May 25, 2007

Gift aids Hispanic diabetes outreach

Featured Image

Michael Fowler, M.D., and Norma Edwards, R.N., use role-playing exercises to convey diabetes information in Spanish at a recent health fair at John B. Whitsitt Elementary School. (photo by Mary Donaldson)

Gift aids Hispanic diabetes outreach

Annette Eskind’s support is helping Vanderbilt improve diabetes education and care in the Hispanic community. (photo by Tommy Lawson)

Annette Eskind’s support is helping Vanderbilt improve diabetes education and care in the Hispanic community. (photo by Tommy Lawson)

Vanderbilt medical students volunteering their time to assist in diabetes outreach efforts include, from left, Bill Heerman, Miranda Raines (holding Kevin Juarez) and Veronica Slootsky. (photo by Mary Donaldson)

Vanderbilt medical students volunteering their time to assist in diabetes outreach efforts include, from left, Bill Heerman, Miranda Raines (holding Kevin Juarez) and Veronica Slootsky. (photo by Mary Donaldson)

A nascent effort by faculty and staff of the Vanderbilt-Eskind Diabetes Clinic to improve diabetes education and care in the Hispanic community is now blossoming, thanks in part to the generosity of a longtime benefactor.

A gift by Annette Eskind, which provides funding over a three-year period, is helping expand efforts in this community and facilitate collaboration between Vanderbilt-Eskind Diabetes Clinic, state government and private charities.

“Where we had the beginnings of a program, (Annette) had a grand vision,” said Tom Elasy, M.D., M.P.H., medical director of the Vanderbilt-Eskind Diabetes Clinic. “She saw what we were doing with our outreach to the Latino community and wanted to make sure that we had the infrastructure in place to sustain — and indeed expand — this initiative.”

Vanderbilt's diabetes outreach efforts in the Hispanic community began largely as a volunteer effort on the part of committed physicians and staff of clinic. Type 2 diabetes, previously called “adult-onset diabetes,” is a growing health concern in the United States, but is hitting particularly hard in the Hispanic community.

“A child of Latino descent born in 2007 has a one in two chance of developing diabetes during his or her lifetime,” said Elasy. “I just can't think of a more dramatic statistic — a 50 percent chance of developing diabetes.”

In addition to the elevated risk of developing the disease, Elasy noted, Hispanics also have a higher risk of developing the complications of diabetes — blindness, amputation, kidney damage and cardiovascular disease.

With the growing Hispanic population in the United States, the need for improved diabetes awareness and care in this community is extraordinary.

“The Hispanic population is growing faster than any other population, and their risk of diabetes may be twice that of caucasians,” said Michael Fowler, M.D., an assistant professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism.

Fowler has spent countless hours volunteering his medical services on Tuesday night “diabetes clinics” at the Siloam Clinic in Nashville, and has also distributed Spanish-language educational materials at a local farmer's market.

Despite the efforts of Fowler and the other Vanderbilt physicians and nurses that help staff the Tuesday night clinics, they can reach only a limited number of patients.

“The human need outstrips the supply at this point,” he said.

While improved delivery of care for diabetes in this population is critical, another key factor in combating this growing health threat is education and awareness. And the Eskind gift has helped set in motion a massive collaboration between Vanderbilt, state government and private charities.

Inspired by reading about Fowler's work in the VUMC Reporter, as well as a New York Times series about the Hispanic diabetes epidemic in New York City, Eskind committed three years of funding to help facilitate Vanderbilt's outreach efforts.

“Diabetes is probably one of the easiest conditions to diagnose, but one of the hardest conditions to manage,” said Eskind. “Being a social worker, I know that outreach is the essential thing.”

“Annette's gift allowed us to establish a coordinated infrastructure,” Elasy said. Building this infrastructure included purchasing materials, developing curricula, and hiring new staff to assist with outreach efforts, starting with Norma Edwards, R.N., a nurse practitioner who speaks Spanish and has special training in diabetes care.

For the new program, called “Controlando la Diabetes Juntos” (Controlling Diabetes Together), Edwards, Fowler, Elasy and others have worked to develop educational materials that convey the danger of diabetes to Spanish-speaking audiences in creative ways, such as through role-playing demonstrations.

In partnership with a local charity, Catholic Charities of Tennessee, the team — which includes several volunteer medical students — launched this effort at a health fair at J.B. Whitsitt Elementary in Nashville in late April, where they acted out scenes to educate Hispanic families about diabetes.

Also as part of the outreach efforts of Catholic Charities, the group regularly performs health needs assessments, gives guidance on means to obtain health care services, and provides educational materials at a variety of venues serviced by Catholic Charities.

In addition to the Eskind gift, Elasy credits an alignment of resources, opportunity and vision. In 2006, Gov. Phil Bredesen launched an initiative, called Project Diabetes, focusing on innovative education, prevention and treatment programs for diabetes and obesity.

An added boon to the effort is the Medical Center administration's commitment to community service. In his “State of the Medical Center” address this spring, Vice Chancellor for Health Affairs Harry Jacobson, M.D., noted that the role of an academic medical center involves more than the oft-stated tripartite mission of research, clinical care and education.

“He made it explicitly clear,” said Elasy, “that we must be partners in the community to improve health care in this state…move outside the walls of the institution…to improve the lives of those in our community.”

An additional gift from Donna and Jeffrey Eskind, M.D., chair of the Vanderbilt Diabetes Center board, will go toward evaluating the programs — an expensive and labor-intensive, but necessary, process.

“At the end of the day, we have to demonstrate whether our efforts are working or not,” said Elasy.

The Eskind gifts have helped transform community-minded ideals into a tangible program to improve diabetes care and education statewide, starting with a population at high risk.

“I was thrilled to be able to do it, and I'm thrilled with the results that are coming from it,” said Annette Eskind. “I feel that the ball is rolling for us. We hope for Vanderbilt to serve as a model for other clinics and other hospitals working with Hispanic populations.”

“This is certainly an opportunity to make a difference given the alignment of vision, resources, people and infrastructure,” Elasy said. “It really is a wonderful season in the life of this institution and in the life of the state.”