Finding Health Care

Managing diabetes, with limited local options
by Veronica Zaragovia, KUT

People who live in Manor know each other. They spend a good amount of time outside chatting with their neighbors. I found Edaisi Mas after I told her neighbor I was searching for diabetics. He told me to go next door.

“Let me know!” Mas yells out to her neighbor, asking him to keep an eye on the school bus. She’s waiting for her great grandson. Mas, 68, is Cuban and has diabetes. She moved to Manor from Austin with her granddaughter about two years ago.

“I feel fine here but everything is far away for me — like clinics. I have to go to Austin to see my psychiatrist, my dentist, my eye doctor is over there. Everything’s in downtown Austin.”

Her ultrasound appointments are in Austin, too. Her primary doctor is here in Manor, though, and she can walk there from the house.

When her grandson’s bus arrived, they went inside and I saw I had a missed call from Megan McAuley. I had given my card to McAuley’s nurse outside a multi-colored apartment complex for seniors.

I quickly walked over to her apartment to hear her story about having type 2 diabetes. I knocked on the door. She and her dog greeted me.

McAuley, 62, was diagnosed with diabetes almost 20 years ago after a kidney transplant. I found that McAuley, like Mas, is trying hard to manage the disease.

McAuley buys organic, non-GMO food even though she’s on food stamps, and even though she has to go to Austin to get it. She buys vegetables from the local Walmart.

“Before I got the van I rode my tricycle to Walmart, on the service road of 290,” McAuley says. “It was a little bit scary but you know, hey, gotta do what you gotta do.”

 McAuley moved here from Austin because she likes the small town feel, but she has to keep going to Austin for all of her medical care – including dialysis.

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Dr. Alina Ramos at Manor’s health clinic treats patients with severe complications from diabetes — nerve damage, cardiac disease, hypertension. She says one plus of care at this clinic is the solid doctor-patient relationship.

“We don’t want people to necessarily go to the hospital for these illnesses because they see somebody they’ve never seen before and doesn’t know their case,” Ramos says.

The clinic – a CommUnity Care federally supported center – has group classes in Spanish and English for diabetic patients. Staff members can teach patients how to use new medications, but she wishes more specialists would come work in Manor.

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“I think people think that Manor is someplace between earth and the moon because it’s very difficult to find providers who are willing to come to this clinic in particular,” Ramos adds.

More specialists are slowly heading here as the population has grown.

In the last two years, an urgent care clinic opened in Manor and a dermatology office.

With such limited access to medical care, do people here understand how to manage an illness like diabetes?

That’s what researchers at the University of Texas at Austin’s School of Nursing are studying. They chose Manor as one of the sites for a study on health literacy using CommUnity Care patients. who read a list of words in English or Spanish.

The words included portion, obesity, dosage, calorie, infection, ketone, triglyceride, carbohydrate. I spoke to one of the participants who did the study in Manor — Lorena Becerra. She has lost 30 pounds since starting to get care at this clinic, has given up tortillas and is regularly taking her medicine. “I do it so that I can take care of my four children,” she told me at her Austin home, about a 10-minute drive from the Manor CommUnity Care clinic.

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Nicole Murray, a doctoral student at the School of Nursing, worked on a study about health literacy among people with diabetes with Professor Miyong Kim, who designed the study. Murray says many of the participants on the survey have limited health literacy. “They have difficulty pronouncing or enunciating the words that are very commonly used with diabetes management,” she said. “In addition they had difficulty interpreting information from a food label, which we hope people with type 2 diabetes understand really well to understand how many carbohydrates they’re taking in, or what a serving size is.”

Professor Kim says people would be empowered to make healthy decisions if they could analyze the information on a food label.

“It’s not always their priority to read labels and buy nutritious food. Sometimes they have to make a decision for what is the cheapest meal that can feed four, five, six people in their household. We are completely aware of that complexity of chronic disease management, particularly among an underserved population,” she says. But Kim adds that reading a food label would be one big step forward. “Within their resource, they can make smart choices about their diet, their exercise their information – the ability to really looking for what is bad information  and what is good information,” Kim says.

Kelli Royse, also part of the team, noted how isolated the Manor clinic is. “All the other clinics I could tell you where the closest grocery store is, or gas station,” Royse says. “But in that area it seemed like there wasn’t much around.”

