South Texas, the land of mild winters and rich soil that grows fruits and vegetables to feed Texas and the nation, is also a fertile environment for the precious seeds of better health. And thanks to the cooperation and partnerships of individuals and agencies ranging from the residents of colonias along the Texas-Mexico border to the Texas Legislature and the Health Science Center, those seeds are being planted and are beginning to produce a vigorous crop of education and good health.

Despite what might appear to be overwhelming odds, including one of the fastest growing populations in the nation and the longstanding scarcity of physicians, dentists, nurses and allied health care providers, the seeds of positive change are taking root. Graduates of the many health education programs begun throughout South Texas by the Health Science Center in cooperation with other institutions in the last few years are now treating patients and teaching a new generation of health care providers.

Educational programs begun in the past decade with Health Science Center expertise in cooperation with South Texas institutions such as U. T. Pan Am, U. T. Brownsville, Texas State Technical College and Sul Ross State University Rio Grande College are being turned back over to these South Texas institutions as the programs mature and gain accreditation. A vibrant, "virtual" university, functioning without walls by means of a sophisticated telecommunications network connecting underserved areas to the Health Science Center, is filled with courses and two-way interactive audio and video teaching and learning.

And in addition to health career students, patients such as 53-year-old Sara Flores of Raymondville, who lives deep in the Valley just 35 miles from Mexico, are learning about their health and transferring that knowledge to their children and grandchildren.

"When I was working around the house, I would get so tired that all I wanted to do was sleep," she recalls. "I didn't know it was my blood sugar making that happen." Flores was able to get her diabetes diagnosed at Su Clinica Familiar (SCF) in Harlingen and was given a blood monitoring device to check her own blood glucose levels at home. This clinic, which treats about 12,000 adult patients, in addition to thousands of pediatric patients, consults with San Antonio's Health Science Center professionals such as Roberto Villarreal, M.D., assistant professor in the Department of Family Practice, as it maintains its medical mission for residents of the Lower Rio Grande Valley.

"I began to learn about the extent of the South Texas health needs about 15 years ago when I was working with the World Health Organization to assess conditions on both sides of the border," said Dr. Villarreal, who grew up in the McAllen area. "Many people at that time felt that poverty and lack of education would keep the population from being able to improve their health status, but we are showing otherwise. In a culturally appropriate setting, with, for example, a dedicated physician and a bilingual diabetes educator such as Lita Silva [registered nurse and diabetes education coordinator] in Harlingen, we are showing that these patients can change and do improve."

Dr. Villarreal, who helped start the Diabetes Outcomes Clinic at SCF several years ago, is also associate director of the South Texas Health Research Center and works with the Valley Primary Care Network to design the best possible clinic experience for diabetic patients. He makes sure that they learn how diet and exercise affect their health and makes sure they see an ophthalmologist, a podiatrist and other specialists who can treat any health problems caused or worsened by diabetes. He recently presented findings from a random records review at the Harlingen clinic to the Society for Medical Decision Making, showing good control of diabetes in the clinic's patients.

Said Flores, "Now that my diabetes is under control, when I feel tired for no reason or have other problems, I know what's happening and what I can do about it. I'm able to take pills to control it, and I don't have to take injections. When I first went to the classes they offered, I didn't think they would tell me anything that would help me; but, after the second class, I started feeling better. They teach you about your diet, what to eat and what to avoid, and show you videos of people who have diabetes who are living a healthy life, and it gives you encouragement. We learn about exercise and how important it is, and when I do the things I've learned, I feel good. I wasn't ready to die yet," she said. "I want to watch my grandchildren grow up."

"Improving health care outcomes for diabetes is truly a challenge," said Elena Marin, M.D., executive director of Su Clinica Familiar. "Several years ago, after many years of treating diabetic patients with minimal improvements, we at Su Clinica Familiar decided that to justify the resources spent, a more dramatic improvement was needed. This required the monumental task of changing patient behavior and physician practice patterns. We set out on a project that led to the development of a model of health care for diabetics, and it has proven to be effective at our clinics.

