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‘These people were never given the chance to catch up’: Inside the diabetes belt of rural Mississippi

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11 months ago

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Melvin Jones, a 64-year-old native of Cleveland, was in his 30s when he was diagnosed with diabetes. He knew he was at an increased risk because of his family history.

In 2013, at 54 years old, Jones had two toes on his right foot removed and would later lose the big toe on his left foot. He didn’t know it then, but he had peripheral artery disease, or PAD, a condition where plaque builds up in peripheral arteries – those that do not supply blood to the heart or brain – and restricts circulation. Without treatment, a patient will continue to need further amputations and will die young.

One doctor told Jones he would likely need to amputate his entire foot – but Jones, whose condition made him retire early from his job at Baxter Pharmaceuticals, was resolved not to let that happen.

“I thought ‘I don’t want that,’ and me and the doctor were through,” Jones said. “It would have changed my life. I already can’t drive my truck no more.”

But many diabetics in rural Mississippi don’t have access to the care Jones went on to receive to avoid further amputations. Diabetes and the cardiovascular problems it causes are often asymptomatic at first, or symptoms are obscure. A lack of specialists coupled with some of the lowest social determinants in the country leave regions like the Delta prone to late detection of diabetes and a high rate of amputations.

Now, Jones goes to cardiologist Dr. Foluso Fakorede’s Cleveland clinic, Cardiovascular Solutions of Central Mississippi, for regular wound care from a nurse practitioner who travels to the clinic every Thursday from Oxford.

His life is different now, but he’s thankful he can still move around and hasn’t had to undergo a major amputation, which, for legs, is characterized as any cut above the ankle joint.

Mississippi is the only state with every county represented in what is called the “diabetes belt” of the U.S., which spans an upward arc from the deep South to Appalachian states, according to the Centers for Disease Control and Prevention.

Fakorede said academic institutions should be investing in the region through medical research, but it’s not an attractive market.

“I’ll make the argument that it should be,” he said. “Because these people were never given the chance to catch up. And now we’ve left them to suffer in isolation and in pain.”

With 14.8% of its adults diagnosed with the disease, Mississippi is second only to West Virginia in prevalence.

Uncontrolled diabetes, which runs rampant in rural and underserved areas, can lead to blindness, kidney failure, high blood pressure, high cholesterol, heart attacks, strokes and gangrene.

Mississippi, one of 10 states that has not expanded Medicaid, is the fifth highest uninsured state. In Bolivar County and several other Delta counties, at least one in five residents have medical debt in collections.

About one in three diabetics over the age of 50 will develop PAD, which often goes undiagnosed and untreated in medical care deserts like the Delta.

When it is caught, doctors often have an “amputation-first” mentality, which results in the loss of limbs and early mortality – despite the fact that a procedure exists to clean out the arteries of a PAD patient and restore blood flow to extremities.

Within five years of an amputation, diabetics stand a good chance of being dead. Nationally, Black patients are four times more likely to suffer diabetes-related amputations than white patients.

“It’s a death sentence,” Fakorede said, “and it’s very often preventable.”

The procedure capable of decreasing a PAD patient’s odds of amputation by 90% is called an angiogram, an invasive diagnostic imaging test that detects arterial blockages. Revascularization is the therapeutic procedure that cleans out those arterial blockages.

Jones received five angiograms and revascularization procedures in both his legs over the course of the last two years.

The number of angiograms a diabetic patient with PAD will need depends on a number of risk factors such as age, race, hypertension, heart conditions and habits such as diet and tobacco use.

In the U.S., more than half of patients never receive an angiogram or revascularization procedure before a major amputation.

At his Delta clinic, Fakorede, the only cardiologist in Bolivar County, estimates that the number of amputees who never had an angiogram is close to 90%.

Dr. Foluso Fakorede follows up with patient Joann Moore at Cardiovascular Solutions of Central Mississippi in Cleveland, Miss., Wednesday, Nov. 29, 2023. Credit: Eric J. Shelton/Mississippi Today

Fakorede, who was born in Nigeria and spent his teenage and young adult life in New Jersey, struggled to justify moving to Mississippi and opening his own clinic. He knew nothing about the place and had never operated his own business. But when he saw how great the need was in the Delta for a procedure he was skilled at, he knew his mind was made up.