The clinic itself shares space with various other services. “It has a thrift store, a health and human services, a WIC and a CommUnity Care clinic, all probably within the same square footage as some of the other clinics we were at,” Royse adds.

She and her team are planning to work with community health workers, or “promotoras,” who can educate people with diabetes in their communities. They’re also working on developing a mobile video game with the UT game department that would teach people self-care skills and health literacy.

Diabetes is more common in minorities. And according to the Pew Research Center, blacks and Hispanics reach for their phones more than whites for information about health conditions. And in a place like Manor – with limited medical access and a growing majority-minority population – those kinds of solutions are just what the doctor ordered.

More people, more health problems
by Caleb Pritchard, Austin Monitor

“If you build it, they will come.”

So goes the famous mantra (slightly altered) of the Kevin Costner classic Field of Dreams. When the film came out in 1989, the town of Manor had an estimated population of just over 1,000 residents. More than a quarter century later, that number has blown past 7,000.

That explosive growth has far outpaced the infrastructure typically associated with functioning communities, thus turning the famous phrase that haunts Costner’s corn-farming character on its ear: The people are coming, and they are finally building Manor.

The building boom has seen the opening of the new 290 East Toll (also known as the Manor Expressway) as well as new shopping centers, including one anchored by a Walmart. More slow to develop, however, is a social safety net strong enough to absorb the new families priced out by the rising cost of living in Austin, Pflugerville or Round Rock.

Until this year, uninsured parents’ primary option for low-cost professional health care for their children required a trip into Austin. If they relied on public transit, they could catch one of three buses that leave in the early morning and return in the late afternoon. In other words, the trip would require a full day’s commitment.

Manor Independent School District social worker Becky Rivera explained how that put families between a rock and a hard place. “A lot of our parents are minimum-wage earners, so they don’t have the luxury of earning vacation time or sick time,” Rivera said. “Basically, if they don’t go to work, they don’t get paid.”

Enter the Manor Mustang Health Center. The full-service clinic opened in April in a small building behind MISD’s Manor Tech High School just at the mouth of the Manor Expressway.

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“We’re here to help the families know that the financial part of it doesn’t have to be a reason not to bring their children in,” said Erica Windwillow, the site manager of the clinic, which is the bounty of a partnership among the school district, Austin Travis County Integral Care and the People’s Community Clinic. Together, they work with families who can’t afford health care costs.

“(The Children’s Health Insurance Program), traditional Medicaid, Sendero, you name it, we can screen for services that they could potentially qualify for,” Windwillow said. “And if they don’t qualify for those services, we do have a discounted sliding scale that they are able to be part of as well.”

Windwillow was standing in the health center’s shiny new lobby, beneath bright signs featuring inspirational messages like, “Dream until your dreams come true” and “Imagine, inspire, dream.”

“We want these kids to feel that this clinic is a place (where) they can feel comfortable, a place where they can grow, where they can express themselves – a welcoming home to them and their families,” she said.

To highlight the community’s urgent need for a backstop to catch struggling families, Rivera pointed to a troubling statistic vexing the district, which covers 100 square miles between Austin and Elgin with Manor at its center. Of its 8,500 students, nearly four in five qualify for reduced-price lunches. While families are finding affordable housing in Manor, she said, it comes with its own hidden costs.

“Our families have to live together,” Rivera said. “And they live so far out, (Capital Metro) is not available to everybody in every corner. They have to spend a lot of money on their vehicles because that gets them to and from Austin and to and from work.”

But while Manor Mustang Health Center is there to provide a much-needed safety net for some families, a major gap in coverage still remains.

“Currently, we are only taking elementary students here,” Windwillow explained. “Of course, if the family loves the services that People’s Community Clinic provides, the adults and the adolescent children, we’re encouraging them to go to our main clinic in Austin for the time being.”

Windwillow did not reveal any concrete plans for expanding coverage to older students, but she hinted, “Stay tuned.”

For struggling families, the service couldn’t come soon enough. Rivera said that the district’s population is expected to more than double in the next 20 years. The extra stress that kind of massive growth could bring to bear isn’t lost on one Central Texas leader.

“It’s time for us to embrace this issue,” Travis County Judge Sarah Eckhardt declared in her downtown Austin office. “It’s time for us to wrap our arms around it and say, ‘We need to look at all the areas in Travis County and all of the opportunity and get it distributed throughout Travis County so that all individuals can have access to it.’”

In other words: The people are coming to Manor. Now let’s build it.