Commentary: Diabetes Prevention Program

12 hours ago 13

Yanjari Montanez’s face brightens as she sees my co-worker and me coming up the steep stairs to her small apartment with bags of colorful produce — fruits, vegetables and other healthy food items. She welcomes us to sit outside her door on two folding chairs and offers us something to drink. Potted plants in cartons and cans adorn her tiny porch and she has decorated her door with some simple holiday décor.

“I would invite you in but there isn’t much space and I’m a little embarrassed.”

We sit on the porch on a balmy November South Texas day and chat with Montanez about how she ended up here in Brownsville, and what she misses most about her home in the state of Quintana Roo, Mexico.

“I came here legally when I married my husband, who is from here. I left my life behind including my grown children. I used to work in a bakery and had a lot of purpose and connections. Now I feel pretty isolated. The rhythm of life here is really different. People seem very disconnected and stressed. I am waiting for my work authorization so I cannot even work. That was fine when we came because my husband had a good job as a welder in Corpus Christi. When he got very sick, we had to move back here and now he is struggling to piece together enough work to support us. Nobody plans for this but sometimes life happens, and now we can barely pay the rent. With the medical bills and the medicine, there are many weeks we barely have enough to eat. This makes it hard to afford the healthier food and causes both of us a lot of stress, which isn’t healthy for us either.”

What Montanez faces is common in our community. Challenges and barriers that impact her and her husband’s health, that have nothing directly to do with health care.

“I feel very isolated because we only have one car and the buses here don’t have a lot of routes. My husband needs the car to find work, and I am here at home feeling stressed and alone. We do go to church, which is where I found out about this program. It was just what my husband and I needed. He has a liver disease and had been very sick. I have also gained a lot of weight here, which is surprising because I often run out of food. I think the food we can afford is not healthy and also, I don’t walk everywhere like I did in Mexico. Maybe also the stress.”

Montanez is part of a program called the Diabetes Prevention Program-Group Lifestyle Balance, which is managed by the UTHealth Houston School of Public Health here in Brownsville and funded by the Centers for Disease Control and Prevention.

UTHealth partners with numerous clinics and community organizations to deliver this effective 12-month program in numerous locations across the Rio Grande Valley. DPP focuses on preventing diabetes, healthy weight loss and healthy lifestyle change through group support, stress management and addressing other social needs. In a unique collaboration, UTHealth and the Brownsville Wellness Coalition, with support from funder Methodist Healthcare Ministries, is now able to address non-medical needs that are often barriers to otherwise motivated people adopting healthy lifestyle changes.

Participants are screened by the program for social needs like housing, transportation, food insecurity and even stress and depression and are provided referrals to a social service team from UTHealth that works with them to address these bigger challenges so they can focus on their health improvements. This was just what Montanez needed to feel connected and supported in her new home.

“I have learned so much and connected with other people who also struggle with their health. My husband and I have made small changes that have resulted in big differences for our little family! When I told the (staff) that I was feeling very stressed at home and my relationship with my husband was strained, we were referred to free counseling services which has helped us communicate and support each other.”

Montanez attends her DPP group at partner clinic Su Clinica, which is several miles away from where she lives. She struggles to get a ride to the group because her husband is often working, so the social worker arranged for transportation so she could continue attending the group. Montanez was screened as “food insecure;” she was provided food to address her nutrition insecurity. Much of the produce provided in this partnership comes from local gardens and farms through a unique partnership with the Brownsville Wellness Coalition. Much of the produce provided to participants is purchased from local farmers and growers, supporting the local food system.

“I understand that I won’t get all of this support forever, but I can’t tell you enough how much it has helped me get my footing here and make the healthy changes that have resulted in huge differences in my health and my husband’s health! It has given us some room to breathe and a chance at a healthy future. Luis (case manager from UTHealth) provides me with information and referrals so now I am learning how to navigate life here. When I get my authorization to work, I will be healthy and more independent. The connection I have made with other people in the group has reduced my stress and made me feel less isolated. In Mexico I was someone, and here I felt like nobody, until I found this program and I am so grateful! I told the DPP coach and Luis that now I want to volunteer and help others in this program. Sometimes the weight of all of the problems at once can make you feel so alone, but the support from (DPP) has helped me remember that I matter and my health matters!”

Lisa Mitchell-Bennett is senior project manager at the UTHealth Houston School of Public Health Brownsville Campus.