Climbing Fences: Obstacles to Diabetes Care in South L.A.

The average American with type 2 diabetes who has access to a television, the internet, a radio, a library or any other media outlet knows that eating right, exercising, taking medications as prescribed and managing stress are the best ways to prevent complications and prolong life. However, the latest statistics show that African Americans and Hispanics continue to experience the highest rates of at least four serious complications of diabetes: cardiovascular disease, blindness, amputation and kidney failure. In fact, Service Provider Area #6, a.k.a. South Los Angeles, continues to have the highest number of preventable diabetes related hospitalizations in L.A. County.

"When you talk about SPA 6, there are a large number of people here.who live 200 percent below the Federal Poverty Level. That population is primarily African American and Latino," said Dr. Tracy Robinson, medical director at the To Help Everyone Clinic on Western Avenue in South L.A., which provides healthcare services to low or no income families with the help of community support. "There is a huge disconnect for the uninsured or underinsured patient who has to navigate his way through the [healthcare] system. Patients who cari't pay for services present a problem because they may need critical care but [the medical provider] doesn't have anyone to bill and can't be reimbursed. So, their ability to take the preventative measures that would reduce complications of diabetes is severely compromise."

With clinics like T.H.E. that "serve the poor,, government and community help allows them to provide a variety of services for people who can't pay but those services can only go so far.

"[For example]," said Robinson, "you have a diabetic who's uninsured. They come in. We give them medication to help but they need an eye exam. We can do a retinal screen here. Then we have to contract with someone who will read those screens for us."

For services they can't provide there, doctors at the clinic refer patients to the county where getting a doctor's appointment can take anywhere from six weeks to six months.

According to a New York Times report, "a shortage of primary care physicians and low Medi-Cal reimbursement 'rates have made .South Los Angeles one of the most difficult places in the nation to both receive and give medical care...the situation in South Los Angeles is particularly grave ' because Medi-Cal offers the lowest Medicaid reimbursement rate per capita nationwide, which has made recruiting new physicians difficult, according to recruiters..."

Responsibility for health also lies with the diabetes patient.

"Taking care of your body should be a priority," say medical experts at the American Diabetes Association.

"Spending time early on, on [self] care could delay or prevent the onset of dangerous diabetes complications later in life."

But SPA 6 patients face challenges in that area also. In a perfect world, besides an endocrinologist, an opthamologist and a podiatrist a diabetic would have on his or her team, a mental health expert, a nutritionist and a personal trainer. Those who don't, could at least walk to the local health food or grocery store with enough money for a month's worth of healthy balanced meals.

Those who have issues surrounding their negative lifestyle choices, like overeating, being sedentary, smoking or alcoholism, would be encouraged to seek out professional mental therapy or at least a nearby support group. But the difference between what is needed and what is actually available is great.

"We know that our surrounding environment doesn't do much to support health," said Gwen Flynn, policy director of the Community Health Council an organization here that works to eliminate health disparities between the poor and more affluent areas.

The community is deficient in what other communities in L.A. County take for granted, Flynn said.'.

"We [often] come into contact with people in this area who know what they need to do and they want to do it. They go to the doctor who tells them to eat healthy and to do this and do that and they come back to their neighborhoods and there's nothing there. You have to go to Culver City or Santa Monica to get to [health food stores like] Whole Foods and Trader Joe's and some people are stranded in the area. They don't have transportation and have to work with what's here."

What's here is close to 1000 fast food joints compared to about 30 health food stores. Major grocery stores are here but have a limited supply of specialty health food items for alternative diets and there are about eight liquor stores per square mile.

"You have to be a little more resourceful here to get the help you need, like finding out where the health fairs and free health screenings are," added Nancy Watson who is involved in assessing health delivery systems at CHC.

According to Centers for Disease Control, in 2007 23,6 million Americans had diabetes, with nearly a third undiagnosed, Another 57 million had pre-diabetes, and are likely to have the disease if they did not alter their living; habits. The 23.6 million represents a 13.5 percent increase from the 20.8 million in 2005, they said.

The body of a person with type 2 diabetes either does not produce enough insulin or has cells that are not able to 'use it properly, resulting in too much glucose left in the blood.
Immediate effects of high blood sugar include frequent-urination, increased thirst, blurred vision, increased hunger and fatigue. Perpetual high glucose levels can result in heart disease, kidney failure, blindness, limb amputation, diabetic coma and death. Poor diabetes control also makes patients more susceptible to infections, they can experience tooth decay and loss, nerve damage and depression.

In recent years South L.A. residents have seen a growth in farmers' markets where more fresh fruit and vegetables are available and affordable along with healthy cooking classes. And, last year the L.A. City Council approved Councilwoman Jan Perry's proposed one year ban on new fast food joints in the area. T.H.E. is also doing its part by continuing to educate diabetic patients on how to live well despite their limitations.

"We have a nutritionist and a social worker on site," Robinson said.

"One thing we're looking at is how to become better champions for the patients as far as advising them on things they can do to [positively] impact their lives. We are currently trying to design a clinic just for patients who have the top chronic conditions that can be helped with proven scientific preventative measures.

"We also have primary care physicians who understand that the treatment of the condition is not just about dispensing medication. It goes beyond that 15 to 30 minute visit with the doctor. We have to deal with the whole person."