Awakened in America
Awakened in America
S1 Ep #7 Part 2: Antiracism in Healthcare
Host Z & Host Jess continue their discussion with Dr. Panagis Galiatsatos, asking questions specific to Antiracism in a healthcare setting and his opinion on the Affordable Care Act.
Hi listeners. Welcome back. This is part two of episode seven, addressing the healthcare disparity in the country right now. In part one, you heard dr. Ghali at Santos of Johns Hopkins, introduce himself and describe his passion for bringing together health care professionals and community to address people's needs. It was truly inspiring. And today he will be answering some questions from Z and myself, including his feedback on the affordable care act, which is so timely with the election coming up. And we hope you enjoy your listening
Speaker 2:Awakened in America
Speaker 1:On a journey to create dialogue about diversity, inclusion
Speaker 2:And optimism.
Speaker 1:And actually, we'll just start with a quote of yours from another podcast that I heard you on. I wanted our listeners to hear it because I thought it was a really good summary. You said for those of us who study health equity, it's not a shock, but it is an ethical reckoning. What to make of this for a lot of us is quote, welcome to the conversation we've been having it for decades and a pandemic will sure as heck shine a light on these issues we've been screaming about constantly. So, um, question for you, you know, kind of zooming out a little bit on that. Do you think systemic racial bias in healthcare is actually a public health crisis and not just, yeah,
Speaker 2:But it transcends like racism. Is it transcends? It's not, it's in healthcare, it's in housing, it's in education, it's in transportation. I mean it links them all together. And let me tell you why, like, you know, like, so my, so my research, like I always say like, Hey, you know, I focus on health disparities and how to mitigate it through community engagement and how ever extroverted I may seem. And like, and I love working with the community. I am in my heart and introverted and numbers guy. So I go back and I locked down and I crunch out numbers. I do a lot of geospatial analyses. And the purpose for that is, you know, I can always give validity in the numbers to say, this is why we're doing this. It might seem like we're going out and just doing some blood pressure checks for community, but there's a bigger piece behind us. We're ultimately we do try to align some population health strategies with community health interests to get a public health goal and being a long and critical care doctor. One of my biases, especially seeing it clinically was always around a pathological syndrome called sepsis. You may have heard of sepsis here and there. It sounds horrible. It is. It literally is Greek for glass rotting. Um, and so why a gear to that was because in my clinical practice of a decade of practicing in the intensive care units, minorities, socioeconomic disadvantaged, suffered more sepsis that I could ever see in all substances is you have an infection and then you have this massive cacophony have a responsible immune system that overreacts to the infection relief leading to organ dysfunction, organ failure and death. Sepsis is the number one cause of in hospital death. And number one reason, you're leading an intensive care unit. Well, you're going to have, this is going to COVID. So my interest of sepsis was why am I seeing such racial disparities in it? Why am I seeing such, you know, socioeconomic experience in it? And I began to dive into the literature that's published in short I've actually, you know, my clinical suspicions were reaffirmed by published data. There's some of the earliest studies into the early two thousands said, Hey, this study out of Harvard by dr. Martin published in new England journal medicine, 2003 said, Hey, 1979 to 1999, African Americans develop more and Hispanic Latinos develop more sepsis than their white counterparts. And at younger ages, meaning, you know, the conversation about catching the virus and then developing severe symptoms, kind of two different stories. But yeah, the Venn diagrams overlap a lot, but the question is definitely why do they develop more severe consequences from an infection? And I think the story was always there about sepsis. So I see this because my years at the NIH, I spent studying racial disparities around sepsis and how not just racial disparities that sometimes think race could be more of a surrogate to understand contextual level variables like how the neighborhood can drive. And yet I was plugging out some such similarities. I mean the immunological profile of things like diabetes and high blood pressure, right? Some of the inflammatory markers, there are the same ones that are found in sepsis. So there's an overlap there. So it sounds it's. So to me, it's like having patients where they live in poor conditions, they, you know, the process through their living high stress food, the homicides that are happening, right? This institutional racism that is dictated housing to how violence is constructed in neighborhoods. Suddenly people develop these noncommunicable diseases like diabetes and high blood pressure create this kind of physiology of poverty with this immunological profiling. Then you get an infection you get, I get, but for people with this kind of ravaging over time, it's like the spring has sprung, right? They're broken at this moment. So I say this because when the pandemic was coming and this is another day, this that's like clear my head, you know, February lemon, we were having an ethics meeting. And I, all I could think about, I was like, we're about to have an infection. I've been studying her for the last four years. Like, and if infection hits people of minority races, especially living in socioeconomic disadvantage, guess what? They're going to develop sepsis. And, you know, I just remembered, like not thinking someone called me and I was like, guys, like my mind knows something else. And I just said this, I like, I word vomited out in an academic setting a little unprofessional and get it. But like, hadn't, I may have done a professional curse, which is like, probably I threw the word heck out or something. So yeah, like that my colleagues attentions and then shorten up. I mean, we were seeing this play out in real time, you know, disproportionate impact on African Americans when Hispanic Latinos. And if you, especially, if you were poor ravaging and I was just beside myself, because like, you know, like, think about knowing it's going to happen and you can't change anyone to prevent it. Right. It's like, you know, you can see the tidal wave coming and I could just scream to people, but no one's moving. They're just standing there. And then here it is. No, actually, sorry.
