Episode 5-Vot-ER

Transcript

0:00

Welcome to Pulse Check, Wisconsin.

Chris : 0:27

Yo, welcome back. How's everybody doing? I hope you're doing well. I hope this podcast reaches you doing well in your life and in your health. This is Chris Ford. I'm an emergency medicine doctor here in Milwaukee, and I also practice throughout the state of Wisconsin. For those of you who are new to the podcast. For those of you who are joining us again, thanks so much for joining us for now our fifth episode. We're up and running. Our last episode was with Governor Evers, so if you missed that episode, feel free to go back. We covered a topic that affects everyone's health. In the state of Wisconsin, which is the impending nursing shortage that we have had in the state of Wisconsin and that we are estimated to have worsen in the upcoming years. So if you haven't had an opportunity, feel free to go back and check that out. Feel free to check out. Dr. Jeanette Kowalik's interview, who was our former Milwaukee health commissioner, who provided some real good insight into what was going on during the pandemic, as well as gave some insight from a first person perspective to autoimmune diseases and how that affects your health from her own perspective in navigating the healthcare arena. And in our very first episode we had a very special guest that came along with us. Amanda DeLeon from Community Medical Services, who gave us some very good insight into what resources are available through the community for folks who suffer from opioid use disorder as well as addictive disorders in general. So feel free to go back to listen to all those, which will be available to you at all times. The website will be available for any resources that were mentioned in the show notes. And if you need any additional resources, again, feel free to reach out to me via the website or via social media as well today, we have a jam packed episode filled with our traditional case, which will highlight some of the things that we will discuss with our experts. So with that being said, we'll go ahead and start with our first case. So it's a Tuesday afternoon and I get an EMS call that there is a 54 year old male who is coming in that is a bit uncooperative. He's screaming out in pain. As soon as the patient arrives, the patient appears to be in a tremendous amount of pain. He is crying and is holding his left eye. The patient is unable to provide any significant report. As to what happened, EMS is able to tell us that the patient works as an auto mechanic. He was grinding the rim of a car wheel on Sunday and he began to have some worsening eye pain throughout the weekend and into the week. He called EMS because he was in so much pain and he didn't know what else to do at this time. On my examination of the patient, I was able to calm him just by talking him through the process and tell him what we're going to do next. The patient was unable to allow me to take a look in the eye. Just in taking a look at the eye with the eyelid closed, I didn't see any signs of any bleeding. There's no signs of any trauma to the eyelid itself. As such, after I got some history from the patient, telling me that he had no history of glaucoma, no history of any trauma otherwise, I felt it appropriate to give him some numbing eye drops that In other cases, could be damaging to the eye itself, but in this case, it seems as though it was appropriate to do. So I gave the patient a couple drops of Proparacaine in the left eye, and after I was able to do this, the patient's eye felt better. He was able to open an eye, and I was able to get a good assessment of the eye itself. What I was able to see was that the pupil, which is normally circular, looks to be intact. There was no, as we call it, irregularity or any change in the shape of the pupil itself, the patient's photophobia, meaning his pain associated with the light exposure had resolved. His vision was intact he had 20 40 vision in both eyes, and together 20 40 vision as well. And so, with his eye now being in less pain, I was able to do a slit lamp examination where we use some special equipment to take a look at the cornea to see if there's anything that is embedded in the cornea or any sign of trauma. By staining the eye and using the slit lamp, I was able to see that the patient had what we call an inclusion or what appeared to be a small piece of metal at the six o'clock position of the cornea itself, and surrounding that metal piece was what we call a rust ring, which can be damaging for the eye and cause some permanent visual disturbances if not removed Even with the patient's pain under control, during that examination with the slit lamp, the patient was unable to sit still for too long. The patient was able to cooperate somewhat with the examination, but certainly would not be able to sit still for long enough. With the equipment that I had in the emergency department I was working with at the time to try to remove the rust ring and the foreign body with a needle. Fortunately, at this emergency department, we are able to get a hold of ophthalmologists who are on call relatively throughout the day, especially during clinic hours, in hopes to have patients such as this who are more emergently presenting and need a potentially vision saving procedure. We're able to get them to that clinic relatively quickly. So I get on the phone with the ophthalmologist and the ophthalmologist is in my camp of we need to get this patient to my clinic as soon as possible today. Unfortunately, I'm not working in Milwaukee. I'm going to have to have him come out to my clinic, which is in Waukesha. She's able to fit that patient in today, but she would need him to get there immediately. I go back in the patient's room and I float this plan to him and implore him that in order to save the vision in his eye, he's gonna have to get out to this clinic as it's the only clinic that's gonna be available to him within our network to get to. I asked the patient about transportation because sometimes at this particular emergency department As a lot of patients don't have cars or have a way to get out to some of these far clinics. The patient unfortunately tells me at this time he's unable to get to the clinic out In Waukesha because he doesn't have a car. And he's not certain as to how to get out there with the buses that run that way. Especially with this eye pain that is starting to come back at this time. As such, I reach out to our amazing social workers who are able to talk to medical transport, as well as our Lyft services available at the hospital to attempt to get the patient to the Waukesha office. I get a call from the ophthalmologist about an hour and a half into this presentation who's asking me where the patient is. And I inform her that this patient has no way to get to the clinic at this time and that we're working as hard as we can. The ophthalmologist is understanding. About two and a half hours into the visit, we're finally able to get the patient a ride situated. and the patient is able to go to the ophthalmology clinic and have the foreign body as well as the corneal rust ring removed. As of my last assessment of the patient's chart, the patient's pain had resolved and his vision is back to baseline. There's a couple things that we can take from this case. First off, with regards to the medicine itself, the patient had a piece of the metal that implanted into his cornea. We see this often, and it's very painful when you have these corneal abrasions or scrapes to the cornea, as well as corneal foreign bodies. The cornea itself is about 0. 