CoDE--Attacking and Controlling Diabetes in the Inner City

Yesterday the Dallas Observer carried the following story regarding our Community Diabetes Education initiative here at Central Dallas Ministries.

I wish you could meet Helen Rodriguez-Farias. Her work is saving lives, literally.

I thought you would like to read the report.

(http://www.dallasobserver.com/
Issues/2006-04-06/news/news2.html)
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Health Class
Central Dallas Ministries documents diabetes among the undocumented
By Jesse Hyde

Article Published Apr 6, 2006 --The Dallas Observer

Its just after lunch on a warm Wednesday in March, and Helen Rodriguez-Farias is seeing her third patient of the day. The nurse beside her, whom Rodriguez-Farias is training, pulls on a pair of gloves and preps the needle. She says something in Spanish to the patient and pricks the woman’s finger, drawing blood. The woman smiles, says she had a Coke this morning. If her blood sugar’s high, that’s the reason.

Rodriguez-Farias nods and jots down the woman’s blood sugar. It is still high but has dropped considerably since her first visit to the clinic a few months ago. The woman, a 35-year-old housekeeper named Angelica Lopez, has Rodriguez-Farias to thank for that.

Rodriguez-Farias is the community health worker at the Central Dallas Ministries clinic here on North Peak Street, not far from Baylor hospital. Several times a day, she helps women like Lopez manage their diabetes through an innovative program that is unlike any other in the country.

Diabetes has been called the Rodney Dangerfield of diseases because it gets little respect when compared with killers like AIDS or cancer. While Type II diabetes (which does not require insulin shots) can be effectively managed through proper medication, diet and exercise, it can lead to blindness, amputation or death if ignored for too long. In urban areas like Dallas, diabetes is growing faster than any other disease, especially among segments of the Hispanic population. In fact, one in every two Latinos born in the United States in the last five years is expected to become diabetic, according to the Centers for Disease Control and Prevention.

There are several reasons for this—genetics, diet, poverty—but one of the main reasons the disease is growing among poor Hispanics, specifically among illegal immigrants, is that without insurance, it’s hard to find adequate medical care. And those hospitals that do treat the uninsured, such as Parkland, do not treat patients without a Social Security number.

Enter Rodriguez-Farias and the CDM clinic. The clinic, which has three full-time doctors and a small pharmacy, is one of the few places in the city where illegal immigrants can go for health care. What makes the clinic truly unique, however, both in Dallas and in the United States, is that it does more than dole out medication to undocumented immigrants who have diabetes. It also teaches them how to manage the disease.

“When someone comes in, often they’re going in because they feel sick. They’re not going in for their diabetes. Their vision is blurry, they have no energy, they can’t stop peeing. They just want to be seen,” says Elizabeth Prezio, a doctor who specializes in diabetes education. “But somebody’s got to tell them, ‘I know you have a cold, but you also have diabetes, and we need to come up with a plan to do something about it.’”

To this end, Prezio and several other doctors started a program called CoDE, or Community Diabetes Education, at the CDM clinic in July 2003. The program’s goal was to teach the clinic’s diabetic patients to manage the disease. That’s where Rodriguez-Farias, the clinic’s diabetes educator, comes in.

“She grew up in the neighborhood, so she knows these patients,” Prezio says. “They trust her, and they are not intimidated by her. They’re not afraid to tell her the things they would be afraid to tell the doctor.”

As the clinic’s educator, Rodriguez-Farias meets with diabetic patients three times during the first six to eight weeks after diagnosis, teaching them how to measure their blood sugar at home and how to make changes to their diet and lifestyle. If, over time, a patient is not getting better, Rodriguez-Farias will try to figure out what the problem is with the help of one of the doctors downstairs.

“You can only imagine how much physician time this saves, particularly because these patients are Spanish-speaking and two of the three doctors are not fluent in Spanish,” Prezio says. “So much of chronic disease management is providing a listener for the patient. Doctors don’t have time to sit down and say, ‘What did you have for breakfast today?’ ”

Today is Lopez’s second appointment. Rodriguez-Farias asks her what she ate for breakfast and lunch. Three tortillas, an egg and a banana shake, Lopez says. Rodriguez-Farias raises her eyebrows. A banana may seem healthy, she says, but it is loaded with sugars and carbohydrates. It may be the reason Lopez’s blood sugar is a bit elevated. Lopez nods.

To make her point, Rodriguez-Farias pulls out a picture of a festering wound on the bottom of a man’s foot. “Do you see that?” she asks, pointing to the red, pus-filled center. “Those are maggots.” Lopez winces. High blood sugar makes it hard for cuts to heal, Rodriguez-Farias explains, and diabetics must check their feet regularly or small wounds can end up infecting the bone. In this case, the man ignored a cut for too long and had to have his heel amputated, then his foot and then his entire leg.

Most of Rodriguez-Farias’ patients—she has more than 200—are women like Lopez. Almost all of them have Type II diabetes. Some of Rodriguez-Farias’ patients have been visiting her for two years. If they want, they can visit her indefinitely.

“The other day I had a guy call me who had seen one of our fliers who wanted to sign up for the program. He had really good insurance, he was taking the best medications, but he wasn’t getting any better. He wanted someone like me to tell him what he could and couldn’t eat,” Rodriguez-Farias says with a smile. “But he didn’t qualify.”

But Prezio wants more than anecdotal evidence to prove the effectiveness of her program, which is why a study is under way to prove that those who visit the clinic and enroll in the education program do better than those patients who don’t.

“So far we have data for six months, and the education group is doing much better than the other group,” Prezio says. The goal, she says, is to expand the program to other area clinics that serve the uninsured and the undocumented.

It’s something Rodriguez-Farias wants to see happen. Her dad died from diabetes at the age of 54 and suffered for decades from complications related to the disease. “If he had been a part of a program like this one, I’m sure he’d still be alive today,” she says.