Speaker 1:It was actually just a good point that you made that I wanted to piggyback off of. But, um, you felt so strongly when you saw all of this coming, you know, and it's something you've been studying on, you know, in your free time or however you want to say it anyway. But do you feel like there are other physicians that had the same reaction? Or if not, why not? If it's this public health issue, do you feel like there is support around you in the medical community with people who feel the same way about this glaring health disparity and what it brought to light and in the medical community when Coca hit?
Speaker 2:So yeah, I mean, definitely a lot of other colleagues are within Hopkins. Definitely. Like no one is going to hear the word health disparity and not want to help the challenges and definitely colleagues throughout the nation. I've risen up a colleague that I trained at a den age, Tyson, Bella, the university of Virginia know someone who's risen up like others as well. The challenge there though is, you know, people who want to help with health disparities and bless their hearts. I mean their hearts going in the right direction. But I think the first part people begin to kind of break is realizing I can talk about it. I can run the data and tell you yep. Disparities here, disparities there, but then you're left with, well, what do I do? Pontiac has just described this as a, the physiology of poverty. I can't fix poverty. And so this goes back to my community engagement work, like the reason why I was screaming. Wasn't just because I knew this was coming it's also, cause I knew there was nothing we were going to do to fix it immediately. Like there is nothing to undo decades of institutional racism, plaguing our neighborhoods. And I see this because seeing the community engagement work that I've done and gone into, like I often still leave being like, let's make a difference. Like, because it's still so reactive. Like I'm, I'm I, if it feels like a snail's pace now, knowing we're in a pandemic, but like I'm working with housing units to make them feel responsible for patient's health outcomes. Right? Meaning if their tenants are up to the hospitals over and over again, maybe we should do something differently in the housing units to help them. Right. When I, you know, realizing people can, can get nutrition, like, can we work with people like, like a meals on wheels to deliver nutrition to the doors of our patients. Right? It's so much more complex, but like my goal, my dream would be to have all these other variables feel the weight of health outcomes on them, nutrition, housing. The other part is school is education. Like everyone is in their own silo. Like I'm just focused on in these letter grades and so forth. I'm like, I know, but that, that doesn't lead to help. Like you can't, you would like that. Like if I, if I could have my way with all those work that I've done, I mean now, like what I would say is like, everyone's got to focus on the same goal and just work to see how you can get that through education, through housing. Yeah. We don't have, there's not a niche. There's not like an, a magic solution. Like no one's coming up with a vaccine for health disparities and everything that I see right now is just people bless their hearts. It's in the right place, but it's just actions without commitments. We really mean to put an end to health disparities, it's it can't be a hospital loan. It's part of the solution, but it's not the sole one. So that's where I'm like, if I can get more people involved and that's why this curriculum to me is so important. It was if I can change these kids to understand how they become advocates, like the health disparities lecture. When we go, when we're aiming to going around February, the wind for that talk, I'm hoping these kids are like, man, I gotta do something
Speaker 3:Right. Make choices on their health. And if they don't feel like they're getting what they want and feeling empowered to seek something else out and know how to advocate, learn how to write to senators and Congress people right under start to understand, really understand the process.
