Brownsville intrigued me with its contradictions.

A Lamborghini whizzed past a rusted trailer home, swaying the overgrowth of tall yellowed grass that framed the decaying home. Gray roads studded with potholes required tense, sharp steering but they eventually led to beautifully paved, smooth roads with white curves that swayed you, comforted you. You could enjoy the scenic Spanish columns of tall fenced houses before the horizon fell to abandoned furniture protected by sickly, angry stray dogs and their fleas.

I marched in with our bulky intervention or as we liked to call it, a three-pronged solution: a foot model, an educational flip-book and a quiz-based website. We quickly learned that most of our population did not have consistent access to the Internet, so the website became irrelevant. Next, we learned that our flip-book, even though we had specifically written it at a fifth-grade reading level, could not be mass-distributed to our target population because illiteracy was more common than we anticipated. We had underestimated the literacy barriers to health education. Next, we realized that the base we designed to hold our model was simply too cumbersome to be practical.

Those first three weeks, Brownsville’s unexpected anachronistic details taught me that I was ignorant.

I decided to step back. What were the main barriers that prevented individuals experiencing diabetes from taking necessary care of their feet? I wanted to make sure we were addressing the real issues. I wanted to make sure we weren’t just proposing a solution simply because it was the frame from which the problem was originally posited. They said teach wound care, we teach wound care.

Su Clinica helped me set up a series of intensive, 30-minute interviews with a range of professionals involved in patient care. My team and I interviewed a Podiatrist, and his range of nurses and assistants. We interviewed head nurses. We interviewed diabetes educators, nutritionists and physicians between three different clinics, one clinic of which focused specifically on Diabetic Wound Care. We asked questions not only about the barriers patients face in taking care of their feet, but also about the education individuals experiencing diabetes receive about foot care. We wanted to know how our model could fit into and enrich this education, but we also wanted to know what the current challenges to diabetic education have been.

Further, we sat down with over 50 individuals for feedback as to what worked in terms of our foot model design and what needed improvement. I was blown away, not only by individuals’ creativity but also by their commitment to envisioning how our model could be used and how it could be made more impactful. In talking to this variety of individuals, I realized that many were starting to notice how much of a burden diabetic foot problems had become. We weren’t alone in taking initiative and so we found many allies in these clinics and hospitals.

I was ignorant and presumptuous. And the challenges were more complex than we understood from our literature reviews.