Eye clinics focus on Latinos
Eye clinics focus on Latinos
Grassroots network works with volunteer staff
Fact: Diabetes occurs at least twice as often in Latinos as in Caucasians.
Fact: There are as many undiagnosed as diagnosed cases of diabetes.
By anyone's math, these two facts add up to a potentially devastating conclusion in Oxnard, CA, population 150,000, where 63% of the city is Latino: a hidden epidemic of complications from diabetes among a group that is largely poor, with no health insurance.
Fortunately, a cadre of health professionals is on the alert in Oxnard, working together to aggressively combat the problem.
Optometrist Albert Forbes, DO, who retired from practice in Los Angeles 14 years ago, first volunteered as an optometrist at the local hospital's free eye-screening clinic in 1990. But his realization of the extent of diabetes-related eye disease in the Latino clients who came to the clinic inspired him to pursue a more ambitious goal: controlling diabetes among the Latino population and ultimately preventing the devastating complications it can cause.
Today, as many as 20 patients with diagnosed diabetes or diabetes symptoms are seen every other month at the free, half-day clinic, referred there by a network of vigilant public health agencies, neighbors, families, churches, and charities. Where once the clinic did general eye screening, it is now dedicated to detecting diabetes-related eye complications. An additional eight to 10 patients are screened monthly at the Ventura County public health satellite clinic.
What makes this clinic so successful are its grass roots origins and volunteer staff. Forbes and the clinic educator Gloria Chinea, MPH, director of patient and community education at St. John's Medical Center, where the clinic is held, credit St. John's commitment to promoting health for the needy, the passionate dedication of the volunteers who staff the clinic, and the support of the community's health care and social service agencies.
St. John's provision of the facilities, supplies, and paid staff was a major step toward making it possible to provide Oxnard's Latino diabetics with free care. The clinic's pharmacist, dietitian, and educator are paid by the medical center. The recruitment of highly trained health care providers to volunteer their services, however, was what made the clinic truly viable, says Forbes.
The clinic's professional volunteers now include two optometrists, a retina specialist, translators, and two registered nurses. Hospital volunteers also help out at each clinic by facilitating appointments, medical records, and making the patients feel welcome.
Both Forbes and Chinea say the demand exists for more frequent clinics. Expansion "is only a question of finding competent professionals to make a commitment" to staffing the clinics, says Forbes. While he praises the growing level of volunteerism and commitment to health education among his optometrist colleagues across the nation, as well as among physicians, he feels strongly that there is room for growth. It is "incumbent upon health care professionals to donate care," he says.
Forbes addressed the need for increased involvement by health care professionals in the free care of Latinos with diabetes and other issues in a seminar on how to create a Latino diabetic eye-screening clinic at the Centers for Disease Control and Prevention's 1998 National Diabetes Translation Conference, held April 27-30, in Tampa, FL. The conference brought health care providers, diabetes educators, and policy-makers at the local, state, and federal levels, as well as the private-sector, to explore practical approaches to reducing the burden of diabetes.
Frank Vinicor, MD, director, Division of Diabetes Translation at the CDC, notes, "There are important lessons to be learned from Albert Forbes about how he has established a relationship with the Latino community, an important segment of the population that has at least twice the risk of diabetes compared to whites."
Chinea says patients' perceptions that clinic staff want to be there - "that the care is from our hearts" - are strongly correlated with their positive attitudes towards learning self-management skills and following treatment regimens. Forbes agrees, noting, "Caring and kindness are pretty potent once clients sense that you can work on a different level with them."
Cultural competency also is essential to working effectively with a diabetic Latino population, says Chinea. The clinic staff provide bilingual and bicultural education for patients, both one-on-one and in classes. They provide practical disease management strategies such as how to make appropriate food choices on a tight budget, how to integrate traditional high-carbohydrate ethnic foods into the diet through portion control, and how to increase exercise in a culture where automobile travel is the norm.
Health care providers also need to understand the traditional values and beliefs of this culture in order to successfully assist Latinos in understanding traditional Western concepts of medicine, says Chinea. For example, Latinos believe that eating nopales, a type of cactus, reduces blood sugar. In fact, Latino patients at the clinic learn it doesn't reduce blood sugar, but because it is high in fiber - thus, filling -and contains essentially no calories, it is a good food choice.
Funding for clients is the biggest challenge
Funding for follow-up care for the clinic's patients remains the biggest hurdle to successfully treating the complications of diabetes in Oxnard's Latino population. The clinic's staff continue to grapple with the issue of how to integrate uninsured or indigent patients into the medical care system.
Although staff refer patients for follow-up medical care that is available free or on a sliding scale, Forbes says that because of financial reasons, it is not uncommon for patients who are diagnosed and referred for care to re-appear at the clinic, without having seen the specialist they were referred to. Worse, patients sometimes return with increased complications from their diabetes because they have not received the recommended care following their clinic appointment.
"Significant as the clinic is" in detecting diabetes among Oxnard's Latinos, says Forbes, "we need more funding for patient follow-up."
For more information on eye clinics, contact:
· Albert Forbes, DO, and Gloria Chinea, MPH, St. John's Regional Medical Center, Oxnard, CA. Telephone: (805) 988-2865.
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