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New Spanish-Language Comic Book on Living with Diabetes

The cover of the


By Claire Hutkins Seda, Writer, Migrant Clinicians Network and Managing Editor, Streamline

Migrant Clinicians Network’s groundbreaking new Spanish-language comic book, “Mi salud es mi tesoro: Un guía para vivir bien con diabetes,” or “My Health Is My Treasure: A Guide to Living Well With Diabetes,” tells the relatable story of Goyo, an agricultural worker with a new diabetes diagnosis. Illustrated by artist and frequent MCN collaborator Salvador Saenz, the colorful, low-literacy comic book allows clinicians to share how to live with diabetes, with content tailored specifically for agricultural workers. Goyo’s conversations with a coworker friend help him navigate the potential pitfalls of living with diabetes, and lead the comic book reader through several stand-alone pages on diet, exercise, foot care, and illness prevention. The comic book is particularly notable for its recognition of mental health.

A new diabetes diagnosis can produce emotional strain, like confusion over what to eat, frustration or disappointment over food choices at community and family gatherings, fear of complications, and anxiety over maintaining health while migrating. These new stressors may add to a mobile agricultural worker’s existing mental anguish due to the nature of farmwork employment -- temporary, physically demanding, sometimes exploitative -- and the stress of migration, with the dozens of barriers to health and well-being that it erects. 

On caring for emotions, the comic illustrates being away from family, not being able to communicate with ease, and missing the comforts of home. “But there are things we can do to feel better,” the comic continues, with concrete recommendations to build community, maintain communication with family, and seek health services. This direct recognition of the emotional toll of living with diabetes as an agricultural worker is largely absent in most patient-facing diabetes materials. 

The comic’s recommended diets include an example menu that follows the American Diabetes Association’s low-carb, low-fat diet, and a second example menu of a strict whole-foods, plant-based diet, both of which have been well documented to lower hemoglobin A1c. The foods recommended are familiar to readers from Mexico, Central America, and the Caribbean, like a salad of jicama, carrots, and celery with chile and lime, or black beans with cumin. A fill-your-plate page emphasizes the inclusion of a wide range of vegetables. The exercise recommendations keep in mind an agricultural worker’s low income and limited time outside of work, recommending lifting sand- or water-filled water jugs, gardening, and walking as low-cost exercises that are widely accessible. The final page of the comic allows the reader to fill in recorded A1c levels at appointments and to track goals relating to medicine, exercise, food, and weight control. 

The following two pages are excerpts from the new comic book. The entire comic book is available for download and printing here. Subscribe to MCN’s blog to be notified of the release of new MCN materials, including the diabetes comic book: www.migrantclinician.org/blog.

Health Network and PRAPARE
In 2016, just as PRAPARE was set to launch, Migrant Clinicians Network was beginning to develop its new database to better serve patients enrolled in Health Network, MCN’s bridge case management program. Over the course of the following year, MCN configured the new database to allow for the integration of PRAPARE data, in which one health center’s PRAPARE data can be transferred to the next health center, as a mobile patient moves.
“When we started thinking about that data and [Health Network] case management work, so much of case management isn’t just ‘are you taking your medication every day?’ It’s more about, ‘How can I help you access care and manage your health in general?’” explained Anna Gard, RN, who assisted MCN in the development of the new database. “One piece of this is: ‘Let me help you find a health center.’ But the larger pieces around effective case management are, ‘How are you going to get there? Is there public transportation? How are you going to pick up your medications if you live in a hostile community and you’re afraid of leaving the house?’ PRAPARE gives a structured format to capture [these] data, in a form that’s been tested and validated.”
As more health centers provide case management and chronic care management to address the social determinants of health, Gard noted, integration of the PRAPARE data with Health Network, a virtual case management, seemed to make sense. Now, the Health Network team is working to fit PRAPARE into their own workflow.
Saul Delgado, Health Network Data Specialist, who has been integral in building and launching Health Network’s new case management system, notes that asking such personal questions over the phone, when a patient doesn’t have transferrable PRAPARE data from a previous health center, can be challenging. “When we call, the patient doesn’t know you. They’re very scared to answer these kinds of personal questions, whereas when you go the clinic, you at least see the nurse or case worker face-to-face,” he explained. But he recognizes the utility of the data, and has developed the PRAPARE data screens within the database to be easily accessed from the main patient information screen. With drop-down menus, Health Network Associates can populate the information they hear from patients, like how many people live with them in their household, or if they’re worried about losing their home. The information, either attained from a previous health center or inputted by a Health Network Associate, will be transferred when the mobile patient gets to his or her next destination, just as the basic medical records do.
“Health centers are doing more to integrate social and behavioral determinants of health, and we’re recognizing that all of those things have to be integrated with care management. So we’re on the forefront,” Gard concluded.

MCN Streamline Spring 2020

Read this article in the Spring 2020 issue of Streamline here!

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