Community health workers confront poverty in Bexar County – San Antonio Express-News

Bertha Casares, left, talks Thursday in her apartment with community health worker Rita Pendergast during the promotora’s home visit. A new study conducted by UT Health San Antonio faculty found that one-third of the patients were able control their type 2 diabetes after building a relationship with promotores.
SAN ANTONIO — Bertha Casares has managed her diabetes for the past 30 years by drinking an herbal tea called moringa, watching her sugar intake and staying on top of her regular medical exams.
But what helps her the most is the regular home visits from Rita Pendergast, a promotora who works for Nosotros, a program jointly funded by UT Health San Antonio and University Health.
Nosotros is a group of community health workers committed to working with Bexar County’s most vulnerable population — patients who may otherwise not be able to make it to their doctor’s appointments because of various socioeconomic barriers such as lack of transportation, financial constraints or poor access to healthy foods.
Casares, 79, was scheduled for her second surgery for breast cancer when they found out she had COVID-19. Her cancer treatment was delayed for four months while she recovered.
Bertha Casares, left, shares a laugh Thursday in her apartment with community health worker Rita Pendergast during the promotora’s home visit. A new study conducted by UT Health San Antonio faculty found that one-third of the patients were able control their type 2 diabetes after building a relationship with promotores.
“Just seeing her makes me feel better,” Casares said in Spanish at her apartment on the city’s southeast side. “When I was really sick, having her company meant a lot. She’s a good friend.”
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Pendergast, who has been seeing Casares for the past five years, said they are not ruled by time. She said sometimes it takes up to 10 visits for patients to open up. But when they do, it feels like “magic.”
In recent years, researchers have been focusing on “social determinants of health” to improve patient care and health outcomes and ultimately reduce provider costs.
Dr. Robert L. Ferrer, a professor of family and community medicine at UT Health San Antonio, said physicians should be working to find out what’s going on outside of the doctor’s appointment. He and his colleagues recently conducted a peer-reviewed study that shows how interventions by promotores can make a difference in helping patients with chronic disease.
In San Antonio, 15.5 percent of residents have been diagnosed with diabetes. The study, published in the Annals of Family Medicine last month, found that one-third of patients were able to control their Type 2 diabetes after building a trusting relationship with one of the clinic’s promotores.
“The intervention was only 12 weeks long, and yet the effect was apparent four years later,” said senior study author Dr. Carlos Roberto Jaén, a professor and chairman of family and community medicine at the Long School of Medicine.
Bertha Casares, listens Thursday in her apartment to community health worker Rita Pendergast during the promotora’s home visit. A new study conducted by UT Health San Antonio faculty found that one-third of the patients were able control their type 2 diabetes after building a relationship with promotores.
Nearly 1,000 participants came from a primary care practice at University Health’s Robert B. Green Campus and other local medical offices and were monitored between 2013 and 2017.
Ferrer said 320 patients were able to lower their A1C, a blood test that measures average blood sugar levels over the previous three months.
Another 399 participants were able to overcome some obstacles to self-care, but they need further assistance. The remaining patients agreed to meet with a promotora, but it fell through.
The study found that the first group experienced fewer hospitalizations and emergency room visits over the four years than the others.
“We’ll go with them to their doctor’s visits and can even take a doctor to their home,” said Dr. Carolina Gonzalez Schlenker, an assistant professor at UT Health San Antonio and one of the study’s authors.
Schlenker oversees the Nosotros program and provides training for staff. Their biggest obstacle is poverty.
Bertha Casares, left, talks Thursday in her apartment with community health worker Rita Pendergast during the promotora’s home visit. A new study conducted by UT Health San Antonio faculty found that one-third of the patients were able control their type 2 diabetes after building a relationship with promotores.
The promotores sometimes rely on a special fund, basically the clinic’s medical staff pitches in so that they can order an Uber for a patient to get to an important appointment or purchase a microwave so they can heat up meals.
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Many of the patients Nosotros serves are older residents, raising their grandchildren, refugees or people who are homeless.
Schlenker said when a patient doesn’t get to do the intervention, they often see them later at the clinic with uncontrolled diabetes and in need of an amputation.
Raul Trevino, another member of the team, said during a weekly meeting that they try their best to meet the patient where they are and listen to them so that they can grow to trust them.
“We don’t mind the long hours, working late or going to low-income areas,” he said. “We want to give them the opportunity to better themselves.”
laura.garcia@express-news.net
Laura Garcia is a reporter at the San Antonio Express-News focused on health care. Previously, the South Texas native was the features editor and nonprofits reporter at the Victoria Advocate. She is president of the San Antonio Association of Hispanic Journalists, which gives scholarships to communications students and advocates for diversity in news.

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