Community health workers confront poverty in Bexar County

SAN ANTONIO — Berta Casares has managed her diabetes for the past 30 years by drinking an herbal tea called moringa, watching her sugar intake and keeping up with regular medical checkups.

But what helps her the most are regular home visits from Rita Pendergast, the promoter who works for Nosotros, a program jointly funded by UT Health San Antonio and University Health.

Nosotros is a group of community health workers committed to working with Bexar County’s most vulnerable population – patients who may not otherwise be able to make it to their doctor’s appointments due to various socioeconomic barriers such as lack of transportation, financial constraints, or poor access to healthy foods.

Casares, 79, was scheduled for a second surgery for breast cancer when they found out she had COVID-19. Her cancer treatment was delayed for four months while she recovered.

Bertha Casares, left, shares a laugh Thursday in her apartment with community health worker Rita Pendergast during the promoter’s home visit. A new study conducted by UT Health San Antonio faculty found that one-third of patients were able to control their type 2 diabetes after building a relationship with promoters.

William Luther, Personal Photographer / Personal Photographer

“Just seeing her makes me feel better,” Casares said in Spanish at his apartment in the city’s southeast. “When I was really sick, her company meant a lot. She is a good friend.

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Pendergast, who has been seeing Casares for the past five years, said they are not time-driven and that it sometimes takes up to 10 visits to open up. But when they do, it feels like “magic.”

In recent years, researchers have focused on the “social determinants of health” to improve patient care and health outcomes and ultimately reduce provider costs.

Dr. Robert L. Ferrer, professor of family and community medicine at UT Health San Antonio, said doctors need to work to discover what’s going on outside of the doctor’s appointment. He and his colleagues recently conducted a peer-reviewed study showing how promoter interventions can make a difference in helping patients with chronic diseases.

The study, published in the Annals of Family Medicine last month, found that a third of patients were able to control their type 2 diabetes after building a trusting relationship with one of the clinic’s promoters.

“The intervention lasted only 12 weeks, and yet the effect was evident four years later,” said lead study author Dr. Carlos Roberto Jaen, professor and chair of family and community medicine at the Long School of Medicine.

Berta Casares listens Thursday in her apartment to public health worker Rita Pendergast during the promoter's home visit.  A new study conducted by UT Health San Antonio faculty found that one-third of patients were able to control their type 2 diabetes after building a relationship with promoters.

Berta Casares listens Thursday in her apartment to public health worker Rita Pendergast during the promoter’s home visit. A new study conducted by UT Health San Antonio faculty found that one-third of patients were able to control their type 2 diabetes after building a relationship with promoters.

William Luther, Personal Photographer / Personal Photographer

Nearly 1,000 participants came from a primary care practice on University Health’s Robert B. Green Campus and other local medical offices and were followed for four years before the COVID-19 pandemic.

Ferrer said 320 patients were able to lower their A1C, a blood test that measures average blood sugar levels over the previous three months.

Another 399 participants were able to overcome some barriers to self-care but needed additional help. The remaining patients agreed to meet with a promoter, but this fell through.

The study found that the first group had fewer hospitalizations and emergency room visits over the four years than the others.

“We will go with them to their doctor’s visits and we can even take a doctor to their home,” said Dr. Carolina Gonzalez Schlenker, an assistant professor at UT Health San Antonio and one of the study’s authors.

Schlenker leads the Nosotros program and helps train staff. Their biggest obstacle is poverty.

Bertha Casares, left, talks Thursday in her apartment with public health worker Rita Pendergast during the promoter's home visit.  A new study conducted by UT Health San Antonio faculty found that one-third of patients were able to control their type 2 diabetes after building a relationship with promoters.

Bertha Casares, left, talks Thursday in her apartment with public health worker Rita Pendergast during the promoter’s home visit. A new study conducted by UT Health San Antonio faculty found that one-third of patients were able to control their type 2 diabetes after building a relationship with promoters.

William Luther, Personal Photographer / Personal Photographer

Organizers sometimes rely on a special fund, mainly the clinic’s medical staff, who pitch in so they can order an Uber for a patient to get to an important appointment or buy a microwave so they can heat up food.

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Many of the patients said they were helping older residents, raising their grandchildren, refugees or the homeless.

Schlenker said when a patient can’t make the intervention, they often see him later in the clinic with uncontrolled diabetes and a need for amputation.

Raul Trevino, another team member, said during a weekly meeting that they do their best to meet the patient where they are and listen to them so they can trust them.

“We don’t mind long hours, working late or going to low-income areas,” he said. “We want to give them an opportunity to improve themselves.”

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