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Meet Dr. A. Enrique Caballero: a Boston-based endocrinologist with decades of experience providing diabetes care to the Latinx community. After completing medical school in his home town of Mexico City, Dr. Caballero moved to Boston to begin what would become a prolific career in endocrinology and diabetes care.
This included founding the Latino Diabetes Initiative at the Joslin Diabetes Center, a program that combines four main pillars: patient care and education, community outreach, provider education, and clinical research. It would go on to serve as a model for other similar initiatives geared toward underserved communities.
Today, you can find Dr. Caballero at the Brigham and Women’s Hospital, where he continues to serve the Latinx population as the Director of Latino Diabetes Health in the Division of Endocrinology, Diabetes and Hypertension. He is also the Chair for the Health Care Disparities Committee at the American Diabetes Association, and he actively works with the National Hispanic Medical Association, the National Minority Quality Forum, the American Association of Clinical Endocrinologists, and the Latin American Diabetes Association. He has also been a leader in the field of professional education for a long time. He is currently the Faculty Director of International Innovation Programs in the Office for External Education and Director of Diabetes Education in the Postgraduate Medical Education Department at Harvard Medical School.
Despite his downright impressive list of titles and accomplishments, Dr. Caballero remains humble and genial. We had a great conversation about his early start in medicine at a young age; his work providing accessible, effective diabetes care to the Latinx community in Boston; the challenges of training healthcare providers in culturally-oriented care; and even his love of tennis and salsa dancing.
There were many moments during our talk when I couldn’t help but smile, like when Dr. Caballero casually shrugged off the suggestion that he was an “expert” in his field, or when he thanked me and T1D Exchange for our work.
With his feet planted firmly on the ground and his mind hard at work, Dr. Caballero will no doubt continue to address healthcare disparities, advocate for holistic care, and improve the lives of countless Latinx people living with diabetes.
I’d like to talk a bit about how you got started in this field. Why did you decide to study medicine?
It’s a combination of different factors. I grew up in Mexico City, and my parents were teachers and always inspired me to be kind and help people. My father dreamed of becoming a doctor. Unfortunately, he had to quit medical school to work. He later became a psychologist and was very successful, but he had that unfulfilled dream to study medicine. My parents were always very supportive of my studies.
I shadowed an uncle who was a doctor, and I found it so interesting. I also grew up with the idea that there’s nothing better than being able to help people directly. What could be better than helping them with one of the most important things in life? That’s our health.
In Mexico, you go directly to graduate school after high school. I was very young—I skipped several years in school because I was a good student. I entered medical school when I was 17 and I finished when I was only 21. I think that it worked well, but I was very young—it could have been a different story.
Once you were in medicine, what led you to endocrinology?
One thing that I have always liked about endocrinology is that it allows you not to focus on just one part of the body. It is a way to really work with the whole system, not just one particular organ. I wanted to work with the trees without overlooking the forest, so to speak.
As I reflect back, that’s also been part of my philosophy in life. We all have different areas of our lives—personal life, family, friends, professional activity—and all of them are important. In the end, a happy life is when you have a balance of everything.
After medical school, you moved from Mexico City to Boston in order to complete your fellowship in Endocrinology and Metabolism. What stood out to you about the city and about your patients in Boston?
I was at the Joslin Diabetes Center at first, which is a great academic institution fully dedicated to diabetes. At that time, the Joslin patient population primarily comprised non-Hispanic white well-educated people. That was a change compared to what I saw in medical school. I worked with a more heterogeneous population in Mexico.
I was inspired to open the doors of the Joslin to other people, and then I got more into working with the Hispanic community and other underserved communities affected by diabetes. I founded and directed the Latino Diabetes Initiative for many years. We were able to attract a large number of Hispanic and Latino patients to the Joslin.
What inspired you to continue focusing on the Latinx population after you’d established that program?
I always had three main reasons why I wanted to work with the Hispanic community: The Hispanic community is the largest minority group in the country, diabetes and its complications are more prevalent in this population, and healthcare disparities are very evident. The quality of care that is provided to the Hispanic community is not the same as what is provided to the White population.
What specific barriers does the Latinx population face when it comes to accessing healthcare, and diabetes care particularly?
The first barrier is that not everybody has access to our healthcare system. There are many uninsured individuals and families. Even for those who have insurance, sometimes it’s limited, so they cannot get all the services they need.
But even when people do have access to care, the healthcare system is not conducive to culturally and socially oriented care. There are very few centers, programs, and healthcare professionals that fully understand the social, cultural, and financial challenges that many patients in underserved communities face.