5 millimeters thick. It has five layers in it from the outer to inner layer. And so fortunately this metal foreign object was not large enough and it did not come off with enough force to cause any trauma or any piercing of the globe of the eye. But, again, it's something that can certainly cause some loss of visual acuity over time. Corneal rust rings, or a hue that is around that object, occur commonly when a metallic foreign body becomes embedded in the cornea, and again, removal of that rust ring is paramount in preventing permanent staining of the cornea. or inflammation or again, just loss of vision in that eye in order to remove these foreign bodies what we need to do is we often can remove some foreign bodies in the emergency department., We usually will use a very small gauge needle to try to get that out. However, Again, in order to avoid any significant trauma to the globe, what we want to do is we need to make sure that patients are able to tolerate that. So that means that patients who are younger, so small children those patients, usually are not a good candidate without any sedation to remove that foreign body. Because again, we don't want to cause more damage to the eye. In addition, patients who are confused or uncooperative for one reason or the other. And again, pain can be a big part of this. We want to make sure that again, we're are doing this procedure in the best of situations. Commonly, again, we can remove them. I usually will remove some foreign bodies out of the eye with the exception of the aforementioned, but in his case, I felt better to have this foreign body removed at the ophthalmologist's office, because, again, I wanted to not only remove that foreign body, but also remove the rust ring, which again can cause some significant damage to the eye as soon as possible, because we had already been a couple days out, and it's usually recommended that These foreign bodies are removed immediately if possible. I want to plug and do a PSA here. So if you are using any form of grinders, if you are using any form of torches, you always want to make sure that you are wearing protective eyewear this gentleman was a mechanic. He had been doing this for years, but he mentioned himself that he wanted to use his protective lenses and protective goggles, but he couldn't find them. And so he knew that this was a potential that could happen, but a lot of folks don't. So, especially if you're a weekend warrior, like I am doing stuff around the house, you always want to make sure that you are wearing Protective eyewear, and that's eyewear that covers the entirety of the eye, not glasses, but some shop goggles, if available. Again, for anyone who uses Torches or if you're doing any welding you want to make sure that you are using protective eyewear specific for that We don't see foreign bodies as much with welding, but we also will see some burns with the light and the heat associated with welding So you want to make sure you do that. It presents very similarly patients are in excruciating amounts of pain So make sure that you're wearing your protective shields or your protective goggles at that time as well. Now getting to the external factors associated with this case, it's one of the things that I wanted to bring our experts on about because this case covers largely of how your environment or how your surroundings can affect your health. This gentleman did not have access to transportation that he could use himself to get himself out to the other clinic, which in a lot of locations, that's not an issue, but for the majority of people in Milwaukee, that is an issue for you if you don't have your own private vehicle. The patient did not know how to navigate the bus system out to a clinic, which was far away. What we've seen over the last several years is the removal of resources from the inner city communities. Some of that is in health care, and what we see is the creation of health care deserts, as we say, or areas of the population that don't have some of the specialty care, such as an ophthalmologist that can perform these procedures. We're very fortunate at the hospital that I was working at to have on call ophthalmologists, because a lot of ERs, especially the private community ERs, don't have that capability. But again, for some patients who need these treatments, it may not be something that's feasible for them to get to if they don't have a way to get there. Even for us in the emergency department, having the resources with medical transport, having the resources with Lyft provided through the hospital system, as well as having social workers who do a tremendous job in all of our ERs to help our patients bridge the gap between those disparities to help them in those situations in which they present to us in the emergency department and need to find a way to definitive treatment or find a way to primary care doctors. And so that's where the next topic hits home in which having more civic. Engagement, having more say in your representation at the state level, at the community level, at the ward level, etc. That is going to help communities overall. That's going to help prevent some of these healthcare deserts. help prevent some of these lapses in resources available to you. Now voting in general is not going to change everything overnight, but politics and government involvement Is something that will affect you local politics more so affects your day to day affects things that are going on in your community, your garbage pickup, your police, your fire, EMS, all those things are going to be a part of your civic engagement. And so, with that being said, I wanted to introduce our experts that are coming on to discuss a program that they've created. In order to help bridge that gap. We know that the power of voting and the power of equal representation at the state level really feeds into the overall health of the patients that we see day in and day out in the emergency department, as well as in the hospital systems. Research shows that in our communities that are healthier, typically they're healthier because more voters can participate in a democratic process. They have representation that truly represents them at the state levels as well, states with more inclusive voting policies and higher civic participation, usually have a better health outcome and those participation rates that are identified. The broad reach within the healthcare system combined with the roles of doctors and nurses and social workers, et cetera make healthcare an ideal arena for the civic engagement that is seen in our patients and to engage voters. This is the perfect scenario to do so. Because of that one of my colleagues in emergency medicine, his name is Dr. Alistair Martin, created a program that was started initially as a pilot program in Massachusetts General Hospital in 2019. And what Dr. Martin did was he founded this group in order to create an avenue in which he could care for his patients through A means beyond just the medical care that he could provide 1 at a time. He found a vote ER because he believed that in taking that powerful step of voting and by providing avenues for patients to register to ensure that they are registered to vote can. Ultimately change their health care outcomes and so I wanted to invite some representatives from VotER to come on and to discuss the program. We were very thankful to have them on the information that we get was invaluable. So, with that being said, I want to introduce our colleagues from VotER here is the interview all right. Well, thank you guys for coming out today. I want to get into kind of who you are a little bit more explain a little bit in the intro before this interview, just about what VotE R is, but before we get into all of that, I just wanted to just start off and ask what are all your names and what are your current roles within VotE R?

