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Stories for Reprint
Arthritis Ravaging, Under-Diagnosed Among Latinos
By Irene Archos
Abel Balena, a 42-year-old meat-processing worker realized something was wrong when he could not lift himself off the bed in the morning.
"I couldn't put on my pants, my socks, my shoes. The pain would not leave me. My ankles and wrists would swell and I would feel it in my shoulders," Balena explains. "I would go to work and tell the supervisor I couldn't do much so they would send me to the nurse and she would put ice on my fingers, give me Ibuprofen that would bring down the pain but not the inflammation. There were times where I would spend more time in the infirmary than at work."
Since he was diagnosed with rheumatoid arthritis in 2001, Balena has not been able to keep a full-time job like the one he performed at Premium Standard Foods, a meat processing plant in Milan, Mo. From within the quiet confines of his trailer, Balena's sons, Isiah, 5, and Joseah, 6, wrestle with one another. They stop once in a while to give a kiss to their "hermanito" a three-week-old infant bundled in a grey blanket on his mother's lap.
"When I first found out, I had it, it made me very sad. I couldn't believe it was happening to me. I thought this was a disease for old people. I have three kids and a wife that depend on me. I felt like crying," Balena explains. His diagnosis came as a shock, because Latino men are statistically less likely to develop the disease compared to both women and White men.
For much of his working life Balena has relied on his hands for his livelihood. Since coming to the United States 18 years ago, he has worked at a furniture company, a plastics factory, a construction firm, a window factory, and most recently a meat packing plant. His jobs required performing the same repetitive tasks from eight to 10 hours a day, sometimes 12 or 14 hours depending on the job order.
"It is very hard when one has to do I don't know, maybe thousands and thousands times of the same repetitive action in a day, the same thing not for one day or two but for five or six years," Balena says.
To cope with the disease, Balena had to do warm up exercises to get his body ready before getting to work. When his body would "cool down" after the half hour for lunch, he would have to walk around to get his circulation flowing.
Until his diagnosis, Balena had not heard about the symptoms of rheumatoid arthritis except from what he knew from his grandmother who had the disease.
Balena believes many Latinos avoid going to the doctor for regular check ups because they are afraid of what the doctor might find. He, himself, had not had a physical for six years prior to his diagnosis.
"Hispanics always have less possibilities of having health and life insurance, so they think why should I spend $40 or $50 on a blood test so that they can tell me that I'm sick," Balena explains.
Celso Velazquez, M.D., a rheumatologist at University of Missouri-Columbia Hospital, agrees that there is a lack of knowledge about rheumatoid arthritis among the Hispanic/Latino community. He has only seen maybe two or three Hispanic patients during his first six months at MU Health Care. Velazquez attributes this to the language barriers many Hispanic patients face when reaching out for health care in a traditional clinical setting. Access to proper insurance is also a factor, Velazquez adds.
Overall, 38 percent of Hispanics have no health coverage.
A recent study by the Centers for Disease Control and Prevention confirms Velazquez's opinion. The study found that in the United States. Blacks and Hispanics with arthritis are more likely than Whites to experience severe joint pain and arthritis-attributable activity limitations, even though Hispanics and Blacks had lower prevalence of arthritis compared to Whites. Researchers suspect that these differences might be related to disparities in health-care access, use of available health-care services, and language barriers.
Several initiatives are under way to combat these problems.
Maria Sepeda, coordinator of Hispanic programs at the Missouri Office of Minority Health, has worked with the American Arthritis Foundation to translate many publications about the disease into Spanish.
"Many Latinos with arthritis don't know they have it," Sepeda says. "They think it's part of growing old. With enough awareness, however, they could take steps to prevent or control it."
Sepeda believes that cultural habits make it difficult to treat arthritis.
"Latinos don't like to take medicine, and when they do, once they feel better, they dump the medicines," Sepeda explains. This points to the misunderstandings Latinos have about chronic, long-term illnesses such as arthritis and diabetes.
She thinks that improving awareness among Hispanics is key.
A federal project at the University of Missouri-Columbia dubbed "Arthritis Prevention and Self-Management For Migrant and Seasonal Farmworkers" is doing just that.
MU researchers are looking for ways to disseminate information in Spanish about arthritis among seasonal and migrant farm workers. Under the grant, "promotoras," or lay promoters, will deliver information directly to migrant workers through the existing network of 500 migrant health clinics around the country, making sure the technical information is understandable and culturally appropriate.
Many in the Hispanic community know Valentina Mensa, 54, the director of the Latino Center in Milan, Mo., who has been a driving force behind many community educational projects. Few, however, know that she has rheumatoid arthritis.
"It was very hard in the beginning," Mensa explains. "I couldn't make plans with friends in advance because I didn't know when it would strike. "I would get what they call 'flares.'"
Mensa's battle with arthritis has galvanized the inclusion of PACE ("People With Arthritis Can Exercise") classes at the Centro Latino in Milan two times per week for eight weeks. The exercises, developed by the Arthritis Foundation, are gentle but help improve joint flexibility and range of motion, which in turn can help maintain muscle strength and increase stamina.
Besides access to health care and proper diagnosis, receiving affordable medication to combat the life-long illness is another obstacle for the Hispanic community. When Mensa's doctor prescribed the new drug Arava, her next problem was finding an insurance plan that would cover the cost: $400 for 30 pills, more than $13 a pill.
For now, Mensa gets her medication from friends who buy Araba from pharmacies in Mexico.
"I save close to $300 this way," she explains.
Sepeda points out that many Latinos without insurance are not aware of the many free or low-cost local public health clinics that exist in every county in the State of Missouri. Many of the clinics have Spanish-speaking staff and provide a variety of medications that can help even uninsured patients, such as the one in Columbia, located at 1005 West Worley St. For more information, call the clinic at (573) 874-7346.
As for her prognosis, Mensa states she is at the 50/50 border.
"Not the worse, not the best," she elaborates. "It has not limited my life. I stay active and exercise. I would have applied for a handicapped-parking permit, but I do not feel like I am handicapped. I have much faith in God. In the end you can't follow what they tell you. It depends on how you take it."
For more information and resources on arthritis, click on this link Resources
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