Speaker 2:No, Z, Z. I mean like, this is this isn't going to happen overnight. What am I, what am I role models? She was one of our speakers and our, so Prozac Camero Jones out of Atlanta. And she made it clear. She's like the way to, you know, undo institutional racism is just taking a wrecking ball to the current modern societal structure and just destroying it. You gotta rebuild it. I'm like, yeah, no, I know that sounds extreme, but it's true. It's true because everything I'm seeing now, like we're in this pandemic and like, I'm like pulling my hair out when I sit in like administrative conversations, not just at Hopkins. I mean, I'm talking about like everywhere, no knowing no one's coming up with a solution for this. People are just like, let's just, let's just return to where we were. We, we kneeled, we hired more diversity officers. Right. We're good. I'm like, I I've had to place 1000 catheters into people's next in order to say like, I can confidently do this. Like for me, critical care, I one module and you think like, that's enough. I know this. I need a cultural change. You need doctors and healthcare to feel responsible because right now it feels like, it feels like what I felt 10 years ago when I was like wanting to do in the community. I was like, Oh, it's the right thing to do. Yay champion. But like, I was drawn to it cause it like, it was personal to got it. Everyone's got to have this cultural identity shift and it's gotta start from the top down. Like, like, meaning like it can't happen just in medicine. It's got to happen in a kindergartner. So when they become doctors, you already know what's the right thing to do. Right. You can't just start learning to become anti-racist and medical school like that. That's when you were figuring it out, you know, you're behind April. We agree. We agree. Totally. Yeah.
Speaker 3:So, well that was, um, that was a lot to take in, but I'm, I'm thankful that you, um, that you put that out there as a medical professional, as a physician, um, as someone who's also in the community, as someone who has colleagues that are physicians that are dealing with COVID COVID patients, pulmonary care, critical care. Um, I really admire you for stepping up and putting that information out there. Um, because honestly, you know, as a person of color myself, I don't think very many physics. I think you're the first that I've heard say admit to it. That was not a person of color I should say. Um, and, uh, and so I, I hope that more joined the cause. Um, because I think that, like you said, it's true, unfortunately, so much needs to be on done Jess and I have these conversations and, and we've actually said on previous episodes, you know, that this is it's like brainwashing in a sense. And so you have to dismantle years, decades, you know, of, of basically being taught from a child like that one group is better than another group. And then that precipitates all these different ideas that are not true. And then we just, we just kind of, it was kind of like a house with a poor foundation. You just kept stacking the bricks on top, you know, one day it's going to topple over. And I feel like, I feel like now is the topple over point? Like, you know, we say that there's like a trifecta here, you know, between COVID the current administration and, um, you know, George Floyd's murder, like it was a perfect storm for, you know, hopefully for some awakening, for a good segment of the population, there are still, uh, a good segment that, you know, doesn't believe that anything needs to change and doesn't, you know, own up to the fact that things are not right and that something needs to be done about that. So, yeah. I just want to say, I was briefly just gonna mention about the affordable care act and you mentioned on doc talk that health is more complex. It's, it's more holistic. So in your opinion, what effect would eliminating the affordable care act have not only in the 20 million that are already uninsured, but the additional 12 million who have COVID related loss of health insurance in our country.
Speaker 2:I mean, I don't know, like I, sorry. I'm like, I'm a, the dramatic pause is just more cause like, like why take away something that is getting us the conversation to getting healthcare to everyone, right? We're starting, like we believe in education for all. We have a public school system. Yes. I get it. It's an equity issue there too. Cause some is better than others. I get it. But it's there for everyone, right? We have free transportation for everyone. Right? You can drive near these roads. You know, there's not, there's not a, you know, how has healthcare not part of this conversation? It like, to me, this is why this is mind blowing is because if you, if this America's supposed to be America for all right, if we want the best resource America has isn't it's gadgets. It's not it's I don't know, like whatever America puts out comps out it's it's people, right? You can't achieve greatness if you don't have health. Right? So if your main product to the world is the ideas of your citizens, that you better protect those citizens, public education. Great. Get it, transportation, work on it, more housing more quickly, but social healthcare, it needs to be that conversation. So to me, the affordable care act is the, the right thing to do to get it in that right direction. Is it perfect? Well, nothing we do is perfect. It needs more building a more, you know, conversations to have in order to improve it. Yes. But taking it away. That's just to me, that's just saying like, I don't know how to fix it, so I'm going to scrap it and I don't care call it the affordable care act. Great. If you will, if you want to praise Obama. Fantastic. And for those who, but, you know, these are presidents, these are men and women who are going to have their own faults, right? So it's an act of legislation from a person voted by Americans, keep it, don't undo it, keep it and enhance. It definitely needs to happen. Like I'm flabbergasted. When we talk about healthcare, healthcare is meant for all. And I see this because if anyone wants to fight me on this, I'm like America runs on it's people. And if it's people aren't healthy, they're gonna get about America. That's it. You want America to achieve it's own equity,
