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.

Episode Transcript

Speaker 1 (00:01):
Hi listeners.
Welcome back.
This is part two of episodeseven, addressing the healthcare
disparity in the country rightnow.
In part one, you heard dr.
Ghali at Santos of JohnsHopkins, introduce himself and
describe his passion forbringing together health care
professionals and community toaddress people's needs.
It was truly inspiring.
And today he will be answeringsome questions from Z and

(00:21):
myself, including his feedbackon the affordable care act,
which is so timely with theelection coming up.
And we hope you enjoy yourlistening

Speaker 2 (00:32):
Awakened in America

Speaker 1 (00:35):
On a journey to create dialogue about diversity,
inclusion

Speaker 2 (00:39):
And optimism.

Speaker 1 (00:47):
And actually, we'll just start with a quote of yours
from another podcast that Iheard you on.
I wanted our listeners to hearit because I thought it was a
really good summary.
You said for those of us whostudy health equity, it's not a
shock, but it is an ethicalreckoning.
What to make of this for a lotof us is quote, welcome to the
conversation we've been havingit for decades and a pandemic
will sure as heck shine a lighton these issues we've been

(01:09):
screaming about constantly.
So, um, question for you, youknow, kind of zooming out a
little bit on that.
Do you think systemic racialbias in healthcare is actually a
public health crisis and notjust, yeah,

Speaker 2 (01:24):
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 intransportation.
I mean it links them alltogether.
And let me tell you why, like,you know, like, so my, so my
research, like I always saylike, Hey, you know, I focus on

(01:46):
health disparities and how tomitigate it through community
engagement and how everextroverted I may seem.
And like, and I love workingwith the community.
I am in my heart and introvertedand numbers guy.
So I go back and I locked downand I crunch out numbers.
I do a lot of geospatialanalyses.
And the purpose for that is, youknow, I can always give validity
in the numbers to say, this iswhy we're doing this.

(02:06):
It might seem like we're goingout and just doing some blood
pressure checks for community,but there's a bigger piece
behind us.
We're ultimately we do try toalign some population health
strategies with community healthinterests to get a public health
goal and being a long andcritical care doctor.
One of my biases, especiallyseeing it clinically was always

(02:27):
around a pathological syndromecalled sepsis.
You may have heard of sepsishere and there.
It sounds horrible.
It is.
It literally is Greek for glassrotting.
Um, and so why a gear to thatwas because in my clinical
practice of a decade ofpracticing in the intensive care
units, minorities, socioeconomicdisadvantaged, suffered more

(02:51):
sepsis that I could ever see inall substances is you have an
infection and then you have thismassive cacophony have a
responsible immune system thatoverreacts to the infection
relief leading to organdysfunction, organ failure and
death.
Sepsis is the number one causeof in hospital death.
And number one reason, you'releading an intensive care unit.

(03:13):
Well, you're going to have, thisis going to COVID.
So my interest of sepsis was whyam I seeing such racial
disparities in it?
Why am I seeing such, you know,socioeconomic experience in it?
And I began to dive into theliterature that's published in
short I've actually, you know,my clinical suspicions were
reaffirmed by published data.

(03:34):
There's some of the earlieststudies into the early two
thousands said, Hey, this studyout of Harvard by dr.
Martin published in new Englandjournal medicine, 2003 said,
Hey, 1979 to 1999, AfricanAmericans develop more and
Hispanic Latinos develop moresepsis than their white
counterparts.
And at younger ages, meaning,you know, the conversation about

(03:56):
catching the virus and thendeveloping severe symptoms, kind
of two different stories.
But yeah, the Venn diagramsoverlap a lot, but the question
is definitely why do theydevelop more severe consequences
from an infection?
And I think the story was alwaysthere about sepsis.
So I see this because my yearsat the NIH, I spent studying
racial disparities around sepsisand how not just racial

(04:18):
disparities that sometimes thinkrace could be more of a
surrogate to understandcontextual level variables like
how the neighborhood can drive.
And yet I was plugging out somesuch similarities.
I mean the immunological profileof things like diabetes and high
blood pressure, right?
Some of the inflammatorymarkers, there are the same ones
that are found in sepsis.

(04:38):
So there's an overlap there.
So it sounds it's.
So to me, it's like havingpatients where they live in poor
conditions, they, you know, theprocess through their living
high stress food, the homicidesthat are happening, right?
This institutional racism thatis dictated housing to how
violence is constructed inneighborhoods.
Suddenly people develop thesenoncommunicable diseases like

(05:01):
diabetes and high blood pressurecreate this kind of physiology
of poverty with thisimmunological profiling.
Then you get an infection youget, I get, but for people with
this kind of ravaging over time,it's like the spring has sprung,

(05:21):
right?
They're broken at this moment.
So I say this because when thepandemic was coming and this is
another day, this that's likeclear my head, you know,
February lemon, we were havingan 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 thelast four years.
Like, and if infection hitspeople of minority races,

(05:42):
especially living insocioeconomic 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, Iword vomited out in an academic
setting a little unprofessionaland get it.
But like, hadn't, I may havedone a professional curse, which
is like, probably I threw theword heck out or something.

