Prevention on the streets — Step Inside the Family Van

By: 
Joanne Suarez and Allison Lewis
family van on the street

Few things are as frustrating as walking out of a doctor’s office with more questions than you had before the visit. This is the reality for many of The Family Van’s clients, whose doctors often don’t look like them, understand their background, or speak their first language. These clients often leave their appointments confused and come to the Van for care in a welcoming and culturally sensitive environment.

The Family Van is a mobile health clinic that has been providing preventative health care in Boston’s underserved neighborhoods for 28 years. We meet people where they are and improve the health of our communities through free health education, screenings and referrals.

High blood sugar or diabetes is a common issue of clients who come to us. The Family Van doesn’t diagnose their conditions, but that doesn’t mean that our clients are on their own if they receive a high blood glucose reading. In fact, that’s where our partnership with them really begins. We accompany them on their health journey and address many factors, internal and external, that affect their health.

The diets of our clients are highly culturally diverse in nature and often high in starch and sugar. Simply telling people to eat healthier isn’t helpful. Nobody likes being told what to do, and it is important to take the time to get to know them and understand their cultural preferences. On the Van, we use a process called motivational interviewing as a tool to understand the context behind a client’s eating habits. This process allows us to meet our clients without judgement and support them in making behavioral changes on their own terms.

We encourage our clients to take steps toward a healthy lifestyle, which could mean keeping a food log, tracking what they eat and recording its effect on their blood sugar. We advise people on how to reduce their intake of sodium and sugar and help them understand how to read labels and practice portion control—all great ways to manage glucose levels. We help our clients set attainable goals, educate them on the best methods to reach those goals, and partner with them along the way, encouraging them to come back to the Van and let us know how they are progressing and what barriers they are facing.

We also try to help clients understand the relationship between mental health and diabetes. Stress and lack of sleep have a negative effect on the endocrine system, which in turn raises blood sugar levels. Recognizing and managing the biological, psychological and social stressors that can impact their diabetes is a practice our clients use to stay healthy.

If our clients are already on a treatment plan recommended by their doctor, we do our best to help them stick to that plan. We teach them how to use their glucometers so they can check their own blood sugar throughout the day and show them how to set alarms on their phones to remind them to take their medications.

Sometimes our clients are unhappy with the treatment plans prescribed for them, but find it difficult to bring up with their doctors when they feel rushed or intimidated during appointments, or if they have trouble expressing themselves due to a language barrier. We help our clients talk with their doctors about their concerns by writing down talking points, questions and goals that they want to cover during their next visit. If a client is interested in getting further support outside the doctor’s office, we can connect them with our collaborators in their community who run wellness programs to support diabetes management and prevention.

We encourage clients to continue to visit the Van for support and keep us updated about their progress. We will always be there with a warm smile to welcome them, partner with them and help them take control of their health. We want The Family Van’s clients to know that we see them as a whole person. We try to fill the gap that occurs in doctor-patient interactions when the condition, not the person, is addressed. We have found that our model of care, which we call “the knowledgeable neighbor,” has helped the people in our communities improve their health. When people feel seen and heard, they are motivated to change their behaviors.

Our clients in Boston are included among the 30 million Americans living with diabetes. Fortunately, The Family Van is part of a larger mobile health network providing care across the country. If you’d like to know what services are available near you, or are interested in starting a mobile clinic in your area, we encourage you to look into our sister organization, Mobile Health Map, because when wellness is within reach, our communities are healthier.