 Thank you for your interest in coming here and it's my pleasure to be able to introduce Captain Evers who is an RN who works at the Cancer Treatment and Research Center and what was the byword that Dr. Davis used this morning about your health and now all of a sudden we have an illness and what do you need to get through that illness? Travel agent. So this is more and more very important in health care delivery and access to health care is you'll hear I didn't I told Captain I haven't heard travel agent, that's some kind of a journey, but but travel agent, patient navigator, nurse navigator, nurse coordinator, those kinds of positions and let's say how many of you are permanent tourists? What are your areas or you? Case management. Case management. Health educator. Health educator. You guys? Fiscal accounting. Okay. Health educator. Community relations. Community relations. Health education. What are y'all? I'm not with any of the planning council but that's in the center. Planning council is a concern, I mean what about y'all? Social worker. Social worker case manager. American administration. Okay, so what you are are links to the health care system, either for wellness promotion or for chronic disease management. So without any further ado, Captain, talking about the fabulous role that you have. Captain, thank you. Okay, it's a small amount. Well, maybe you can't hear me, so I would say this, I am a patient though. Okay. So I do kind of do it. Like you said, I am a registered nurse. I've been with the Cancer Therapy Research Center for over 12 years. I have a new role now and that's a patient navigator but I am specifically a patient navigator for HVB groceries. So what that means is that any any employee of HVB, there's 80,000 throughout the state of Texas, can call me if they have a question or concern about cancer or a family member. So right now I have patients throughout the state of Texas, a lot of them in Houston and Temple, Dallas, San Antonio. Some call for just a quick question. Some call me to navigate the whole journey of their cancer. So it's fairly new position. It's a new idea that HVB combined with CPRC and so it's kind of a prototype that they're working on now and see how it goes. They also have a patient or they call them partners, a partner health center if everybody knows who it is, it makes for San Antonio. It's written in their road where the big warehouses. The warehouse has 13,000 employees there. So they've opened their own health center there which has a lot of nutrition education. They have their own physicians, their own medical staff and so that's open just for their employees. Yes, so it's growing fast and so hopefully we have different companies coming in and it's kind of a different idea with nurse navigator. So throughout the time, if I say nurse navigator, it doesn't mean they're just nurses. Navigators can actually be social workers. They can be a trained other person within the system. So if I say nurse navigator, just clear that that includes their yes sir. How long has this navigator, I would say navigation, navigator a system been in effect? I'll show you in just a second. Okay, so we'll go through the history, but has anybody heard of that nurse navigator before today already? Because normally when they ask me what I do, I say where do you work and I tell them where I work and what do you do on my nurse navigator and this is usually what I get. A nurse navigator, they kind of are like well what does that mean and my poor mother trying to tell people what I do, she says she's just a nurse. So anyway, so let's take a look at how it started. The history was in late 1980s, Dr. Freeman who was president of American Cancer Society at the time, he identified different barriers of groups of people why they weren't getting in health care the thing. And he wasn't a surgeon. Groups of concerns that he was looking at specifically were minority support and uninsured. And it's similar, this is like 1980s and it's the same group of people that we're dealing with now. So he put together a hearing which he actually involved in cancer patients. It wasn't the physicians, it wasn't the social workers, he asked the cancer patients what's preventing you from getting the prevention and the treatment that you need. So what they found out, he put in a report to the nation on cancer before in 1989. The critical findings of the economic new disadvantage, they face significant barriers to care especially when it came to the treatment of cancer and we'll go with the barriers here in a minute. They also made great sacrifices to obtain cancer, the cancer care or chose not to to even see cancer because of their inability to pay. Everybody knows cancer is very very expensive. And so a lot of them, if they're having a hard time paying their bills or a hard time, you know, with car payments or gas payments or anything like that and to see that you may have a chemotherapy co-pay kind of, they may not be able to choose to seek care. They also, those who were poor, experienced greater pain and suffering and death. And it wasn't because they have a low tolerance for pain, it's that usually by the time that they were sick enough to go to an ER or to seek treatment, they were already in the late stages of the disease and often it was imperiable at the