Awakened in America
Awakened in America
S1 Ep #7 Part 1: Antiracism in Healthcare
Host Z & Host Jess sit down with Dr. Panagis Galiatsatos from Johns Hopkins Medicine where he serves as a Pulmonologist as well as Director of the Health Equity Steering Committee. How has COVID-19 shined a light on healthcare disparities in the U.S.? How can hospitals do a better job of listening to the communities they serve? Tune in to hear his feedback.
Hey listeners, hope everybody's doing well. And staying safe today is episode number seven, where we are going to be talking about healthcare and how you can be an anti-racist in a healthcare setting, as well as the healthcare disparity among races in our country. Currently with us today, we are thrilled to have dr. Portuguese golly at Santos. Enjoy your listening to
Speaker 2:Awakened in America.
Speaker 1:Nine's on a journey to create dialogue about diversity inclusion
Speaker 2:In optimism.
Speaker 1:Do you want to say hi to our listeners before we get started? Hi weekend. Thanks for joining dr. Gallien Santos. Anything you want to say to our listeners?
Speaker 3:Yes. Uh, first of all, just it's an honor to be here. Um, first of all, I can just also, uh, congratulations. You got the name, correct? Uh, my parents are immigrants came to America. They wanted to assimilate to the American dream, but they still wanted to give their son a linguistic nightmare for kindergarten. You guys nailed it. Um, but yeah, no, it's, it's such an honor to be here and especially to talk about the topic. That's just so important to talk about. So yeah, this is exciting. Thank you guys.
Speaker 1:Yeah, definitely. So like I said, this is such a current topic and the reason that we're bringing it up is we find inequities and disparities and a lot of different aspects that fall under the diversity anti-racism umbrella. But because of COVID, it's kind of shined a light more so on the healthcare disparity. And just to start off with a few stats related to COVID, um, black and Latino patients are two to three times as likely as white patients to be diagnosed with COVID-19 and more than four times as likely to be hospitalized for it. That in itself is a really unsettling stat. Um, and then in addition to that, black patients are actually more than twice as likely to die from the virus and also at younger ages, but that was actually published in a really insightful article by the Atlantic, just, uh, the end of September called five ways the healthcare system can stop amplifying anti-racism. So having said all that, I just wanted to give dr. G a Z and I call you a quick little recap of his credentials and it's a little bit lengthy. So here we go. He is assistant professor at the Johns Hopkins school of medicine in the division of pulmonary and critical care medicine. In addition to that, he's the coach here of the Johns Hopkins health equity steering committee, and is also the co-director and cofounder of medicine for the greater good. I know you have some more recent developments things that you're doing actually in the schools to educate people. So if you don't mind, actually just starting there and telling us a little bit about, maybe start with the medicine for the greater good and, and kind of where you've taken that to educate children would be great.
