Issue link: https://tmcpulse.uberflip.com/i/759603
t m c » p u l s e | d e c e m b e r 2 0 1 6 19 uncontrolled diabetes, most of whom are uninsured. It is part of a Medicaid 1115 Waiver, which allowed Texas Health and Human Services to expand Medicaid managed care to impoverished areas. The program is built around community health workers, known as "promotoras," who go door-to-door to provide education, encourage behavior change and offer referrals and support for improving blood sugar results. At home and in the workplace, the promotoras build continuity between the messages delivered by the providers of the Salud y Vida program during clinic visits and the participants' actions at home and in the community. If uncontrolled diabetes was diagnosed, promotoras support and educate individuals on everything from A1C tests (which measure average blood glu- cose levels) to foot sores—a hallmark of diabe- tes and one that often leads to amputation. "When the promotora first came to take my A1C, she said, 'Not good, sir, lose weight,'" Garza said. "I didn't even know what A1C was. I thought A1C was an energy drink, one of those like Red Bull. I mean it. Why? Because, my whole life I knew about the law, immigration, attorneys, accidents, about everything, I knew. But I didn't know about health. I focused on fighting for my family to grow, for them to be respectful, honest, hard-working, but I never thought of learning about health." Garza is a family man, his face framed by a long beard he's been growing for two years as a religious promise for one of his sons. He built his auto business—The Family Road Service—for his children to inherit. His house, painted a robin's egg blue and situated on a sizable, well-kept strip of land, is home to mul- tiple members of his family, including children and in-laws. He is grateful that they have all embraced a healthier lifestyle. "God has blessed me through the effort my wife has made, my family has made," he said, "because eating doesn't change for the diabe- tes patient only. No one got away in my house. Why? Because they have to look after father- in-law or grandpa? No. Because they've also learned that they need to have a balanced diet and exercise to have healthy lives." (continued) Left: Alma Martinez explains healthy nutrition choices to a diabetes self-management class. Right: Joseph McCormick, M.D., regional dean of the UTHealth School of Public Health in Brownsville. A patient's home in the Valley, where more than 90 percent of the population is Hispanic and nearly 70 percent of the population has no health insurance.