Speaker 3:Get it citizens to have the health equity they deserve. I agree. I, you know, honestly, as an example, uh, I actually, well, I worked at the Mayo clinic in Arizona and um, you know, I had a patient one time. I think we were discussing cause patients, you know, they're bored, they're sitting there sometimes they don't have anything to do. So they shack up interesting conversation. And I think I had a patient bring up the affordable care act, but at the time, uh, Obama was in the administration. And so a lot of people were saying Obamacare and not necessarily in a positive light, but, um, anyway, so I had the discussion with the patient and you know, I always tried to, you know, kind of walk a thin line because I don't want to, uh, insult the patient and I don't want to offend them either. Um, but the patient was like, yeah, I don't know about this Obamacare things. And I said, well, the way that I look at it is I'm a nurse. You know, I'm taking care of you. And I said, and all the other nurses here, I said, if everyone can't get vaccinated and that affects our health, and if our health is affected, we can't take care of you. So, you know, the way that I was looking at it, even as a medical professional is the health of our country. Like you're saying, if we're running ideas and you know, the, all the advances are based on the product of people, how can we not think that it's important for everyone to be vaccinated? The point is that you have access to it. So how can we talk about everyone doesn't have a right to access to care. I said, because that just makes everyone vulnerable. In my opinion, as a nurse, I said, we have different diseases that are coming back now that we had eradicated previously. And the reason that that's happening is because everyone is not having access to quality health care. So I don't understand myself why that's not a priority. I mean, I see, I think it's, it's a health crisis. It's a public health crisis. And like you said, yes, everyone's concerned about a vaccine because everyone wants to get back to the real world and everything like that. But we should be putting the same effort into figuring out how to correct the system that created this problem in the first place for everyone and puts and puts people of color or, you know, causes the disadvantage or creates the health inequity. Like we should be concerned. Those, those should be top priorities. Um, to think that we can all just get back to the business of life and that, you know, I, I, I don't quite understand it myself. Dr. G I don't
Speaker 2:Know. I don't listen. If we're going to destroy institutional racism that plagues all of us, you know, health disparities is just one of its outcomes. I mean, you have educational disparities, you have housing disappearing, you can't fix one without you have to focus on all of them. It's gotta be equitable. Right. And so, yeah, you're spot like the, to me, the affordable care act is a step in the direction that I wish education till there should be an educational care act, right. Should be a housing care act. All of them need to March together. They're not like we're humans. Right. I create anything perfect first, but it's a gosh darn right attempt. That's what you do. That's the American thing. You take your predecessor that was voted on by Americans and you continue building on it. Like that's America. Like you take something to keep growing it. Like, to me, like my Democrat or Republican, you're both Americans, it's a ying and a yang. Don't divide it like balance each other out move forward. But to me, like if you want one solution of overcoming health disparities really is health for all. I think we talked about that Medicaid example in the beginning, it still breaks my heart because that's such a reaction, like you need to figure out how to keep them healthy so they can just be at their best moving forward or Medicaid can be there as kind of Medicaid should be there for like a last resort, not the resort of the poor. Right. That's the difference.
Speaker 3:Yeah. Hm. Well said doctor. Yeah, I think that's spot on. And that kind of leads into, um, a story that I heard about, um, on NPR recently, it was a Latinex woman and she was speaking about, uh, recently over, I guess, maybe March, April timeframe. She found out that, well, she assumed her mother was going to be diagnosed with Alzheimer's, but she had to, you know, go through the steps. And, you know, she finally goes to the doctor's appointment with her mother and the doctor basically said, yeah, your mother has Alzheimer's, um, you know, Google it. And she said, you know, like the way that the physician told her, it was almost as if, when she learned she was nearsighted. And so, you know, she left with really no tools in the toolbox. And, you know, I could see that or listen that, you know, she felt helpless. And then she said that, you know, she owned her own, tried to get her mother into clinical trials and her mother ended up getting a placebo thought about that. And I said that that happens. So oftentimes, you know, I can even say as a person of color that many times we're spoken to as if we don't know what the doctor is saying, or, um, like we needed broken down into some different language and, you know, there's assumption that we don't read or, you know, we don't educate ourselves or we don't have family members that can even be doctors that, you know, might have some knowledge. And so I just felt like, and then it leads into like the Medicaid thing, because I feel like, um, and communities of color, and not only, but in communities of color where we're talking about these health disparities, there are a lot of people that are using Medicaid and I've heard instances, um, I'm actually in school, I'm getting a doctoral degree, um, a DMP and advanced public health, health nursing, actually.
