Columbia St. Mary's
Milwaukee

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Make sure to read the personal stories below of men and women whose lives are changing thanks to this program.

As part of her Columbia St. Mary's (CSM) parish nurse ministry in 2006, Julia Means made weekly visits to the New Life Church Food Pantry. To her dismay, she discovered that from 30 to 40 percent of the pantry clients were both hypertensive and untreated. Most were impoverished, uninsured and ineligible for coverage. Most were African-Americans, who as a community experience higher levels of hypertension and diabetes. Ironically, most could be treated with medication that may cost less than $10 per month. For lack of treatment, however, many experienced strokes, kidney failure and congestive heart failure.

Discussions with CSM Community Services staff and CSM Family Practice Residency faculty led to the idea that a treatment program could be created to target hypertension and diabetes in this specific community. A grant application for funds from the Healthier Wisconsin Partnership Program of the Medical College of Wisconsin was submitted. A three-year grant was awarded to develop a CCDM Clinic model of service.

A hypertension and diabetes protocol was developed by Dr. Jim Sanders, faculty member of the residency clinic. The protocol used physician assessment and oversight along with nurse practitioner and nurses as treatment providers. Food pantry clients and other community members were screened for hypertension and diabetes and referred to the clinic for care. Laboratory testing was based in the clinic as well as an outpatient pharmacy. Using a "Window of Opportunity" philosophy, providers could offer laboratory testing, health education, care management and medications from the CCDM Clinic site in the food pantry. Since most food pantry clients come to the pantry at least once a month, patient compliance was fairly good. Cooking classes supplement other health education and served as an additional incentive for clinic attendance.

Over the course of the past three years, CCDM has screened thousands of people and treated 434 patients for hypertension and diabetes. Treatment results have been remarkable, particularly in the area of blood pressure control:

• Dr. Sanders found that 97 percent of enrolled patients received low-cost hypertensive medications while 97 percent of diabetic patients also received low-cost medications. Hypercholesterolemia patients received low-cost medication 94 percent of the time.
• 100 percent of patients who smoked were provided with tobacco education.
• 61 percent of hypertensive patients achieved a reduction in both systolic and diastolic blood pressure of at least 5 mmHg.
• 76 percent of enrolled patients achieved 5 mmHg systolic pressure reduction and 71 percent achieved 5 mmHg diastolic pressure reduction.
• Average systolic reduction for all enrolled hypertensive patients was 24 mmHg.
• Average diastolic reduction for all enrolled hypertensive patients was 13 mmHg.
• Average reduction of 15 percent A1c for all enrolled diabetics.
• In diabetics presenting with A1c above 9.5, average reduction of 46 percent in A1c.

The treatment model is sustainable, even without grant funding since it relies primarily on nurse practitioners and nurses to offer direct treatment and most of the medications provided are generic and low-cost. Laboratory services are provided on a "clinic cost" basis to further control expenses.

CCDM was just renewed in its funding from the Medical College of Wisconsin and will expand to two other church-based sites over the next two years.

Personal Experiences

DAVE
Dave, age 50, is one of CCDM's 'charter' patients and likely one of its most ardent supporters. And he would be happy to tell you in no uncertain terms why. "If it weren't for these people, I wouldn't be here today," said Dave, striking a theme often repeated throughout his remarks. "Anything I could do to keep this clinic going, I would do it," he said, engaging in a little playful but heartfelt hyperbole. "Because there's a thousand more, a million more out there like me."

Dave spent 13 years commuting 45 minutes each way to a job in Jefferson County, where he worked in a packing house. When he was working, he had insurance. "When my job left, my insurance left. I have not had any since," he said. At the time, Dave was unaware of his hypertension. He had been coming for years to the food pantry in the same church basement where CCDM is located. After reading a flier about the clinic's program, he paid a visit. What Dave learned startled him. He recalled one of those first blood pressure readings at about 197/116 "My blood pressure was so high, I could have blown a gasket at any time," he said. "Then I found out I was diabetic and had high cholesterol. I got all kinds of problems I didn't know before I came here."

Dave was one of the first patients of the clinic and was happy to receive medication to treat his diabetes and cholesterol. Since he was one of the first patients, Dave was featured in a newspaper article written about CCDM. The syndicated story, which included Dave's photo, was picked up by hundreds of papers across the country.

He laughs today, gazing at the photo. "Look at me," he said. "I was a butterball, as big as Santa Claus." Back then, he weighed 265 pounds. His current weight is 214. But neither his weight nor his blood pressure dropped immediately. Dave wasn't getting enough exercise and regularly indulged his sweet tooth. "I was drinking too much Kool-Aid. I love Kool-Aid. And Scooby Snacks, cupcakes, doughnuts, fried foods. I love that. It took a long time to get to where I wanted to be."

