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Norma Reyes stopped giving her children lots of soda and juice, allowing all four of them to split one small bottle on rare occasions. She lost 10 pounds and serves smaller meals at home.
But the struggle continues with her husband and brother-in-law, who she said are both prediabetic and need reminding that, nutritionally, one beer equals two cups of rice.
Reyes, 37, learned techniques to improve her family’s wellness through healthy eating and exercise in a lecture and Zumba series run by Luminis Health, which serves a heavily Latino population in Prince George’s County, an area hit hard by coronavirus.
At the height of the pandemic, the hospital system recruited churches to host education sessions and vaccine clinics, forging relationships that helped them learn more about the needs of the community — a model providers aim to replicate in underserved areas. As infection rates receded and vaccination rates climbed, community health workers shifted focus to the underlying circumstances that drove health disparities. More than 2,200 Prince George’s County residents died of covid, placing the county second only to Baltimore County in Maryland, data show.
“There was a huge need and a golden opportunity for us to make those relationships, make those bonds stronger, understanding really what they needed,” said Alexa Morán, a community health provider at Luminis health and a physician in her home country of Ecuador.
Hispanics are more than 50 percent more likely to have diabetes than non-Hispanic White people, according to the American Diabetes Association. About 12 percent of Hispanic adults in the United States have been diagnosed with diabetes, compared to about 7 percent of non-Hispanic whites, data show.
Henry Rodriguez, a pediatric endocrinologist and clinical director of the Diabetes & Endocrinology Center at the University of South Florida, said the reasons for health disparities for people of color also make preventing and managing conditions like diabetes difficult. Challenges include access to healthy foods, reliable transportation, parks and walkable neighborhoods that are safe, and affordable health insurance.
More than 2 in 5 people with diabetes delayed routine medical care during covid, and more than 1 in 10 said their health insurance was disrupted during the pandemic, according to the ADA. Studies suggest about 30 to 40 percent of covid deaths involved people with diabetes.
Rodriguez said partnerships like the one with Luminis Health in Maryland are necessary to create programs specific to cultural and dietary differences to truly help communities make lasting changes.
“We focus as medical providers on the individual but this is much larger than the individual,” he said. “Because diabetes affects so many aspects of life and so many Americans I think the greater way to address it is really looking at the greater community.”
Sister Carmen Soto took notes during the penultimate class on a recent Tuesday morning in a three-month series held in a building on the grounds of St. Bernard Catholic Church in Riverdale.
Six other students listened to Morán’s presentation, including Reyes, whose 4-year-old daughter sat silently in her stroller. The lesson focused on a fictitious woman, Rosana, who learned after changing what she was eating that she also had to reduce calories or increase exercise if she wanted to keep losing weight.
Soto has worked for about a decade with the parish in Riverdale, home to immigrants from South America as well as Central America and the Caribbean. More than 1 in 5 county residents identify as Hispanic or Latino, compared to 1 in 10 statewide.
At first, Soto observed the class but found the information so valuable that she registered. She now avoids fried foods, cooks with healthy fats, substitutes parboiled or brown rice for white rice and tries to remember beans are a source of protein but also carbohydrate.
“Diabetes is high in the community and parents are concerned,” she said. “If you learn how to cook deliciously your own meal, your children will learn how to eat it, too … You eat bread, you eat rice and you eat tortillas and they’re all carbs.”
She promoted the classes at Mass, fielding a lot of interest, but many of the women — who tend to cook for everyone in their household — couldn’t participate without child care, which not all the classes offer.
The same is true at another series, a lecture and Zumba class at College Park United Methodist Church, where only four women attended a recent class because three others were sick, one was in the emergency room with her ailing child and another had just given birth. The women who made it had bloodwork to test their progress since class started and then moved chairs aside for a Zumba class; Morán danced with her students.
She learned while working in rural areas of Ecuador that as soon as she arrived in a town she had to meet the heads of the church and police before any residents would listen to what she had to say. She applied those lessons in Maryland when covid-19 infections were disproportionally impacting people of color; Luminis relied on organizations already serving the people they were trying to reach.
Morán went to St. Bernard and other churches to answer questions about the coronavirus vaccines and returned with clinics administering doses, a successful mission that helped her gain the trust of residents with every reason to be skeptical of institutions, she said.
At the clinics, some people confided in her that they hadn’t been to the doctor in a year, intensifying her desire to meet the community’s specific needs.
The rapport she created throughout the pandemic continues in class. She and her colleague, Karen Lagarda, a community health nurse at Luminis, joke with their exclusively female students about the men in their lives.
“We know what to do, but we still struggle with our fathers because neither of them take care of themselves,” Morán said.
The program, funded by a Maryland Community Health Resources Commission grant of $90,000, is part of an ongoing effort to reduce health disparities, said Tamiko L. Stanley, vice president and chief diversity equity and inclusion officer for Luminis Health.
The goal is to have 75 percent of Latino patients with their A1C — a measurement of average blood sugar levels over three months used to indicate prediabetes — under control; they are at 65 percent now, up 4.5 percent from last year, she said.
Reyes is highly motivated, she said in Spanish as Morán translated.
She was already living in the United States a decade ago when her father, an undiagnosed diabetic, died of a heart attack in Mexico. She was unable to return to say goodbye.