Aliya: 19:17

Chris, it's so good to see you. I'm Aliya Bhatia, and I'm Vote ER's executive director.

Emani: 19:23

Hi, Chris. I am Emani Lee, and I am the Wisconsin State Organizer.

Marin: 19:29

Hey, Chris. Thanks for having me. Uh, it feels like just yesterday that we were working together at UW. Um, but I'm Marin Darcy. I am an emergency medicine and critical care, um, physician at the University of Wisconsin.

Chris : 19:44

Well, again, thanks so much Excited to get into it. Can you explain to us what vote ER is and what role it plays specifically in the community?

Aliya: 19:51

Vote ER is a nonpartisan organization founded by an ER doctor who realized that the best way to holistically help his patients, uh, was to improve their overall health by looking outside of the clinic walls. And make sure that we can impact people's surroundings and the social determinants of health. And as a result, VotE R is in 700 institutions worldwide, nationwide, including in Wisconsin. Um, one of my favorite stories about VotE R comes from a doctor in our VotE R community who was writing a prescription for a patient's asthma. And at the end of the patient's visit, he asked her if she was registered to vote. She didn't understand why, uh, and he explained that he could prescribe her all the inhalers in the world. but only civic engagement was going to lead to improving the air quality where she lived. Whether it's a story about inhalers, or the opioid epidemic, or reproductive health, or the affordability of care, it is increasingly clear that healthcare professionals can have an even more influential role in healing our communities and healing our democracy. And it turns out that 60 percent of those who are registered to, not registered to vote, say they have never been asked. Bodiar makes it easy and fun to support our patients to ensure their voices are heard in the local and national elections on the very policies that shape their health outcomes.

Chris : 21:07

Awesome.