(06:04):
So yeah, like that my colleaguesattentions and then shorten up.
I mean, we were seeing this playout in real time, you know,
disproportionate impact onAfrican Americans when Hispanic
Latinos.
And if you, especially, if youwere poor ravaging and I was
just beside myself, becauselike, you know, like, think

(06:25):
about knowing it's going tohappen and you can't change
anyone to prevent it.
Right.
It's like, you know, you can seethe tidal wave coming and I
could just scream to people, butno one's moving.
They're just standing there.
And then here it is.
No, actually, sorry.

Speaker 1 (06:43):
It was actually just a good point that you made that
I wanted to piggyback off of.
But, um, you felt so stronglywhen you saw all of this coming,
you know, and it's somethingyou've been studying on, you
know, in your free time orhowever you want to say it
anyway.
But do you feel like there areother physicians that had the
same reaction?
Or if not, why not?

(07:04):
If it's this public healthissue, do you feel like there is
support around you in themedical community with people
who feel the same way about thisglaring health disparity and
what it brought to light and inthe medical community when Coca
hit?

Speaker 2 (07:22):
So yeah, I mean, definitely a lot of other
colleagues are within Hopkins.
Definitely.
Like no one is going to hear theword health disparity and not
want to help the challenges anddefinitely colleagues throughout
the nation.
I've risen up a colleague that Itrained at a den age, Tyson,
Bella, the university ofVirginia know someone who's
risen up like others as well.

(07:42):
The challenge there though is,you know, people who want to
help with health disparities andbless their hearts.
I mean their hearts going in theright direction.
But I think the first partpeople begin to kind of break is
realizing I can talk about it.
I can run the data and tell youyep.
Disparities here, disparitiesthere, but then you're left
with, well, what do I do?

(08:02):
Pontiac has just described thisas a, the physiology of poverty.
I can't fix poverty.
And so this goes back to mycommunity engagement work, like
the reason why I was screaming.
Wasn't just because I knew thiswas coming it's also, cause I
knew there was nothing we weregoing to do to fix it
immediately.
Like there is nothing to undodecades of institutional racism,

(08:24):
plaguing our neighborhoods.
And I see this because seeingthe 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 soreactive.
Like I'm, I'm I, if it feelslike a snail's pace now, knowing
we're in a pandemic, but likeI'm working with housing units

(08:45):
to make them feel responsiblefor patient's health outcomes.
Right?
Meaning if their tenants are upto the hospitals over and over
again, maybe we should dosomething differently in the
housing units to help them.
Right.
When I, you know, realizingpeople can, can get nutrition,
like, can we work with peoplelike, like a meals on wheels to
deliver nutrition to the doorsof our patients.

(09:08):
Right?
It's so much more complex, butlike my goal, my dream would be
to have all these othervariables feel the weight of
health outcomes on them,nutrition, housing.
The other part is school iseducation.
Like everyone is in their ownsilo.
Like I'm just focused on inthese letter grades and so

(09:28):
forth.
I'm like, I know, but that, thatdoesn't lead to help.
Like you can't, you would likethat.
Like if I, if I could have myway with all those work that
I've done, I mean now, like whatI would say is like, everyone's
got to focus on the same goaland just work to see how you can
get that through education,through housing.
Yeah.
We don't have, there's not aniche.
There's not like an, a magicsolution.

(09:49):
Like no one's coming up with avaccine for health disparities
and everything that I see rightnow is just people bless their
hearts.
It's in the right place, butit's just actions without
commitments.
We really mean to put an end tohealth disparities, it's it
can't be a hospital loan.
It's part of the solution, butit's not the sole one.
So that's where I'm like, if Ican get more people involved and

(10:14):
that's why this curriculum to meis so important.
It was if I can change thesekids to understand how they
become advocates, like thehealth disparities lecture.
When we go, when we're aiming togoing around February, the wind
for that talk, I'm hoping thesekids are like, man, I gotta do
something

Speaker 3 (10:32):
Right.
Make choices on their health.
And if they don't feel likethey're getting what they want
and feeling empowered to seeksomething else out and know how
to advocate, learn how to writeto senators and Congress people
right under start to understand,really understand the process.

Speaker 2 (10:48):
No, Z, Z.
I mean like, this is this isn'tgoing to happen overnight.
What am I, what am I rolemodels?
She was one of our speakers andour, 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 tothe current modern societal
structure and just destroyingit.
You gotta rebuild it.

(11:09):
I'm like, yeah, no, I know thatsounds extreme, but it's true.
It's true because everything I'mseeing now, like we're in this
pandemic and like, I'm likepulling my hair out when I sit
in like administrativeconversations, not just at
Hopkins.
I mean, I'm talking about likeeverywhere, no knowing no one's
coming up with a solution forthis.

