World Health Day: Beat Diabetes
April 7, 2016
Today is World Health Day! This year the day has been committed to raising awareness about diabetes. To highlight the prevalence of diabetes among homeless and formerly homeless people, we invited Dr. Van Yu, Chief Medical Officer of CUCS’ Janian Medical Care, to share his insight into this treatable, yet debilitating disease.

Why is diabetes so devastating for many homeless and formerly homeless people?

There are several reasons why diabetes has a more devastating effect on homeless and formerly homeless populations than other people.One of the main reasons is that, even though diabetes is easily treated, homeless people lack access to treatment. There are different reasons for that. Typically, you receive medical care for diseases like diabetes in brick and mortar clinics and these can be difficult for homeless people to access, especially those who lack insurance. Clinics are also very structured and it takes a fair bit of personal organization and resources to navigate. Things like follow-up appointment, specialty care, and laboratory tests can be daunting.

Something we also see is the lack of understanding of illnesses, especially for people who are very ill. Many homeless people have this obstacle which is: ‘I feel fine, so I don’t take my medicine.’ If you don’t understand the connection between treatment and disease, then you are less likely to engage in treatment effectively. And the treatment can sometimes be complicated even if you understand that connection. If you have to give yourself insulin, that is often a difficult schedule with various contingencies. Someone has to teach you.

Also, homeless people, especially seriously mentally ill homeless people, are more prone to diabetes to begin with. Certain ethnic groups have a higher instance of diabetes and so do people with schizophrenia.

Lastly, some of the non-treatment ways to manage diabetes like diet, exercise, and other lifestyle factors are difficult to do when you are homeless. It can be very hard to eat a healthy diet for diabetes when you are living in a shelter or on the street.

How is Janian Medical Care helping clients with chronic illnesses like diabetes?

One of the main ways that our primary medical care initiative helps clients is through access to care. Since people have trouble going to the brick and mortar clinics, we are bringing the care to them. We work hard to remove a great deal of logistical and bureaucratic obstacles for them. Care is provided for people who are uninsured and we help with working out insurance issues for those that are. We do it right there on the spot, especially since we are integrated with the social service team whose expertise includes insurance and benefits issues.

Clinics often don’t have the time, energy, or resources to ensure their patients are adequately educated about their health. The way we have solved this is by having the primary care provider address education or understanding issues as part of their care. Instead of seeing four people in an hour, we will see one person an hour and spend that extra time on them. That time is actually an investment and has a lot of dividends down the road; saving time, money, energy and resources. The patient will be less sick, require fewer visits with us, and fewer hospital visits in the community. We think this is a smart investment.

The integration of our primary care teams and psychiatrists is also very helpful. If one of the obstacles to effective engagement in care is psychiatric symptoms, then the combination of the psychiatrists and primary care practitioners is often the most effective in dealing with it. That works both ways, where we can cover for each other to increase our reach.

Even if the care is not through us, we help clients accept care from other places – it is person -centeredness in action. People start participating in their own health care when they feel a particular kind of engagement in it. Connecting with our patients in this way requires time and resources, and a certain kind of clinician. You cannot put any clinician into this; it requires a certain philosophy and personality. The people who can be more creative and open-minded not only feel better doing this but actually are more effective.

Can you tell us about a client success story battling a chronic illness?

On one particular case, I was working with a client who was psychotic with chronic illnesses, including diabetes. He would never come to see me but I would visit him and we would talk for twenty minutes, just keep conversation going. He was very ill and not seeking the help he needed. Then one day, he took himself to the hospital. I am convinced that the reason he did that is because he was more engaged with everyone. When he came back, he ended up working with Emily, one of our primary care providers. I think it because of that care that he kept taking his psychiatric medication and I did not have to see him as much as before.

His medical condition has improved so much that he is on half the medicine he needed before. His heart is in much better shape and his diabetes is under control. He is engaged with the staff and taking all his medicine, it is remarkable. It is one of those cases where if you told me two years ago that it would turn out this way, I would have said you were crazy.