>> Over the past two decades,
life expectancy in rural areas
has declined.
One reason is the prevalence of
diabetes.
With support from the pulitzer
center and in collaboration with
the global health reporting
center, or special correspondent
reports from the Rio grande
valley in Texas.
It is part of our ongoing
series, "Rural rx."
>> Dissidents -- it is
dinnertime in edinburg, Texas.
>> She's drinking lemonade, but
the lemonade is sugar-free.
>> They are watching sugar
because as Ira has diabetes,
diagnosed last fall.
>> She just kept picking up
every single virus.
I was like, we cannot do this
anymore.
I need to find out what's wrong
with my daughter.
>> I was getting sick, like
super sick.
>> She is not in the hospital.
>> They found that three months
before, her body had stopped
making insulin.
Looking back at the signs where
she was always thirsty, she Peed
a lot so much, she would get up
so much in the middle of the
night, and I was like, you need
rest, I would never have thought
this could happen to her.
>> This is the testing strip to
test what my blood is.
I'm scared that's going to go
too high or too low.
>> 11% hour 37 million Americans
have diabetes, and it is an even
bigger problem for rural areas.
In places like south Texas, the
percentage of people with
diabetes ranges from 15% to 21%.
Dr. Yvonne Melendez is a family
medicine specialist and top
public health official in hit
ouko county.
-- Hit all go -- Hidalgo county.
>> We are the most obese, most
diabetic, most hypertensive, and
average education level of
eighth grade.
>> In diabetes patients, about
6% have type one, an autoimmune
disorder.
The vast majority have type two
diabetes, which is closely
linked to diet and lack of
activity.
>> Remember that type 2 diabetes
goes hand-in-hand with obesity.
>> Across the country, rural
children are 26% more likely to
be obese.
>> Add to that the fact that
here in the south, there is not
too much exercise, either from
weather or because the distance
is too long and we do not walk
like people in New York, for
example.
>> Hispanic Americans are much
more vulnerable, far more likely
to have type 2 diabetes then
non-hispanic whites.
>> We have all the factors of
diabetes.
If you are not at least 20%
overweight here, you are
considered skinny.
We have 70% to 80% carbohydrate
diets.
It is if you will -- I hate to
use the cliche, but it is a
perfect storm.
>> Sylvia Garcia is a nurse
making home visits.
Her program run by UT health
Houston.
>> The biggest problem sometimes
is poverty because they don't
have the money to buy their
medicines.
>> Before Gloria Cortez was
connected with this program,
just getting to the doctor was
an ordeal.
>> To go to the doctor, it took
about an hour.
Sometimes all day.
>> This is a part of the country
that if you do not have a
vehicle, then it is extremely
difficult for you to get around.
The public system is murderous.
It is just nonexistent.
>> Diabetes requires constant
management.
>> How do you get to the
pharmacy?
How do you get to your doctor?
How did you get to the
follow-up?
>> Visiting nurses is one
solution.
Another comes from UT, which
sends a mobile unit around the
region.
>> Once a person has it under
control, you need to think about
the long-term.
>> We try to make it to areas
that are a little further out, a
little bit more rural clinics,
rural areas.
>> For transportation is not the
only challenge.
>> I think we are deeper in
poverty here than in many
places.
>> Linda Nelson is senior
director of clinical operations
for UT health Rio grande valley.
She oversees the mobile unit as
well as a network of clinics.
>> If we don't have a low cost
health system for them, they
don't come.
A lot of our patients are day
laborers.
If they don't go to work, they
don't get paid.
>> You commonly ride to patients
who are having to pick between
sustaining life for their family
or help -- for their family,
versus health?
>> Sure.
>> A research project at UT
Houston found the true
proportion is even higher.
>> Here in the Rio grande, more
than 50% of the community does
not have access to health
insurance.
50% is a very high number.
>> Chemical rate and status can
be another barrier to care.
Many medical providers don't
even ask, so they don't scare
patients away.
>> There were people who did not
go to the clinic to pick up
medication because they were
afraid of being detained.
They struggle a lot to get
people to go to their
appointments, to get people to
go pick up their medications.
>> For some families with
children, it is a complicated
dance, according to Deborah who
runs the south Texas juvenile
diabetes association.
>> The children may not be
undocumented, but the parents
are undocumented, so that
creates this crazy, you know,
distrust of the system.
>> Undocumented or not, treating
chronic illness puts a premium
on lifestyle changes.
>> Healthy vegetables are also a
bit more expensive.
>> Despite being surrounded by
farmland, for people here, fresh
fruit and vegetables are hard to
come by.
>> So we started a specialized
food pantry, and we have a
community garden so we can also
educate our families on how to
have a healthier lifestyle.
>> Prevention is key.
>> Ivan Melendez says for most
people, it also takes a change
in mindset.
>> How did you convince a
42-year-old man with a family of
three, all five of them, to go
get their diabetes check?
How do you feed someone who has
eggs and beans and bacon in the
morning and a fajita platter at
lunch and a hamburger in the
evening?
It is a lifestyle.
So it is a tremendous hurdle.
>> Diet may not cause type one
diabetes, but certain foods can
lead to a dangerous spike in
blood sugar.
When you look around the
cafeteria and you see takes and
candy, what do you think?
?
>> Sugar up.
>> Do your friends know?
>> Yes.
They are like, we support you.
We love you.
>> She has a much better chance
of beating the odds by catching
and treating it early.