Lessons Learned From Reporting Diabetes Hot Zone Project

CHJ Fellow

February 18, 2013

Social determinants of health. Yawn.

Every time I heard the phrase “social determinants of health” it came with some long-winded description, sometimes with perplexing words like “obesogenic” to describe people who were poor, minority and uneducated living in the same area. It seemed too nebulous a topic to try to tackle. I had no intentions of doing a “social determinants of health” story.

Instead, I would write about something more specific, diabetes. I planned to reveal the tragedy behind a disease that is so pervasive, so obvious, so accepted here in the South that people do not see it for the public health threat that it is.

When I wrote my Diabetes Hot Zone proposal to the California Endowment Health Journalism Fellowships, I had three basic story ideas: to detail the family cycle of the disease, to show how it was disproportionately causing kidney failure deaths for African-Americans and to look at food culture as a pathogen. But I wanted the families and the health care workers to tell the story from their perspectives with video diaries.

I submitted my proposal without having any families lined up, but I did have the commitment of Mary Bufwack, chief executive officer of United Neighborhood Health Services, to help open some windows. While I am generally satisfied with how the stories turned out, the video diaries portion of this project proved to be a real challenge. I did not achieve what I wanted, but I did learn some valuable lessons the hard way.

First Lesson: Make people want to be reality stars. I went to organizations, community clinics and Meharry Medical College asking for folks to help me find families where a young person was growing up in a diabetic household. Mary Bufwack put me in touch with Nancy Mason, a social worker for the federally qualified health center, who then put me in touch with Lynn Stuart, director of youth services. He introduced me to Deonta Ridley, who turned out to be my only star. At one point, I was so desperate to find other folks that I was at a diabetes walk going up to strangers showing them my video cams and asking them to participate. That day, I noticed all the booths. I realized a smarter approach would have been to set up a booth and have folks sign up for consideration - something akin to an on-the-spot casting call. While I was there, my phone rang. It was Deonta, apologizing and regretfully saying he could not work with me on the project because someone had stolen his video cam. Having given a camera to only one family - one that subsequently never responded to my phone calls or emails - I left the event to spend time with Deonta. I brought him another video cam.

Second Lesson: Insist that your subjects periodically share clips. Deonta was perfect for the project. He weighed almost 400 pounds his junior year but lost enough weight to make the football team his senior year. The obesity-related diseases of diabetes and hypertension had devastated his family. Deonta is trying to escape this cycle. He had filmed himself working out at the YMCA and shot clips of his football season. All of that was lost when the camera was stolen. After I gave him his second camera, he filmed more clips, including participating in Nashville Mayor Karl Dean's challenge walk. He downloaded those to a computer that crashed. We lost those, too. However, he came through with a gem of a clip - one of him decorating a Christmas tree and introducing his grandmother, Nellie Diaz. Karen Kraft, a member of The Tennessean's online team and an experienced videographer, pieced his clips together with on-camera interviews and photographs for a very compelling video.

Third Lesson: Keep your subjects engaged. I spent half of a Saturday every two to three weeks with Deonta over a three-month time frame. If I had not done this, the Diabetes Hot Zone project would have fallen through. There was one four-week period where we had no communication. Another project at work - the national fungal meningitis outbreak first discovered in Nashville - was consuming all my time. In addition, I was driving to Mississippi and staying with a sick family member at a hospital some weekends. The telephone was the only way to stay engaged with Deonta, but his number no longer worked. It took me a couple of trips knocking on Deonta's apartment door until we reconnected and I got the new telephone number.

Fourth Lesson: Do not intervene. When I took Deonta to the Farmer's Market, to the Aldi grocery and to a coffee shop, I did not stop him from making bad choices. I gritted my teeth and bought him a sugary chocolate drink at that coffee shop because that's what he ordered. This was very difficult for me. At Christmas, I wanted so badly to take $100 worth of healthy groceries to his grandmother because I knew she was struggling. I had to constantly remind myself that was a reporter, not a social worker.

Someone more experienced with video journalism might have avoided all of these pitfalls, but as print media becomes increasingly digital old dogs like me are trying to learn new tricks. I have not given up. I bought six video cams and still have three of them. There will be other opportunities for journalistic pieces where the subjects can help tell the story.

Now - about that social determinants of health thing. When I had pictured the Diabetes Hot Zone in my mind, it was a street-scape of modest bungalows with a church on the corner - a placid place where people weren't paying attention to a disease that was silently killing them. But Deonta lives in a gray apartment complex where people are getting shot on a regular basis and there’s no place to run. It is surrounded by an interstate highway and two four-lane express routes. As I was wrapping up the project, there was a homicide outside the apartment gate at a spot where I usually parked.

Now, I’m actually intrigued about social determinants of health. Could the constant stress of living in this environment make people crave the comfort of high-carb, sugar-numbing food? With diabetes so prevalent in some ZIP codes, shouldn’t health officials focus on them as if a communicable disease is spreading? How can a child have a chance at good health when the physical and family environments are so bad? What can be done to battle the complacency? There’s a lot more to learn about and report.

First Day Main Bar (Diabetes Hot Zone)

http://www.tennessean.com/article/20130120/NEWS07/301200057/In-pockets-Nashville-diabetes-runs-rampant

First Day Side Bar

http://www.tennessean.com/article/20130120/NEWS07/301200051/With-dramatic-weight-loss-Nashville-diabetes-counselor-sets-example

First Day Graphic (map of Diabetes Hot Zone)

http://www.tennessean.com/assets/pdf/DN199495119.PDF

Second Day Story (Living with Dialysis)

http://www.tennessean.com/article/20130121/NEWS07/301210027/2275/RSS05

Third Day Story (Passion of food debate)

http://www.tennessean.com/article/20130122/NEWS07/301220033/Food-s-role-diabetes-debated

The USA Today versions of two of the stories

(Living with Dialysis)