Along with the early blood pressure readings, CCDM professionals told Dave to cut down on the grease and sugar, and get regular exercise. "They gave me a packet telling things I should eat," Dave said. "Vegetables are number one. They taught me how to drain the water in canned foods and rinse the extra salt out. How to eat the right way." Dave also took to exercising. He can now run one or two miles a day, or ride a bike four or five miles. "They had to train me to handle my blood pressure," he said.

Dave became the first person to receive medications from CCDM. He also learned there about his diabetes and high cholesterol, and how to take care of himself. About a year and a half ago, when Dave's sugar level reached about 435, CCDM sent him directly to the hospital. "In other words, these people saved my life. I'm serious, man," he said. "I recommend people to come here. Because if you don't got Medicare or any insurance, the other people really don't want to see you."

Dave's kids — "My kids are number one," he said — are mostly grown. But he does have a 14-year-old daughter. "That's the baby," he says. Before, he got tired and dizzy easily. Now he has the energy to do things with her. "You'd be surprised how many black people have these problems," said Dave in conclusion. "I mean this from my heart: Without these guys, I wouldn't be here today. And I know it. I know it. When somebody saves my life and is helping me out, I'll tell the world."

ROSE
Rose, age 60, recently made her first return visit to CCDM after a year's absence. Like others who navigate along the fringes of the health insurance system, she has relied on CCDM when other resources proved unreliable. A quiet, reserved woman, Rose responds cautiously to questions about her medical history and needs. She has had a number of health issues in her life. Heart problems and depression run in her family, and both have touched her directly.

"I've lost everyone in my family, starting around the time I was in college," she said. "My father died of heart attack. A couple of female cousins had heart problems early in life. I've had the same problem for many years but have treated it."

Stress has been a recurring factor in Rose's life. In her 20s, she became a collections investigator for the Internal Revenue Service. She likes working with people, but her job required her to interact with others under trying conditions, issuing liens and levies to recover payments due. During her five-plus years with the IRS, Rose began developing health problems. Her colleagues, she noted, were also succumbing to work-related pressures. One supervisor suffered a heart attack; another had a mental breakdown. The career path she thought might help define her future had turned into a minefield.

Rose has held other jobs over the course of her career. She has worked as a program assistant, a census worker, and a receptionist. She has held several temporary positions. As she shifted between jobs, her insurance options have shifted, also. Sometimes that has meant an increase in fees or a discontinuation in coverage. Sometimes it means a switch to a formulary insurance model that replaces one medication with a cheaper, less reliable alternative.

About two years ago, a parish nurse recommended CCDM. At the time, Rose's blood pressure was "very high." She used CCDM's services for about nine months until she could obtain insurance. She also learned there about her high cholesterol levels.

CCDM helped Rose understand that the problems she was experiencing with her blood pressure medication had to do with its diuretic properties and her low potassium levels. The clinic prescribed a different medication to solve the problem. She noted that, in addition to helping her adopt healthy dietary practices, the clinic has been careful to take her other medical needs into account while providing the proper medications for her.

Currently unemployed, Rose views CCDM as the kind of place that helps people who have lost their jobs or who are in transition cope with pressing health needs. "It's more important these days to have a clinic as a stopgap solution, because you can't always get insurance that quickly. There are waiting lists," she said, "and problems with renewals you just don't know about beforehand."

As a returning CCDM patient, she values the care she receives. "It's a very special clinic," Rose said about CCDM. "People here take the time to help you. I've always felt very welcomed. They are careful, they take all the necessary tests. They also discuss the results with me. That's very nice, because I like to know what's going on. Not all physicians will do that. I think that in itself can help lower your blood pressure — when you know people will listen to you and treat you well. I think that's important. You don't feel like a number here. You feel like a person."

ERNELL
Ernell, age 48, doesn't like needles. A burly, muscular man, he sits tensely, mumbling as a CCDM technician carefully locates the right spot on his forearm to draw blood. As she gently inserts the needle, Ernell winces, turns away, and kiddingly lets out a howl. The outcry draws an amused reaction and a different kind of needling from CCDM staffers within earshot, who have heard Ernell's complaints before. He protests loudly, and the teasing escalates. The exchange plays out on each visit, and all actors seem to enjoy their roles.

That Ernell should harbor such fears about needles is striking, considering that, as a self-employed electrician, he is accustomed to scaling ladders up to 300 feet high inside the huge wind-power turbine towers he helps to wire, carrying a 100-pound load of tools over his shoulder. The full climb takes 45 minutes in either direction.

Ernell has diabetes. He learned about the disease when he lived in Phoenix and was still insured. His blood sugar readings went as high as 500 and 600. One time, at work, the office doctor took his reading at 849 and immediately called an ambulance. Ernell refused to go to the hospital, unwilling to admit he had a problem. He changed his mind as symptoms developed. He needed to use the bathroom several times each night and became dizzy whenever he stooped or squatted down.