Speaker 3:No, of course happy to. And then we can also just even circle back to those kinds of conversations that you were having about those current stats, because you know, it's so yeah, because it ties into like what I've been kind of doing my almost my entire life unintentionally. So I I'm born and raised in Baltimore. My parents are immigrants. They came over, I was born in this city, actually. I always laugh. Like, you know, Hopkins there's two times in my career that they rejected me. And the first time was at birth. My mom went to the hospital and she couldn't speak English, but my dad was like, we don't have insurance. Like we just have cash. And they're like, no, this is not the hospital. I mean, that's the story. My parents tell me. So I went to a different hospital to have me. So, Hey, the irony is I became a professor there now though. Um, but you know, going into medicine, I only, I always thought of myself as, you know, becoming an academic physician, meaning I do clinical work and then I have a research theme. And the way you get trained in medical school is, you know, labs, science, the basic sciences. That's what you gravitate to. And like, honestly, that's where my heart was going until then, like time for residency, I applied to Hopkins specifically a hospital called Bayview. And you know, why I wanted to go there is because that's the hospital that was in my community. I was like, Oh my God, I got to go back and give back to my community. Like I grew up in a immigrant heavy area, right? A lot of Greeks, but also a lot of North Africans, a lot of Hispanic Latinos. And we just, all jelled, none of us really spoke English, but we understood humanity. Like you help one another out. And from my standpoint, I never had, you know, my dad was a painter. I didn't have those skills. My mom was a seamstress. I didn't have those skills. God knows I couldn't cook that well. So I was excited to like, become a doctor and then go back into this community and give back. But that's when I started to realize medicine's limitations, like early as an intern, I began to really struggle with my identity as a physician. Right. I had just dropped$200,000 on medical information and I never felt like he could reach my community. Yeah. I could go over diabetes from the genetics to the pharmacokinetics, up to the physiology and the complications that's having. It did nothing for my patients. When they went back out to the community where they couldn't access their medications, they couldn't get transportation to their doctor's offices. God knows it. Couldn't find, you know, nice nutritious food to need. So like, what's the point of like telling them all these things to do when they didn't have an environment that allowed them to be healthy. And it just, it really bothered me. Cause these were also, weren't like patients, I know we get attached to them and then we have to like move on. But for me that was hard to do because like, you know, I would sit with them and they're like, Oh, I knew your mom and dad, or like, Oh my God, on a heat, like, you're you played soccer with my son or my babysitter was my patients. Like, you know, like I became incredibly attached cause this was the community. And so the way medicine for the greater good began the is I began to go into my community. I went to the churches and spoke about medicine, healthcare, and then realized I'm like, this makes an impact. It's not just like the doctor talking, but it's a trusted doctor from the community speaking in a manner that they understand. And oftentimes in Greek, because it's a language, you know, my truth spoken. But so that the community members, like I won them over just because of my narrative, there was an already established trust and he knew how I talked. He knew that. I knew that like, Hey, go to old him, go to this corner store. You can find some good foods. Like they knew that. But like, they love that that's, it's better than the doctors can go in and exercise. They're like, you don't know my community, man. Like, you don't know what happened to walk through just to be able to be safe. And you know, like I see this because I recognize it was a good thing to do. Right. I knew it was the right thing to do, but I didn't know if this like aligned at all with an academic career. Like I wanted to be a lung and critical care doctor. Every mentor I had in that field was like, you got to do basic science. You've got to get a lab going. And that like, like my mind knew that was what I had to do. My heart's like, dude, you got to help your community, man. Like, like, and like I felt like I had these dueling competitions of like, I want to be an academic physician at the same time. I want to help my community, but wanting to do that, I had no idea who I could mentor after or like who could role model me at. But with that said like I did have a lot of people that would champion this. Like my program director caught wind of what I was doing and was encouraging of this. This is Colleen Christmas, the president of our hospital recruited some Florida. Who's been doing this for years. So I began to go to him. This guy's name is Dan Hill. I mean, I, you know, the beautiful story of this is like he became a North star and ultimately, and we met at a restaurant called the red star, which I, I love you. And I'm like, Oh astronomy. But like, we, you know, he like to discuss like, Hey