Marin: 21:07

Um, and, and I can, um, sort of speak to what, what vote ER is. And so, my story, I, um, I was telling Emani when we, when we met, earlier this year, sort of, Why I was compelled to work with ER, why I was called to this work. And I grew up in rural southeastern Wisconsin. I like to say I'm from the Lake Geneva area, but technically I'm from Genoa City, which is It's about a town of 2, 000 people, and, I always sort of felt, like a, a privileged person. I was able to, go to Notre Dame, I, um, met my husband in Chicago in medical school, we couples matched and ended up at UNC Chapel Hill, and again, still felt like I had this, like, privileged, dazzling life. It was when I was actually a third year. I was, it was my chief year. And I hadn't gotten home to see my family in about six months. So I came back maybe June or July and hadn't seen my family since Christmas. And I was shocked to see, that my dad had lost maybe 30, 40 pounds, since I had last seen him. And I was like, Dad, what's going on? Like, Like you've lost so much weight and he was just like, Oh, I've, I've got a bad gallbladder and, this was in the context of the, recession that we had, that started in 2008. My mom, um, always worked in the real estate industry and obviously there, there were really hard times in that field. So she got laid off of her job, maybe 20 years. And she kept getting rehired at new places, but she was the last one hired, the first one laid off again. And my parents went without health care for a few years. So anyway, I told my dad, like let's just go to the ER. Let's, let's figure out sort of what's going on because I knew he didn't have any other access to care. And we were pretty stunned to find out that he had stage four colorectal cancer. And despite attempts at palliative chemotherapy, he, he, Essentially died within five months and as a physician who's lost their loved one to a preventable disease due to lack of access to care, like, I, I can't describe to you how to the doctor, but I can't describe to you how just how, how much that hurts the soul. And I would see just sort of the same story again and again in my day to day life working in the ED down in North Carolina. And so it was like the stars aligned, honestly when I met, you know Alistair through Azita Hamadani, our chair at the time, in January of 2020, and he told me about his program to invite folks in the ED while they're waiting for care to register to vote, and it, it gave me this, like, overwhelming desire to do something to fix the system, it gave me an outlet for it, and so Vote ER has, you know, a special place in my heart. And now I'm, I was one of the early partners. I did the civil health fellowship. And now I, I sort of fancy myself like a unofficial advisor. But I, I'm so excited to that you're highlighting the work of this organization.

Chris : 24:33

Absolutely. And thanks so much for sharing. Marin you know, I find that in Each one of these interviews that we do in each episode, you know, each individual that I have come to interview has this personal connection to the work that they do. And, you know, even more so in our field, emergency medicine, you see folks who have been there and have walked in those steps and it, it makes it more tangible for you and it makes work like this. So, You know, invaluable that you can proceed and, you know, kind of put yourself in the position, having that experience with your father and, you know, trying to make the system better from within is, is just, you know, I commend you as a friend and also as a, as a, as a colleague too. So. Emani, I had a quick question. So Wisconsin is typically seen as a political litmus test. So, and by that we say, given how diverse our populations are, um, in upcoming episodes, we'll kind of talk about what communities of interest are and how we consider that in terms of voting makeup, as well as in, redistricting. But Wisconsin is a truly purple state in that respect. Why are initiatives such as VotER are so particularly important in states with similar makeup like Wisconsin?

Emani: 25:43

Yeah, and I know you said quick questions, so I'm going to try to give you the quickest answer to that. So to me, when we visualize American culture, right, you can immediately picture like farmlands, diverse big cities, so many music scenes, and like really intense state fair food. But, you know, then that picture starts getting dark and you're reminded of all the ways that American culture is dangerous and desolate. Um, Wisconsin, like Michigan, is one of the only places where that level of abandonment and manufacturing and agriculture just lingers for miles. And I grew up on the north side. You see it only on the north side. And With the limited access of a thriving workforce stunts communities like they're already living in health systems that they can't afford so folks end up developing resilience that makes something like a trip to the doctor the last resort when you factor the cost of care, transportation, wait times due to shortages, all on top of society's problems just sitting right next to you in the waiting room and. Honestly, I feel like I can personally speak on this given my own experience with Wisconsin's healthcare system. So I actually had an extremely unorthodox entry to life saving care. That was the result of a police mandated hospitalization and contested parking tickets. And as odd as it sounds, I was literally lucky that Milwaukee police found me because compared to folks living up in Lac du Flambeau, it's like, They wanted affordable said treatment, they would have to face criminal charges in exchange for sentencing. So, you know, after I got discharged, I spent months on waiting lists to qualify for therapy. And, you know, after a while, like I just gave up. But my saving grace was when I contested parking tickets because Like, they just love college students. And, uh, yeah, they do. And I requested community service. So I had a court advocate through Justice Point, and it's so sad that that program no longer exists at the, uh, Milwaukee Courthouse. But my court advocate got my documented health history approved by a judge for cognitive behavioral intervention and lib citation payments. So because of that, I had a therapist. for a full year and honestly, I'll just like never forget what it felt like to be an adult and to feel safe. Um, you know, for, for once I could say. So, limited access to care is just a major issue in both rural Wisconsin, like where Marin is from, and urban Wisconsin, you know, where I'm from Milwaukee. Yet neither side actually realizes that we're having the same experience. And there's like a harsh division like that in Wisconsin, especially in Michigan too. Um, but to answer your very quick question, I'm wrapping up, I'm wrapping up, but I, I see VotER as that force, uniting, um, you know, communities like where we're in, we're in is from where I'm from. So no matter where you live, like VotER are is uplifting healthcare professionals who Are seeing beyond physicalities who are focused on non medical conditions that are determining our health outcomes. So in looking back, I realized that if I did have a physician like Marin asking me questions about uh, How are you doing at home? How's school? Or are you a part of your community? Like what's going on? I feel like I probably would have like ran for office. I could have been your local mayor by now. Um, so I'm really fortunate to be involved and to be involved in my home state because it just, it's just. Really emphasizes that there's so much more on the line.