Later, after moving to Milwaukee, Ernell monitored his blood sugar daily. But he had no insurance or medicine. He learned about CCDM through his church two years ago. CCDM treats Ernell for diabetes and borderline hypertension. He quibbles about the latter, claiming that his aversion to needles will cause his blood pressure to spike whenever he visits a clinic. "I don't care if it's a foot doctor," he said. "I feel the same way." Ernell has learned a lot since coming to CCDM. On his first visit, he weighed 280 pounds. Today he weighs about 240. "If I lose this," he said, pointing to his stomach, "my diabetes will improve. I'm working on it, but it's a battle. It sticks to you like glue."

He now eats more vegetables, salads, dates, pecans, and cashews, and he avoids chips, sweets, and sodas. "I drink fresh squeezed orange juice and stay away from processed sugar," he said. Ernell has also been to CCDM's cooking classes. He has learned about seasoning food while avoiding salts and sugars. "They also want my cholesterol to go down," he said. Ernell admits to cheating just a little from time to time. But when he climbs the towers, he takes enough food with him for one long, demanding shift: four apples, four bananas, four oranges, a big bunch of grapes, and lots of water. He also keeps a journal of his blood sugar readings, in case the doctor wants to check.

An electrician for 23 years, Ernell gets exercise on the job. Climbing up the wind towers is extremely challenging, but the work is seasonal. He also does residential, commercial, industrial, and marine work, which keeps him physically active. CCDM has been good for Ernell. He calls the clinic's staff friendly and helpful. "They don't have any attitude," he said. "They're nice to you, want to know how you're doing. They're real cool and help you unwind."

If he could change anything, Ernell would like CCDM to offer a wider range of medical services. "If I had another problem, I don't know where I'd go. Because the hospital, they wouldn't take you," he said. "Keep the staff, because the staff is good. I like the staff."

MARTHA
The original diagnosis of hypertension has caught many of CCDM's clients by surprise. Not so with Martha, age 48. She had her suspicions. "I thought that I might have high blood pressure because I was having lots of headaches and felt irritable," said Martha. She was struggling with a good deal of stress in her life. But her unemployment insurance had run out, and she didn't have any health insurance to fall back on. She learned about CCDM from her sister a year and a half ago. Now she and her two sisters are regular clients of the clinic.

Martha's first visit was an eye-opener for her. "I got here just in time," reported Martha of that first encounter with CCDM. "I learned that I was on the verge of a stroke. When they took my blood pressure, it was 200 over 100-something."

Family tensions were contributing to Martha's condition. Her married daughter, a mother of three, had just purchased a house in Rockford, Ill., and frequently found herself overwhelmed with her new responsibilities. "Every month I go down to Illinois, even though I live here," said Martha, who added that she often stays for a week or two at a time, helping out with her grandsons and the baby. "They will come and pick me up any time," said Martha. "My daughter will tell me, 'Mom, I need a break from the kids!' I love my grandkids, but those visits were helping bring my blood pressure up."

Upon learning of Martha's elevated blood pressure, the clinic's staff immediately arranged for medication. After several bi-weekly visits, the problem was slowly brought under control. Then another problem arose. While in Illinois, Martha suffered a delayed allergic reaction to the medication. She was taken to an emergency room there, and stayed in the hospital for about a week. "They told me the medication does that sometimes," Martha said. But the new prescription ordered at the hospital was ineffective. Upon her return to Milwaukee, Martha visited CCDM. She was given another prescription, which caused her nausea and acid reflux symptoms. The clinic immediately substituted a fourth medication, which addresses Martha's hypertension without causing any side effects.

Under the guidance of CCDM, Martha has made additional changes to her diet and routine. "I walk every day, no matter what the weather is like," she said. "If I don't get my walking in, I just don't feel right." Martha has also cut down on salt and has replaced her vegetable oil with olive or canola oil. She also eats more vegetables, steamed or sautéed, and less fried foods. "It works for me," she said.

But perhaps the most important advice Martha received at CCDM concerned her stress. "When I first started coming here, they told me that I needed to learn how to stay calm. I had to learn that," Martha said. "My daughter had a tough pregnancy, and I was really stressed out. There was a lot of screaming and hollering."

"That's another thing I learned by coming here," she continued, referring to her relationship with her granddaughter and grandkids. "I learned that I cannot put you before me. Because if I don't take care of myself first, I can't help you."

Martha appreciates the personal care and concern she received at CCDM, which has enabled her to overcome her hypertension and its related issues. "All the people here are great," she said. "They do what they can to help you. That's why I love coming here."

JASON
Jason is a young man with a busy life and ambitious plans. At age 35, his health care needs are relatively few. But CCDM serves a critical role in his life, helping him deal with his high blood pressure when he has no other resources to draw on.

