"You Brung Me Dem Greens, So Dem's What I Et"

Trying to help an elderly, legally blind, illiterate patient manage his diabetes at home alone is a dicey undertaking. Unable to remember medications more than once a day; unable to read instructions, see reminders, or understand the numbers on his blood glucose meter; and dependent for food on whoever happened to shop or share on a given day or given week, "José" was for me a project. A Southern Black man with an unlikely Hispanic name who landed in Chicago during the Great Migration decades before, José had survived his younger years by fixing cars and picking up whatever unskilled jobs were to be had, and as an old man lived with a string of women passing through his bedroom but otherwise not in his life, a few fellows who turned up now and then to play cards and see what cons they could pull off, and once or twice yearly visits from a daughter who lived elsewhere but used her father's apartment as free accommodations when she came to town to visit her friends. José was estranged from his wife, and his son was in jail. And his blood glucose was elevated.

236, 274, 341, 299. I would arrive early to do the testing that José couldn't, and the results always were well above the "ideal" target range, which for a fellow of his age and his circumstances was approximately 90-120. Lowering the numbers by adjusting his medication was risky, because there was a constant possibility that no one would happen to bring food one day and José simply wouldn't eat. In that case his blood sugar could plummet dangerously low. Mentally competent, José was adamant that he would not move and didn't like the home-delivered meals that a well-meaning social worker once had ordered for him.

In those days one of my neighbors offered her garage as the drop-off point for Community Supported Agriculture shares, and always had unclaimed boxes of fresh organic produce left over from deliveries. She began bringing them to me, and I'd load their contents into an assortment of plastic bags and the next morning take them to poorly nourished, high-risk patients who didn't have the resources to procure such things themselves. One day I dropped off a bag for José.

My next nursing visit was the following day, when I pricked José's finger and waited for the meter to register the usual elevation. Instead it read "96."

"José!" I exclaimed, "That's perfect! What did you do differently yesterday; what did you eat?"

He looked at me tolerantly and replied, "You brung me dem greens, so dem's what I et."

With the once-daily medication regimen that his doctor finally had worked out and a single delivery of fresh produce instead of fast or convenience food, José's blood sugar level went from dangerously elevated to normal.

The problem was access to good foods. We had found ways to work around blindness, illiteracy, difficulty remembering medications, and all the rest, but with poor results . . . for want of food, proper food.

I wish José's problem were unique.

"Ronald" was a tall, skin-and-bones cardiac patient who had undergone heart surgery, and lived in a rough, "food desert" neighborhood on Chicago's west side. His wife once explained that going shopping entailed a long walk to an overpass where they could cross a busy expressway followed by a long walk back on the other side until they reached a grocery store. Then whatever they purchased had to be carried back to the overpass and back home, regardless of the weather, gang activity, or other circumstances. The only alternative was an overpriced "mom and pop" corner store that sold alcohol, lottery tickets, and abundant quantities of chips and pop, with a few staples and dairy products tucked in among the rest.

I told another of my neighbors about Ronald, and she immediately offered excess vegetables from her own garden. Ronald was a man of few words, but he thanked me when I delivered her gift, and the appreciation in his eyes was genuine. But the best part was my visit the next week, when Ronald told me how very much he had enjoyed those vegetables. In fact, although he had been spending his days resting in his bedroom, the day his wife was preparing the vegetables she turned around and found him sitting at the kitchen table.

"Whatchoo doin' there?" she had asked him, incredulous.

"I'm gonna say the blessing," he told her calmly, "because this is a blessing." He added for me, "And it is,it truly is."

That day Ronald enjoyed the most nutritious food he'd had since he left the hospital, if then, and also finally had been inspired to make his way out of his bedroom. When I discharged him from home healthcare a short time later he had progressed to the front porch, and was beginning to walk down the street.

All from an occasional bag of produce that was more than the family that grew it could use.

Ironically, among the boarded up buildings in Ronald's neighborhood there is an abundance of open space. And while José's neighborhood is more densely populated, residents determinedly try to grow what they can.

"Willie" was a long term patient of mine who immediately planted a garden where the city had torn down old, dilapidated buildings across the street from his home. Knowing that land was to be developed as the new district police station I gently suggested Willie's efforts might be for naught and better directed elsewhere, but he was determined . . . to the very moment the bulldozers upended his little plot. "Arlene" had nothing but a concrete stoop outside the door of her row house in the projects, but she carefully tended pots of tomatoes and greens. I drive through other neighborhoods where the sides of buildings meet the sidewalks, which in turn meet the streets, yet residents find patches of land to grow vegetables and herbs, or spots in the sun where pots can be placed and tended.

We know that nutrition is key to good health, and we know that our most malnourished and underserved populations have deep historical roots in caring for the land and growing food, yet vacant lots abound with broken bottles, old tires, and gang activity while we promote health with pharmaceuticals and things medical.

This is easy and relatively inexpensive to change, but it requires some effort and more than a little thought "outside the box," because our medical and social thinking is very much boxed in!

I have written about the importance of change being easy and natural for those affected. In this instance that means engaging people where they already go, tapping the authority they already respect, appealing to what they already value, and strengthening social networks that already are the fibers of their lives.