Chris : 29:45

Amazing. And I'll tell you what, you know, Your your time frame is still there. You can run at any point in time. So don't worry So, you know you brought up a couple good points there right and and some of it is how you know Presence and ability to vote and actually having your vote counted towards, decision making and discharge, you know, who is going to represent you at the state level. A lot of folks, that I talked to, especially doing the redistricting process. They didn't really know that correlation between the 2, but, you know, I guess, from Marin, how does participation in the democratic process, such as voting, as we talked about before, um, how does that correlate with health outcomes that we see in the ER in the primary care settings?

Marin: 30:29

Yeah, it's, it's, um, obviously it's not like a direct cause and effect sort of Thing because health care civic engagement there such nuanced concepts and so interwoven. But frankly, any participation in the democratic process especially in including voting is actually linked to improved health outcomes by influencing policies that impact social determinants of health. And one of the things that I don't think that patients always understand is that. Elected officials are supposed to represent the voices of everyone in their district, but being a realist it's the people who got them into office who are likely to keep them in office that I think their needs, their issues tend to be prioritized. So by helping. The average patient connecting voting to their health care and highlighting the importance of that infection. We actually have the ability to elevate the voices of people in need and health care professionals like I can't fix health care by myself. You can't fix health care by yourself. The medical community can't fix health care. We need to bring in the wider population, and we need to encourage them to sort of make demands, like, ask for things to be better, and voting is not going to, like, be a panacea by any means, but it's a tangible, sort of, first step in, in getting

Aliya: 32:03

there. This, uh, feedback loop that, you know, Marin is speaking to, and that Emani alluded to, It's a big part of why we exist as an organization. And there's research at the global, national, state, and local level about this, uh, integrated link between voting and health outcomes. Um, and one of the, the coolest studies is in, Southern California at the University of Southern California. A researcher decided to look nationally, in particular at nonpartisan local elections and take a look at what happens when a narrow segment of society votes versus when a broad range of society votes from all different perspectives, renters as well as homeowners, younger voters as well as older voters, voters of color as well as white voters. What happens when you get this full spectrum and this full breadth? And what he found in his research is that when more people vote, politicians start actually focusing on that. They invest in improving their environments and their communities and all these key social, societal, and environmental factors that are directly impacting patients health. Um, and as y'all know, you know, 80 percent of someone's health is determined outside of clinical walls. It's being determined by whether they have clean water in their neighborhood, whether there's green parks in their neighborhood. Um, it's being determined by all of these different factors. And so at Vote ER, we want to have patients voices heard, and in turn, make sure their health and quality of life and longevity is improved. And the American Medical Association, as well as the American College of Physicians, are just two of a number of organizations that have acknowledged this link through their resolutions, and have named voting as a determinant of our health, and it's been so cool to see some of these, you know, biggest names in health and healthcare, validating this work and this effort. And then it all ties back to, uh, the National Voter Registration Act of 1993, and the fact that organizations that are 501c3s are able to conduct nonpartisan voter engagement activities. Why? Because so much of the work that those nonprofits do is going to be heavily influenced by the policy environment around them, and it's critical to make sure that stakeholders, um, who are benefiting from those nonprofit supports, also have a voice in shaping the broader environments that create those supports. Um, so specifically health professionals and health organizations can point patients to nonpartisan resources and voter education resources, as well as provide them get out the vote prompts and reminders.

Chris : 34:23

Yeah. And all that, you know, just to kind of echo what you guys are speaking to, you know, by the time that this Is published, it will no longer be a spoiler alert. But, we recently had on Governor Evers to talk about kind of what we're discussing right now, how voting and how participation in the democratic process contributes to things like the nursing shortage, like, kind of the disparities that Emani was speaking to on the north side of Milwaukee here that we saw during the pandemic. These are things, these are reasons why I got involved in redistricting, these are the reasons why, you know, I got involved in Vote ER, etc. just to kind of give that ability for my patient demographics that we're seeing both in the rural setting as Emani spoke to as well as in the urban setting, because there are similarities in lead exposure. There are similarities in housing insecurity and social determinants of health that affect people throughout the state of Wisconsin. And so, when you, when you have that tangible, reality and you have, The ability to say, you know, maybe the national election is not as important. It's important still still vote in the national elections. However, those local elections, which sometimes are nonpartisan, those are folks that are going to be representing you and going to be making more of a play in your day to day and have more effective your day to day as well. So thank you guys for touching on that. Taking it back to how VotER, how people may interface with it if they come to the emergency department, if they are going to the primary care setting, et cetera. Um, can you guys share the role of what we know as the badge backers, that are given to healthcare professionals and how they help folks register to vote in that setting?