(11:30):
People are just like, let'sjust, let's just return to where
we were.
We, we kneeled, we hired morediversity officers.
Right.
We're good.
I'm like, I I've had to place1000 catheters into people's
next in order to say like, I canconfidently do this.
Like for me, critical care, Ione module and you think like,

(11:51):
that's enough.
I know this.
I need a cultural change.
You need doctors and healthcareto feel responsible because
right now it feels like, itfeels like what I felt 10 years
ago when I was like wanting todo in the community.
I was like, Oh, it's the rightthing to do.
Yay champion.
But like, I was drawn to itcause it like, it was personal
to got it.
Everyone's got to have thiscultural identity shift and it's

(12:13):
gotta start from the top down.
Like, like, meaning like itcan't happen just in medicine.
It's got to happen in akindergartner.
So when they become doctors, youalready know what's the right
thing to do.
Right.
You can't just start learning tobecome anti-racist and medical
school like that.
That's when you were figuring itout, you know, you're behind
April.
We agree.
We agree.
Totally.

(12:37):
Yeah.

Speaker 3 (12:37):
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 aphysician, um, as someone who's
also in the community, assomeone who has colleagues that
are physicians that are dealingwith COVID COVID patients,

(13:01):
pulmonary care, critical care.
Um, I really admire you forstepping 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 thatI've heard say admit to it.

(13:21):
That was not a person of color Ishould say.
Um, and, uh, and so I, I hopethat more joined the cause.
Um, because I think that, likeyou said, it's true,
unfortunately, so much needs tobe on done Jess and I have these
conversations and, and we'veactually said on previous

(13:44):
episodes, you know, that this isit's like brainwashing in a
sense.
And so you have to dismantleyears, decades, you know, of, of
basically being taught from achild like that one group is
better than another group.
And then that precipitates allthese different ideas that are

(14:05):
not true.
And then we just, we just kindof, it was kind of like a house
with a poor foundation.
You just kept stacking thebricks on top, you know, one day
it's going to topple over.
And I feel like, I feel like nowis the topple over point?
Like, you know, we say thatthere's like a trifecta here,
you know, between COVID thecurrent administration and, um,

(14:27):
you know, George Floyd's murder,like it was a perfect storm for,
you know, hopefully for someawakening, for a good segment of
the population, there are still,uh, a good segment that, you
know, doesn't believe thatanything needs to change and
doesn't, you know, own up to thefact that things are not right

(14:47):
and that something needs to bedone about that.
So, yeah.
I just want to say, I wasbriefly just gonna mention about
the affordable care act and youmentioned on doc talk that
health is more complex.
It's, it's more holistic.
So in your opinion, what effectwould eliminating the affordable

(15:12):
care act have not only in the 20million that are already
uninsured, but the additional 12million who have COVID related
loss of health insurance in ourcountry.

Speaker 2 (15:23):
I mean, I don't know, like I, sorry.
I'm like, I'm a, the dramaticpause is just more cause like,
like why take away somethingthat is getting us the
conversation to gettinghealthcare to everyone, right?
We're starting, like we believein education for all.
We have a public school system.

(15:44):
Yes.
I get it.
It's an equity issue there too.
Cause some is better thanothers.
I get it.
But it's there for everyone,right?
We have free transportation foreveryone.
Right?
You can drive near these roads.
You know, there's not, there'snot a, you know, how has
healthcare not part of thisconversation?
It like, to me, this is why thisis mind blowing is because if

(16:06):
you, if this America's supposedto be America for all right, if
we want the best resourceAmerica has isn't it's gadgets.
It's not it's I don't know, likewhatever America puts out comps
out it's it's people, right?
You can't achieve greatness ifyou don't have health.
Right?
So if your main product to theworld is the ideas of your

(16:28):
citizens, that you betterprotect those citizens, public
education.
Great.
Get it, transportation, work onit, more housing more quickly,
but social healthcare, it needsto be that conversation.
So to me, the affordable careact is the, the right thing to
do to get it in that rightdirection.
Is it perfect?
Well, nothing we do is perfect.

(16:50):
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 justsaying like, I don't know how to
fix it, so I'm going to scrap itand I don't care call it the
affordable care act.
Great.
If you will, if you want topraise Obama.

(17:11):
Fantastic.
And for those who, but, youknow, these are presidents,
these are men and women who aregoing to have their own faults,
right?
So it's an act of legislationfrom a person voted by
Americans, keep it, don't undoit, keep it and enhance.
It definitely needs to happen.
Like I'm flabbergasted.