Speaker 2:Congratulations.
Speaker 3:Thank you. Yes. And I'm so, you know, one of my colleagues had mentioned that, uh, he was in a situation where he was working with a physician and, uh, the surgeon actually didn't want to take Medicaid patients. And they had been approved for, you know, the surgery and everything. And they, they did need the surgery, but it was almost like whoever was like the frontline scheduler wouldn't even send him those patients because they knew that he would have refused them. And so there's nurses saying how he basically tried to like backdoor it some kind of way and slip the patients and, you know, some other kind of way. And at one point he did succeed and the doctor was like, how did this patient get through? Cause I was a Medicaid patient. And so, um, you know, I'm like, uh, so how our doctors like incentivize or de-incentivize to help Medicaid patients, is that, is that not a barrier to this problem?
Speaker 2:So, I mean, all of it is, I mean, you know, like, and every hospital has a different kind of way of how it gets paid and reimbursed. And every state gets to be governed a little bit differently. Maryland's different from say others and so forth. But I mean, it's spot on like, and again, but like, you know, needing to have to get to that level of Medicaid. I mean, like, we got to like what drives a population to me that like, we got to go to the roots. Right? Right. Like, yes, let's react in real time. First of all, like figure out a better payer system. So everyone gets healthcare and then let's go back to the Genesis. You know, that's what, like for me to break institutional racism, we can't sit here. You know, he can't sit kind of like holding a bucket to toss out a flood. You know, we got to go to the root of the flood. And so you're spot on. I mean, we got to change incentivizations we got to change the payment system. I get it. But that's a bandaid onto the flood, right? Like we need to go further back. And this is what I'm alluded to it like that doctor is acting, you know, people can sit back and say, he's acting out of institutional racism. He himself may not say like, I'm racist. Do I just want to get compensated for my work? I'm like we understand, but the actions aren't in accordance with institutional racism, right. So you got to take it back from that and keep going back. But at the end of the day to defeat institutional racism, we can wound it with some reactions in the short term, or we can kill it off by getting everyone together, feeling accountable. Cause to me like Medicaid, you know, that's an, that's a outcome of, you know, just putting people in a disadvantage to begin with. Right, right. Like I get it's purpose and I love it. But if you keep putting people at an, a disadvantage, like go back, like it's not there. It's not a community's fault to me. What I've learned is that it's never community's fault. If you're not giving them the resources they need, like you're going to get the outcomes of that. So my like my, my narrative is that of a son of immigrants. Right. I, you know, to me, coming to America is different than my colleagues of African American ancestry. I get it. And while I can't have that history or that narrative, and I have my own, we can still walk together because this is a concept of America. That's me, isn't an ethnicity. I think it's an idea. And if it's not a dream that we can all achieve together and we get to figure out what the heck these barriers are that are keeping us from that we've got to demolish it. Cause like America should be this land. I was told you as a kid right. Of opportunity. But I shouldn't have to look at someone and say, well, because of their color, I know they're not going to get the same opportunity as me. That's like, we're human. That's it like my XE, that story breaks my heart. And there's so many ways to combat it. And it's easy probably to blame the surgeon immediately. But that surgeons acting in accordance of a system that allows this and you gotta, you gotta take it all the way back. I mean, you've got to kill it all the way, you know, to me, like, I love that we have Medicaid, but that's still a reaction we've got to figure out why, you know, going all the way to the back to the basis of it. So, you know, one answer to this, my answer to fix health disparities is to take a wrecking ball and destroy the social constructs we have now that allow for institutional racism to exist because I'm seeing this pandemic do what it's doing salt back in spring breaks our hearts. And you know what, it's October, same populations are being ravaged. Clearly we haven't done anything to expect us. We would have done something. I mean, we're trying to figure out a vaccine in an expedited fashion and no one's having a sense of urgency with fixing health disparities. So, you know what, here's another last, last point. I don't have a, it's your last part? I can say as many points as you guys want. My other goal, by the way, another goal of mine is always to try to like plug and held. The spirit is where we can have these conversations was what I feel like is going to be just easier is if you just have millions of people understanding that and grow into your profession or that, you know what, let's take out the old bring in the new that's my bias of teaching the youth is also like, man, if we can come to this idea of science, supplemental social justice, that's what I said earlier.
