Block-By-Block program aims to curb sky-high diabetes numbers
By JULIE MINDA
RESURRECTION HEALTH CARE
CHICAGO — When Migdalia Davila's husband lost his job in 2007, the 53-year-old diabetic and asthmatic was left uninsured and unable to pay for her doctor appointments and medications. Once his unemployment checks ran out, "I was off my medications for a year," she said. "I was constantly sick."
Late last year, through word-of-mouth, Davila, a resident of Chicago's Humboldt Park neighborhood, heard about a diabetes program "block captain" who could help her. Connecting with Maria Sanchez, Davila learned that she and her husband could go to a nearby clinic to get discounted care and medications.
"It was such a relief, and I feel so much better," Davila said. "And, I now have a doctor, and that's so important."
Diabetes is rampant in Humboldt Park, a predominantly Puerto Rican community of about 65,000 people. A 2006 report by Chicago's Sinai Urban Health Institute found that more than 20 percent of Puerto Ricans in Humboldt Park had been diagnosed with diabetes. The community's rate of Type 2 diabetes was higher than the rate in any other neighborhood in Chicago. No other Puerto Rican community in the world has reported such a high diabetes rate.
A collaboration of Chicago-area health care providers including Saints Mary and Elizabeth Medical Center hope to stem the tide of diabetes through a prevention program called "Block-By-Block — the Greater Humboldt Park Community Campaign Against Diabetes." The effort, which covers a 72-block section of Humboldt Park, aims to educate people about diabetes and to identify diabetics in order to help them to manage their condition and access care.
Launched in April 2010, Block-By-Block employs members of the community as block captains, arms them with knowledge gleaned from intensive training on diabetes then dispatches them to search out people with uncontrolled diabetes or people whose lifestyle puts them at high risk for the disease. Team members use their social connections to identify — and gain the trust of — medically underserved neighborhood residents.
"This is an urgent need here," said Project Director Jaime Delgado. "We're finding people in an advanced stage of illness here — there have been cases of amputations and blindness in our community because of diabetes. We need to catch this early," before the condition progresses for more people.
New resources
Victor Villalobos, community relations director of Saints Mary and Elizabeth, was part of a group of Chicago-area researchers, public health experts, government and community leaders that created Block-By-Block.
The task force also established and funds the Diabetes Empowerment Center, a ground-floor space along a major commercial thoroughfare in Humboldt Park that houses the Block-By-Block offices and meeting and community space. Saints Mary and Elizabeth pays the salary and benefits of a center staff member and provides space at the hospital for training and meetings.
The center aims to make it easier for people to learn about and prevent diabetes. It offers free exercise and cooking for health classes and has free bilingual education materials aimed at preventing or managing diabetes. Villalobos grew up in Humboldt Park, and he sees attitudes and behaviors changing for the better. Awareness of diabetes and its consequences is up and people are taking advantage of the neighborhood center and other wellness resources.
Canvassing the neighborhood
Three of the program's four block captains are from Humboldt Park or nearby; three are of Puerto Rican descent and of that group, two are diabetic. Block captains were selected not for their knowledge of diabetes — they acquire that in training sessions — but for their personal characteristics. Delgado explained: "We chose local people who are familiar with the neighborhood, who are wired in. They are 'homegrown' people who have a passion for community work."
Active outreach is at the heart of the Block-By-Block program.
Since last fall, the program's block captains have taken to the sidewalks pulling wheeled briefcases stocked with the laptops they use to administer their surveys; basic equipment to measure respondents' height, weight and blood pressure; and information on diabetes prevention and management. They are systematically covering every address in their assigned quadrant of Humboldt Park in the hopes of talking to members of each household about diabetes.
During this first phase of their work, they are asking Humboldt Park residents to complete a survey about diabetes. The block captains determine whether acknowledged diabetics are accessing medical care. For those not yet tested, the captains determine their level of risk and urge those in danger to get screened. The captains also can help coordinate that testing. Saints Mary and Elizabeth has agreed to handle the diabetes testing of hundreds of Humboldt Park residents. The hospital or the block captains also help the diabetics determine where best to access follow-up care. In the future, the center hopes to offer basic care services for diabetics.
When this survey and initial outreach phase is complete around October, the team will be expanded, and will begin phase two — follow-up visits to each identified diabetic to help them develop basic disease-management plans.
Closed doors
There are challenges to cold calling on an entire neighborhood. It can be hard to catch people at home, so the captains return repeatedly, or try back during evening or weekend hours.
