Home visits and self-education help control diabetes
On Thursday, June 26, Matewan native Vicki Hatfield and Dr. C. Donovan “Dino” Beckett travel to Aspen, Colorado, to accept the prestigious Robert Wood Johnson Foundation Culture of Health Prize on behalf of Williamson, W.Va., a $25,000 award which honors six communities nationwide that are transforming health by bringing together a broad range of partners to improve health outcomes for residents.
WILLIAMSON, W.Va. — Vicki Hatfield has been attacking Mingo County’s high diabetes statistics for nine years now. A certified nurse practitioner and diabetes educator, she sees more than 100 diabetes patients a month at the Williamson Family Care Center.
Her statistics were proving that she was helping her Williamson-area patients’ lower their blood sugar, but she wasn’t satisfied.
“We were seeing only a fraction of the people in Mingo County who need it,” she said.
So, with the help of Marshall University and community partners, she started the Mingo County Diabetes Association “to help prevent people from getting diabetes, not just treat them after they get it.”
The association organized a lunchtime walk challenge, Walk to Los Angeles, “to see which team could cover the distance to LA first.” Under her leadership, the Diabetes Association teamed up with other Williamson organizations to organize monthly 5Ks, a farmers’ market, Tuesday night track, three high-tunnel greenhouses and a raft of programs aimed at reducing Mingo’s high diabetes rate.
“It’s rare that you have, in a small community, someone with the expertise concerning diabetes care and prevention such as Vicki Hatfield,” Dr. C. Donovan “Dino” Beckett, director of the Williamson Family Care Center, said. “Her dedication and commitment to the residents of the area is unprecedented and has improved hundreds of lives, not only affecting individuals but improving health across the entire community.”
Hatfield continued to see patients at her office, but she was bothered that a lot of country people, particularly low-income people, couldn’t easily make it into town for medical appointments.
“And literacy can be a real stumbling block, too,” she said. So she wrote a grant to fund a program that would let nurses visit diabetes patients and people in danger of diabetes at home.
In spring 2013, the Mingo Coalition was awarded $2.5 million from the Centers for Medicare and Medicaid Services.
Roma “Cookie” Eanes, who lives about 12 miles from Williamson, became one of the first patients in the new program. When Cookie first came to see Vicky that spring, her A1c — a measure of blood sugar — was 10.7, a potentially life-threatening level. Anything above 7 is considered unsafe. “She’d been putting off getting care because she didn’t have Medicare yet,” Hatfield said.
“It was quite evident that we needed to change her therapy,” she said. Her plan: Get Cookie on insulin to stabilize her while lowering her blood sugar through diet and physical activity.
But Cookie refused to take insulin shots. “She said, I’ve lived a good life, I’m 65, my children are raised and I’m ready to go. In essence, she was saying she would rather die. And she hung up the phone when I called to talk to her about it.”
Hatfield persisted and finally had the chance to show Cookie how tiny the insulin pin (needle) is. Cookie agreed to the shots and started the home visiting program.
Every two weeks, two nurses stopped by her home to check her blood sugar and help her develop habits that would keep it down. Each time, Cookie’s husband, Walter “Weasel” Eanes, stayed close at hand, listening attentively.
When the nurses visit, “they check all my numbers, they check my machine, they check my averages, ask me if I have any questions, they check my blood pressure,” Cookie said. “They are very thorough.”
Weasel learned how to do all those things and soaked up their advice about nutrition. He became very involved in Cookie’s treatment. That’s the ideal scenario, Hatfield said. “And the progress that she and her husband have made has been amazing,” she said. “Very amazing.”
That’s one beauty of home visiting, she said. The whole family can get involved.
At last count, Cookie Eane’s A1c was 5.7 and she has greatly reduced the amount of insulin she needs.
On a beautiful recent day, Hatfield drove some visitors over narrow winding roads to visit Cookie and Weasel at their neatly kept mobile home. Cookie met them at the door, eager to tell her visitors how the program has helped her.
“Before I started this program, I would get up, I would grab a snack cake,” she said. “That was breakfast. Now, I don’t even go near the dessert table. I no longer crave it.”
“It has made a disciplined eater out of me,” she said. And a disciplined exerciser, too. Daily, she heads to the treadmill tucked beside the bed in her bedroom. “Before the program, I couldn’t even walk to my treadmill. Now, I go at least one hour.”
She looks forward to the visits from the nurses.
“It’s like I tell them every time they leave. I hug them and tell them you don’t know what that means. It’s a support knowing somebody else cares.”
“The program, it’s changed both our lives,” Weasel said. “It’s changed our eating ways. I learn everything I can about it. I always thought it was the food. But I’ve learned. A bad night’s sleep. Stress. Worry. Anything can cause her sugar to go up.”
Weasel’s blood sugar is normal, but he checks Cookie’s blood sugar three times a day now and closely monitors her diet. “But I very seldom have a high number now, do I?” Cookie said.
Before the home visiting program, Cookie was too weak even to shop, he said. “I went to Wal-Mart by myself. She wasn’t even able to push a buggy. But now, why, she outshopped me.”
Weasel attends Diabetes Coalition classes with his wife. He is constantly figuring out ways to lower her carbs. “She loves a MacDonald’s Big Mac. OK, I laid and thought on it — 45 carbs is the highest she can have. So when I order her a Big Mac, I make ’em leave the center bun out. Cuts it down to 35 carbs. It gives you room to play with.”
He looks back on their former diet in dismay. “Before we started this, I was killing her. I didn’t know what I was doing,” Weasel said. “See, I hadn’t gone to a coalition class. And we hadn’t had our first visit from the nurses. Instead of 45 carbs, I was giving her 200 carbs.”
“Sometimes, the main thing people need is good information and encouragement,” Hatfield said, driving back to Williamson.
“I’ve found that Appalachian people are very resourceful,” she said. “Once given the tools, they become experts in their own little world, in their community. They become very proud of what they know, and they want other people to experience their success. And they share that.”
Reach Douglas Imbrogno at firstname.lastname@example.org or 304-348-3017.