Frances Burton, a bilingual diabetes educator at Novant Health, has a personal story she shares with students. And she loves sharing it because it shows patients that they can control their own destiny.
“Years ago, I was diagnosed with pre-diabetes,” she said. “I was overweight, but I lost the weight. And I have been great for the past 10 years. I’m very proud of that. I exercise and eat my veggies and salads.”
Burton loves the food of her culture. But she’s made modifications in her diet – “compromises,” she called them – and has learned to enjoy fresh, whole foods. She tells her students they can do the same. She knows it’s possible, after all, because she’s done it herself.
Most of her students already have Type 2 diabetes and are not following dietary and exercise guidelines. Many forget to take their medication and check their blood sugar.
Diabetes is an urgent public health issue in America. More than 34 million Americans have Type 2 diabetes, about 1 in 10. Certain minority groups, including Blacks and Latinos, are at greater risk than white Americans.
And failure to control it can lead to serious health consequences, including amputation and blindness. The people who most need this education and empowerment often have the greatest difficulty making it to class.
“Three or four years ago, we were doing in-person classes for the Latino community,” Burton said. “They would come to us – which wasn’t easy for them because most of them don’t have their own transportation.”
When COVID-19 hit, it made in-person classes impossible. Burton and her students are making do with phone calls now, but she eagerly awaits the day they can meet in person again.
Her students live on the margins. Some are undocumented workers; most are uninsured. They are worried more about paying this month’s rent and phone bill than they are about their Type 2 diabetes.
“We see so many disparities in health care,” she continued. “These are people who are disadvantaged socioeconomically. Just getting them to come to class or join a call is usually the first challenge.”
A teacher and an ‘empowerer’
Burton works most closely with the Samaritan Southside clinic in the Waughtown neighborhood of Winston-Salem. A group of volunteer physicians and nurses and a social worker holds two free clinics a week. The volunteers provide Burton with names and contact information for patients who need diabetes education.
When students show up – meaning, dial in – it’s a positive sign. If they’re interested enough to make a call, she may be able to get through to them. Burton tries to get them to realize they have a serious, but manageable, condition. She empowers them to take their health into their hands.
Once she has their attention, it’s her job to educate and motivate. Some of her students have had diabetes for several years and never addressed it.
She starts by asking questions.
- Do you take your medication? How and when? (Some of them don’t realize they need to take two pills a day – but spread out over hours.)
- What do you eat each day?
- Do you know how many carbohydrates are in what you eat? Do you know how to measure carbs?
- Do you have a family member or friend who can be your emotional support and accountability partner?
- Do you have children? What do you feed them?
“We only have one hour for these small-group phone calls,” Burton said. “I try to cover a lot of stuff in that hour. If my students have children, I stress the importance of setting a good, healthy example for them.”
It is possible to lay the groundwork for a major life change in just an hour. Teresa Cummings, a manager in diabetes care in Winston-Salem who also covers Thomasville and Kernersville is Burton’s manager. She manages a team of nine and works mostly in prevention with people who have pre-diabetics.
‘We transform lives’
“If you catch diabetes early,” Cummings said, “you can head it off at the pass.”
“We transform lives,” she continued. “We encounter some people who are very reluctant to even sit down with a dietitian. We encourage them to take control, and then we give them the tools to do that.”
“Some patients think it’s OK to skip medication,” Burton said. “They don’t check their blood sugar; they may not even be able to afford a machine.” Drug stores sell self-monitoring blood glucose meters starting at about $20 – but if you need that money for rent, you may feel like it’s a luxury you can’t afford.
“Maybe they visit the clinic because they’re feeling terrible,” Burton said of patients who show up at the Waughtown clinic when their conditions have worsened. “Or they go to the ER. It’s very frustrating for me. I wish I could do more for them, you know?”
“I try not to scare them,” she said. “I lead with the good news: Type 2 diabetes can be controlled by lifestyle changes. And then I try to motivate them to make those changes. I engage them in the conversation.”
Even over the phone, Burton knows when she has a motivated pupil. “If they participate in class and ask questions and engage with me, I know they’re getting it,” she said. “But some students say: ‘Well, I'm happy the way I am.’”
She doesn’t give up on anybody, though. She’s got an hour – and she’s going to use every minute of it.
“I love my work,” she said. “I am working with people who truly need me.”
Frances Burton’s healthy Cuban picadillo
Picadillo is a traditional dish in many Latin American countries and the Philippines. It’s made with ground meat, tomatoes and can have raisins, olives and other ingredients that vary by region. This is a healthy, quick and easy version of the traditional stew.
1 pound ground chicken or ground turkey
1 medium onion, chopped
1 green bell pepper, chopped
1 medium carrot, chopped
2 cloves garlic, chopped
1 teaspoon oregano
1/2 teaspoon cumin
1 can tomato sauce
Salt and pepper to taste
- In a saucepan, pour about 2 tablespoons of olive oil and sauté the onion, pepper and carrot until tender.
- Add oregano, cumin and garlic and stir and cook for another minute.
- Add ground chicken, salt and pepper. Stir.
- Cook covered, over medium heat, for about eight to 10 minutes until meat is done.
- Serve over rice or baked potato.