Emani: 35:56

Um, so the voter registration badge is one of many digital tools available for healthcare professionals. And for reference, it sticks out from behind your typical medical ID badge. And it's allowing for voter registration to be accessible for your patients and the providers. So when you think about the role of providers, often they are the only people in a patient's life asking about your well being. So providers, as well as our founder, Alistair, as Marin mentioned, have found it more natural when you're engaging with your patient to talk about voting during the social history process. I know y'all call it rooming. Um, but essentially the provider has their badge out, the patient will take their phone out and scans the QR code through the phone's camera. And that code automatically allows patients to access their state's official voter registration page. And ultimately, you don't need to be a political expert that is remembering rules and dates because the provider is not the one who's registering. voter, although I would say it is important that you know what day is our, our election days. Um, but anyway, all of this is built into our tools because they were made by healthcare professionals for healthcare professionals. And that's what sets us apart.

Marin: 37:26

Yeah. Emani is exactly right. I, I usually sort of, um, stick it in with the social history, and I'm just very matter of fact exactly the same way I am when I'm asking other sensitive details, and usually I'll say something along the lines of, Voting is one of the most important things that we do in healthcare. You can scan this badge and register through the Wisconsin government website. And if you're already registered, then please show up. Please commit to vote. And I will frequently say like my life's pretty hectic. The only way I can reliably vote is with getting an absentee ballot through the mail. And that's one other thing that this website can help you do. And to be honest I was reticent to do this at first knowing that Wisconsin is a purple state. Was someone gonna sort of like yell at me or scream at me? And I've never had a negative interaction and people are just sort of like, intrigued, interested. Sometimes they say yes and scan it, sometimes they don't. But I feel like I did my best to empower them. And to be fair, I don't just limit myself to patience. I harangue all of the co workers I can think of as well to make sure that they're registered.

Chris : 38:41

And you know what, that probably makes up a considerable amount of the population, right? You think about how many people work in the hospital and how many allied health care professionals too, you know, they may talk to a patient. I, I'll echo what you're, what you're saying as well, you know, a lot of people have seen my badge backer, you know, some of the nurses, some of the techs as well, and they've asked for some, right? And so they may be getting their family members to register too. So it's having this ripple effect that's, that's going to be invaluable, especially in, you know, Very critical elections coming up too.

Marin: 39:09

You know, Chris, do you remember Mark? The delightful nurse, his last name is escaping me right now. But he found me, maybe it was, It was, I don't know, May of of twenty, I don't know, it was several months after the most recent like presidential election and he told me, Marin, I was so inspired by your Vote ER work that I called all 16 of my like extended family members in Wisconsin to say, say, are you registered? Do you have a plan to vote? And I was like, Oh my God, that's amazing. And he was like, wait, that's not the best part. He said one of his, I think it was like a cousin. She was inspired by him. So she helped set up a voter registration drive at her church. And I think something like 114 people registered. Used the services to either get an absentee ballot or register. And I, it was just like the sweetest, most amazing thing that someone could have told me.

Chris : 40:06

Yeah. And, you know, things like that, especially, you know, that 114 votes, those are tangible, you know, populations of votes, you know, what you consider in, you know, in my district in particular, we recently had a special election. That race, for a state level was decided by about a thousand people, right? So if you have 114 people that register or even that 16 number initially, you know, that's going to be, that's going to, that may have an effect down the road that more so than people will think. So I guess just kind of getting into specifics of elections, does VotER support individual candidates or any political parties in particular? Some folks may, you know, as you said, may have some apprehension, um, around towards that and in terms of, should I be asking patients, et cetera.

Aliya: 40:48

At VotE R, we are working with some of the most trusted professionals in the United States, and in our work, in everything we do, we want to deeply respect that trust between a patient and a medical professional, and therefore partisanship has no place in our work. Civics, though, the idea that everyone should be involved in shaping our destiny, that is really important to the work that we do. So as a result, all the work we do at VotE R is fiercely nonpartisan, because our work is about making patients voices heard, it's about empowering their agency, and that's what we are focused on, not who wins or who loses.