Speaker 1:Yeah. We're aligned with that. I mean, I think educating on anti-racism in all of its forms and fashions at a young age is what's hopefully going to really make a big difference, you know? And in the meantime, this has been a really humbling, ugly period in our country's history. You know? And I think like you said, the accountability piece is huge and acknowledgement that we have problems that go really, really deep and being willing to accept that and educate ourselves. I'm talking about myself and my fellow white people to learn more about why this is here and, um, ways that we can change and start influencing those closest to us and starting there as a, as a starting point.
Speaker 2:Yeah.
Speaker 3:You know, it's funny, you mentioned about the trust building earlier that the Digi, you had a study out with the congregations and I think on doc talk, you mentioned how you were able to vaccinate like 300 people in two months, which is like remarkable. I mean, that's really remarkable. And you know, it made me think about, you know, what's going to happen when this vaccine comes up because I can already tell you that black people will not be lining up. I mean, I'm sorry to say that I'm only one of many, but based on, you know, historical context, it's, it's, it's not, it's just not going to happen right away. And so, and I think I heard and you can correct me if I'm wrong since, um, since you're a doctor, but I heard that we have to reach like, at least like 95% or so in order to achieve herd immunity, something along those lines, I'm not sure.
Speaker 2:No. So you're, first of all, like you're spot on community engagement. It has to, you know, I try to preach it. It has to take it. Yeah. Respect like these things, your kindergarten teacher taught you, right? Like your respect, the nice grassroots approach, listen to them. But you also have to take it into a social historical context. You can't go in there just thinking like new chapter. No, there's, there's tons of old. So I agree with you Z. Like I know. So I've been recruited to help with a vaccine trial out of Johns Hopkins solely for like, Hey, dr. G can you help us with the community? I was like, I mean, I can, I can put you in a position to talk to them about the vaccines, but not like some magical shaman who can like get them to come and get it. And they're like, Oh, well, I thought they listened to. I was like, no, I listened to that. That's what I do. I go into the, listen to that. But like, you know, look, if people don't want the vaccine, like I it's up to them and you're right. I mean, Madison's public trust has been broken countless times for the same populations that are being ravaged by Kobe. I go right now, the vaccine trial is I want these populations to at least be aware of it, hear about it and let them turn it down fine. Or if they say you're like, you know what? New chapter I'll work with you guys fine. But I don't know what that did not hear them. I don't want them to be so, you know, people to be so turned off like, well, they're going to say no anyway. I'm like, no, you go in, treat a human talk to them, let them yell at us. They should. Why not? I mean, we're representing something that they don't trust. You know, there's nothing wrong with that. And together we can come together. You know, so many people get uncomfortable because they feel like I don't want to get yelled at for things, people before me to it, but that's not how it works. You know? Like the, when I started medicine for the greater good, I was offered to make it its own nonprofit, leave Hopkins leave. I can start it. I was like, no, I'm going to sit with Hopkins because it's got to rewrite a new chapter and that's it. It's got tons of resources. What do you think I'm going to give this up? Like, let it restart a whole new chapter together and come at this. And the same thing with the vaccines, like from my standpoint, like we need to figure out how in real time to work the population, the bullshit and be, can we get them to be vaccinated? The goal should be, can we earn their trust to can say no to the vaccine fight? And I get it, it's going to break my heart. But at least we're writing something. At least they can walk away saying like, but they came and talked to us, right. That's an instant in the right direction.
