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Evelyne Fleury-Milfort, RN, MSN, CDE, FNP, is a diabetes nurse educator in Los Angeles, California. She works at the University of Southern California University Hospital and at a low-income clinic.
DIABETES HEALTH: How long have you been involved with diabetes care?
Evelyne Fleury-Milfort: Probably 9 years now.
DI: Where do you work?
EF-M: I work at the University of Southern California, at the University Hospital and the Department of Medicine: USC Center for Diabetes. I'm also doing a residency one day a week at a low-income clinic called T.H.E. I think it stands for "To Help Everyone." They see patients on a sliding-scale basis, and they serve a diverse ethnic community: African Americans, Hispanics, Asians.
DI: Is there any difference in the care given at the low-income clinic and that provided by the hospital?
EF-M: Not in the care that I give; I treat everybody the same. The frustration is that low-income patients can't always afford the supplies to test, so you have to get creative. I'm running a sample medication drive, trying to get samples from different reps and companies to give to patients who don't have insurance and can't afford the medication. It's frustrating to see people who are doing everything they can, but can't afford medicine. I'm also talking to some glucose meter companies, trying to get some meters and strips for my patients. You really have to be creative.
DI: What do you like about working with diabetes?
EF-M: I like working with the patients and I like working with a team. I like working with a patient when they think that nothing is going to work, then helping them to change their perspective on diabetes. It's really nice to see patients getting comfortable with their diabetes, and to keep them from being too hard on themselves when things don't go perfectly. My background as a psychiatric social worker helps with that. I also work to keep the team from classifying people as "non-compliant" because then they are written off, they don't get the care they need to keep healthy.
DI: You were a psychiatric social worker? Why did you change professions?
EF-M: Life prompted the change. I was a social worker in Quebec, and when I came the United States I didn't speak the language very well. It's hard to be a therapist when you have trouble communicating. So I went into nursing. I started at the Glendale Diabetes Treatment Center of America, and I used to fill in for the CDE when she wasn't there. When she left, I got the job. I started the diabetes program at Northridge hospital. You know Northridge, the epicenter of the earthquake.... But I moved here to Los Angeles two years before that.
DI: What do you dislike about working with diabetes?
EF-M: There are two aspects I find difficult. When a patient does everything they can, and they still get complications. It's humbling. You realize that you don't have all the answers, that sometimes it comes down to genes. I also find the health care system frustrating, when the lack of coverage prevents a patient from getting the care they need. When someone who is poor changes jobs and health insurance, they have to either change providers or pay for the old care out of their own pocket, and diabetes is already an expensive disease. Acute care is better covered than long-term or preventative care, and that's a mistake. I hope someday we will have a health care system that will better help people with diabetes.
DI: What books and magazines do you recommend to your patients?
EF-M: Well, for the patients that can afford it, I recommend "Living Well with Diabetes" from the International Diabetes Foundation. I also recommend a membership in the American Diabetes Association, so they can get the "Diabetes Forecast," which is getting better about treatment and information. I also recommend "DIABETES HEALTH." For myself, I get the magazines: the ADA's "Diabetes Care, " the AADE's "Diabetes Educator." They are more up-to-date, they have all the latest research.
DI: Do you have any tips for diabetes educators or patients?
EF-M: For patients, they need to learn to live their lives with diabetes, they need to learn to be a person with diabetes instead of a "diabetic." They need to use their health care team to get healthy. They should concentrate on total health rather than just diabetes health.
For educators, they need to keep intellectually stimulated so they don't burn out. Don't be in a vacuum, join the ADA, AADE, or some other local organization to resource themselves.
Evelyne Fleury-Milfort was nominated for Educator of the Month by Dr. Alan Marcus for reaching patients that were previously untouched and for setting new boundaries for the role of diabetes nurse educators beyond simple education to empowerment and entitlement.