Residents of Midtown struggle without a grocery store. This is the story of one man whose health severely declined after the closing of the area's only store.
As I read the consultation from the doctor my heart sank.
The patient was a middle-aged man who had a past medical history of type II diabetes, congestive heart failure and chronic kidney disease at the fourth stage which is pre-dialysis. The ordering physician, a kidney specialist, wanted the patient to be more compliant with his diet. The patient’s three diseases, without a proper diet and medications, are fatal.
I am a registered dietitian at a St. Petersburg acute care hospital and I love educating patients. Providing diabetes education to a patient at the bedside is a tall order. CHF education, with its strict sodium limitations, is too. Add renal restrictions of potassium, phosphorus and protein and the task is nearly impossible. This diet education was for all three diseases and the patient, who had been discharged, was eager to return home.
I met Charles dressed in his street clothes with his shoes on sitting on the edge of his hospital bed. He was hospitalized five days prior for shortness of breath and pleural effusion which were brought on by his congestive heart failure. Ready to get out of the hospital but not wanting to return, Charles asked his doctor to speak with a dietitian about what not to eat. He knew intuitively that his diet had contributed to his failing health.
To the best of my ability, I taught Charles to count carbohydrates for his diabetes, limit sodium for his heart failure and limit proteins and minerals that are hard on the kidneys. I then began to question him on his living arrangements and access to a kitchen.
Charles told me he lived in a rooming house in the Midtown section of south St. Petersburg, Florida. With one refrigerator that was common to all residents, Charles said he couldn’t trust his roommates to not steal food items he put in the refrigerator but could lock foods away in his room. He had access to a full kitchen with a stove and microwave oven. With this information we began to run down the list of shelf-stable items he could store in his room that would be within the limits of his diet. We discussed many strategies and seemed to be making some ground. But then Charles abruptly stopped and sadly told me of the Walmart Neighborhood Market that had just closed one month prior.
“I used to walk there,” he said. “Every other day I walked there and got fresh vegetables and fruits, nuts and other stuff that I would store in my room.”
“So, how do you get groceries now?” I asked.
“I don’t,” he answered. “Since that store closed I’ve been eating junk from a gas station. Chips and crackers and stuff. And that’s when things got bad for me.”
I confirmed Charles’s suspicions that his current diet compared to his other healthier one was probably exacerbating his CHF and kidney failure. I also confirmed that managing diabetes on highly processed diet was more difficult because of added sugars and lack of fiber. He seemed despondent and hopeless and I was, too.
How could I help a patient whose only food choices were packaged, salty, processed food products? How could I help a patient who wanted to do better but just couldn’t make it happen because of a lousy food environment? How many people like Charles were impacted by the store’s closing and whose health was failing because of it? And, finally, how much was the loss of one grocery store costing the healthcare system in hospitalizations, medications and other medical expenses?
Charles and I kept working together trying to come up with a solution. He said at the first of the month he had money to take a cab to the super Walmart on 34th Street to do shopping in bulk. We discussed the canned fruits and vegetables he could buy that were safe for his kidneys. But with almost all processed foods comes salt. Prior to the store closing, Charles could keep his sodium low by eating fresh fruits and vegetables. Now, Charles had to make very serious concessions. His diabetes, was better managed, too, with access to a grocery store. Now his diet was at the mercy of low fiber, low nutrient-light processed foods.
Charles left the hospital shortly after our talk and returned to the rooming house. I see that since our encounter in March 2017 he has had two more hospitalizations each for complications relating to his diet-related illnesses.
The lack of access to fresh and frozen fruits and vegetables, beans, grains, meats and dairy presents grave health consequences to the City's poorest and sickest. Many communities across the US have improved or even resolved their food desert problems with creative partnerships with government, non-profits and local businesses. St. Petersburg languishes far behind other cities of similar size and orientation. Lack of incentive, vision or prioritization elsewhere have taken us to where we currently are.......and Charles eats orange-colored peanut butter crackers for dinner.
*Charles is not the patient’s real name.