Appeared in Brownsville Herarld and Valley Morning Star on December , 2013
By Lisa Mitchell-Bennett
Elvia* nervously steps on the scale and hands me the folded card she pulls from her pocket. As I write the weight onto the card, her face lights up and she announces that she has lost 2 pounds this week. “I lost an inch too! It’s working!” The room spontaneously explodes in applause for her, although they had all been focused on writing their goals for this week. “Felicidades mihita”, an older lady touches Elvia’s arm as she makes her way back to her seat beaming.
It’s an unlikely group of strangers that have bonded over the last few weekly meetings in a small classroom off the Gonzalez Park gym in the Southmost neighborhood of Brownsville. They are all ages, the youngest is 28 and the oldest is 70. What they have in common is their diabetes, which up to now has been uncontrolled and causing them all kinds of other health problems. When these folks get into see a doctor, or drop in at a hospital emergency room with blood glucose levels alarmingly high, they are often judged by health care providers who may not see the whole picture or understand the barriers they face. Many have been labeled “difficult” or “non-compliant patients”. Often misunderstood, they face insurmountable barriers if left alone to manage this complicated disease. Most of these individuals don’t have any health insurance, and are often unable to pay for the medicine and equipment (insulin, glucometer, strips) to be able to monitor and control their diabetes. Some are living in violent homes, without electricity or water and others without transportation or at times even enough food to eat. They come to the group to learn about how to set goals for their health, address barriers, monitor their blood glucose and stay on top of their medications. They also learn how to prepare and eat healthy food and increase their physical activity to achieve a healthy weight, which is key to improving diabetes control. A “promotora” or community health worker is assigned to each participant and follows up with home visits to insure folks continue with the plan and have the additional support to make healthy changes.
Julie Orta, a Community Health Worker with the program says many of the participants just need someone to listen and encourage them. “Sometimes they don’t have anyone to support them. Several of the participants can’t read so when they go to the doctor and are handed a pamphlet about diabetes, they get intimidated to ask questions. Or they simply can’t get to the doctor in the first place because of x, y or z barriers they face at home. In some cases they don’t have access to a doctor, and have to use the emergency room at the hospital as their “clinic” which isn’t effective and ends up costing all of us more.”
This new approach to diabetes care is being piloted in Cameron County after numerous institutions came together to address the high costs of this disease which affects 1 in 3 adults in the Rio Grande Valley. Salud y Vida (Health and Life) Rio Grande Valley Chronic Care Management program has already improved lives of participants and helped them better manage their diabetes. Salud y Vida brings together key healthcare institutions in the Valley, including hospitals, clinics, mental health providers, university and community based organizations to address the burden of diabetes among the poor and uninsured in our communities. A team of health professionals review cases of individuals who are enrolled in the free program to ensure they are managing their diabetes, staying out of the hospital and getting connected with crucial educational and clinical services. A team of community health workers and nurses are deployed in the community. Eventually the goal is to connect health records electronically and provide a means to share securely and confidentially important information to better manage care through the Rio Grande Valley Health Information Exchange. The program is redesigning the way very ill indigent and uninsured patients are treated by providing a coordinated, personal approach through education, skill building, and support to help them enjoy a healthy, productive life, which saves us all money.
Back in the classroom, another middle-aged woman shares with the group, “My family doesn’t support me, in fact they make fun of me! My husband gets angry if he sees me trying to exercise or eat healthier. He gets jealous and says I must be trying to lose weight for another man.”
“It’s really hard to make healthy changes when you are cooking for everyone in your house and they demand unhealthy food. The only place I feel supported is right here in this group. It’s been a blessing!”
An elderly man responds that because of support from the program, he and his wife have completely changed the way they live. His wife comes to the group to learn how to help him and sits next to him with a huge smile and tears in her eyes. “I realize we have to do this together,” he adds. “She is the one who gets me to go out for a walk, to get up from my chair and move–take my medicine. But I know I have to start being responsible for myself. Sure we are still gorditos, but we are working hard to lose the weight. My goal is to be like him!” (pointing to the guest speaker who has been able to control his diabetes without medication after years of healthy eating and fitness.)
Another young woman jumps into the conversation. “I never really knew how sick I was since I never had a glucometer and strips to check my blood sugar, and really didn’t know what it meant anyhow. Angelica (another Community Health Worker) came into my home and showed me how to check myself, got me the supplies I needed. Now I realize why I always felt so bad. I was only eating one meal a day and not eating the rest of the day. Learning how to get on a schedule of eating smaller meals more often and checking my sugar has helped a lot. I write the numbers down on the record card she gave me and now when I go to the doctor I can show him. I am starting to understand how I feel when my sugar is too high or too low. She really helped me and even figured out how to get me some food from a church in my neighborhood so I always have something to eat in my house, even when the money is tight.”
Salud y Vida is providing a comprehensive approach to caring for the uninsured with lower-cost quality preventive care because Tu Salud ¡Si Cuenta! (Your Health Matters!) For more information about the Salud y Vida program, call the UT School of Public Health at (956) 882-6754.
*Name has been changed.
Tu Salud ¡Si Cuenta! is a community-wide campaign supported by the University of Texas, School of Public Health and Transforming Texas in Cameron County.