Edwin Fisher is on a mission to promote peer groups for diabetics across the world and has found great interest in China

For most people with a sweet tooth, ice cream is a treat, but for someone suffering with diabetes, resisting it, and foods like it, can become a daily battle.

Lu Xin, 53, a Beijing resident and diabetic, has fought his culinary desires for 15 years, and like many in his situation has found it a difficult journey.

"Early this June, his situation became worse and even his eyesight was affected, because he constantly ignored his diet," his wife says.

It is a situation Edwin Fisher has seen with many diabetes sufferers over the past 40 years and one that led him to join Peers for Progress seven years ago.

Fisher is global director of the organization, which aims to create support networks for people with diabetes. These networks aim to help diabetics live a healthy lifestyle in terms of sleep, food, exercise and stress management.

In a year diabetics spend an average of six hours in a doctor's or other health professional's office, meaning the rest of the year they are on their own to deal with their health issues, says Fisher.

"It's very easy to get somebody to do the same things for a few days. The problem is that diabetes is for the rest of your life. That's where it's important for patient education and peer support, more mechanically, just support for people to continue to do things on the day-to-day basis that diabetes requires."

Fisher says he has heard many diabetics talk about the support they receive from friends, family or organizations.

"So I realize that self-management is very dependent on the people around us. In a supportive environment we can do a pretty good job of taking care of ourselves."

Peers for Progress was founded in 2006 by the American Academy of Family Physicians Foundation with funding from the Eli Lilly and Company Foundation. Fisher joined it from the start, promoting peer health support around the world.

"During those thousands of hours, people need to get answers to their questions, talk over how they are doing, and, sometimes, just get off their chests the frustrations that managing a chronic disease can provoke.

"The encouragement and occasional assistance of a peer - someone who understands the disease and what it's like to live with it - can have remarkable benefits."

Helping others is something Fisher was brought up with and encouraged to do by his parents.

"I think understanding how people behave and how people can help themselves create a better life sounds a very interesting and important question.

"I have always been very excited about the things that I was understanding, and very gratified by being able to take that knowledge, and use it to help people find a more satisfying life."

Since 2006 he has promoted Peers for Progress in nine countries and collaborated with more than 60 other organizations.

According to Fisher, there were many peer support groups before Peers for Progress began, but most ran on small and very stretched budgets. Lack of communication between programs and the absences of evaluation of their effectiveness were also issues.

"Our task is really to help all these programs to learn from each other and share information and improve.

"We have a whole website full of program material, program models that we are trying to help organizations around the world to use so they can improve their programs."

Despite cultural and economic differences between countries, the fundamental aspects of peer support programs are universal, says Fisher.

"It makes me feel a deeper commitment to promoting this program, because the more we talk to people about this, the more we see its results."

The largest response has been in China, which has about 92.4 million diabetics. Since 2008, leaders from Beijing, Shanghai, Nanjing, Anhui province, Hong Kong and Taiwan have worked with Peers for Progress to help promote its programs. In November, 40 representatives from 17 hospitals in 12 cities participated in a training exercise with Peers for Progress to learn how to develop programs for the tens of thousands of patients they serve.

"We have met many patients and professionals here. They have been very interested in peer support, and see it as a very practical strategy for providing help and a strategy that fits in well with China's emphasis on working together harmoniously."

According to Muchieh Maggy Coufal, senior program manager of Peers for Progress, who accompanies Fisher to China four to five times a year, the major issues their organization faces in China are related to the newness of the idea of peer support.

"The main challenge here is getting resources to get people to develop programs within their hospitals and community health centers," she says.

Fisher says that in China, peer support needs to take into consideration that many diabetes patients are concerned about being a burden to other people. But seeing people doing morning exercise together in the parks, he realized China has a tradition that is very compatible with Peers for Progress.

"I think there are ways in which China provides some unique challenges in terms of concerns about being a burden to other people, but also provides some unique energies in terms of a long tradition of a very healthy harmony in working together."

In Anhui province, retirees teamed up with Community Health Center staff to run monthly meetings for people with diabetes, and organized taijiquan classes, morning exercise groups, shopping trips and even fishing expeditions. There were benefits for diabetics' weight, blood pressure and blood sugar levels.

Sun Zilin, vice-president of the Medical School of Southeast University, says it has cooperated with Peers for Progress in several cities, including Nanjing and Tianjin, and plan to expand promotion efforts across the country.

"Patients with diabetes will easily feel anxious and impatient," he says. "I think peer support can help them be optimistic and increase their quality of self-management. Our task now is to find a way to effectively promote it in China."

In Africa, Uganda and South Africa, despite funding being ended, peer support programs have continued to thrive, with increasing numbers of participants, says Fisher.

Peer support is no panacea and could be improved in many cases by better integration with healthcare systems, he says.

"A key source of help may be just next door, a trained peer supporter. As one patient put it, 'The doctor and nurse tell me what to do, but the peer supporter helps me figure out how to do it'."

Fisher has ambitions to continue expanding the reach and scope of Peers for Progress. He wants it to include other chronic diseases besides diabetes and has been in talks with the Chinese Center for Disease Control and Prevention about expanding the program across China.

chenyingqun@chinadaily.com.cn

(China Daily 01/11/2013 page20)