SALT LAKE CITY — Controlling diabetes is challenging under the best of circumstances. Try doing it when you're homeless.
That's Murphy Yazzie's lot in life, attempting to control a chronic disease without a regular place to live or the ability to eat regular meals. He also requires insulin to manage his diabetes.
"I don't know what I'd be doing without this place," Yazzie said of Fourth Street Clinic, a comprehensive health care clinic that serves physical and mental health needs of homeless men, women and children.
The clinic, which serves 3,800 people, was recognized recently as the first primary care clinic in Salt Lake, Tooele and Summit counties to meet benchmarks of the Utah Beacon Community Program. The program helps Utah’s health care organizations cut costs and improve their services using technology and best practices.
Fourth Street Clinic has increased blood sugar and cholesterol screenings by 20 percent under the program's goals. It also has increased the number of patients who are controlling their blood glucose, LDL, the so-called "bad cholesterol," and high blood pressure by 10 percent. Retinal and foot exams offered by the clinic have increased 10 percent.
The clinic has also established a connection to Utah's Clinical Health Information Exchange.
“Our long-term goal has been to create a model of care for uninsured, homeless patients that puts their health on par with those who are housed and have regular access to private practice clinics,” said Dr. Christina Gallop, medical director of the clinic.
At age 48, Yazzie said he knows he needs to do more to manage his diabetes.
"My dad passed away with it. My mom's got it. My sister's got it, but I have other siblings that don't have it," he said.
On Thursday, Fourth Street Clinic's certified diabetes educator and pharmacist Phuong Vo Sheffer put Yazzie through the paces of better managing his diet.
Managing blood sugar requires close monitoring of carbohydrate intake.
"What's is the magic number?" Sheffer asked.
"Sixty (grams of) carbs. Per meal, right?" Yazzie said.
"That's it," Sheffer said.
Sheffer said managing carbohydrate intake doesn't have to be a drag. It's about making smart choices and eating carbohydrates in moderation.
With that, Sheffer displayed a plate of plastic fruit, each piece labeled with its respective grams of carbohydrates.
Lemons and limes had the lowest carbs, but as Yazzie observed, "How would you eat a lime?"
Sheffer also instructed Yazzie to eat portions of meat roughly the size of his palm.
"That's nothing," Yazzie said.
"But you'll be healthy," Sheffer said.
Yazzie, who has been homeless for the past three years, was diagnosed with diabetes nearly 20 years ago. He knows a lot about managing the disease, but being homeless presents many challenges to complying with a management plan.
"I'm supposed to eat six to eight small meals a day. I'm lucky to eat once a day," he said.
But last year, with the help of the Fourth Street Clinic, Yazzie had the condition largely under control. "Then I sort of slacked off."
Yazzie is on a waiting list for permanent supportive housing. It would be far easier to maintain his health if had a place to live and could eat regular, healthy meals, he says. In the meantime, he's working to get back on track, he said.
Fourth Street Clinic's electronic health records are helping Yazzie and his health care provider keep track of his condition, screenings, treatments and self-care efforts.
Homeless people tend to die prematurely, largely due to untreated disease.
“Our homeless patients need more than a Band-Aid approach to medicine," Gallop said. "They need ongoing access to high-quality services that promote better health for years to come.”
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