Jason found CCDM a little over a year ago. Once a month, his church sponsors blood pressure screenings after Sunday services. He thought it prudent to have his blood pressure checked, and it was there that he learned about his hypertension. Three weeks later, following his cousin's suggestion, he came to CCDM. His mother is now a client there, too. Before his job left town, Jason had good medical coverage. Working for a large Oak Creek-based manufacturer of automotive parts, Jason spot-welded, inspected and packaged catalytic converters. "I didn't realize at the time that those converters were so expensive," Jason mused. "They didn't seem that expensive to me when I was making them."

When he lost his job after 17 months, he also lost his coverage. Jason was able to arrange for interim coverage for a period of time, but it didn't last for long. Now Jason sells new cars for a foreign and domestic auto dealer in Waukesha, often putting in 50-hour weeks there. The job is working out pretty well, but he receives no health care benefits. Jason is also a business management and entrepreneurship student at the University of Phoenix. He plans to graduate in 2014. After that, he would like to open his own video café, maybe a chain of them, where customers could try out the latest video games over a cup of coffee and a muffin or sandwich. He would also offer the games for sale or rent.

Jason's fast-paced life makes him susceptible to grabbing fast food from time to time. "I don't diet much," he said. "I stay away from fast foods and don't eat a whole lot of fried foods." He tries to be careful about what he eats, avoiding salt and eating more vegetables. But he's busy, between work and school, and often finds himself grabbing a quick meal in the car. He knows that making his own lunch would be a good idea, but hasn't worked that into his schedule yet.

Exercise is not on the top of Jason's to-do list. At home, his work-out is limited to mowing the lawn. At the dealership, he does a fair amount of walking when he takes customers out on the lot to look at cars. But, much of his time on the job is spent sitting and waiting for customers to show up, and studying during the quiet stretches.

At CCDM, Jason receives the support he needs to continue integrating good diet and exercise advice into his daily regimen. His regular visits there are not likely to change. "The service here is really good,' said Jason during a visit to CCDM. "The people here offer you what you need. They are concerned about your health. When I lost my job, I never would have got the help I needed someplace else. I like it here. I'm comfortable here. It's a warm atmosphere."

And perhaps, on a sultry summer day, just a little too warm. When prompted for suggestions on how to improve the clinic, he came up with one: "They need to make it a little cooler inside."

PAT
Pat worked for more than 30 years in the health care profession. But now, at age 64, she is unemployed, without health insurance, and looking for work. She lives near the church where the CCDM clinic is housed, and she had been making monthly stops to the food share program there. That's where she learned about CCDM.

"I already knew that I was borderline hypertensive and borderline diabetic, and had high cholesterol levels," said Pat. As an employee, she had adequate medical coverage and was able to have her condition assessed. But, having lost her coverage, she decided to take advantage of CCDM's services a year ago. That's when she learned that her counts had become elevated.

Pat began her career as an LPN in 1977. She worked on a surgical floor at the University of Chicago's Billings Hospital for six years. Then she left and worked at a variety of clinics and nursing homes. Her jobs required her to participate in patient lifting and transporting, which at the time was hard on her knees. In 2000, Pat moved to Milwaukee and found work in a nursing home. Then, on the advice of a niece who was a City of Milwaukee employee, she explored public-sector employment options and took a job with the Milwaukee County Division of Mental Health. Later, to cut down on her commuting time, she became a nurse for the Milwaukee County corrections system. She remained employed there until 2008.

"I don't work anymore but am looking," Pat said. "I don't want to be sitting around the house." Pat looks after her health. A knowledgeable health care services consumer, she looks forward to the day she turns 66, when she will once again be eligible for health insurance. Until then, she gets her annual testing done at the Well Women's Clinic, and she visits CCDM monthly. At first, to get her rising blood pressure, blood sugar, and cholesterol levels under control, she became a weekly regular at CCDM.

Pat is reticent to talk about her career with her caregivers, and is content to follow their instruction and advice. "I have a low-salt diet," she said. "I exercise on a daily basis. Where I live there are stairs. Every morning — I'm up by around five o'clock — I go up and down the stairs at least five to 10 times. I do that each day." Pat also takes advantage of the cooking demonstrations that CCDM's clients register to attend.

CCDM provides other services that may go unreported, but not unappreciated. "I just lost my dad last year," Pat said. "Sometimes I've come in here and just cried, but they help me calm down." At about that time, Pat's creatinine level also became a bit elevated, but the CCDM doctor was able to detect and resolve the issue.

"I'm happy here, very happy here," said Pat in summing up her feelings about CCDM. "The medication, that's a big plus for me. I know practically all the ladies here. They are very concerned. They give me good information, and they are interested to know how I'm doing."