SAN JUAN, On June 15, the U.S. Department of Health and Human Services announced a grant of $2,366,117 to Nuestra Clinica Del Valle to assist the clinic in serving South Texas residents.
Clinic leaders say this is a major step forward for NCDV, as the majority of its patients are uninsured, and about 90% of their patients fall below the 200% federal poverty line. NCDV serves Hidalgo and Starr counties, with nine clinics in Hidalgo County and two clinics in Starr County.
Lucy Ramirez, NCDV’s chief executive officer, and Dr. Carlos Medina, the clinic’s chief medical officer, agree that more funding is beneficial for the clinic considering the unique needs of the Rio Grande Valley population and how NCDV serves those needs.
As a community clinic, NCDV focuses on three main diseases: hypertension, obesity, and diabetes. According to Ramirez, the incidence of diabetes is getting worse. The number of people diagnosed with diabetes at their clinic is increasing, as more people are transitioning from pre-diabetic to diabetic, because they do not make the necessary lifestyle changes to prevent the progression to diabetes.
Medina believes there is a common belief that becoming diabetic is inevitable, due in part to patients having observed their family members become diabetic. Some patients also take the condition lightly because of their family members’ experience with diabetes. Medina described his experience trying to motivate his patients to move away from the notion of “Oh, nothing happened to such and such; they had diabetes forever and they ate whatever they wanted forever” to understanding every person is different.
Medina, Ramirez, and the NCDV staff challenge the belief that diabetes is “not a big deal” and remind their patients that the progression from pre-diabetic to diabetic can be prevented if patients make the necessary lifestyle changes, such as change in diet and more exercise. If not, the consequences can be grave. As Ramirez says, “We see it with our patients that have to be dialyzed and end up in the hospital because they were diabetic and didn’t take care of themselves.”
In addition to the three diseases of focus, Medina also mentions “a sharp increase” in MeSH. With MeSH, patients get a fatty liver, or cirrhosis. Cirrhosis is typically caused by drinking an excessive amount of alcohol to the point where it no longer functions. In the case of the RGV, however, Medina claims the patients are “having that end process, but with someone who either drank very little or didn’t drink at all.” He has seen patients require a transplant or pass away from MeSH “and never having a drop of alcohol.” A potential explanation for this phenomenon is a diet filled with high calories, high fat, and high carbs, which can be found in the typical beans, rice, tortillas, and red meat we see in the RGV. Medina notes he is not sure if many people are aware of what foods are best for them or what other healthy food options are available to them.
Medina and Ramirez understand the process of initiating these lifestyle changes is gradual, as habits, especially eating habits, are hard to break. Thus, NCDV has integrated their behavioral health component with their primary care. NCDV’s Licensed Professional Counselors, or LPCs, work in collaboration with medical providers to educate patients and “convince them that this (diabetes) requires a lifestyle change.” NCDV screens their patients yearly for depression and sends their patients to the LPCs if patients are grieving, struggling with substance abuse, or experiencing uncontrolled diabetes. NCDV also offers an array of services, such as x-rays, dental, pharmacy, and lab, to name a few. NCDV has “some of the highest certification for patient centered medical homes,” according to Medina. Although it takes “a lot of coordination,” Medina says being patient centered is what is best for the patients. NCDV hits the mark in providing well-rounded care, from providing mental health support to lab and x-ray services.
NCDV recognizes the tight-knit nature of the RGV. As Medina sees among his patients, “they probably get the most from each other.” He thinks a grassroots approach and simply “talking to each other” would be helpful in addressing the health deficits in the RGV. NCDV uses this strong sense of community to their advantage and recruits certified promatoras who educate and encourage the community to take care of their health. The promatoras of NCDV give presentations and distribute fact sheets over different health topics, such as COVID-19, heart disease, and diabetes. NCDV has a partnership with the Mexican Consulate in which the promatoras give presentations about NCDV at the consulate to assure the community that NCDV will serve anyone regardless of residency or insurance status. Promatoras’ training, education, connection to the community, and experience participating in other grassroots organizations make them a trusted and valuable resource. Ramirez says, “Hearing it from the doctors and then hearing it from the promatoras carries a lot of weight” because NCDV ensures the information distributed by the promatoras corroborates what the doctors tell their patients. In a time when misinformation is rampant, dissemination of consistent and accurate information is what the RGV needs, Ramirez argues.
Considering all of the services NCDV provides to the RGV and the population it serves, funding can be an issue. Many NCDV patients do not have insurance, partially due to the lack of Medicaid expansion in Texas. Ramirez says a lot of patients fall into the “coverage gap,” in which patients do not qualify for insurance on the marketplace due to income guidelines, but they are not eligible for Medicaid because they earn too much. Expanding Medicaid could lessen the financial burden on safety net clinics like NCDV because, Ramirez explains, “more (insured) people would come in, but more people would come in and you would have the means (to pay) and you would have the means to be able to bring on more people, more providers, (etc.). Financially you’d be able to also grow the practice.” Ramirez says more funding could bring specialists on site and more providers to the clinic. Currently, for specialty care, NCDV can only help uninsured patients find a provider that will work with them and “offer discounted rates to try to get the consult that they need.”
Ramirez and Medina want the public to understand NCDV’s role in the community as a clinic that is owned by the community and serves everyone and anyone. As Ramirez says, “We can make this clinic whatever we want to be, but we have to do it as a community.” NCDV will serve patients when they have Medicaid and when they do not have Medicaid. Medina says, “It’s not going to be different for someone who is insured versus uninsured. We treat people the same.” NCDV, Median said, is here for the people of the RGV, “for the places that need it the most.” NCDV’s federal grant is one of their “major” sources of revenue, and with the new $2,366,117 grant provided by the HHS, Ramirez said, NCDV will continue to serve the RGV with high quality and well-rounded care to everyone who needs it, not just the uninsured or poor.
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