“You walk through Walmart or Kroger here,” Fakorede said, “and I promise you you’ll see someone who has had a limb taken off or a dialysis catheter around their neck.”

In the end, Fakorede said the Delta proved to be far more similar to his hometown in Nigeria than he thought. They are regions that, for the majority of residents, reflect nothing of their country’s wealth – despite the rich resources they provide that contribute to that wealth.

“That is actually what made me stay – that similarity,” he said.

In the Delta, Fakorede explained, there are a number of socioeconomic factors that contribute to what he calls “the perfect storm” and leave people at a greater risk of chronic and life-threatening conditions.

Studies have shown that the body’s inflammatory response to chronic stressors like poverty, food deserts and unemployment – all of which pervade the Delta – can accelerate diseases like PAD.

Fakorede believes that a large part of the problem is inadequate screening measures. The United States Preventive Services Taskforce, or USPSTF, is the governing body that doctors look to for recommendations on who to screen for which conditions.

The USPSTF has not endorsed a screening for PAD, despite the fact that the five-year mortality for undiagnosed or untreated PAD patients is higher than that of breast cancer and prostate cancer, and studies have shown minorities are disproportionately affected.

“That is atrocious,” Fakorede said. “These patients have existed for decades. We know that this disease is destroying them because it’s taking them out of the workforce. It’s taking them out of their homes. They’re ending up in caskets early on.”

Meanwhile, Ozempic shortages are sweeping the nation as doctors prescribe the FDA-approved, weekly Type 2 diabetes medication to patients without diabetes for weight loss.

In Mississippi, nurse practitioner KC Arnold, director of the Ocean Springs Diabetes Center, witnesses the shortage daily.

“Every single day I’m getting a call: ‘hey, my pharmacy can’t get this,’” Arnold said. “In all my years of helping people with diabetes, this has been the biggest challenge for me to help people get what they need.”

Arnold’s facility is nurse practitioner owned and run – a rarity in Mississippi, where restrictive and expensive collaboration agreements limit the freedom with which nurse practitioners can operate.

Ozempic has a weight-loss version called Wegovy, but it isn’t covered by Medicare, so doctors will sometimes prescribe Ozempic in its place. The Mississippi Board of Nursing has guidelines that prohibit nurse practitioners from prescribing the weight loss drugs off label. But that rule doesn’t apply to doctors.

Arnold says she supports insurance companies covering a drug that addresses obesity. But until that happens, doctors shouldn’t be prescribing Ozempic to patients for weight loss.

“I can’t get the medicine for my patients with Type 2 diabetes,” she said. “Insurance needs to change to help people with weight – I’m all for that – but right now my patients with diabetes need medicine they’re not getting.”

And the drug isn’t just prescribed to people with diagnosed obesity. Chelsea Handler, a comedian and host of the 2023 Critics Choice Awards, joked that “everyone’s on Ozempic” in Hollywood.

Many insurance companies don’t cover drugs prescribed off label, but those who can afford it are paying premiums out of pocket.

“You know who ain’t getting it?” Fakorede said. “We ain’t getting it here in the Delta. There are people who are not even diabetic who are getting it in the Upper East Side in New York. Socioeconomic status matters.”

Dr. Foluso Fakorede takes a call from a professional in wound care while at Cardiovascular Solutions of Central Mississippi in Cleveland, Miss., Wednesday, Nov. 29, 2023. Credit: Eric J. Shelton/Mississippi Today

Mississippi’s alarming rate of diabetes plays a significant role in another of the state’s abysmal health statistics: leading the country in infant and maternal mortality.

Pregnancy tends to highlight the socioeconomic disparities of diabetes since some women receive Medicaid coverage for the first time during pregnancy, according to maternal-fetal specialist Dr. Sarah Novotny.