Speaker 1:You know, for those of us like myself, again, admittedly, a lot of this I've been blind to for a long time, the systemic racism and it's many ways, you know, the way that it's, um, kind of penetrated society here. But if you don't take our word for it, there's some really sad and startling examples that I came across when I was kind of doing some Googling before we spoke. And I'm sure you're familiar. Doctor G and Z and now myself. Um, the Tuskegee study of untreated syphilis in the Negro male is what the study was called. And it was a 40 year experiment between 1932 and 1972. What I found even more troubling was it was actually run by the public health service. Um, and so for any listeners that aren't familiar with, it basically it's, it followed 600, 600, excuse me, rule black men in Alabama with syphilis over the course of their lives, refusing to tell patients their diagnosis, refusing to treat them for the debilitating disease and then actively denying them a treatment in some cases. And that was all taken from, uh, another article recently in the Atlantic. Um, and then, you know, taking it a step further, I was reading about kind of the implications that, that has on trust. And once the study itself came to light, you know, I guess it was probably in the mid seventies or something like that. Um, I can't imagine they have it that that would Regan the minority community when you realize your health was disregarded in such a way over such a long time, you know, and something that is, I think now pretty, you know, it could have been prevented and treatable, correct me if I'm wrong. Obviously I'm no medical background, but, um, you know, the family is affected by that health wise, but also mentally just the trust that was broken there. And, um, you know, fortunately that was in 72 when the study was ended. But yeah, unfortunately there are more current examples like 1998. Um, this was something XE actually sent me. It was probably in the New York times, there was, um, federal research, ethics officials investigating several psychiatric experiments in which 100 New York city boys, many of them black or Hispanic were given the now banned Daya drug fenfluramine. Um, so again, you know, this is stuff that's happening. This is the reason yeah. You know, there's this, this broken trust. Um, some of the reasons, anyway, I should say, and then finally, another, just one last step for people new to this conversation like myself, the Washington post in July published an article talking about African American children as a mother of young children, myself. This one really, uh, struck a nerve for me. Um, African American children are three times more likely than their white peers to die after surgery, despite arriving at hospitals without serious underlying conditions. Um, so that, you know, the way I read that is you're taking an apples to apples comparison. Neither child had underlying conditions. Why is this happening? And then, you know, for women that are pregnant, even black and native American women are three times as likely as white women to die in prison and see, um, so obviously that's all very heavy and, um, even repeating it now, it's kind of unbelievable to be in 2020 and yeah. Have this sort of disparity. Um, so anyway, I was just gonna kind of turn this into a question here. So in light of this lack of trust and disparity in the statistics between white people and people of color, um, I was curious, dr. G if you have any times you can recall when you have been vocally anti-racist in a workplace setting. I know you do all of this fantastic work, um, you know, with the organizations you're involved in, but I guess, you know, can you, can you actually think of examples or ways if any of your medical colleagues are in situations where they kind of observe something that is being influenced by implicit bias or racist ways that they could kind of like step in and kind of change the course of action for that patient? Yeah, no, I mean,
Speaker 2:I can give you my even, you know, so it goes a little bit of both ways to both, um, you know, for a healthcare professionals, towards patients and patients towards healthcare professionals. My, the ones oftentimes directed to me is when I come in, cause keep in mind, like for new patients, all they saw was my name. So here I come in now I've gotten darker, like a patient would be like, Oh, you're a white doctor. Thank God. Alright. We got some education to do. Or my other favorite one is like, Oh, you speak English. I'm like, all right, good. So I say this because the implicit bias is, again, it's not a unique variable to medicine, but there's definitely learning opportunities, right? Because for, from a patient standpoint, yeah. You know what? We have ways to kind of make sure that, you know, we can, you know, redirect that, like I'm not going to undo that implicit bias in that patient immediately, but I can at least begin the conversation moving forward. Because if it's not me, it's gonna be someone else next time. And then for patients, yeah, we see this oftentimes, I mean like the Tuskegee, like that's horrible. There's other more cause that that's extremely easy to fix or you can fix them within the system. But to me, the bigger concern is like the ones that are in the gray area that actually feed a lot of institutional racism, feed a lot of implicit bias that we're like, is it really? Or is it not? No, no, it is. It's just so muddied in the water. And so entangled in our kind of everyday activities that we just for, not that forget, like, you know, we, we just don't recognize it anymore. And so from my standpoint, it goes back to what MDGs goal was to, to no longer do equal plans for patients, but to do equitable ones. Listen to me, here's a subtle one that you both doctors never probably think of. Like, you know, patient comes in, we're diagnosing them with a new noncommunicable disease and all that means it's non-communicable meaning it doesn't communicate. Meaning like, I can't give you my cancer. I can't give you my high blood pressure. My diabetes communicable could be like, yeah, I can give you my Cogan, come in. And it's like, alright, well, we're going to start you on this drug and I want you to eat better. And I hear you. I'm going to print out this list off the CDC of all these fine fruits and vegetables. You should be eating. And I want you to exercise. Here's