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"Fellows for Life are dedicated to action together, each approaching the challenge with a unique skill set," says Shawna Mitchell-Sisler (left, with Erin Lutes). "One by one, year by year, Fellows are proactively assessing their communities and creating positive change."

As students at the University of California, San Francisco School of Nursing, Erin Lutes and Shawna Mitchell-Sisler were placed on a clinical rotation at Glide Health Services (GHS)—a clinic in San Francisco’s Tenderloin district that serves the area’s  underserved and uninsured people (a number of whom are dealing with psychiatric issues).

The duo adored working with GHS, its staff, and its clients—and soon identified the need for a program that answers the “whys” and “hows” of disease management for individuals living with both diabetes and mental illness.

So they applied to become Schweitzer Fellows and launched SF EMPOWER—a focused, interactive intervention program for psychiatric patients with diabetes-related health issues. Their ultimate goal? That their patients will take ownership of the program and emerge as active participants in their diabetic and mental health care.

Why did you decide to develop your particular project?

Lutes: Every month, GHS hosted a Diabetes Day that inspired both of us to further explore the unmet needs of GHS’s diabetic community. We both started our work with a few simple adjustments to the GHS Diabetes Day offerings. Shawna conceived of and organized a comprehensive diabetic foot care assessment and intervention that included washing the feet of participants, providing a light foot massage, testing sensation, and supplying a clean pair of donated socks and a “to-go foot care kit.”

It was not, however, the foot care assessment that had the most profound impact on our clients or us. More so, it was the closeness and immediate intimacy of washing our patrons’ feet that broke down barriers we might have encountered as their providers in an exam room, revealing to us a new way to address gaps in patient care and education.

I met Mike [not his real name] at one of the Diabetes Days offered at GHS. “I know I need to take care of my eyes and feet because I have diabetes … but I don’t know why,” he told me. Once married and employed, Mike was disabled by a work injury, lost his job, and became depressed. His partnership dissolved. Before he knew it, he lived on the streets of the Tenderloin in San Francisco. In addition, Mike was diagnosed with Type 2 Diabetes last year. “I know I need to eat well,” he told me, “but I just can’t do it on my budget. I have to eat what I can get. And there really isn’t a grocery store in this area [the Tenderloin].”

The “whys” and “hows” can be overwhelming for anyone with diabetes. For example, why is it so important to take care of diabetic feet? How can I make healthy food choices when my local store only carries salty snacks and beer? We realized there was a huge need for a group dedicated to learning about diabetes, medications, nutrition, physical activity, and perhaps even more importantly, how to cope with everyday stressors.

In addition, people with mental illness are particularly vulnerable when it comes to chronic illness. For example, many of the medications that patients take for mental illnesses unfortunately cause their bodies to become insulin-resistant and develop Type 2 Diabetes. According to the CDC, nearly 26 million Americans have diabetes, and an estimated 79 million U.S. adults have prediabetes. Additionally, statistics show that 1 in 4 adults are affected by a diagnosable mental illness in a given year. That’s a lot of people dealing with both mental illness and diabetes. We realized that there wasn’t a resource for the Tenderloin community dedicated to both. Our group is designed to fill that gap.

What do you hope will be the lasting impact of your project on the community it serves?

Mitchell-Sisler: The focus of our peer-teaching and peer-leading component allows us to harness the knowledge and energy of our previous participants. It is our genuine hope and goal to have some of our participants trained as peer teachers. In this way, they would be the continual thread throughout the lifetime of this project, providing insight, leadership, and ideas to further develop the curriculum of our group sessions–and fulfilling our intention to make this a truly collaborative, interdisciplinary intervention.

Lutes: Our main goal is to empower our patients to have ownership of this group and be active participants in their diabetic and mental health care. We hope that our participants will become peer-teachers and peer-lead future SF EMPOWER groups.

What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?