(17:32):
When we talk about healthcare,healthcare is meant for all.
And I see this because if anyonewants to fight me on this, I'm
like America runs on it'speople.
And if it's people aren'thealthy, they're gonna get about
America.
That's it.
You want America to achieve it'sown equity,

Speaker 3 (17:51):
Get it citizens to have the health equity they
deserve.
I agree.
I, you know, honestly, as anexample, uh, I actually, well, I
worked at the Mayo clinic inArizona and um, you know, I had
a patient one time.
I think we were discussing causepatients, you know, they're
bored, they're sitting theresometimes they don't have

(18:11):
anything to do.
So they shack up interestingconversation.
And I think I had a patientbring up the affordable care
act, but at the time, uh, Obamawas in the administration.
And so a lot of people weresaying Obamacare and not
necessarily in a positive light,but, um, anyway, so I had the
discussion with the patient andyou know, I always tried to, you

(18:34):
know, kind of walk a thin linebecause I don't want to, uh,
insult the patient and I don'twant 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 Ilook at it is I'm a nurse.
You know, I'm taking care ofyou.
And I said, and all the othernurses here, I said, if everyone

(18:58):
can't get vaccinated and thataffects our health, and if our
health is affected, we can'ttake care of you.
So, you know, the way that I waslooking at it, even as a medical
professional is the health ofour country.
Like you're saying, if we'rerunning ideas and you know, the,

(19:19):
all the advances are based onthe product of people, how can
we not think that it's importantfor everyone to be vaccinated?
The point is that you haveaccess to it.
So how can we talk abouteveryone doesn't have a right to
access to care.
I said, because that just makeseveryone vulnerable.

(19:42):
In my opinion, as a nurse, Isaid, we have different diseases
that are coming back now that wehad eradicated previously.
And the reason that that'shappening is because everyone is
not having access to qualityhealth care.
So I don't understand myself whythat's not a priority.

(20:03):
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 wantsto get back to the real world
and everything like that.
But we should be putting thesame effort into figuring out
how to correct the system thatcreated this problem in the

(20:24):
first place for everyone andputs and puts people of color
or, you know, causes thedisadvantage or creates the
health inequity.
Like we should be concerned.
Those, those should be toppriorities.
Um, to think that we can alljust get back to the business of
life and that, you know, I, I, Idon't quite understand it

(20:44):
myself.
Dr.
G I don't

Speaker 2 (20:48):
Know.
I don't listen.
If we're going to destroyinstitutional racism that
plagues all of us, you know,health disparities is just one
of its outcomes.
I mean, you have educationaldisparities, you have housing
disappearing, you can't fix onewithout you have to focus on all
of them.

(21:09):
It's gotta be equitable.
Right.
And so, yeah, you're spot likethe, to me, the affordable care
act is a step in the directionthat I wish education till there
should be an educational careact, right.
Should be a housing care act.
All of them need to Marchtogether.
They're not like we're humans.
Right.
I create anything perfect first,but it's a gosh darn right

(21:30):
attempt.
That's what you do.
That's the American thing.
You take your predecessor thatwas voted on by Americans and
you continue building on it.
Like that's America.
Like you take something to keepgrowing it.
Like, to me, like my Democrat orRepublican, you're both
Americans, it's a ying and ayang.
Don't divide it like balanceeach other out move forward.

(21:52):
But to me, like if you want onesolution of overcoming health
disparities really is health forall.
I think we talked about thatMedicaid example in the
beginning, it still breaks myheart because that's such a
reaction, like you need tofigure out how to keep them
healthy so they can just be attheir best moving forward or
Medicaid can be there as kind ofMedicaid should be there for

(22:14):
like a last resort, not theresort of the poor.
Right.
That's the difference.

Speaker 3 (22:20):
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 aLatinex woman and she was
speaking about, uh, recentlyover, I guess, maybe March,

(22:40):
April timeframe.
She found out that, well, sheassumed 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 goesto the doctor's appointment with
her mother and the doctorbasically said, yeah, your
mother has Alzheimer's, um, youknow, Google it.

(23:01):
And she said, you know, like theway that the physician told her,
it was almost as if, when shelearned she was nearsighted.
And so, you know, she left withreally no tools in the toolbox.
And, you know, I could see thator listen that, you know, she
felt helpless.
And then she said that, youknow, she owned her own, tried
to get her mother into clinicaltrials and her mother ended up

(23:25):
getting a placebo thought aboutthat.
And I said that that happens.
So oftentimes, you know, I caneven say as a person of color
that many times we're spoken toas if we don't know what the
doctor is saying, or, um, likewe needed broken down into some

(23:48):
different language and, youknow, there's assumption that we
don't read or, you know, wedon't educate ourselves or we
don't have family members thatcan even be doctors that, you
know, might have some knowledge.
And so I just felt like, andthen it leads into like the
Medicaid thing, because I feellike, um, and communities of

(24:10):
color, and not only, but incommunities of color where we're
talking about these healthdisparities, there are a lot of
people that are using Medicaidand I've heard instances, um,
I'm actually in school, I'mgetting a doctoral degree, um, a
DMP and advanced public health,health nursing, actually.

Speaker 2 (24:31):
Congratulations.

