by Sophie Novack
March 1, 2019
Daniel Zamora still remembers the smell. At first he didnāt realize anything was wrong. A small blister appeared on his left pinky toe where his sneaker rubbed against his skin. He had developed blisters before, but this one wouldnāt go away. First the tip of the toe darkened, slowly turning the jet-black color of his hair. Then the color spread toward the rest of his foot.
He was used to ignoring such things. It was 2016, and Zamora, now 55, had gone his whole life without health insurance. Born in Matamoros, Mexico, he moved across the border with his family to Brownsville when he was about 6 years old. For decades, Zamora, a legal permanent resident, worked maintenance jobs for low pay and no benefits. He couldnāt afford to take time off or see a doctor. Sometimes, when he wasnāt feeling well, heād brew an herbal tea from the leaves of the moringa tree just outside his front door. He often tried curing his cuts and blisters with ointment or rubbing alcohol. Occasionally, if things got really bad, he reluctantly went to the emergency room, where, he says, doctors made snide remarks about his inability to pay.
So he waited. Maybe it would pass.
Finally, the smell got unbearable. Like road kill in the hot South Texas sun. A couple of months after the blister appeared, Zamora drove 2 miles to Valley Baptist Medical Center, where doctors quickly diagnosed him: His diabetes, uncontrolled for years, had blocked blood flow to his toe, preventing it from healing. What began as a minor blister was now a life-threatening emergency. Zamora says the doctors sent him home with medication to treat the wound, but a few weeks later he went back to the ER, where he had two toes on his left foot amputated to prevent gangrene from spreading up his leg.
Daniel Zamora, 55, was diagnosed with diabetes about 10 years ago. In 2016 he had two of his left toes amputated.Ā Veronica G. Cardenas
When Zamora found out he had diabetes, about 10 years ago, it didnāt come as much of a surprise. In the Rio Grande Valley, nearly one in three people has the disease, triple the national rate. The Valley is among the poorest and least-insured regions in the country. Itās also overwhelmingly Hispanic, a population that has a higher risk of developing type 2 diabetes.
Perhaps the most visceral indication of the Valleyās diabetes crisis is the shocking number of people living with amputations. The rate of diabetic amputations in the Valley was about 50 percent higher than the state rate in 2015, according to data from the state health agency. In Cameron County alone, where Zamora lives, hospitals recorded 281 diabetic amputations that year. Thatās more than 50 percent higher than the national rate, according to the Centers for Disease Control and Prevention. The estimated amputation rate in smaller Willacy County, just north of Cameron, was more than four times the national rate. āGood gracious,ā said Ed Gregg, a CDC epidemiologist, when looking at the data. āWhatās going on with Willacy?ā
When he first found out he was diabetic, Zamora says, he ādidnāt pay too much attention to it.ā Both of Zamoraās parents died from diabetes, which is the seventh-leading cause of death in the United States. His father used a wheelchair for the last years of his life, after a diabetic amputation above the knee. In the Valley, thereās a fatalism associated with the disease, often considered an inevitable inheritance.
What Zamora didnāt realize is how big an impact a small blister would have on his life. For months after the surgery, he couldnāt walk. Nor could he afford professional wound care, so his son came by each day to change the bandage. Zamora had to quit his job cleaning a nearby gym because it required him to be on his feet and lift heavy weights. Along the way, he racked up about $100,000 in medical bills, which heāll never be able to pay. When he developed an ulcer on his other foot, he went to see a doctor in Matamoros, because it would be cheaper. Finally, last summer, Zamoraās disability qualified him for Medicaid and Medicare.
When I ask how heās doing, Zamoraās typical response is: āsurviving.ā Heās frustrated that he had to wait until he was very sick and couldnāt work to get health coverage from the government.
āBeing diabetic is real badā¦ā Zamoraās voice trails off. āA lot of people die from it.ā
Heās adjusting to life as an amputee, but he still loses his balance, wobbling ālike an eggā when he walks. That, along with vision problems due to the diabetes, makes manual labor difficult. But without a high school diploma, he has few job options. For now, Zamora is surviving on a disability check thatās even less than the $1,300 a month he made at the gym.
Itās a story told over and over again in the Valley: You donāt know you have diabetes until itās severe, because you rarely see a doctor. You get a cut or blister but ignore it, because diabetes-related nerve damage means you canāt feel it, or youāre too busy working or taking care of your family to go to the doctor. The wound gets infected. By the time you get help, the infection is so bad that amputation is necessary. You canāt afford proper care, so sometimes the wound gets infected again. You get another amputation.
Diabetic amputations have a domino effect on the lives of patients and families. It begins with the patient exiting the workforce, sometimes decades early, āwhich creates every complication we can think of,ā said Belinda Reininger, regional dean at the UTHealth School of Public Health in Brownsville. āThe familyās economic situation is negatively impacted; children may have to start working and supporting their parents, slowing or putting aside their educational attainment goals. ā¦ Weāre already an area known for living $20,000, $25,000 below the median income of the state ā to lose your wage earner is just tremendous. Thatās at the family level; you magnify that to the society level and it continues to ripple.ā
Each diabetic amputation represents not just a personal tragedy, but a failure of the U.S. health-care system. The epidemic also suggests a possible future for the rest of the country, as the Latino population booms and health officials grapple with how to get diabetes under control. The number of adults diagnosed with diabetes in the United States quadrupled between 1980 and 2014. CDC researchers now project that the number will nearly triple by 2060.
A new study published in Diabetes Care in November found that following a two-decade decline, the rate of diabetic amputations nationwide increased in recent years, especially among young and middle-aged adults. Gregg, who worked on the study, told the Observer that though diabetes care overall has improved, the āalarmingā findings are a āwake-up call.ā He says amputations are important indicators that something went wrong with diabetes management, because theyāre generally preventable in patients who can acce