Marin: 41:25

Yeah, I would say that sometimes patients will say, Doc who are you voting for? Or, or something along those lines. And I usually say, like, that's between me and, and, and my ballot. But I just tell people, I just want you to vote. I want you to make your voice heard. It doesn't matter to me who you vote for. I care that you are you're, you're turning out and making your voice heard. And most people are just, Happy to hear hear something along those lines. And I will say if they ask me more specific or nuanced questions if I don't think that specifically the Vote ER website would be able to help, I'll oftentimes refer them to one of our One of our partners out in the community that is, again nonpartisan, like the League of Women Voters they have so many sort of resources about individual candidates, platforms, and, and things of that nature, and so you don't have to answer questions, you just have to send people to the place where they can get their answers.

Chris : 42:23

What effect has VotER had since I believe it was 2018 was its inception. What effect has it had since that time?

Aliya: 42:32

Almost exactly four years ago, I was in Milwaukee. This is crazy to think about. I was in Milwaukee setting up a community health center with Vot Er's work as it then existed in 2020. Uh, and then of course, March, you know, 12th COVID becomes a pandemic. I've, you know, go home quickly, quarantine. Uh, and despite the fact that the pandemic completely changed everything we were doing, we've had exponential growth, new ways of engaging since then. And it's been incredible to see the growth of the movement. We now are working in over 700 hospitals and clinics around the United States. Uh, and we're official partners. There were 350 health organizations, associations and the like. There's about 50, 000 health professionals across the nation who are individually doing their part to help their patients health by empowering their voices to be heard. And then we've gone deeper than that to, to partnering with federal agencies. We work with Health and Human Services, who has put out guidance on how community health centers can implement the National Voter Registration Act effectively in their organization. And so these are the different ways in which we work with organizations, organizations and government. Entities around the country, but Chris, we know that health professionals are among the most trusted professionals in the country, and that actually shines through in our impact when health professionals encourage patients to vote through vote er. We see that those individuals turn out at 11 percent higher rates than the average voter. What we also see is that we have a bigger impact on first time voters, young voters, and voters of color, and so therefore we know that folks like you, folks like Dr. Darcy, you can make an immediate difference on patients you serve with asking this simple question to help patients register to vote.

Marin: 44:17

I don't remember the exact number, but in the very first year of Vote ER at UW, I think, sort of, our core group helped it was like something like 870 people either registered to vote or got an absentee ballot during during the COVID 19 pandemic. COVID pandemic, which obviously felt very important, and I think we ranked something like eighth or ninth in the country for the, the competition amongst the med school or the med schools, and it, it was just, it was fun. It, it was like, amazing to see UW be in the, in the top ten.

Chris : 44:52

Absolutely. And like you said, you know, that the, the registration processes, especially in the state of Wisconsin is, is very unique in that, you know, how you need to register for it, you need to renew it every year. And so to have that number of people who, you know, may get to election day, may not have transportation to, you know, a voting poll or to not have you know, the ability to leave work to do it, you know, that, that's again, a tangible amount of the population that's going to vote that may have not before.

Marin: 45:21

And I don't know if it's the winter weather or whatnot, but both my husband and my car batteries have died four times in the last three weeks. And so yeah, it's, it's been a lot. But it's just like the sort of thing that you remember, like, it doesn't matter if you have the best laid plans, like life happens and having that absentee ballot is the sort of thing that gives you a little bit of flexibility and grace. That you may not have exactly on election day.

Chris : 45:49

Absolutely. Outside of those badges that we just discussed there are quite a few programs that Vot ER has grown in that four year time span that's been ongoing. Can you guys elaborate on kind of the number of various programs that are available? So, like civic engagement, the fellowship, et cetera. Chris?

Emani: 46:08

And I know you're using that keyword program, but I want to emphasize that VotER is a genuine community of healthcare professionals who care about civic engagement. And while our digital tools work best with those who have smartphones we also provide discharge paperwork about voting, posters, pamphlets, template emails, text scripts, just whatever, of course, within reason you need for patients. And. On top of all that we offer, we have workshops, training, a grant program backed by the National Association of Community Health Centers. An eight month fellowship for health care professionals interested in leading their own grassroots organizing campaign and just so much more because VotER are is catering our work to any health care professional ready to make a change, whether that's tomorrow or months from now, and one of the biggest things on the Vot-ER calendar is civic health month in August. Which has become such an uplifting celebration of communities, civic engagement and the link between voting and our health. I do want your listeners to know, mark your calendars for National Voter Registration Day on Tuesday, September 17th. Because this is a national day of action focused on voter registration. So again, we truly are creating a healthy community with members across our nation. And the coolest thing is. That's that's not the end to everything that we can provide because we have additional flagship programs like the healthy democracy campaign that challenges universities to register to vote. We're in, you're going to help me out this year we have our, I'm not taking no, I mean, anyway, but, um, we have our emergency patient voting campaign that helps patients in the 38 states. Um, and that's something that I'm voting while hospitalized is something that most aren't aware of. So that's why educational programs like our civic health fellowship are beneficial to those such as Marin. I am respectfully calling you out who's an alumni and can share more about that experience of the fellowship.