time. Late-stage cancer can be very painful, it can cause a lot of suffering, especially if it's not treated early. And then they also fatalism was prevalent among this population. Fatalism, fatalism in cancer probably going to dilate. I won't put my family through the stress of it, I won't put them through the financial trouble, so I just won't go seek care. So with these findings, nurse navigation was born. In 1990, they started the first navigation program in the Harlem Hospital Center in New York City. It was breast cancer only, it was the first group, and it was paid for by a grant from the American Cancer Society, which was what Dr. Friggin was the president of the American Cancer Society. So that's how it started. It did two studies. One was before the navigation program started, they went back and looked at 606 patients from 1964 to 86. They were all of the low economic status and have to not have any medical coverage whatsoever. And as you can see, only 6% has stage one at the time diagnosis. Stage one is very early, stage mostly treatable, often curable. After the navigation program, the General American College of Surgeons went back and looked at the different cancer patients again, treated at the Harlem Cancer Center under the navigation program. Now the key here is nearly half had no medical insurance on initial evaluation. The key here is that the navigator either found the insurance, found the resources, found the financial assistance. So that will change their thinking. So then staking improvements, now they have 41 at stage zero. Stage zero usually doesn't require chemo or radiation. And then stage one. So they went from 6% to 41%. And five-year survival rate went from 39% to 70. So they almost doubled what the use of nurse navigator. And this is back from the 90s. This does some of the program, not rocket science patients who work with an navigator got care faster and were efficient even though it's not. Why the grant improvements? Well, they offer free and low cost screening. The immigrants were, it was just a breast cancer. So they have their own detection. So that's why they had the increase in zero and one stage. They promoted early treatment without delaying. Without delaying is that the patients often they would come on their stage two and three, or they would be diagnosed and then not seek treatment after that. And so the navigator would carry them through that stage two, get them a surgeon, the radiation, the medical oncologist, whatever they needed. And then public education and community outreach. They went out to the community, told them about the program that they had, told them about the low cost or free mammograms and really increased their program there. So the role of the nurse navigator. Who is a nurse navigator? And I told you it could be an educator, it could be a social worker, it could be a nurse. It could be an LBN, an RN. It could be a medical assistant who's been specially trained. Anybody that's interested in navigating, you just have to have a true compassion for people because you really are their advocate the whole time. And it doesn't necessarily have to be cancer. It can be any chronic disease. It could be diabetes. It could be heart disease. Anything that would require multiple appointments, stravagant treatments. What is it? We're advocates. That's what we are. We're just there for the patient to do whatever they need. And where they can be in a hospital. There's a big program over at North Central Baptist for their health program. We have a nurse navigator. And I know she's currently navigating over 150 patients. So it's a growing program. The one thing about that program is she works with a set group of physicians. So she has a set group of surgeons, a set group of radiation oncologists, and a set group of medical oncologists. So the patients are navigated within that system. And then, like I'm actually at CTRC, but I work with patients throughout the state. So I have an office there. If they want a second opinion, I can go right into the clinic next door and the doctors are there. But it can actually be in a private physician's group also. When you can get them pre-diagnosis, you can get them at the prevention stage. You can get them right at the beginning, middle, right when they're getting chemo. And I'm actually working with family members now who contacted me after the family member had passed away. So I'm actually helping them after death. Never met the patient. The patient had expired before they were contacted me. So I'm helping them with multiple, multiple forms and health insurance, life insurance is being paid out and that can just be completely overwhelming. And how? It's just resources. I brought a bunch of them. We'll go through that's what you'll hear. Resources, resources, resources. It just becomes overwhelming. Sometimes they just don't know where to even start. And so the how is that you're there to help them. And questions and answers, as you see, it goes both ways. They have questions I try to answer. If I don't have the answer, I go back with a question to somebody I work very strongly with the with our social worker because there's things that I just don't even know where to start and she has all the community resources. So it's a big group effort. So you have cancer. Is anybody in here at home?