Ana Tuipulotu’s day begins with phone calls to Pacific Islander patients. She leaves a message for a patient who works 7 days a week as a caregiver. Ana recommends that she find a substitute so she can come in for a one-on-one education session. The patient’s Hemoglobin A1C , (a measure of how well diabetes is being controlled) is 11.9, a blood sugar count that is dangerously high.
Ana grew up in the Kingdom of Tonga, an archipelago in the South Pacific where the daily mean temperature is in the mid-70’s January through December. She was a health educator there before coming to the States.
Diabetes is not common in Tonga, she says. The difference is the food and the lifestyle. “Back in the Islands, people can’t afford soda, canned or frozen foods. Most people have their own plantation. Everything they eat is fresh. They pull the taro and yams out of the earth and cook it the same day. If they need fish, they go to the sea, catch it and eat it. Or they kill a chicken from the yard.”
Food is an essential part of the culture. Every Sunday morning in Tonga, people wake early to prepare the meal, taking taro leaves, stuffing them with meat and coconut milk, wrapping it with banana leaves and laying them on very hot stones in an earth oven that is covered over with banana leaves and soil. “It’s quiet over the whole island; the only thing you hear is the church bells. In the afternoon, after families return from church, you set the food on a table and if you have 4 neighbors, you divide the food, putting a portion on a plate to give to each of them; they do the same for you.”
In the islands, she says, people are much more active. “You get up and go outside to work in the garden or hang the laundry. It’s not like here where you stay in the house every day and lock the door and you only have a small patch for a yard.” These differences take their toll on the health of islanders.
24% of RFHC’s Pacific Islander patient population has diabetes.
Teaching patients to manage their diabetes is a top priority. Diabetes has alarming consequences, if unchecked. It takes aggressive training in self-management to help patients bring diabetes under control. RFHC’s Chronic Disease Management team has 5 Patient Navigators (2 Pacific Islanders, 2 Latinos, and 1 African American) who are trained to gently, but firmly coach patients in the management of diabetes.
On Friday morning, 24 Pacific Islanders arrive for a special diabetes education session. All of them are there because they have uncontrolled diabetes. 99.9% don’t understand the relevance of their A1C number recorded on a paper handed to them at the start of the class.
Ana lectures for an hour. She talks with power and energy, gaining momentum like a locomotive as she drives home the realities of diabetes. She diagrams on the white board. “This is what happens when arteries narrow.” She mimics the muted boom-boom of the heart pumping harder. She sketches the kidneys that can fail, leading to dialysis and warns of hemorrhage in the eye that can cause blindness. She reaches into a box and brings out a life-sized foot. Blood glucose can injure the walls of tiny blood vessels that nourish your nerves, especially in the legs.
You can’t miss the message. Ignore diabetes and you can lose your eyesight, kidney function, even your limbs. The effect on the audience is obvious. From casual attention at the start to alert recognition. Their awareness collectively seems to have jumped from a 3 at the start to a 10 at the end.
Let’s do the numbers
Total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the U.S. adult population by 2050. (Source: Population Health Metrics 2010)
The dramatic rise in the number of diabetics has health care organizations across the nation making chronic disease management a top priority. Last fall, Ravenswood was one of six community health centers in the nation to be awarded a three-year grant for a comprehensive chronic disease prevention and navigation services demonstration project.
The costly consequences:
- Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.
- More than 60% of non-traumatic lower-limb amputations occur in people with diabetes.
- Diabetes is the leading cause of kidney failure, accounting for 44% of new cases.
Currently, more than 360,000 people in the United States are undergoing dialysis, according to the US Renal Data Service. Medicare spends approximately $73,000 annually per dialysis patient.
The above article also appears at the Ravenswood Family Health Center's Spring Newsletter which can be seen by clicking here. For more information about this article or the author, email email@example.com.
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