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Starr Treatment for Community in the Rio Grande Valley

A pioneering diabetes research program celebrates 25 years of community ties

 

It’s not quite the traditional stuff of an institutional birthday party: free blood sugar and cholesterol testing, along with blood pressure and glaucoma screening.

But for the 25th anniversary of the Starr County Health Studies, part of the Human Genetics Center at The University of Texas School of Public Health, those gifts to the community were a perfect fit.

Since early 1981, the research field office has pried open vital secrets of type 2 diabetes, all the while keeping an unusually close connection with this county on the Rio Grande 100 miles upstream from the Gulf of Mexico.

Starr County Health Studies has documented the terrific burden of adult-onset diabetes among Mexican-Americans, played a central role in identifying the first genetic variation to raise a person’s risk for the disease, and shown how tailored, community- based education can help diabetics control their life-threatening disease.

Outstanding Relationships

“None of this would have been possible without the outstanding cooperation of Starr County residents and leaders,” said Professor of Epidemiology Craig Hanis, Ph.D., principal investigator and leader of the project for 24 years. “There’s nothing quite like this in the world. And I don’t mean just the studies, but also the relationships.”

Alberto Barrera, artist, songwriter and retired Rio Grande City educator, understands this connection well. His mother and late brothers were part of the original diabetes study years ago, and now he comes to the remodeled residence in Rio Grande City every Thursday to check his blood sugar.

“The thing I like most about this place is that they really keep you on your toes,” Barrera said. “They warn me when my blood sugar gets high; we review my diet and talk about what to avoid eating. They really tell people what’s going on and spread great information about diabetes.”

Since 1981, the field office has provided more than 81,000 free glucose screenings, some 21,000 physical examinations and thousands of other tests. It has long worked with local health-care providers to refer residents who have discovered they have diabetes or other conditions through the office’s screening programs. The office is a referral center for the Texas Commission for the Blind, enabling it to refer people for initial treatment of diabetic retinopathy – the leading cause of adult blindness.

The first key to dealing with type 2 diabetes is knowing that you have it. Insulin deficiencies allow a dangerous buildup of glucose in the blood, damaging organs often before a diabetic realizes he or she has the disease. It’s the seventh leading cause of death in the United States and can lead to stroke, blindness, heart disease, kidney failure and limb amputations. An estimated 17 million Americans are diabetic, and the incidence of type 2 diabetes is on the rise worldwide.

“This program has served many people who might not have been touched by the medical community otherwise,” said retired school counselor and administrator Wilfredo Garza. “The staff has always been patient, informative and caring.”

Culturally Sensitive Research

A research program that developed a culturally sensitive approach to teaching diabetics to manage their disease helped Garza and others learn how to manage their blood sugar by watching their diet, exercise and blood glucose. That effort continues under the leadership of Sharon Brown, Ph.D., now associate vice president for research at The University of Texas at Austin.

Wilfredo’s sister, Felicia Garza, a retired school principal, especially appreciates the personal touch provided by the field office staff. “The staff is tremendous, always available. They take excellent care of you and encourage you to call them anytime.”

Presently, four people work full time at Starr County Health Studies: Research Technician Miriam Muniz, Research Nurse Anna M. Pope, Laboratory Technician Alda Clarke and Office Manager Hilda Guerra, who has excelled in that job for 25 years.

“Much of our success is due to Hilda’s ability to integrate with the community and elicit support and enthusiasm from study participants,” Hanis said. “She seems to know everyone in Starr County.”

This was important, because the field office initially relied heavily on door-to-door recruitment to gather family information and genetic samples critical to understanding and attacking diabetes.

In those early days, Jesusa Salmon, who remains a volunteer at the field office, also was instrumental in recruiting people for research projects. “Jesusa would knock on any door, talk with anybody in conditions that might intimidate other people,” Hanis said. “She is absolutely fearless.”

Hanis tells of Salmon spotting one study participant walking into a popular breakfast spot one morning. She followed him in and pulled him out of the restaurant. “He was coming in later for an appointment and he was supposed to be fasting,” Salmon said with a smile.

Scientific Handle on Diabetes

The community connection is important, says Human Genetics Center founder and now professor emeritus Jack Schull, Ph.D., who established the Starr County Health Studies office with SPH faculty associate Sara Barton in 1981. Local physicians, led by Mario Ramirez, M.D., had invited Schull to come to Starr County and get a scientific handle on the diabetes that they saw plaguing their patients and ravaging their families.

“The Rio Grande Valley had been visited very often by hit-and-run scientists who came in and did studies and left,” Schull said. “People were sympathetic and willing to give us a break. But they also were waiting for us to show we weren’t like the other carpetbaggers.”

Salmon and Guerra led the outreach, and the tradition of free screenings was begun. “Anyone could walk in at any time and we provided that as a service. We were sensitive to their concerns,” Schull said. “Without the level of cooperation we’ve always had, we would have been dead in the water 30 years ago.”

Hanis, a newly minted Ph.D. in genetics from the University of Michigan, arrived later that first year. During an anniversary celebration at the La Borde Hotel in Rio Grande City on Feb. 23, Hanis recalled what it meant to be a young genetics researcher working with Schull.

“Jack Schull was one of the five or so scientists in the world who essentially created the field of human genetics,” Hanis said. “We would come down here, rent a Lincoln town car – the largest vehicle you could rent in those days – drive it to the lumber yard and fill it up. We would go to the field office and spend the day building interview stations. We’d come back here to the La Borde and have dinner. Then Jack would smoke a cigar and drink a brandy while we talked science.

“Jack was editing major journals, traveling the world to lecture, and right here on this patio, I had him to myself, hour after hour,” he said.

“I’ve learned a lot here about science, about people and about diabetes that I couldn’t have learned anywhere else,” Hanis told a celebratory gathering in the hotel’s patio. “I think we’ll stay a while longer. We aren’t going anywhere.”

Research continues on the genetics of diabetes, hypertension and diabetic retinopathy and on other factors that fuel the plague of diabetes.

By Scott Merville, Public Affairs