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PROMISE AND PERIL IN SOUTH L.A.

Bringing healthful choices to an unhealthy place

St. John's Well Child and Family Center sees 50,000 patients each year, roughly 30,000 of them children. It has vaulted ahead of the healthcare debate, moving the focus from sickness to wellness.

October 04, 2009|Scott Gold

Teresa Rios' hair was still wet from the bath. She pulled it back with a rhinestone band, reached for her cane and stepped into the musty hallway of her apartment building. She counted the steps to the front: One, two . . . 22 in all. Then the stairs, four of them. Left, onto the sidewalk: One, two, three . . .

South Los Angeles was still waking up. Rios walked past the tamale man on the corner, past the homeless man washing his face in a fountain at the park, past a little bakery, its pasteles still in the oven. She crossed the street -- 36, 37, 38 . . . -- and caught the No. 754 bus, headed north on Vermont, toward salvation.

An hour later, she and 20 others gathered in a dull carpeted room at a community center. Most were in their 50s, their bodies signposts for hard-lived lives. Many were overweight. Malnutrition had left some severely bowlegged. Most had diabetes -- the disease that stole Rios' vision.

Suddenly, Ana Ruth Varela, their leader, burst into the room. She had just changed into sneakers and she was ready to dance. She cranked up a boombox. Stretching soon gave way to aerobics and full-throated life lessons. "Movimiento! Viva una vida mas larga!" Varela shouted. "Movement! Live a longer life!"

Rios, 52, placed her cane on a folding chair and smoothed her pleated skirt with her palms. At first she padded her feet, gently, as if they had fallen asleep. Soon she was marching and swinging her arms like a drum major.

It was one quiet victory in South L.A.'s healthcare transformation -- leapfrogging squabbling politicians to turn one of the nation's most distressed neighborhoods into a laboratory for preventive care.

'A tremendous need'

Amid South L.A.'s many ills, it is easy to forget that it is also a very unhealthy place.

St. John's Well Child and Family Center, the largest clinic in the neighborhood, sees 50,000 patients each year. Roughly 30,000 are children, and though St. John's doesn't keep track, many are undocumented immigrants -- a community, said President and Chief Executive Jim Mangia, "that we serve proudly and loudly."

According to St. John's, 54% of child patients have high levels of lead in their blood; the metal, a neurotoxin that hampers brain function, is a vestige of slum housing. Forty percent of adults have diabetes. An average of 12 children a week suffer either from rat bites or cockroaches in their ears. Few have health insurance.

"There is a tremendous resilience here," Mangia said. "But there is still a tremendous need as well."

A central piece of President Obama's healthcare initiative strongly emphasizes preventive care, disease management and public health -- all avenues, Obama contends, for expanding access to doctors while saving lives and money.

There is plenty of debate in Washington over whether preventive care is cost-effective. A recent report in the New England Journal of Medicine found that some programs save money while others don't.

There is little debate that the efficiency of preventive care depends on the target: the patients. Cancer screening, for instance, is most cost-effective when the target population is at a high risk for cancer. Few communities in the nation are more at risk than South L.A.

With public and private hospitals in the L.A. area's southern end shutting down or scaling back with regularity, nonprofit community health centers in South L.A. have shed their doc-in-a-box image. A coalition of seven now provides 40% of primary care here, Mangia said.

St. John's, once housed in the back of a church, is now a $20-million-a-year operation funded by government and nonprofit public health grants, and it handles nearly half of the coalition's 300,000 yearly patient visits.

And it has vaulted ahead of the national healthcare debate, nudging the focus of care away from sickness -- the traditional American model -- and toward wellness.

Teresa Rios was a typical case when she arrived at St. John's four years ago, suffering from severe headaches. She had long ago lost her vision, "and I just thought I was depressed," she said. She was -- but she was also in an advanced, debilitating stage of diabetes. Rios' kidneys were failing, she was in danger of losing her feet and her blood pressure had skyrocketed.

St. John's put her on dialysis and stabilized her blood, but it didn't stop there.

At no cost to her, staff members enrolled her in nutrition and exercise programs, like her weekly dance class. She learned about healthful eating, about proper use of medicine -- "not how to take more, but how to take less," she said.

St. John's connected her with Braille instructors and helped her obtain novels that were recorded on tape, which helped draw her out of a deep sadness.

She is not out of the woods, but she has lost nearly 30 pounds -- she's down to 136 -- and now cruises around town on her own, tapping the sidewalk with her cane and counting the paces between every landmark.

"I was in really bad shape. No more," Rios said. "I feel great. I really do."

Some small steps

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