look, you could be doing this. And like, I never thought about doing it in a way that allowed me to do the right thing and allow my career to grow in medicine. I see this because I had no one, I had no role models. I had no one to like guide me. And it was the hardest thing to decide, to say fine, I'll make an academic career in it. I still don't know what that means. Like, I don't know who's going to pay me to do community engagement, but then like, yeah. So then my chief year, I mean, one more year after residency, I stayed on to be the chief resident and I launched medicine for the greater good in conjunction with my program director, calling Christmas, who believed in this and we somehow convinced the chairman of Madison. So this is where the story gets interesting. Right? What medicine for the greater good was. It was to take physicians in training and tell them how community impacts health outcomes. Right? So we had workshops, people from the community came in reverends in moms, like they all came in and talk. And then we did what every physician does, where you learn in school with you go bedside by the patient and learn about the patient, right? So we got these doctors and we put them and planted them in the community or work with them with health projects that they identify they can help with. Right? You can't empathize with them and walk in their shoes, but gosh, darn it. We can walk next to them and understand the struggles that they have. So the next time I'm in clinic and trying to create a plan for you no longer will that create equal plans. Now I'm going to be creating equitable plans. And so that was my revolution with medicine for the greater good. And there's a little bit more to this story that I want to mention, and hopefully your, your, your listeners appreciate this. So my chief year, I poured our blood, sweat and tears into it. And my biggest fear as I left was knowing that probably like I'm going to go into my training to be a lung and critical care doctor. Now I'm actually going to go to the NIH to spend four years there. I have no idea how I pass this Baton. Right. I did such a big job to build it up. And now I'm like kind of leaving it to kind of just get further training around this time. The uprising of Freddie gray began to happen in Baltimore and the program directors who help build this, just saw medicine for the greater good as something important. So they wrote this beautiful op ed published in new England journal of medicine and it was published. And I took it, you know, I'm sitting here only my 80th hour of a weekday work in critical care. And I drove to the Baltimore sun headquarters and I dropped it off. Like I sealed it. I gave it to one of their writers called Andrew McDaniels and it put it in the mailbox address to her. She emails me and she's like, that's very kind of old school dropping things off. Let's go ahead. And um, you know, can I come out and write a story about you? It's like, sure. So she comes out and you gotta understand, like I'm like leaving the ICU. Once my shift is over driving up to Baltimore from Bethesda, it's about a 40 minute drive with no traffic just to like continue with MDG stuff. Like, you know, doing it like out of my blood, sweat and tears. Cause I believe in this, right? It comes, gets these pictures done. And Christmas Eve, I get a phone call from my aunt and uncle, my aunt and uncle, you know, blue collar individuals. They work for the Baltimore sun and local newspaper by at night delivering them. And they call me two in the morning and they're like, why didn't you tell us you're going to be on the cover of the Baltimore sun. This is December 24, 2015. The reason why I'm saying this is because, all right, that's great. You know, feel good story. Then January comes and president Daniels of Hopkins calls my chairman and goes, I'm sitting here with a letter from Congressman Elijah Cummings telling me about medicine for the greater good. You got to tell me what the heck this is. So Congressman Cummings read that newspaper commented, like wrote a letter. We invite him to kick off our symposium and he's like, yeah, I'll be your speaker. By the way, we actually had a symposium speaker already lined up. It was Lena Winn who like now is like, so such a celebrity status, but she was just becoming our health commissioner of Baltimore. And I was like, you know, we're gonna, we're gonna push you back one week to have congressmen coming. So she's like, that's, I just remember I bumped into the Congressman Cummings at like one event several years ago. And I like, I wouldn't hugged him. Like, I mean, his security people were like, who's this guy. And I'm like, I'm sorry. And like, I have like tears miles. I was like, you're the reason you're belief in medicine for the greater good, got every academics attention. Like when people say, how did you get him? Did you start it? I was like, Oh, I just had a congressmen approve it. And I'm like, yeah, I know. Like it's a lot of the right stars lining up. I get, it's a story, sweat and tears. But it's also a story of like people believing your mission outside of your circle. So, yeah. Sorry for rambling. But it's just, to me, it's just such an important story because it's not like one that I could tell someone else to like do just, if you believe in your work, others will believe in it and it's the right thing to do for medicine. Yeah.