Marin: 48:33

Yeah. I was honored to be part of the first class and It's hard to truly summarize the fellowship because it's so unlike any sort of training, community, anything that I've ever been a part of. But we had literally like world class leaders Teaching us, coaching us, speaking to us, and like Emani said training us in the principles of grassroots organizing and advocacy work, and also just basic things about how to build and lead a team and These are the sorts of like leadership skills that are so applicable to other aspects of my professional life. And frankly, my personal life, like I'm a better teammate. I'm a better teacher. I I'm a better leader for the fellowship. And so I can't recommend it enough.

Chris : 49:27

If someone wanted to get involved with all the efforts, uh, VotER, how can they reach out?

Marin: 49:34

I know that Emani has her, her her sort of canned response. I'm just gonna say, you don't need Vote ER necessarily to make a difference. Though, obviously I wildly believe in it, but it's if you, it's just like a very basic thing that you need to decide as a person is that you and everyone else in your circle is registered to vote and is consistently turning out at the polls. And I will say, I'm sure my extended family and friends are sick of me and all of my reminder texts that I send in the weeks leading up to the elections, but like it. It's important and I need them to show up for, for my patients and again, just like requesting the absentee ballot so that, like, I can be sure that my, my voice is heard. And I've, I've gotten creative here, I created, like, an epic dot phrase called dot voter info. And it basically has a ton of sort of specific information for voting in Dane County, as well as the greater Wisconsin and I've shared it to be added to patients after visit summaries and with the idea of I'm, I'm empowering them.

Chris : 50:47

Yeah, I may have to steal that from you.

Aliya: 50:50

We'll do. I'll send it to you right

Chris : 50:51

after this. I appreciate it.

Aliya: 50:53

Well, Chris, you are, you are in luck because, uh, we have actually been working with Epic directly and they have actually rolled out what is now a VotER module that any hospital or clinic can incorporate that has

Chris : 51:05

Awesome.

Aliya: 51:06

Couple questions from the sort of social history part that you can load in or if you discharge paperwork items that you can load in. So we've really gotten to a place where you can incorporate vote ER in so many different ways to to your work, um, to make sure that those who are listening can stay in touch with us. Most important thing we need you to do right now is go to vot-er.org/join. That's V. O. T. Dash e r dot org slash join. If you join our email list there, that will allow us to find you to keep in touch with you and plug you into the best programs that suit different place or the different environment in which you're working and make sure we're providing the best possible resources for you.

Emani: 51:46

And just to add, if you're in Wisconsin, I'm Emani. I'm your point of contact. And we'll be personally falling up with it. Yes, I am. I am true Midwest. Nice. Um, however, however, if you're a healthcare professional and you say bubbler instead of water fountain, I need you to go to this website, vote.health/pulsecheck I'm going to say it again. Vote dot health. Pulse check. And once you're on the site, go ahead and order your free voter registration badge courtesy of VotER

Marin: 52:24

And if you email Emani and she can't answer your question, she will get you to, to someone that can. And so that's, What's so amazing about this organization is just the accountability and the fantastic people that gravitates to this work and this organization.

Chris : 52:43

Well, thank you guys so much again. Um, you know, I can't, Explain how much I appreciate the work that you guys are doing. And, you know, like you said, you've had over 700 institutions that you're in already, you're obviously making a difference in not only Wisconsin, but nationally. So thank you so much for, for joining us. Thanks for giving that information. We'll link all the links that we discussed before for anyone that has any interest. Um, so thanks so much, Marin please give everybody my love at home. I consider UW my home. So tell everybody I miss them and I love them.

Marin: 53:13

We'll do, we'll do. We miss you too. Bye.

Chris : 53:19

So I want to thank everyone for listening here again today. I want to thank our colleagues from Vote ER, Ailya, Emani, Marin as well. I want to invite you to join us for our next episode, which will be our sixth episode, which will be upcoming in the next couple weeks. Um, as always, feel free to reach out to us either through the website or on social media. We always get back to you. I want to thank you again for providing such valuable feedback and invite you to continue to press forward because we're in this together. This is your podcast. This is a podcast for the people of Wisconsin and for the people of Milwaukee. So the more involved that you are, the better that we can do to tailor it to what you want to hear, the topics that you want to discuss from a medical standpoint, as well as from a community health standpoint. So feel free to reach out again. Again, as always, thank you so much for joining us. Be sure to take care of yourselves. Take care of each other, and if you need me, come and see me.