To start there’s no formal way in the healthcare system to address social determinants of health. In addition, healthcare professionals are lacking training for the skills that would help us work with patients from different racial backgrounds and languages. Whereas we’re not fully responsible for modifying the wide range of social challenges in our patients, we should be identifying these problems and then referring patients to other professionals as needed.
In response to that need, you began the Latino Diabetes Initiative at the Joslin Diabetes Center, and later the Latino Diabetes Program at the Brigham and Women’s Hospital. What challenges did you face in getting those programs off the ground?
Everybody agrees that working with underserved communities is important, but very few organizations are able to truly support programs that address healthcare disparities. Getting started often requires a huge effort of going outside the institution and talking to a lot of potential stakeholders. In the end, I got support from individuals, foundations, community-based organizations, corporate entities, and the academic institutions. But it was very difficult to get there.
Now, once you establish something and it’s successful, then it’s easier—everybody wants to join. But to get things off the ground in the beginning is extremely difficult.
Reflecting on it now, what do you think has been the most significant impact of those programs?
I’m very proud that we have been able to identify a model for comprehensive programs that address not just clinical care, but also patient and professional education, community outreach, and clinical research. We were able to identify that our patients really did better, and then we were able to export the model to other centers. There have been other programs around the country that build on the same ideas of integrating culturally and socially oriented teams.
Now, I’m doing something at the Brigham and Women’s Hospital that I’m very proud of. At the Joslin, our patient care and education activities took place at this center located in the heart of Boston. I was waiting for people to come and see me. In this new phase in my career, I have decided to go to the community. I am working at a community health center where the vast majority of patients are from the Latinx community and I closely work with primary care physicians and a multidisciplinary team that is addressing the social determinants of health at a more comprehensive level.
You’re obviously very busy – you have your fingers in a lot of different pies! I wonder, with so much going on, how do you maintain a sense of connection to the patients your work is ultimately serving?
I realize that as a specialist in this field, an “expert,” if you want to call me that—
I think we can definitely call you an expert.
Well, you know, something that I learned from my parents, particularly my mother is that remaining humble in life goes hand in hand with your growth as a person.
I realize that I won’t be able to see all patients with diabetes. My role is to see some patients and then help others improve the way in which they take care of their patients. This is why professional education is so important!
But I love seeing patients, because if I can help them, I get to remember that experience of being able to improve someone’s life. It’s the same feeling that I am sure other healthcare providers also experience. I think that happiness could become a collective happiness if we all dedicated our lives to grow and help each other somehow.
If you had to provide just one piece of advice to healthcare workers about how they can remain connected to their patients from underserved communities, what would that advice be?
If you see a patient from an underserved community whose diabetes control and overall health are not at the desired level, don’t blame the patient. Instead, think about how other factors in that person’s life may be impacting their ability to follow the recommendations you have provided.
There may be emotional or psychological issues, financial constraints, or social and family aspects that you’re not considering. Ultimately, those factors are probably more important to address if you want to help.
The unquestionable scientific advances in diabetes care — new pharmacological tools, improved technology to evaluate glucose levels and deliver medications, and overall telemedicine approaches —are fantastic. But as great as they are, they will never be enough. If we want to help patients improve their health, we must address all these other factors.
A lot of your work has focused on people living with type 2 diabetes. Can you speak at all to any work that you’ve done with the type 1 diabetes population?
There are many patients in underserved communities with type 1 diabetes, and research shows that access to healthcare and the utilization of current technology is much lower in these communities. For example, the percentage of people using insulin pumps or continuous glucose monitors is much lower in underserved communities compared to the non-Hispanic White population.
Again, we come back to the same issues around access to healthcare and affordability. The out-of-pocket expenses are prohibitive for some of these communities. Disparities and inequities exist not only in type 2, but also in type 1. This needs to be addressed.
There is a huge need to make all these devices more affordable and provide equal access to them across all racial/ethnic groups. Culturally and socially oriented programs should be created to provide proper education and support to all patients. There is also a need to proactively incorporate patients from underserved communities in research studies. Many studies are done in the mainstream White population, and then people believe the results are equally applicable to underserved communities. That is not true.
When you’re not working, what might I find you doing in your personal time?
You can most likely find me at home with my wife and our four daughters, on a tennis court, or in my library. Oh, and one more thing: As a Latino person, you cannot forget that I love dancing: salsa and bachata, and all the Latin rhythms.
Would your wife tell me that you’re a good dancer? Sounds like yes.
Well, why don’t we say she’s a good dancer, and I follow.
Perfect – as long as it works together. Thank you so much for speaking with me today, Dr. Caballero.
Thank you for the fine work you are doing. We’ve come a long way in diabetes, but we also have the opportunity to do better things. And you’re doing that! So thank you and T1D Exchange, on behalf of so many people out there as well, for the work that you’re doing.
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