Mitchell-Sisler: Health education and health promotion—period. We must give our communities the resources and tools they need to heal from within.This resiliency is not stumbled upon randomly, though; it takes a proactive, formal commitment to the greater good. There will never be enough doctors, nurses, therapists, or other professionals to fill all the needs of our society. We must empower each group with the information and ability to navigate their needs. This is achieved best through culturally competent and targeted health education.

Lutes: Access to health services. Health is a basic human right, and lack of access can be devastating for individuals, families, and entire communities. At a time where chronic diseases like Type 2 diabetes affect millions of Americans, it is essential that services are available to everyone.

This issue affects all people: young and old, healthy or sick, rich or poor. However, the impact is felt the most by vulnerable populations, such as those living in the Tenderloin of San Francisco.

Health access must be addressed at every level simultaneously. It will take everything from grassroots efforts from community members and organizations to legislative measures. In addition, health professionals play a particularly important role in advocating for increased health access. They have unique insight into the devastating impact chronic illness and other health issues can have. Health professionals can help their patients give voice to their experiences. Also key in this conversation is prevention. If we can create access to preventative services as well as treatment, we can begin to address such an overwhelming issue.

What has been the most surprising element of your experience as a Schweitzer Fellow?

Lutes: I have been floored by the overwhelming positive response that we have received from peers, faculty, and patients. It seems that almost everyone we have talked to has their own story about a friend, family member, or patient who has been affected by mental illness and/or diabetes. I knew that diabetes and mental health were two important subjects, but the more I learn, the more passionate and determined I feel about this project. The depth and breadth of both issues can be overwhelming. However, we recognize that starting with the basics, such as diabetic foot care, can have a profound positive impact on an individual’s life. It’s the little things that can make such a big difference.

Mitchell-Sisler: It may seem like an obvious point, but I was absolutely floored to see how many people in our immediate network (and beyond!) are 100 percent willing to assist in great cause if just asked. As a graduate student, we sometimes live in the world of the hypothetical. Initially overwhelmed with the amount of connections we needed to establish to get our program up and running, I had it in my head that our site was doing us this massive favor. I was nervous and hyper-alert that our program was a burden to an already classically over-extended non-profit. After various meetings with our site supervisor and staff, I was floored about how much they were willing to do and how excited they were about the project. I was able to contextualize all those previous worries when I remembered that this is a win-win for everyone. What a wonderful gift on all levels.

What does being a Schweitzer Fellow (and, ultimately, Fellow for Life) mean to you?

Mitchell-Sisler: “Human progress is neither automatic nor inevitable … Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.” – the great MLK.

Our world has a lot to get done. There are seemingly endless voids in care and countless barriers to services, but I firmly believe that the Schweitzer family can fill this need. I feel honored to be a part of Schweitzer and step forward as a professional and a concerned citizen to correct glaring health disparities.

Fellows for Life are dedicated to action together, each approaching the challenge with a unique skill set. One by one, year by year, Fellows are proactively assessing their communities and creating positive change. We are, in a sense, igniting resiliency. Again, what an honor is to be a part of it all.

Lutes: Albert Schweitzer said, “I decided that I would make my life my argument.” I, too want my future practice as an Advance Practice Nurse as my argument for the need for increased healthcare access for all people.

In addition, the Fellows for Life network emphasizes the importance of creating an enduring relationship with the communities we are currently working with for our Schweitzer project. I love the idea that this project will continue to develop, flourish, and grow long after our Fellowship year is over, and I look forward to a lasting relationship with Glide Health Services and the Tenderloin community.

Lutes and Mitchell-Sisler are Schweitzer Fellows in the San Francisco Bay Area. Click here to read more about the Bay Area Schweitzer Fellows Program and the Fellows like Lutes and Mitchell-Sisler it supports in creating and carrying out yearlong direct service projects. To make a gift to The Albert Schweitzer Fellowship in honor of Lutes and Mitchell-Sisler’s work to empower psychiatric patients who have diabetes-related health issues, click here.

Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.