Speaker 3 (24:34):
Thank you.
Yes.
And I'm so, you know, one of mycolleagues had mentioned that,
uh, he was in a situation wherehe was working with a physician
and, uh, the surgeon actuallydidn't want to take Medicaid
patients.
And they had been approved for,you know, the surgery and

(24:56):
everything.
And they, they did need thesurgery, but it was almost like
whoever was like the frontlinescheduler wouldn't even send him
those patients because they knewthat he would have refused them.
And so there's nurses saying howhe basically tried to like
backdoor it some kind of way andslip the patients and, you know,

(25:18):
some other kind of way.
And at one point he did succeedand 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 tohelp Medicaid patients, is that,

(25:39):
is that not a barrier to thisproblem?

Speaker 2 (25:43):
So, I mean, all of it is, I mean, you know, like, and
every hospital has a differentkind of way of how it gets paid
and reimbursed.
And every state gets to begoverned a little bit
differently.
Maryland's different from sayothers and so forth.
But I mean, it's spot on like,and again, but like, you know,
needing to have to get to thatlevel of Medicaid.
I mean, like, we got to likewhat drives a population to me

(26:07):
that like, we got to go to theroots.
Right?
Right.
Like, yes, let's react in realtime.
First of all, like figure out abetter payer system.
So everyone gets healthcare andthen let's go back to the
Genesis.
You know, that's what, like forme to break institutional
racism, we can't sit here.
You know, he can't sit kind oflike holding a bucket to toss

(26:28):
out a flood.
You know, we got to go to theroot of the flood.
And so you're spot on.
I mean, we got to changeincentivizations we got to
change the payment system.
I get it.
But that's a bandaid onto theflood, right?
Like we need to go further back.
And this is what I'm alluded toit like that doctor is acting,

(26:49):
you know, people can sit backand say, he's acting out of
institutional racism.
He himself may not say like, I'mracist.
Do I just want to getcompensated for my work?
I'm like we understand, but theactions aren't in accordance
with institutional racism,right.
So you got to take it back fromthat and keep going back.
But at the end of the day todefeat institutional racism, we

(27:09):
can wound it with some reactionsin the short term, or we can
kill it off by getting everyonetogether, feeling accountable.
Cause to me like Medicaid, youknow, that's an, that's a
outcome of, you know, justputting people in a disadvantage
to begin with.
Right, right.
Like I get it's purpose and Ilove it.

(27:30):
But if you keep putting peopleat an, a disadvantage, like go
back, like it's not there.
It's not a community's fault tome.
What I've learned is that it'snever community's fault.
If you're not giving them theresources they need, like you're
going to get the outcomes ofthat.
So my like my, my narrative isthat of a son of immigrants.

(27:50):
Right.
I, you know, to me, coming toAmerica is different than my
colleagues of African Americanancestry.
I get it.
And while I can't have thathistory or that narrative, and I
have my own, we can still walktogether 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 wecan all achieve together and we

(28:15):
get to figure out what the heckthese barriers are that are
keeping us from that we've gotto demolish it.
Cause like America should bethis land.
I was told you as a kid right.
Of opportunity.
But I shouldn't have to look atsomeone and say, well, because
of their color, I know they'renot going to get the same
opportunity as me.
That's like, we're human.
That's it like my XE, that storybreaks my heart.

(28:39):
And there's so many ways tocombat it.
And it's easy probably to blamethe surgeon immediately.
But that surgeons acting inaccordance of a system that
allows this and you gotta, yougotta take it all the way back.
I mean, you've got to kill itall the way, you know, to me,
like, I love that we haveMedicaid, but that's still a
reaction we've got to figure outwhy, you know, going all the way

(29:00):
to the back to the basis of it.
So, you know, one answer tothis, my answer to fix health
disparities is to take awrecking ball and destroy the
social constructs we have nowthat allow for institutional
racism to exist because I'mseeing this pandemic do what
it's doing salt back in springbreaks our hearts.

(29:23):
And you know what, it's October,same populations are being
ravaged.
Clearly we haven't done anythingto expect us.
We would have done something.
I mean, we're trying to figureout a vaccine in an expedited
fashion and no one's having asense of urgency with fixing
health disparities.
So, you know what, here'sanother last, last point.
I don't have a, it's your lastpart?
I can say as many points as youguys want.

(29:45):
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 havethese conversations was what I
feel like is going to be justeasier is if you just have
millions of people understandingthat and grow into your
profession or that, you knowwhat, let's take out the old
bring in the new that's my biasof teaching the youth is also

(30:08):
like, man, if we can come tothis idea of science,
supplemental social justice,that's what I said earlier.