Speaker 1:Well, I think that's incredible. And I think that's what drew us to pursuing you as a guest is not very often. Do you find a doctor who dedicates themselves to this more holistic community involvement approach? Yeah. So when we saw that, I was like, we would be so fortunate. So thank you again for joining us today and really commend you for all of the, like you said, blood, sweat, and tears that you've put into this in your, uh, after your day job. Um, and I also wanted to know before we go on, because you're also a published author. You mentioned, um, there's a book series, the person, the doctor you collaborate with, I think in Florida, Dan Hale, you said, um, and the book is called building healthy communities. So I just wanted to make sure it's, um, it's noted for our listeners in case they want to check it out and I I've read some of it, uh, truth be told him I'm not finished, but it was really interesting just to kind of hear the ways that you've kind of really dedicated yourself to integrating in the communities and the positive response that you've received as a result. And so many points kind of resonated talking about, um, a lot of churchgoers, a kind of like an aging population. And maybe sometimes it's harder for them to have access to kind of like basic guidelines on how to take care of themselves. You know, they're not as tech savvy or whatever is younger people like ourselves. So making that connection and it was kind of like a light bulb moment. I was like, Oh, that's such a great idea to connect with, um, that aging population. I'm thinking about my parents and stuff. You know, they go to church and all that. And then also the connection with the trust that church goers put in their pastor or their, their priest or whoever is kind of the leader of the church. And sometimes depending on your experience and your practitioner that you're seeing, you don't necessarily have that report established. So to have that collaboration coming from the doctor, as well as the head of the church together, I think is brilliant.
Speaker 3:I appreciate it, honestly, that brilliant, supposed to my colleague Dan Hale, who he was like, dude, we've been doing this like follow this path. And it actually like writing the book and then like other publications. The reason I emphasize it is because it's one way we can disseminate our message through the channels of academia. But at the same time, like what we try to hint at is recognizing like health disparities are not going to be broken by hospital. When you think of Baltimore, I mean, you've got one of the world's best hospitals of Johns Hopkins planted there, and you still have health disparities, Cleveland clinic in Cleveland, massive health disparities. There it's like a, hospital's got to be part of the solution, but also recognize that it can't be the only solution. And so that's what we try to emphasize in the book, like the more communities and communities, just such a broad term, the reason why we, we choose in this book, a faith based organizations it's because where else do you get a collection of adults gathering weekly with an innate sense of trust and have a great kind of hierarchical leadership ties into your message? Do they disseminate it so well? So thank you for commenting on the book, but it's, from our standpoint, it's important to recognize, like right now we're writing another series for building healthy communities by working with schools. And definitely we'll do a lot with perfect segue. A lot with COVID-19 makes no sense right now, but yes, back back to you guys, sorry, you just, this is,
Speaker 1:That's a great segue. I was just going to say the goal of the podcast is to normalize these discussions that are difficult, you know, about race and racism and anti-racism and those sorts of things. But for me personally, where I'm hoping I can take this as more influencing curriculum and education, you know, as my children get older and start going to big kids, schools, elementary schools within, you know, a big public school district, that's kind of where I'm hoping to be able to kind of influence things surrounding anti-racism. So when I read what you're doing, kind of educating, uh, students at a very young age about COVID and things like that. Could you tell us our listeners a little bit about that initiative that you're doing?
Speaker 3:Oh yes. No happy to. So let me, let me start off with kind of the Genesis of this, right? So I guess there's always a precursor to like what X, what we're doing, why, how we got here, you know, and you know, the value of community engagement from my standpoint. So I'm, I'm an adult and I care for adult patients. So like, while kids are awesome, you know, they're good for them. Like I never, like, it never dawned on me to potentially work with that generation until like one of my colleagues is like, who does a lot of research in the youth specifically around asthma was like, you get all this, we have all this science done. It could really create advocates and its youth group. We should try to create curriculums to work with them. So we reached out to a variety of schools in Baltimore city to scientists, team jurors reached back out to me and we created actually a curriculum intended for seventh and eighth graders. I