Small Changes Make a Big Difference

Three months ago, a patient who I will call “John” went to the emergency room. He was experiencing nausea, excessive urination, blurry vision, and a tingling in his feet.  He had a blood sugar of 832, about five times the normal level. He was informed that he had diabetes, handed several handouts, told he would need to start injecting himself with insulin multiple times a day, and sent home.

By the time John came into the health center the next day to follow up with his primary care doctor, he was completely overwhelmed. He had family members pass away from diabetes; he had seen people lose their limbs. He had a fear of needles, but now they were a part of his every day life. On top of the insulin he now needed to afford a glucose meter, testing strips, and pills – all without insurance.

As the Health Education Specialist at East Liberty Family Health Care Center, I work each day to tackle the various needs of patients like John. I meet with patients one on one to educate and counsel them about their health improvement plans– from diabetes management to tobacco cessation. I run monthly groups for weight loss and diabetes, so that patients can gain information and also support from their peers. I also work to connect patients to resources available in the area, so that we can navigate the barriers that they face to receiving care.

Ellie (right) collaborates with another Health Corps member to bring nutrition education into her diabetes support group

The first step with John was to meet with him and help him understand his new diagnosis. He’d had a cursory education session while in the hospital, but had come away with many more questions than answers. We started small – discussing what carbohydrates are, what insulin does, and why having sugar in the blood can be bad for health. Once we had those bases covered, John seemed to relax a bit. Rather than just being told he had to change his diet, he understood why. We followed up by discussing and collaboratively setting small goals for his diet. By including John in this conversation we were able to find changes that would suit his tastes and budget, making the goals easier to achieve.

Next, John and I turned to strategies to afford his medications. I connected him to our Medical Support Administrator, who works with our uninsured and underinsured patients to help them attain prescription medications. Together, the three of us enrolled John in prescription medication assistance programs and gave him a blood sugar monitor and testing strips, saving him stress, time and money.

The next week, John attended a diabetes group. We reviewed tricks for reading nutrition labels, shared tips for blood sugar control between group members, and had a diabetes-friendly recipe demonstration from the food bank. After the group, while speaking with John, he told me that he had found the information helpful but even more so he appreciated the support from people who had been living with diabetes for years. John was taking his medications regularly and confident about making healthy diet choices, a far cry from his devastation about his diagnosis just one week prior.

Recently, John came in for his 3-month follow up visit. He is feeling much better – the nausea, excessive urination and numbness in his feet are gone. His average blood sugar over the past three months was a meager 108, way down from the 832 that sent him to the hospital. His diet has also improved significantly, and he has lost 10 pounds. If he continues with these results, he will eventually be able to go off of insulin.

Serving at the health center as an AmeriCorps member gives me the opportunity to help uninsured and underinsured patients better understand and manage their health. Ninety-nine percent of patients’ time is spent outside of the health care center, away from their providers; it is what patients do daily, not their time spent in the health center, that most impacts patients’ health. Therefore, helping patients to adopt sustainable healthy habits such as nutritious diet, ample exercise, medication compliance, tobacco cessation and chronic disease management is of utmost importance. Health education can empower patients to make such positive lifestyle changes, and can make meaningful changes in the lives of patients like John.

Kirstin and Ellie are the two Pittsburgh Health Corps members serving at East Liberty Family Health Care Center for the 2014-2015 service term