"With the help of Dr. Roberto Villarreal at the Health Science Center and Lita Silva and the dedicated staff at Su Clinica Familiar, we were able to demonstrate that our diabetes program was effective and significant," she said.

When Mrs. Flores catches a ride to the clinic once a month and learns more and more about her diabetes during the free classes offered there, there's a ripple effect. She now knows better how to care for her family as well as for herself. Her grandchildren and the rest of her family and friends will benefit from the dietary, exercise and medical knowledge that she now knows firsthand.

And the same ripple effect occurs when a South Texas student decides to enter a health career and remains in the region to treat and to teach, or when a site such as Su Clinica Familiar becomes a model for clinics in other areas of South Texas. "The Health Resources and Services Administration in Washington is looking at the Harlingen clinic as a pilot for diabetes treatment," said Dr. Villarreal. "Other clinics such as those in Rio Grande City and Brownsville are benefiting from the Harlingen model."

"Su Clinica Familiar is currently working with the Bureau of Primary Health Care on a national diabetes collaborative to improve our program even further," added Dr. Marin. "Lita Silva, Cris Perez and Dr. Chandrasckher Reddy are heading the project at SCF. Collaboration with the Valley Primary Care Network and the Health Science Center are of paramount importance to the continued success of this national project."

The roots of cooperation that are supporting today's growing health education programs and improved health status run deep. Back in 1959, when Flores was only 13 years old, the Texas Legislature chartered the first component of the Health Science Center in San Antonio as the "South Texas Medical School" and set the stage for the University's and the Legislature's growing contributions to the health of the South Texas/ Border Region. By the late 1970s, physicians training at the San Antonio medical school to be family practitioners were already traveling from the San Antonio campus to McAllen to see patients with a wide variety of illness who would otherwise not have had access to adequate medical attention.

Throughout the years, state and federal funds have been applied for and made available to South Texas, but a major breakthrough in 1995 allowed a quantum leap for the region. In 1995 the 74th Texas Legislature passed an appropriation that began the South Texas/Border Region Health Professional Education Initiative (STBI). Senators Judith Zaffirini of Laredo, Eddie Lucio of Brownsville and Carlos Truan of Corpus Christi, in concert with Rep. Henry Cuellar of Laredo, Rep. Juan "Chuy" Hinojosa of Edinburg and other House representatives, the entire Bexar County delegation and former Lt. Gov. Bob Bullock created a plan and funding that continues to strengthen and prepare the entire South Texas region for the coming decades.

Today, as progress is made toward a new quantum leap for South Texas--creation of a Lower Rio Grande Valley Regional Academic Health Center (RAHC) funded by the Texas Legislature and The University of Texas Permanent University Fund, the STBI continues to help change the South Texas landscape for the better. Numerous projects are under way to enhance South Texas education and, ultimately, the region's health status. In recent months the three major regions of South Texas each earned renewed STBI funding for ongoing and new cooperative educational programs. (The Mission will feature stories about the programs in future issues.)

"Despite an exploding population and the continuing problems of poverty and access to health care, the STBI has been very effective throughout the region," said Mario E. Ramirez, M.D., vice president for South Texas/Border Initiatives at the Health Science Center. "Some statistics are still being quoted from the last census, which is several years old now, to say that certain areas of South Texas have an adequate number of physicians for the population, but it will be interesting to see what the new census will show. Many of the new South Texans are legal immigrants from Mexico, seeking a better life in this country. My hometown of Roma, for example, which had a steady population of 1,000 for years, suddenly has a 700 percent increase in population, even though there are no major industries there that are attracting those people."

But at the same time, cooperation, partnerships and the planting of seeds continues. New buildings, new programs, new opportunities for the people to learn and to help one another are growing. Public health threats, from infectious diseases to water quality, are being documented and addressed. And thankfully, the life-giving harvest of better health continues to ripen in the fertile soils of South Texas.