Five years ago, Carla Graves, MS, Registered Dietician and Diabetes Educator, began leading one-on-one educational sessions about gestational diabetes with pregnant Hispanic and Latina women who were patients at the hospital's Ob/Gyn Clinic. The Clinic is the main source of Spanish-speaking referrals to Graves, coming to her shortly after their routine screening tests result with a gestational diabetes diagnosis.
Since the pandemic, Graves has taken on additional opportunities to educate the Hispanic community in Chester County, PA in their own language.
In recent years, Chester County's population has become increasingly diverse. From 2000 to 2019, the percentage of residents who identify as Hispanic or Latino increased from 4 percent to 7.6 percent — though the actual count is likely even higher -- becoming the second-most prominent race or ethnicity in the county.
Chester County Hospital continues to implement efforts to ensure that physical and mental health are easily accessible and encouraged among its communities, especially those that have been traditionally underserved.
Online Support and Tailored Programs
With the onset of the pandemic in the spring of 2020, the hospital’s Community Health & Wellness Services quickly shifted all its public programming online. In the process, Graves was offered the opportunity to lead Spanish versions of an established diabetes prevention program and a support group for those living with diabetes and their families.
In addition to her role at Chester County Hospital, Graves also works as the diabetes care coordinator at Community Volunteers in Medicine. This is a clinic in West Chester that serves a largely low-income, Spanish-speaking population. There she has witnessed firsthand how large and urgent the need is for greater awareness of diabetes among the county's Hispanic and Latino residents in particular.
Graves tailored the curricula so that it's more relevant to her audiences. For example, the discussion topic for a support group meeting just ahead of Thanksgiving was “How to Survive the Holidays". Graves replaced many of the American holidays and the foods that are traditionally served during them with more appropriate examples.
Still, there can be a gap. When she first started working at the clinic, most of the patients had immigrated from Mexico. Today, between her clinic sessions and the wellness programs, participants hail from all over Central America. Each culture speaks the language a little (or a lot) differently and has its own set of customs.
How Quickly Change Can Happen
In November, Graves concluded an eight-week program that outlined how participants could prevent diabetes. One participant was a young mother who was just diagnosed with type 2 diabetes. She was there, she told Graves, because she didn't want to take medication for the rest of her life.
She immediately began implementing what she learned during the classes, walking more and eating healthier. And by the last class, she'd lost 20 pounds. Her A1C level — a measure of blood sugar levels which can be used to diagnose type 2 diabetes and prediabetes — was also no longer in the diabetic range.
Even more, she converted her entire family. Her husband, she said, also lost 20 pounds. And their five-year-old son, who was already showing signs of fatty liver, was more active and eating more nutritiously.
"Even though I'm only speaking to a few people at a time, you just never know who those people are going to spread that message to," Graves says. "And because there's so much misinformation out there these days, I take a lot of pride in being able to provide evidence-based guidance."
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As part of many strategic plans in place to improve access to care, Chester County Hospital Registered Dietician Carla Graves has expanded her services to virtual diabetes education programs.
Graves tailors the Zoom-run diabetes education class curricula so that it's more relevant to her audiences. For example, she incorporates cultural replacements for food traditionally served during American holidays.
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