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Diabetes Care and Beyond with Elizabeth Rios

Elizabeth Rios NP
I think in the future, just like they are helping me, I hope I will be able to help them through research and help prevent… the incidence of type II diabetes in the Mexican-American population.
Diabetes Care and Beyond with Elizabeth Rios

Although Elizabeth Rios, NP, is bilingual and bicultural, she finds the most satisfaction from her migrant patient population in something nonverbal and universal: “When they leave the room with a smile, that means a lot to me,” Rios said. “It can mean hope, it can mean relief, it can mean satisfaction, it can mean trust. And when they gain your trust, it means they’ll come back … and they’ll let other people know how safe it was.”

Working with agricultural workers in the health field was not her original intention, says Rios. In nursing school, “there was not much in the teaching,” about migrant health. Her parents were both born in Mexico, and her father and husband both at one point labored as farmworkers. “They talked to me about that a little bit, but I wasn’t aware of all the hard labor that they did, and everything that they were exposed to,” she said. Her first experience in migrant health was as a student at Community Health Partnership, a community health center then located in Woodstock, Illinois, where she had a clinical rotation. “I thought to myself, this is really where I want to be working some day,” Rios said. “I really loved the patient population.” Her preceptor gave Rios's contact information to the human resources department, and she was offered a position as a bilingual nurse on the same day she took her Nurse Practitioner’s exam. Six months later, she was offered a Nurse Practitioner position. “It all came into place—and my wish came true,” Rios said, sounding elated. She is still with Community Health Partnership, which 2½ years ago moved from Woodstock, Illinois, to Harvard, Illinois, and opened their doors to the whole community rather than focusing specifically on migrant workers and their families. The demographics continue to be primarily migrant workers, who mostly work in the local nurseries and in landscaping, Rios says. 

MCN RiosPATIENT HISTORY

While occupational hazards are a huge concern, it is just one of many for her to cover in the exam room, says Rios. Migrant workers and their families “are exposed to different environmental factors besides toxic exposures from their work, that can [also] affect their health, like work stress, family stress, and isolation,” Rios said. She emphasizes that many of her patients have immediate family members in Mexico, but, due to economic and work concerns and legal status, they are unable to visit, even if a mother or father dies -- and that such breaks from their home community and family affect health.  Rios also values a detailed patient history to better understand the many and complex variables that may be affecting a patient’s health. 
After asking about physical signs and symptoms, “I try to go [further by asking] them about their work environment and their home environment. It does take a little bit longer for the first visit, because you get to know them, but at the end, when you can put the pieces together -- maybe after the second visit --  you may have a better idea,” about how to help them, and improve their health,  she said.  “Also, gaining their trust is very important  Once you gain their trust, they open up more to their social issues, especially, that are affecting them.”

While occupational hazards are a huge concern, it is just one of many Rios covers in the exam room. Migrant workers and their families “are exposed to different environmental factors besides toxic exposures from their work, that can [also] affect their health, like work stress, family stress, and isolation,” Rios says. She emphasizes that many of her patients have immediate family members in Mexico, but, due to economic and work concerns and legal status, they are unable to visit, even if a mother or father dies—and notes that such breaks from their home community and family affect health.  Rios also values a detailed patient history to better understand the many and complex variables that may be affecting a patient’s health. 

After asking about physical signs and symptoms, “I try to go [further by asking] them about their work environment and their home environment. It does take a little bit longer for the first visit, because you get to know them, but at the end, when you can put the pieces together—maybe after the second visit—you may have a better idea” about how to help them, and improve their health, she says. “Also, gaining their trust is very important. Once you gain their trust, they open up more, to their social issues especially, that are affecting them.”

PATIENTS AS ROLE MODELS

When asked about her role models, and her inspiration to continue in migrant health, Rios is adamant that her patients are her motivation. “They’re the ones that keep me going, that keep me coming back to work,” she admitted. “Especially with all the issues they come with, it makes you value your own situation at home. They have more hardships, more difficulty with transportation, with physical health, with their mental and family health, and financial struggles.”

WHAT HER PATIENTS NEED

One way Rios hopes to enhance the patient’s experience and better address the chief health concerns of her population is by starting a diabetes type II group session, in which Rios and other staff provide information and assistance in foot care, eye care, diet, and exercise for a diabetic patient. She finds that, currently, providing all the information in her follow-up appointments is too much. In a group, however,  patients will “be able to see that they’re not alone in diabetes care and diabetes management. They’ll see that there are other people who are also struggling with certain issues about their management,” and patients may share ideas on how to better manage their diabetes.  If the group is successful, Rios hopes to replicate the format for other issues most relevant in her community like high blood pressure or toxic chemicals in the workplace, she says.

In addition to such care, Rios believes “we could do so much more in preventing disease.” She commends her clinic for their effective diabetes screening. “That’s important, with most of us being Hispanic, that’s one risk we have,” she noted, but the community needs more information on the causes of the disease to prevent the development of diabetes in the first place, she says. She also stresses the need for mental health services, and believes the community should provide “family-friendly facilities in a way that we can educate families more on becoming physically, mentally, and spiritually well.”

Rios also returned to school to get her PhD in nursing, in hopes of helping her patients further. “My interest is in diabetes type II prevention in the childbearing Mexican-American population, especially those with a low acculturation in the US,” she said. She believes this work serves her in better understanding her patients. “I think in the future, just like they are helping me, I hope I will be able to help them through research and help prevent … the incidence of type II diabetes in the Mexican-American population,” she explained. 

“The patients, they also help me want to learn more, to help them more. They also teach me a lot of things. So, I’m grateful to ... be doing what I’m doing,” she said. The gratitude isn’t just from the patients to her.  “It works both ways.”

30 CLINICIANS MAKING A DIFFERENCE is a project celebrating Migrant Clinicians Network's 30th anniversary through the life stories of 30 clinicians making a difference in migrant health. Learn more about Migrant Clinicians Network.

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