“Often, pregnancy is the first time women have access to health care insurance,” Novotny, who serves as division director of maternal-fetal medicine at University of Mississippi Medical Center, said. “So, a lot of times patients are coming into pregnancy with very poorly controlled diabetes because they didn’t have access to pre-pregnancy care.”

In pregnancy, diabetes can be separated into two categories: women who already had diabetes, whether it be Type 1 or Type 2, and then became pregnant, versus those who developed gestational diabetes during pregnancy.

Women who have preexisting diabetes and become pregnant are at risk of developing vascular problems, high blood pressure, renal problems and retinopathy. Gestational diabetes doesn’t carry the same risks for the mother. Both conditions carry increased risks such as abnormal growth and birth defects for babies.

Women who develop gestational diabetes carry a 50% risk of developing Type 2 diabetes later in life.

Managing diabetes before conception would go a long way in mitigating the state’s maternal and fetal mortality and morbidity rates, according to Novotny. But at the very least, recognizing and diagnosing diabetes during pregnancy can serve as an opportunity for previously uninsured or underinsured women to improve their quality of life.

In the last three decades, despite all the technological and medical advancements that have been made, diabetics in minority populations have seen worse outcomes.

Turning those statistics around would mean prioritizing tackling inequities in health care and recognizing places like the Delta as meccas for research, according to Fakorede.

“We need to be collaborators,” he said. “We need to be hope dealers. We need to be disruptive in terms of using our positive thinking to address some of the systemic inequities that have plagued these people and this region for decades.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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On this day in 1867

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7 hours ago

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November 23, 2024

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mississippitoday.org – Jerry Mitchell – 2024-11-23 07:00:00

Nov. 23, 1867

Extract from the Reconstructed Constitution of the State of Louisiana, 1868. Credit: Library of Congress

The Louisiana Constitutional Convention, composed of 49 White delegates and 49 Black delegates, met in New Orleans. The new constitution became the first in the state’s history to include a bill of rights. 

The document gave property rights to married women, funded public education without segregated schools, provided full citizenship for Black Americans, and eliminated the Black Codes of 1865 and property qualifications for officeholders. 

The voters ratified the constitution months later. Despite the document, prejudice and corruption continued to reign in Louisiana, and when Reconstruction ended, the constitution was replaced with one that helped restore the rule of white supremacy.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Crystal Springs commercial painter says police damaged his eyesight

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23 hours ago

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November 22, 2024

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mississippitoday.org – Mina Corpuz – 2024-11-22 12:21:00

CRYSTAL SPRINGS – Roger Horton has worked decades as a commercial painter, a skill he’s kept up with even with the challenge of having what his wife has called “one good eye.” 

It hasn’t stopped him from being able to complete detailed paint jobs and create straight lines without the help of tape. But last year following a head injury, he and others said people have been pointing out a change in his work. Horton says the sight in his right eye is clouded, like he is looking underwater.

Affected vision, short term memory and periods of irritability – potential symptoms of concussion – followed after he was arrested last September. During an encounter with several police officers, Horton alleges more than one slammed his head into a cruiser and placed handcuffs on so tight that he started to bleed. 

“(The officer) was kind of rough with me and all, and he takes my head and I said, ‘What’d I do?’” he recalled recently. 

Horton ended up being convicted of two misdemeanor charges and has paid off the fines, but a year later he still has questions about the arrest and treatment by the police. 

To date, he has not seen a doctor to evaluate his eye and check for vision or cognitive issues. Horton and his wife Rhonda don’t have a car, and transportation to doctor’s appointments in the Jackson area remains a challenge. 

The Hortons have lived in Crystal Springs all their lives, and they have lived in the home the past five years that belonged to Rhonda’s mother. 

More than a quarter of all people in Crystal Springs live below the poverty line, and that includes the couple. Rhonda Horton said it’s hard to make a living because there aren’t a lot of jobs, but they support themselves as painters. 

That’s how they met Yvonne Florczak-Seeman, who lived in Illinois and purchased her first historical property in Crystal Springs in 2019. She splits her time between the two states. 

