In the Field: Empowering Patients with Diabetes & Hypertension in Puerto Rico

Today is World Hypertension Day, during which we recognize the“silent killer” and its impact on people around the world and push for stronger programs for prevention and control of hypertension. Too often, patients suffer from both hypertension and diabetes. As we wrap up the final weeks of our ECHO series on hypertension, which complemented our recent ECHO series on diabetes, I contacted Elsie M. Padua Rivera, Rehabilitation Counselor and Coordinator of the Collaborative Program at Castañer General Hospital in central Puerto Rico. Elsie has been a very active participant in our ECHO series, asking questions, providing comments and sharing her experience in Puerto Rico. Alma Galvan, Senior Program Manager at MCN and facilitator of the ECHO series said, “Elsie is the kind of participant that you dream of when doing a clinical training in person or virtually.” She and I spoke about how diabetes and hypertension are affecting her community and what her main takeaways from the ECHO series have been. Here’s some of our conversation, edited for brevity and clarity.

Is diabetes a problem in your community?

Diabetes is definitely a problem in our community in Castañer, Puerto Rico. We have a lot of patients who have uncontrolled diabetes, with a hemoglobin A1C of nine or more. Patients with such a high A1C level can have significant complications if the condition isn’t treated properly: visual impairment, ulcers, amputations, nerve damage that can cause loss of sensation, kidney damage, depression, anxiety. In order to prevent these complications, Castañer General Hospital developed the Collaborative Program. In this program, patients assume active and full control of their condition. Patients take the initiative and responsibility to make things happen... The program centers on well-visits from patients with diabetes, rather than crisis care and emergency room visits. It’s important to remember to invest more in preventive services where we can focus all our energy on the disease.

Can you tell a story about one of your patients with diabetes who think that really shows how diabetes affects your community?

My experience as Collaborative Program Coordinator has been eye-opening, as part of my duties is to call patients to present the program and provide services. It’s shocking to hear patients explain that a leg or finger had to be amputated, or that a young patient has to have dialysis treatment, because their diabetes couldn’t be kept in control. I’ve also met a young patient who lost his vision [because of diabetes]. When one reflects on these cases and these very significant complications, one realizes how important it is focus part of our services on prevention. Providing quality prevention programs no matter how small can have a positive effect in creating a healthier community. 

Why did you choose to take this ECHO series?

I decided to take this ECHO series because I wanted to expand my knowledge about diabetes. I’ve always believed that knowledge is power and gives you freedom of choice. Part of my duty as a rehabilitation counselor is to empower our patients, especially those with a disability or disease. If we want our patients to be empowered, we have to start with empowering ourselves. The ECHO series offers me the opportunity to empower myself so I can best support patients and motivate them to succeed.

What have you found valuable in the series that may be different than other webinars?

It’s very interesting to hear the ideas that other health centers have employed to help their patients. I also learned a lot from how other health centers dealt with various situations that we all encounter that are related to cultural differences. For example, people who are not US citizens often fear seeking medical care. They might be afraid that their personal information would be shared which might draw attention to or complicate their immigration status.

What did you learn or encounter that you were not expecting?

I learned how to make sure patients have food options that are considered healthy even in the event of an emergency, like after a hurricane. Some foods we covered: nuts and nut products like almonds, walnuts, and peanut butter; canned foods like beans, tuna, salmon, rice, pasta, or meats; grain products like cereals, unsweetened oatmeal, whole-wheat bread, and crackers; milk including evaporated milk, powdered milk, and shelf-stable milk; fruits like canned fruit in 100% juice, dried fruit, and applesauce.

Additionally, the ECHO series reminded me of the importance of teaching patients about their bodies so they can better control their condition. Finally, what I found in this series and was not expecting was the topic of social determinants of diabetes, obesity, and prediabetes. I found this issue critical because these determinants have a major impact on the patient's condition. According to the American Hospital Association, each year, 3.6 million people do not get medical care because of transportation problems. As health professionals, we have the mission to help our patients to cope with these determinants and not let themselves be defined by them.

What's one thing you hope to incorporate in your work that you learned from the series so far?

I would like to incorporate education for patients so that they can better understand how their body works, as there are some patients who do not have access to blood pressure or glucose monitors. I believe that informed patients who see how their bodies work can better control their blood sugar levels and blood pressure. Additionally, I will continue to emphasize basic diabetes and hypertension education because I think that is the most fundamental tool for the empowerment of our patients. Finally, I would like to integrate other disciplines into treatment because diabetes affects the patient in all areas. A team of professionals working together with the patient to gain control of diabetes through different avenues is critical.

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