Other barriers are more subtle than an unanswered doorbell to a darkened apartment. Many residents are distrustful of people because they've been taken advantage of in the past, said block captain Amelia "Amy" Martinez.
Block captain Johnny Tirado said some people are hesitant to open their doors because they assume the block captain is there to sell them something.
The challenges don't end once residents allow the captains in.
Tirado, a diabetic, said it's disheartening that some people are apathetic about diabetes.
Delgado elaborated, "There is a certain level of fatalism and complacency. Some people feel hopeless because there's a lot of unemployment, teen pregnancy and other concerns in some parts of Humboldt Park."
Also, he said, some in the neighborhood have been treated unjustly; discriminated against when they sought housing, an education or employment; mistreated by the police; deported; or incarcerated at a higher level than other groups. This breeds distrust.
Inroads
But, as the block captains increase their visibility in the neighborhoods, they're being welcomed into more people's homes and lives. During the visits, the block captains don't just talk about diabetes. They get to know residents and learn about the barriers they face in accessing care.
Block captain and diabetic Digna Gerena said she encounters diabetics who have trouble keeping track of their medications or who don't know their glycated hemoglobin, or A1C numbers. The test, which Block-By-Block recommends be administered about every three to four months, gives a measure of blood sugar control over time and is thus a key indicator of how well diabetes is controlled.
Gerena gives people tips, on keeping track of their blood sugar numbers, estimating proper portion sizes and improving fitness levels. She's a motivator. "I give people my personal cell phone number, and they call me with updates. They tell me they're losing weight and feeling better."
Sanchez, the block captain who helped Davila, said she encounters people who are scared about diabetes, who don't want to accept that they could have it. She tells them that being informed is the first step in managing health risks.
"I'm seeing a change in people's attitudes towards health," said block captain Tirado. "People will stop me in the street and tell me they're excited and that they're being proactive."
Humboldt Park diabetes study
The Block-By-Block program's creation was spurred by a 2006 report by Chicago's Sinai Urban Health Institute that found an extremely high prevalence of diabetes in Humboldt Park.
The full report is available on the Block-By-Block website.
A collaborative effort
From the start, Block-By-Block has been a multilayered partnership, with Chicago-area health and community organizations forming a task force in 2007 to study diabetes concerns in Humboldt Park and to develop Block-By-Block.
The Chicago-area organizations now involved in the partnership are:
- Saints Mary and Elizabeth Medical Center
- Rush University Medical Center
- The Puerto Rican Cultural Center
- Sinai Urban Health Institute
- Pueblo Sin Fronteras
- Norwegian American Hospital
- The Greater Humboldt Park Community of Wellness
Each partner has committed to support the program in its own way. Two of the lead organizations in the partnership, Rush University Medical Center and the Puerto Rican Cultural Center, helped to secure $1.3 million in grants from the National Institutes of Health to support Block-By-Block.
Activities that resonate with people
The Diabetes Empowerment Center that the task force established in Humboldt Park offers free information about diabetes and free classes and activities geared toward preventing diabetes. Volunteer instructors from the community teach the classes.
Block-By-Block staff member Leony Calderón coordinates the physical activities program, which is called "Muévete: Movement for Life." The program has a weekly schedule of fitness and wellness classes.
Calderón said she has developed the programming by catering to the inclinations of Humboldt Park residents. For instance, many in the area love Latin music, and so she has arranged for Zumba dance fitness classes that use Latin tunes. The offering has been so popular that the center had to add another session of the class to the weekly schedule.
Calderón tries to offer many beginner-level exercise opportunities through the center, so people can ease into a fitness routine. The center hosts a walking session three days a week and biking once a week. It lends bikes to those who don't have them.
In addition to these staples, the center also has a few class offerings that may not be culturally familiar to Humboldt Park residents but that Calderón believes can benefit them. For instance, she said, the center's yoga and tai chi classes can help people learn to relieve stress in a new ways.
The goal is get people to tune into their bodies, Calderón said.
Assessing risk
Among the questions on the Block-By-Block survey are:
- Has your doctor ever told you that you have diabetes?
- Do either of your parents have diabetes?
- Do you have sisters or brothers with diabetes?
- (For diabetics), Are you now taking insulin?
- (For diabetics) About how many times in the last year have you seen a doctor, nurse or other health professional for your diabetes?
- Have you ever been told by a doctor, nurse or other health professional that you have high blood pressure?