“We painted that porch bar and the rest is history,” Rhonda Horton said, adding that they went on to complete detailed work on mantles, kitchen cabinets and a cigar room at Florczak-Seeman’s North Jackson Street residence. 

Over the years, the couple built a relationship with Florczak-Seeman, who is seeking to open a women’s empowerment center called the Butterfly Garden, in the building next to city hall. 

Yvonne Florczak-Seeman poses for a portrait at her business, The Butterfly Garden, in Crystal Springs, Miss., Tuesday, Oct. 1, 2024. Credit: Eric Shelton/Mississippi Today

Florczak-Seeman has supported the couple numerous times, including helping them pay a late water bill and offering them work. She called them talented painters and hired them again to paint the interior of the future center, located at East Railroad Avenue. 

In pieces, Rhonda Horton told Florczak-Seeman about her husband’s arrest and later the injuries she said he sustained from it. Florczak-Seeman had questions about the encounter and other potential injustices at play, so she offered to help. 

“I just want them to pay for what they’ve done not just to him, but everybody,” Rhonda Horton said. “That’s what I want, justice.” 

The Arrest

On Sept. 24, 2023, Horton was walking home from a friend’s house when officers approached him. One grabbed his arms to handcuff him, and he remembers them cutting his wrist and causing it to bleed.

Then, he said, a second officer slammed his head into the top of the police car, followed by another officer who slammed his head again. During the encounter, a bag of marijuana that Horton said he found fell out of his pocket onto the ground. 

An officer put Horton in the back of the cruiser and took him to the station where Horton asked to speak to the police chief and call his wife. He said the police took his phone and clothes.

Afterward, he was taken to the Copiah County Detention Center in Gallman. 

Police Chief Tony Hemphill disputed Horton’s allegation of mistreatment, saying he did not sustain any injuries that required hospitalization. He said Horton’s wrist was cut while he resisted arrest. 

“He was not brutalized and targeted,” Hemphill said. “If he had just complied, he wouldn’t have had to come up there (to jail) that night.”

Two police reports from the night of the September 2023 arrest detail how officers had responded to a possible assault and were given the description of a white man. While in the area, they encountered Horton — the only person who fit that description. 

Hemphill said a mother called police after her daughter told her she was assaulted. He said officers approached Horton on the street and tried to talk with him to rule him out as a suspect. 

That’s when Horton began “fighting, pulling away, and kicking against (the officer’s) patrol vehicle, trying to run,” according to a police report from the night and Hemphill. Horton denies doing any of that. 

The next day police took Horton from the county jail to the Crystal Springs police station. There, police informed him a teenage girl reported being assaulted. After learning about the assault allegation, Horton remembered feeling shocked and saying it couldn’t be true because he was not on the street where the alleged incident took place. 

Hemphill confirmed the police investigated the assault allegation and found it not credible, meaning Horton wouldn’t face any related charges. He said he communicated this to Horton and his wife early on and since then, which the couple disputes. 

As Horton was being arrested and detained, his wife grew worried because she had just spoken with him on the phone and expected him to arrive home shortly. Rhonda Horton and her adult son started calling Roger’s phone, each not getting an answer. 

Then during one of the calls by her son, someone who did not identify himself answered Roger’s phone and said, ‘Your daddy’s dead’ and then hung up, Rhonda Horton said. 

She was starting to assume the worst had happened. Rhonda Horton wouldn’t have confirmation her husband was alive until he called from the county jail in the early morning. 

The next morning as she talked with the police chief, Rhonda Horton asked the chief about who answered the phone and told her son that Roger was dead. The chief told her the person who answered must have been from the county. 

Hemphill later told Mississippi Today that he did not know about the call and that type of behavior by his staff “is not going to be tolerated.” Similarly, Copiah County Sheriff Byron Swilley said he had not heard about it and could not say whether a member of his department made the comment to Rhonda and Roger Horton’s son. 

A Sept. 25, 2023, citation signed by Hemphill, shared with Mississippi Today, summoned Roger Horton to municipal court for the misdemeanor charges of possession of marijuana and resisting arrest and directed him not to have contact with the alleged victim in the assault case. No contact orders are typically for cases such as domestic violence and sexual assault and they are set by a judge.