Speaker 1 (30:16):
Yeah.
We're aligned with that.
I mean, I think educating onanti-racism in all of its forms
and fashions at a young age iswhat's hopefully going to really
make a big difference, you know?
And in the meantime, this hasbeen a really humbling, ugly
period in our country's history.
You know?
And I think like you said, theaccountability piece is huge and

(30:38):
acknowledgement that we haveproblems that go really, really
deep and being willing to acceptthat and educate ourselves.
I'm talking about myself and myfellow white people to learn
more about why this is here and,um, ways that we can change and
start influencing those closestto us and starting there as a,
as a starting point.

Speaker 2 (31:00):
Yeah.

Speaker 3 (31:02):
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 doctalk, you mentioned how you were
able to vaccinate like 300people in two months, which is
like remarkable.
I mean, that's reallyremarkable.
And you know, it made me thinkabout, you know, what's going to

(31:23):
happen when this vaccine comesup because I can already tell
you that black people will notbe lining up.
I mean, I'm sorry to say thatI'm only one of many, but based
on, you know, historicalcontext, it's, it's, it's not,
it's just not going to happenright away.
And so, and I think I heard andyou can correct me if I'm wrong

(31:46):
since, um, since you're adoctor, but I heard that we have
to reach like, at least like 95%or so in order to achieve herd
immunity, something along thoselines, I'm not sure.

Speaker 2 (31:57):
No.
So you're, first of all, likeyou're spot on community
engagement.
It has to, you know, I try topreach it.
It has to take it.
Yeah.
Respect like these things, yourkindergarten teacher taught you,
right?
Like your respect, the nicegrassroots approach, listen to
them.
But you also have to take itinto a social historical
context.
You can't go in there justthinking like new chapter.

(32:18):
No, there's, there's tons of old.
So I agree with you Z.
Like I know.
So I've been recruited to helpwith a vaccine trial out of
Johns Hopkins solely for like,Hey, dr.
G can you help us with thecommunity?
I was like, I mean, I can, I canput you in a position to talk to
them about the vaccines, but notlike some magical shaman who can

(32:40):
like get them to come and getit.
And they're like, Oh, well, Ithought they listened to.
I was like, no, I listened tothat.
That's what I do.
I go into the, listen to that.
But like, you know, look, ifpeople don't want the vaccine,
like I it's up to them andyou're right.
I mean, Madison's public trusthas been broken countless times

(33:00):
for the same populations thatare being ravaged by Kobe.
I go right now, the vaccinetrial is I want these
populations to at least be awareof it, hear about it and let
them turn it down fine.
Or if they say you're like, youknow what?
New chapter I'll work with youguys fine.
But I don't know what that didnot hear them.
I don't want them to be so, youknow, people to be so turned off
like, well, they're going to sayno anyway.

(33:21):
I'm like, no, you go in, treat ahuman talk to them, let them
yell at us.
They should.
Why not?
I mean, we're representingsomething that they don't trust.
You know, there's nothing wrongwith that.
And together we can cometogether.
You know, so many people getuncomfortable because they feel
like I don't want to get yelledat for things, people before me
to it, but that's not how itworks.

(33:43):
You know?
Like the, when I startedmedicine for the greater good, I
was offered to make it its ownnonprofit, leave Hopkins leave.
I can start it.
I was like, no, I'm going to sitwith Hopkins because it's got to
rewrite a new chapter and that'sit.
It's got tons of resources.
What do you think I'm going togive this up?
Like, let it restart a whole newchapter together and come at

(34:05):
this.
And the same thing with thevaccines, like from my
standpoint, like we need tofigure out how in real time to
work the population, thebullshit and be, can we get them
to be vaccinated?
The goal should be, can we earntheir trust to can say no to the
vaccine fight?
And I get it, it's going tobreak my heart.

(34:26):
But at least we're writingsomething.
At least they can walk awaysaying like, but they came and
talked to us, right.
That's an instant in the rightdirection.

Speaker 1 (34:33):
You know, for those of us like myself, again,
admittedly, a lot of this I'vebeen blind to for a long time,
the systemic racism and it'smany ways, you know, the way
that it's, um, kind ofpenetrated society here.
But if you don't take our wordfor it, there's some really sad
and startling examples that Icame across when I was kind of

(34:54):
doing some Googling before wespoke.
And I'm sure you're familiar.
Doctor G and Z and now myself.
Um, the Tuskegee study ofuntreated syphilis in the Negro
male is what the study wascalled.
And it was a 40 year experimentbetween 1932 and 1972.
What I found even more troublingwas it was actually run by the
public health service.

(35:16):
Um, and so for any listenersthat aren't familiar with, it
basically it's, it followed 600,600, excuse me, rule black men
in Alabama with syphilis overthe course of their lives,
refusing to tell patients theirdiagnosis, refusing to treat
them for the debilitatingdisease and then actively
denying them a treatment in somecases.
And that was all taken from, uh,another article recently in the

(35:37):
Atlantic.
Um, and then, you know, takingit a step further, I was reading
about kind of the implicationsthat, that has on trust.
And once the study itself cameto light, you know, I guess it
was probably in the midseventies or something like
that.
Um, I can't imagine they have itthat that would Regan the
minority community when yourealize your health was

(36:00):
disregarded in such a way oversuch a long time, you know, and
something that is, I think nowpretty, you know, it could have
been prevented and treatable,correct me if I'm wrong.
Obviously I'm no medicalbackground, but, um, you know,
the family is affected by thathealth wise, but also mentally
just the trust that was brokenthere.

