How Watsonville Program Helps Latino Immigrants Manage Their Diabetes

By Vinnee Tong, KQED

Abel Corona sat down to dinner and scrutinized the steak his wife had cooked for him.

“It’s hard to measure the portions,” he says in Spanish. The steak was extremely thin but still, he seemed to have a sense of guilt about it.

The focus on portion sizes comes, in part, as a result of his new efforts to manage his diabetes.

Corona, a Watsonville resident, was diagnosed about a dozen years ago, but didn't do much to improve his health until 18 months ago when he started seeing a new doctor and, perhaps most importantly, started attending weekly group classes in diabetes education.

That’s where he’s been hearing a lot about portion sizes.

The class is run by a Watsonville health clinic, Salud Para la Gente – Health for the People -- as part of a program called Project Dulce. On a recent Thursday evening, Abel joined about a dozen others in a multi-purpose conference room at the nearby Muzzio Community Center.

Nick Sandoval conducts the classes in Spanish. Sandoval blends cultural references, like folk tales, with a dash of humor to teach the classes. One recent class touched on a variety of subjects, from hypertension to cholesterol and basic nutrition.

For instance, Sandoval tells students to think about a deck of cards as a good size for a serving of meat. Or, if they don’t have cards, then to look at the palm of their hand. To drive home the concept, he breaks out in a familiar Spanish song, which translates as “In the palm of my hand, I had her heart.” Students laugh at this. Sandoval says it helps them to remember the lesson.

The class conveys information, but it also serves a more important purpose. It teaches students that diabetes is a manageable disease, and it gives them hope they can continue to earn a living.

In most cases, that need is critical. Sandoval cites one of his students as a typical example:  a fieldworker married to a homemaker.

“He goes, ‘I’m the only breadwinner,' and he says, 'if something happens to me, then there goes my family,'” Sandoval says. The point of his class is to help people understand that diabetes is a manageable illness.

Watsonville is an agriculture town known mostly for strawberries, blueberries and raspberries, but in health circles the area is known for diabetes, too. Latinos suffer disproportionately. In Santa Cruz County, home to Watsonville, diabetes rates are 75 percent higher for Latinos than than they are for whites. Rates are also high in adjacent Monterey County.

Sandoval says all of the class participants have some kind of connection to the local agriculture industry. Corona is the typical diabetes patient for this area: He's Latino and a farmworker.

Corona moved here from Mexico as a teenager, and he works during the harvest season, supporting a family on what is basically seasonal work. He's built a life here. He and and his wife have five children and own their own home.

In his community, diabetes is all around him. He says his two brothers both have the disease, and so did his mother. “And I have friends who have diabetes,” he adds.

In Mexico, Corona says meals were home cooked and only occasionally included meat. When he first arrived in the U.S., he continued eating a Mexican diet, featuring a lot of beans. But eventually he says he grew accustomed to American fare, like pizza from places such as Domino’s and Round Table.

In Sandoval's class, Corona has learned how many carbohydrates there are in a pizza and the quick sugar hit it will give him.

Back at Corona's house, he said a meal like the one in front of him -- a thin steak, pinto beans boiled in water and a chopped salad -- was only an occasional treat back in Mexico. They’d eat it perhaps only once a week. That night at least, he was having a home-cooked meal, which included a salad of onions, cilantro, tomatoes and nopales -- a type of cactus that the Corona family grows in their backyard.

Corona seems acutely aware of his diet, and he says he has Sandoval’s class to thank.

The chief of the California Department of Public Health's Chronic Disease Prevention and Management Section, Majel Arnold, says classes like this help prevent the spread of the disease.

“The evidence has showed that when a person with diabetes is referred to these management education programs, that is does improve their ability to manage their diabetes,” Arnold says.

Sandoval says he sees that evidence in his classes.

“This work is really about having that type of an impact on them, so that people have a sense of hope, that they’re able to manage their own diabetes, and in so doing, feel that their family is safe,” Sandoval says. “Because some of the folks feel that it’s one of those types of diseases that ... is life threatening.”

Corona says in the few months he’s been attending Sandoval’s class, he has already started spreading around his newfound knowledge.

“With my brothers, I share with them what I’ve been learning here,” he says. “And with my wife as well.”