LaKiedra Kangar, who works in municipal court services, said the no contact order was put in place because of the assault allegation. She confirmed Horton was not charged with the offense following the police department’s investigation of the allegation. 

Weeks passed. Roger Horton went to court for the misdemeanor charges, to which he pleaded guilty.  Felony assault charges were not part of the hearing. Municipal Court Judge Matthew Kitchens ordered Roger to pay over $900 in fines for the misdemeanors. 

Horton was able to pay for some of the fine through at least 10 hours worth of court-ordered community service, which he said involved painting buildings for the city. 

Months later after learning about Horton’s arrest and how he said the police treated him, Florczak-Seeman said she wanted to know more. Horton didn’t have access to his arrest documents, so she accompanied him and his wife to the police department to ask for them. 

The first visit, Horton asked but did not receive the arrest report. Florczak-Seeman asked if he had a fine for any of the charges, which police said Horton did even after completing some community service hours. Florczak-Seeman paid for the remaining balance and had him work for her for two days to pay that off. 

This year, they went to the police department a second time so Horton could ask for his arrest paperwork. An officer told him he didn’t need it and that the rape allegation had been investigated and found not to be credible, Horton told Mississippi Today. 

Florczak-Seeman asked why Horton couldn’t receive the report. She said Hemphill asked if she was Horton’s attorney, and Florczak-Seeman clarified she was his representative. 

The chief left for a few minutes and returned with two pieces of paper and handed them to Horton. Hemphill told Mississippi Today he did not recall whether he was the one who handed the report to Horton. 

Florczak-Seeman took the document from Horton and began to read it as they stood in the lobby. She said she was horrified to see the name of the alleged, underage victim and her address in the report.

Hemphill said the victim’s personal information should have been restricted and not doing so was an oversight. 

After reading the report, Florczak-Seeman went down the street to the mayor’s office at city hall to explain what happened, and how she believed the mayor had grounds to fire the police chief because he provided that document to Roger with the alleged victim’s information. 

Crystal Springs Mayor Sally Garland Credit: Crystal Springs website

Mayor Sally Garland confirmed she had a conversation with Florczak-Seeman about the police chief’s employment. 

She said she reviews all complaints about city officials, and Garland said she goes to the department head to get a better understanding of the situation. If she determines there are potential grounds for termination, a hearing would be scheduled with the Board of Aldermen, and the group would vote on that decision.   

Garland did not find grounds for termination, and Hemphill remains police chief. 

A Strange Visit

The Hortons and Florczak-Seeman hadn’t given much thought about the 2023 arrest, until weeks ago when a teenaged girl suddenly showed up in Florczak-Seeman’s yard. 

At the end of September at the North Jackson Street home, Florczak-Seeman heard screaming and found the teenage girl who came onto her property. She asked what was wrong, and the teenager said she was chased by a dog, which Florczak-Seeman and Rhonda Horton did not see. 

The teenager asked for a soda, and Rhonda Horton went inside to get one. Florczak-Seeman asked where the teenager lived, and she gave an answer that Florczak-Seeman said conflicted with what two girls who were standing nearby on the public sidewalk said she told them. 

Then Florczak-Seeman asked the teenager’s name and recognized it as the name of the alleged victim on Horton’s arrest record. Immediately, Florczak-Seeman said she turned to Horton and told him to stay back, and she told the teenager to get off her property, which she did. 

At the moment, they were not able to verify whether the teenager was the alleged victim from the report. Neither the Hortons nor Florczak-Seeman had seen her before, and they only knew her name from the arrest report.

“That didn’t make sense at all,” Rhonda Horton told Mississippi Today. 

Florczak-Seeman called 911 to report the situation and ask for police to come, which they did not. Hemphill told Mississippi Today a dispatcher informed him about the call with Florczak-Seeman, including details with the teenage girl and how she wanted to report the girl for trespassing. 

Florczak-Seeman is one of the people who have noticed a difference in Horton’s vision. It’s clear when comparing the detailed and clean paint job Roger completed at her Jackson Street property in 2019 and the center where he painted last year.