(36:20):
And, um, you know, fortunatelythat was in 72 when the study
was ended.
But yeah, unfortunately thereare more current examples like
1998.
Um, this was something XEactually sent me.
It was probably in the New Yorktimes, there was, um, federal
research, ethics officialsinvestigating several
psychiatric experiments in which100 New York city boys, many of

(36:41):
them black or Hispanic weregiven the now banned Daya drug
fenfluramine.
Um, so again, you know, this isstuff that's happening.
This is the reason yeah.
You know, there's this, thisbroken trust.
Um, some of the reasons, anyway,I should say, and then finally,
another, just one last step forpeople new to this conversation

(37:01):
like myself, the Washington postin July published an article
talking about African Americanchildren as a mother of young
children, myself.
This one really, uh, struck anerve for me.
Um, African American childrenare three times more likely than
their white peers to die aftersurgery, despite arriving at
hospitals without seriousunderlying conditions.

(37:22):
Um, so that, you know, the way Iread that is you're taking an
apples to apples comparison.
Neither child had underlyingconditions.
Why is this happening?
And then, you know, for womenthat are pregnant, even black
and native American women arethree times as likely as white
women to die in prison and see,um, so obviously that's all very

(37:43):
heavy and, um, even repeating itnow, it's kind of unbelievable
to be in 2020 and yeah.
Have this sort of disparity.
Um, so anyway, I was just gonnakind of turn this into a
question here.
So in light of this lack oftrust and disparity in the
statistics between white peopleand people of color, um, I was

(38:04):
curious, dr.
G if you have any times you canrecall when you have been
vocally anti-racist in aworkplace setting.
I know you do all of thisfantastic work, um, you know,
with the organizations you'reinvolved in, but I guess, you
know, can you, can you actuallythink of examples or ways if any
of your medical colleagues arein situations where they kind of

(38:24):
observe something that is beinginfluenced by implicit bias or
racist ways that they could kindof like step in and kind of
change the course of action forthat patient?
Yeah, no, I mean,

Speaker 2 (38:36):
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 patientsand patients towards healthcare
professionals.
My, the ones oftentimes directedto me is when I come in, cause
keep in mind, like for newpatients, all they saw was my
name.
So here I come in now I'vegotten darker, like a patient
would be like, Oh, you're awhite doctor.

(38:57):
Thank God.
Alright.
We got some education to do.
Or my other favorite one islike, Oh, you speak English.
I'm like, all right, good.
So I say this because theimplicit bias is, again, it's
not a unique variable tomedicine, but there's definitely
learning opportunities, right?
Because for, from a patientstandpoint, yeah.

(39:20):
You know what?
We have ways to kind of makesure that, you know, we can, you
know, redirect that, like I'mnot going to undo that implicit
bias in that patientimmediately, but I can at least
begin the conversation movingforward.
Because if it's not me, it'sgonna be someone else next time.
And then for patients, yeah, wesee this oftentimes, I mean like
the Tuskegee, like that'shorrible.

(39:41):
There's other more cause thatthat's extremely easy to fix or
you can fix them within thesystem.
But to me, the bigger concern islike the ones that are in the
gray area that actually feed alot of institutional racism,
feed a lot of implicit bias thatwe're like, is it really?
Or is it not?
No, no, it is.
It's just so muddied in thewater.
And so entangled in our kind ofeveryday activities that we just

(40:04):
for, not that forget, like, youknow, we, we just don't
recognize it anymore.
And so from my standpoint, itgoes back to what MDGs goal was
to, to no longer do equal plansfor patients, but to do
equitable ones.
Listen to me, here's a subtleone that you both doctors never

(40:24):
probably think of.
Like, you know, patient comesin, we're diagnosing them with a
new noncommunicable disease andall that means it's
non-communicable meaning itdoesn't communicate.
Meaning like, I can't give youmy cancer.
I can't give you my high bloodpressure.
My diabetes communicable couldbe like, yeah, I can give you my
Cogan, come in.

(40:46):
And it's like, alright, well,we're going to start you on this
drug and I want you to eatbetter.
And I hear you.
I'm going to print out this listoff 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 printingfrom the CDC 30 minutes a day,
and that's hindered the patientright off the bag.

(41:07):
You might say like, whatever,every doctor tells you to eat
better, go get a medicine.
That to me is, and then I wantto pick this example up because
again, extremes obvious we can,we can center something around
it, but these are the ones thatare happening every day.
And these are feeding into animplicit bias.
Cause that patient leaves andit'd be live in Sandtown,

(41:30):
Baltimore, Lincoln name, keepcoming up there and be like,
that person doesn't know me.
They don't know where I'm comingfrom.
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 ofcigarettes 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 thecorner.
Where am I going to go exercise?
You know what I mean?