know it's going to sound like a cheesy name, but it was called the lung health ambassador program. So we wanted to teach the kids about lung disease and what was interesting from the teachers. Cause like, like at this point I was doing community engagement research. I did health disparities research. The teachers were the ones who were like, you just teach wrong health. You gotta teach about the disparities because these kids are Hispanic, Latino, African American. They know they're at risk for asthma COPT you got to tell them why I was like, you got it. Like we're happy to, but it wasn't just a teaching of why. Like we also wanted to emphasize that they can mitigate this. They can stop this one of the big conversation pieces for the lung health ambassador program, not to sound like a broken record or up 60 years of public health messaging, but it was an anti tobacco, right? So we talked about lung anatomy. We talked about certain lung diseases. We introduced them to tobacco, both combustible cigarettes and electronic. And then we talked about advocacy. Like how can you put an end to this? Because tobacco easily helps result in more prevalence of asthma in youth, from parents who smoke. And a lot of minority population smoke, a lot of people of socioeconomic disadvantage smoke. So definitely trying to fight this. So our first year of doing this, uh, I remember vividly cause it was my birthday. We went to Annapolis, the Capitol Maryland. We've got like eighth graders coming with us to advocate to take the smoking age of Maryland from 18 to 21. Great. And what was cool about the curriculum? By the way, the science teachers, we taught it in their science class. English teachers helped us, uh, help the students like write letters to the governor, to advocate for this bill. That's awesome. And the drama teachers taught in public speaking for the future that came with us well, Annapolis. It was awesome. Uh, we have this cool curriculum and we're like, let's repeat it. So 2019, 2020, we're back in the academic. Yeah, here. Now we're really focused a little bit more on e-cigarettes. We're not only in the city, we're in some rural counties, Justin Z we're like hitting on all cylinders. Then March 11th, world health organization declared a pandemic March 13th, which is a Friday. And by the way, our governor of Maryland we're locking down. So all of our efforts now are kind of stopped. But I will say actually, before we get to the curriculum, I apologize for such a tangential conversation, but it's just such important narrative to understand when that happened, March 14th, we get a call from one of the community partner hat, Mark. He calls me he's out of new sung Academy. That's located in sand town, Winchester where the Freddie gray uprising occurred. And he's like this pandemic, it's going to be tough on black communities. When you know, poor individuals in Baltimore city who don't have a trust of the medical system. Now you're telling them to get tested screened and who don't have access to like, you know, a plethora of food items and so forth. And you're telling them to stay home. And that broke my heart actually. So one of the first things we began doing our, we call them community calls to talk about, COVID-19 call us in this number, Mondays and Fridays and community calls. It's probably my, a brief moment of cleverness. Maybe I thought that's clever maybe, but it was like a community call like a telephone, but it's community calls like it's called an action. We would talk about COVID-19 streamlined information and so forth. And then we'll begin happening. Jess and Z, our teachers that we partner with will get on and just say, we need you guys like our kids. Aren't distracted all they want to talk about as a pandemic, but say this because what we built with the pastor program, what we built with that program, we already really had these connections with these teachers. And so we kind of flipped the script a little bit to make it more COVID-19 but we had the kind of same, um, teaching kind of, um, narrative of how we would approach it because we want to finish with some advocacy. It's not just here's one science factor or the other it's what can you do? Right. And got great enjoyment. They liked it, got some attention of some other people at Hopkins where we went in now we're like, let's make a curriculum. We have to, but what else are we going to do? Like kids are going to go back to school in the fall. It's spread this virus as much as an adult can. We've got to do something. So we created a curriculum, 12 lectures with faculty, from the school of education, public health and medicine. We piloted it over the summer at Morehouse school of medicine. And with usher, Raymond's a nonprofit in Atlanta called the Usher's new look well received. And one of our local reporters, we told her about this Abby Isaacs from WMUR. And she's like, Oh, let me run a story. It was like cute. It was a great story and Hopkins tweets it. And then suddenly our inbox, this MGG inbox and medicine for the greater good inbox, by the way, they get like an email, like a week. Some of it mainly spam. We're being like blown up schools from like Hawaii to Alabama, to Rhode Island. Like we need you guys, like, we need this curriculum, um, countries from Panama