another page I'm printing from the CDC 30 minutes a day, and that's hindered the patient right off the bag. You might say like, whatever, every doctor tells you to eat better, go get a medicine. That to me is, and then I want to pick this example up because again, extremes obvious we can, we can center something around it, but these are the ones that are happening every day. And these are feeding into an implicit bias. Cause that patient leaves and it'd be live in Sandtown, Baltimore, Lincoln name, keep coming up there and be like, that person doesn't know me. They don't know where I'm coming from. They don't know that I'm like, where am I supposed to find these? You're looking at their sheet. Like I can find packs of cigarettes faster. They're gonna find a banana. I was like, what are you doing? You want me to exercise? My brother was just shot on the corner. Where am I going to go exercise? You know what I mean? Like that's the implicit bias that's happening. And after them, I know the patient comes in, who lives in Roland park, Roland park, meeting incomes like$120,000 in Baltimore. You tell them the same stuff. They're like, I can do this. I'll go to the mom's grocery store around the corner. I can park. I can go and walk out. You know, I'm going to make these changes on. My doctor told me I got this. I'm going to conquer it. Or the other person's feeling defeated. Like I don't have an environment. That's gonna allow me to do this. And we talk about like those examples, just so you gain, we shouldn't forget them. You know, they're frightening. The, my concern that we have now is that we have the subtleness and implicit bias that we don't even know what it is when you call it out. You're like maybe I should have asked them where their grocery store is. Like one of my earliest examples. It's something that I reflected on from a Ted talk just still in life. I remember my earliest community engagements. We went to sacred heart of Jesus in Baltimore city, the cathedral Highland town. But this is like for the Hispanic, Latino community. Like this is a massive church. It was first with Germans, then Polish and now Hispanic, Latino. And we held a, we held like a health fair there and we brought fruits and vegetables. Right. We have three mammograms. The mammograms is like, what I've talked about before. And your other one was the fruits and vegetables, fruits, fruits, and vegetables, and no one left with. And I just remember like that same meeting that we talked about, why people didn't want to get mammograms. Cause they didn't want to become patients. Cause they were like, who would look after us? But if we're in vegetables, that was also Charlotte's
Speaker 1:Illuminating. When you said that the people said they didn't want to become patients. That was why they chose not to have a mammogram. Right.
Speaker 2:Cause they were like, who, who would follow it? Like I wouldn't break my bank. Like I'd rather just die of ignorance. Then become a patient. Cause it's just more draining. But the food conversation. Yeah. I just remember like thinking like, do I bring it up for this Ted talk or not? But let me bring it up here because the food conversation, I remember they were telling us, they're like a lot of people don't have running water. They don't have an oven to cookies things in, where are they supposed to store it like that didn't even occur to me. I'll be like gathered pounds and pounds of pounds of fruits and vegetables, you know, were making an implicit bias that people have the means to care for this. I remember a patient who was like, I'm not going to change the way I eat. It was, I'm working three jobs right now. I'm I have to work three jobs for four days to pay for your clinic bill and you know what? I get home. I'm tired. Last thing I'm going to do is go cook a healthy meal. I'm going to grab a McDonald's it's convenient. It's there. I eat it within a few seconds and I could just go to sleep for my next job the next morning. I can't fault someone for that. So yeah, when you just, all the examples you gave, I listen, those are important. But I think that for me, the big picture is what goes under the radar that allows us to still continue this implicit bicycles, this subtleness, the seriousness of this, these actions allow for bigger scale things like the physician. Who's like, I don't want to take Medicaid to him. How's that different than me saying yeah, eat fruits and vegetables. So someone who's like, I don't know where the hell I live. Sorry. I don't know where the head high, but
Speaker 1:You answered the question perfectly. Yeah, no, I think, um, it's, you know, this is such a intertwined topic. I feel like it doesn't matter what we're trying to hone in on. It all comes back to the, you know, many nuances and things that are all happening because of systemic racism. But I think what I took from that is, you know, the importance of the connection, taking an interest in the cause, you know, of making things equitable and putting biases aside and really considering the person and the environment that they're in and treating them accordingly, you know, and we would be in a lot better position if, if more doctors were like you, I think, um, and you really kind of connected a lot of dots, at least for me in this big, you know, problem that we have happening and tied it back to what you do and the amazing work that you do. And I just want to say thank you again for spending this time with us and giving us such straightforward and um, really, Oh yeah. Illuminating feedback that I think hopefully it will resonate with a lot of listeners and um, usually we try to end with something positive. So since we have spoken so much about the importance of health, I'm going to quote my own grandfather. He used to say health as wealth. And I hope everybody out there that's listening is wearing a mask. That's all I've got. How about you Z or dr. G, anything else you want to close with? Be safe, be well.
Speaker 2:Yeah. And I love that you guys perfect. And from my standpoint, you know, there's nothing more American than wanting the best for ourselves and our families and recognize that we can only get that if we all work together, that's it
Speaker 4:Listening to awakened and America, if you enjoy 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 in underscore America and remember be mindful, be grateful. And most of all be you.