(41:50):
Like that's the implicit biasthat's happening.
And after them, I know thepatient 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 grocerystore around the corner.
I can park.
I can go and walk out.
You know, I'm going to makethese changes on.
My doctor told me I got this.

(42:11):
I'm going to conquer it.
Or the other person's feelingdefeated.
Like I don't have anenvironment.
That's gonna allow me to dothis.
And we talk about like thoseexamples, just so you gain, we
shouldn't forget them.
You know, they're frightening.
The, my concern that we have nowis that we have the subtleness
and implicit bias that we don'teven know what it is when you
call it out.
You're like maybe I should haveasked them where their grocery

(42:35):
store is.
Like one of my earliestexamples.
It's something that I reflectedon from a Ted talk just still in
life.
I remember my earliest communityengagements.
We went to sacred heart of Jesusin Baltimore city, the cathedral
Highland town.
But this is like for theHispanic, Latino community.
Like this is a massive church.
It was first with Germans, thenPolish and now Hispanic, Latino.

(42:58):
And we held a, we held like ahealth fair there and we brought
fruits and vegetables.
Right.
We have three mammograms.
The mammograms is like, whatI've talked about before.
And your other one was thefruits and vegetables, fruits,
fruits, and vegetables, and noone left with.
And I just remember like thatsame meeting that we talked
about, why people didn't want toget mammograms.

(43:19):
Cause they didn't want to becomepatients.
Cause they were like, who wouldlook after us?
But if we're in vegetables, thatwas also Charlotte's

Speaker 1 (43:24):
Illuminating.
When you said that the peoplesaid they didn't want to become
patients.
That was why they chose not tohave a mammogram.
Right.

Speaker 2 (43:31):
Cause they were like, who, who would follow it?
Like I wouldn't break my bank.
Like I'd rather just die ofignorance.
Then become a patient.
Cause it's just more draining.
But the food conversation.
Yeah.
I just remember like thinkinglike, do I bring it up for this
Ted talk or not?
But let me bring it up herebecause 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 tocookies things in, where are

(43:53):
they supposed to store it likethat didn't even occur to me.
I'll be like gathered pounds andpounds of pounds of fruits and
vegetables, you know, weremaking an implicit bias that
people have the means to carefor this.
I remember a patient who waslike, I'm not going to change
the way I eat.
It was, I'm working three jobsright now.

(44:16):
I'm I have to work three jobsfor 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 gocook a healthy meal.
I'm going to grab a McDonald'sit's convenient.
It's there.
I eat it within a few secondsand 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 theexamples you gave, I listen,

(44:37):
those are important.
But I think that for me, the bigpicture is what goes under the
radar that allows us to stillcontinue this implicit bicycles,
this subtleness, the seriousnessof this, these actions allow for
bigger scale things like thephysician.
Who's like, I don't want to takeMedicaid to him.

(44:59):
How's that different than mesaying yeah, eat fruits and
vegetables.
So someone who's like, I don'tknow where the hell I live.
Sorry.
I don't know where the head high, but

Speaker 1 (45:09):
You answered the question perfectly.
Yeah, no, I think, um, it's, youknow, this is such a intertwined
topic.
I feel like it doesn't matterwhat we're trying to hone in on.
It all comes back to the, youknow, many nuances and things
that are all happening becauseof systemic racism.
But I think what I took fromthat is, you know, the

(45:31):
importance of the connection,taking an interest in the cause,
you know, of making thingsequitable and putting biases
aside and really considering theperson and the environment that
they're in and treating themaccordingly, you know, and we

(45:51):
would be in a lot betterposition if, if more doctors
were like you, I think, um, andyou really kind of connected a
lot of dots, at least for me inthis big, you know, problem that
we have happening and tied itback to what you do and the
amazing work that you do.
And I just want to say thank youagain for spending this time
with us and giving us suchstraightforward and um, really,

(46:14):
Oh yeah.
Illuminating feedback that Ithink 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 muchabout the importance of health,
I'm going to quote my owngrandfather.
He used to say health as wealth.
And I hope everybody out therethat's listening is wearing a

(46:36):
mask.
That's all I've got.
How about you Z or dr.
G, anything else you want toclose with?
Be safe, be well.

Speaker 2 (46:45):
Yeah.
And I love that you guysperfect.
And from my standpoint, youknow, there's nothing more
American than wanting the bestfor ourselves and our families
and recognize that we can onlyget that if we all work
together, that's it

Speaker 4 (47:01):
Listening to awakened and America, if you enjoy
today's podcast, be sure tosubscribe and leave a review.
You can also find us onInstagram at awakened in
America.
That's awakened underscore inunderscore America and remember
be mindful, be grateful.

(47:23):
And most of all be you.