to, um, Sudan, we're going to be teaching in Sudan. Like they were like, we like, you know, I get, we have this concept of Hopkins, but like, what was clearly a first for the community is can we get a streamline of information that's consistent from experts? Like just tell the kids what's going on. And so what we did, actually, what we did with every single one of these schools is we had these one on one meetings. So they know what they're going to get. And every single school was like, we want you guys in and we've kicked it off. Like right now we were finishing up about a dozen schools in Connecticut. Next week we are going to out in Alabama. And sometime in mid October, we're becoming a mandatory curriculum for Baltimore city public schools. It is. No thank you. But it's so powerful when you talk to action, clearly that is really impressive. It tells you how much the community wants this right to partner with health. They want to promote science. They want to prevent disease. They want to, you know, they want this like Friday morning when our, our leader of the nation went into the hospital, we taught school in Tennessee, in an art class and the lesson there was about the biology of the virus. Right. And we finish off like, how do you think this is kinda barkers? NERC goes, wait, dr. G I don't like, why wasn't he, why will the president bring a face mask? And I'm sitting there, I'm like this kid gets it. Right? And so like from our standpoint, you know, we're going in here just promoting science, that's it. We go over the biology, like the first four lectures over the biology of the virus. It goes over the math of mathematical models. Right? How we talk about, how do we phase in or phase out? We go over the physics of facemask, little John Love. I mean, I could to nerd out on physics in real time. And then we finished it with the chemistry of hand hygiene. That's our first four electrodes. We have eight other ones that goes over from vaccines to how to interpret science, to actually help disparities. So I can tell you, every kid that goes through this curriculum so far where we've had 12 schools out of Connecticut, we have a half a dozen out of Rhode Island so far, and this is all before we even launched in Baltimore city or Alabama or two next big geographic spots. But every single kid gets it. Every single kid finished like one fifth grader, a few weeks back. I was like, when will this set? And I was like, it's going to take a while. But my friend, if everyone does, you know, physical distancing face masking hand hygiene statement was often as you can, this could go away for weeks. And this fifth grader stood up and goes, I'm going to tell everyone I'm sick of this. We got to end it. Now. I'm like, that's the power we want. Like, we're all human beings. We have, we have the ability to have science help us. Right. I get science. That's limitations. Don't get me wrong. I mean, case in point health disparities. Right. But you gotta focus. I mean, when you talk about community engagement, it can't be, we can't be agents. We can't just think, Oh, just adults. Talk to them. Powerful. I mean, I am, if I get it's a bias symbol I'm working with, but if these kids are supposed to give me an insight into the next generation, we're going to be in good hands. These kids are bright, they're intelligent and they get it. And you know what? They are thirsty to do good. And having science as part of their artillery to say, this is how I'm going to think clearly through these problems. Awesome. So, yeah. So that's, I gave you like the background, but you got to know the background cause like, Oh, we just showed up and we're like, Hey, we're doing this
Speaker 1:Nice. That's perfect. Yeah.
Speaker 3:I would say gen Z is community engagement. The one ingredient, if anyone asks like, what's key about it making success as like it's trust. And that, that doesn't happen immediately. It doesn't happen by knocking on the door. I mean, one of my favorite stories is showing up to st. Matthew's or Turner station and Dundalk Baltimore showed up like three consecutive Sundays before the Reverend talked to me invited and he kept them buddy. And he's like, come back. I was like, alright man, but you gotta earn their trust. And it's it. Maybe it sounds simple. Like you just show up for them. That's a lot more than others have done.
Speaker 4:Well, awakened that does it for us today. That was part one of anti-racism in the healthcare setting with dr. G. We hope that you learned a lot today and we hope that too can focus on one important piece. And that is community engagement. We can all do better with recognizing who our council members are, who our state representatives are and senators and reaching out and making a difference. Now isn't really important time to have all of our voices heard as one and individually. So make it happen. And at the end of the day, be you do you for you be safe and be well. And don't forget to reach out to us@infoatawakenedandamerica.com. Take care. Thank you for listening to awakened in America. If you enjoyed today's podcast, be sure to subscribe and leave a review. You can also find us on Instagram at awakened in America. That's awakened underscore underscore America, and remember be mindful, be grateful. And most of all be you.