José and Ronald are African American and live in communities that are deeply religious and have strong ties to the church. Suppose early one Saturday morning the pastor of a church like theirs called leaders of his or her congregation to say that there was something special planned for the next day's services and some extra effort spiffing up the church was in order. I can see the faithful cleaning, touch-up painting, polishing, making their house of worship a reason for pride when their pastor's surprise was unveiled the next day. But suppose the next day just as the pastor stepped into the pulpit there came a great crashing noise and a band of hooting, hollering, unruly youth barged in pushing and pulling dumpsters from the alley, and overturned them, leaving piles of garbage in that freshly cleaned sanctuary. Imagine the pastor continuing his or her sermon: "Scripture tells us that our bodies are temples of God. While we are horrified that someone would dump garbage in our sacred space here, how is it that we put garbage in our equally sacred bodies every day, polluting and poisoning our very own holy temples? You come here wearing your best clothes, with your hair and make-up just so and your shoes freshly shined, just as you cleaned and polished the church yesterday, but is what is inside of you as vile and foul as this rotten, smelly garbage now before us in this sanctuary?"

And suppose that church became a hub for promoting good nutrition, in the name of stewardship of body temples. There would be classes about nutrition and meal planning, gardening groups, and a farmer's market, all springing from such existing activities as the Mothers' Room, the deacons' council, the Sunday School, and more. Fried chicken, macaroni and cheese, ham, and caramel cakes at church suppers would be supplemented, if not replaced, by nutritious, home-grown alternatives, prepared and served by member cooks and kitchen volunteers.

In José's and Ronald's neighborhoods, people "hang out" together, on front porches, street corners, or the "ramps" of public housing. Suppose those groups were mobilized to turn vacant lots, parkways, and back yard plots into gardens. The much-valued camaraderie still would be there, but instead of time being frittered away with idle chatter, games, and crime, gardens would rise, with friends and neighbors there to help, encourage, and celebrate one another. Even gang members who today guard their "turf" might be enlisted to tend and protect it in another way. The harvest not only would feed those who grew it, but would go to the church for those healthier church suppers and for the farmer's market.

Suppose the youth in the church learned to be "personal shoppers" and went in the church van every couple weeks to shop for people like Ronald, who can't hike to the overpass and carry purchases home on foot. Suppose neighborhood schools were enlisted, where students could receive community service credits for assisting with the gardens, classes, and shopping. Suppose assignments in science, English, reading, and other classes incorporated this theme. Suppose students designed a web page for the program, and solicited donations of plants, seeds, and tools. Imagine containers at the checkout counters of home improvement stores and gardening centers inviting patrons to donate not canned goods for a food pantry (so people can eat for a day) but compost and mulch and gardening supplies (so people can feed themselves for a lifetime).

Recently I began the study of Taoist T'ai Chi, after hesitating on learning that all of the instructors are volunteers. "Who has the kind of time to put forth such effort on a volunteer basis?" I wondered. "Will I just be wasting my time?" The answer, I've discovered, in a word is "retirees." Classes are taught by energetic, engaged, enthusiastic highly capable world-traveling former executives and all manner of folks who have come together around their love of this practice and who are eager to share it. Imagine the retirees who love to garden, and would be glad to share their expertise and labor, clergy who no longer serve churches but would enjoy creating sermon notes on the topic for busy pastors, and people who simply have a passion for cooking and eating well and would be happy to share it.

The resources to make programs such as this happen are there. The cost is not great. The need is for leadership from within the community, and resources to assist those leaders in growing and developing their programs.

Where we often err is in assuming that solutions for problems in health and healthcare lie with the "experts," that is, with doctors, nurses, and others who practice professions, as well as scientists, professors, politicians and policy makers, and those ubiquitous "consultants" who look sharp, speak well, charge hefty fees, and ultimately produce little of substance and value.

Many of the answers and resources needed to move forward are latent among the very populations who present with the "problems." This is not about blaming the victim; rather it is about empowering those who are best suited for and most highly invested in making positive change happen in their own lives and in their communities. Identifying and mobilizing appropriate communities is critical, and these must be those that already exist: Church groups, neighbors who socialize, school activities, etc. Surely somewhere in the past every one of us has endured mandatory "group projects" in school where membership was assigned by the teacher or professor and results were mediocre at best, after everyone had endured a painful process of questionable educational value. Indeed, many of the health problems we see are born largely of bad habits: Sedentary lifestyles, poor food choices, and general poor self care. But the energy of true community overcomes the inertia of habit, and it is this that needs to be tapped.

It is important, too, that the various components of community programs be integrated so they are supported and reinforced on multiple fronts. Many will say, "We have community gardens" or "There was a health program at our church last year." While those are valuable and good, small, isolated efforts do not have the same impact as comprehensive, "home grown" programs powered from the "inside" (not imposed by outsiders), where the message is repeated in different forums and in different ways, all complementary and collectively engendering and sustaining a greater energy than a single lecture series or garden club can deliver.

Where to start? Perhaps by driving through a neighborhood like Ronald's, or José's, or yours, knocking on a church or community center door, chatting up the neighbors on the porches and street corners, and starting new community gardens by planting seeds of possibility. Then it very well could be that one day more infirm elders and others would begin to break out in health, just as José did the day his blood sugar dropped to 96, and when outsiders looking on asked in wonder how this could be people could say of that community, in more ways than anyone realized,

"You Brung Me Dem Greens, So Dem's What I Et."