies of medication: diabetic oral agent, antihypertensive drugs, and antibiotics. This situation has forced us to develop specific courses to teach patients to detect the copies of false drugs that patients may have bought cheaply at a local market.
Hypoglymia in children and young adults is another serious problem.
During the workshops with children, the blood sugar is tested and explanations are given about corrective snacks.
Another aspect is the timidity of patients in the presence of the care providers. The consequence is that patients suffer from a lack of psychological support.
Painting workshops reinforce continuing education as well as the self-reliability of patients.
They develop self-confidence and autonomy.
How do you know whether you have made a difference? The various activities we described, linked to therapeutic education, did not exist 4 years ago. Since their creation and development, there is an increasing demand for participation among patients as well as their families.
There is a weekly connection through skype between A.M.A.DIA and the Geneva center, and a monthly video sessions with the participation of experts who are at the disposal of the team of l’AMADIA Hospital. Those meetings allow joint discussions, lectures, supervision, continuing evaluation and support.
The experts have writen some observations about our workshops of Art-Therapy : “The thing that strikes all those who have observed the AMADIA workshops is the extraordinary enthusiasm and commitment of the caregivers and patients. Caregivers experiment continuously new ways of helping patients using art, working with different groups of participants: families, young diabetics, aged people as well as mixed groups."
The example of AMADIA shows that art can be integrated in a global system of care where emotional expression and medical care can be simultaneously present.
Have you or the project mobilized others and if so, who, why and how? Among the various approaches we have developed, we obtained help from the World Diabetes Foundation and the order of St. Jean France and Switzerland. This allowed the improvement of our Hospital AMADIA and the widening of detection campaigns throughout the country. We also have the benefit of monthly Video sessions with Geneva with the help Orange Madagascar and the Foundation for Research and Training for Patient Education in Geneva.
When your donor funding runs out how will your idea continue to live? We think that financial support from donors is of vital importance for the continuity of the painting workshops. Madagascar is a very low income country and so are the majority of our patients. Many people cannot even afford the cost of their daily pills.
However, psychological support is necessary for people living with diabetes. It is fully recognized that painting equipment colors, paper, brushes are expensive. This is why this type of practice should be supported.

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