During an interview at the center in October, Florczak-Seeman pointed to the ceiling and noted spots that Horton did not paint. She remembers telling him about them and realized that he couldn’t see them. 

“The spots on my ceiling are still not painted, and they’re not painted as a reminder of the injustices that happened in this situation and why I got involved,” Florczak-Seeman said. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Job opening: Jackson Reporter

Published

24 hours ago

on

November 22, 2024

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mississippitoday.org – Mississippi Today – 2024-11-22 15:00:00

Mississippi Today, a Pulitzer Prize-winning newsroom focused on investigative and accountability journalism, is building a dedicated team of reporters to provide in-depth coverage of Jackson, Mississippi.

As the state’s largest and capital city, Jackson matters greatly to us and all Mississippians. Launched in 2016 as the state’s flagship nonprofit newsroom focused on Mississippi government and policy, Mississippi Today is focusing our lens beyond the statehouse and to the city of Jackson, serving our readers with the watchdog reporting they’ve come to expect from Mississippi Today. Our newsroom, with a proven record of providing impactful government accountability, aims to serve the city more directly with this team.

Our Jackson team will focus on sharp investigative reporting, watchdog accountability journalism and meaningful cultural storytelling. We aim to both elevate the voices of those working for positive change in the community while offering a balanced perspective on the city’s obstacles and triumphs. Our goal is to deliver impactful, honest journalism that will inform, inspire and empower Jackson’s citizens.

The team will be led by Pulitzer Prize winner Anna Wolfe, an investigative reporter with a decade of experience covering Jackson.

Roles and Responsibilities:

  • We are purposefully casting a wide net, hoping to connect with journalists of many different backgrounds who may be uniquely qualified to help us launch this team. If you’re a reporter with any of the following experience or attributes, this team may be for you.
  • Investigative reporting focused on uncovering systemic issues within government and politics. The bigger the impact of your reporting on government leaders or systems, the better.
  • Political reporting covering not only high-profile candidates for offices, but experience delving into issues and ideas that affect a community. We hope to delve deeply into a deep distrust in the city’s institutions.
  • Cultural reporting that highlights the often-overlooked success stories of citizens who are making a positive impact on their communities.
  • Strong understanding of Jackson (or similar large urban centers) and the unique challenges facing the city and its residents.
  • Commitment to the mission of balanced, impactful journalism that centers and respects the voice of the community.
  • Collaborative mindset and ability to work within a team-oriented newsroom.

The starting salary for this position is $58,000. Compensation is commensurate with experience level.

Expectations:

  • Work with a small team of journalists who are focused on social inequities and racial equality in our area.
  • Willingness to collaborate closely with a small team of like-minded journalists.
  • Get people to talk, find willing sources and protect them while telling sensitive and timely stories.
  • Build trust: Many people who have been impacted by inequities in Mississippi have been victims of predatory practices and forces. This will require empathy, patience and savvy.
  • Work with our Audience Team and data and visual journalists to create compelling story presentations.

Qualified candidates should have:

  • Experience working as a reporter in a newsroom.
  • Ability to work quickly, with accuracy and good news judgment.
  • Comfortability in digital or multimedia journalism spaces.
  • Ability to independently develop and cultivate sources.
  • Ability to use social media for research and to engage readers.

What you’ll get:

  • The opportunity to work alongside award-winning journalists and make significant contributions to Mississippi’s top nonprofit, nonpartisan digital news and information sources.
  • Highly competitive salary with medical insurance, and options for vision and dental insurance.
  • Use of appropriate technology and equipment. 
  • 29 days paid time off.
  • Up to 12 weeks of parental family leave, with return-to-work flexibility.
  • Simple IRA with 3 percent company matching. Group-term life insurance provided to employees ($15,000 policy).
  • Support for professional training and attending industry conferences.

How to Apply:

We’re committed to building an inclusive newsroom that represents the people and communities we serve. We especially encourage members of traditionally underrepresented communities to apply for this position, including women, people of color, LGBTQ people and people who are differently abled. Please apply here.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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