Does Your Zip Code Determine Your Life Expectancy? | With Dr. Lyssa Ochoa - The Echoes Podcast

Episode Transcript
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Intro (00:04):
Good morning, San Antonio starts right now.

Camille Hall-Ortega (00:07):
I was born and raised in San Antonio,
Texas. My parents met andmarried on the east side of the
city. But later when my sistersand I came along, my parents
were faced with some toughdecisions. Much of their life,
their previous church family,their friends that were like

(00:28):
blood relatives were allsituated on the Southeast and
East side of the city. But evenback then, my parents knew that
when it came to our schooling,there seemed to be a better
chance of more opportunity ifthey moved across town.
So they did. They worked hardand insisted that their girls
would grow up as NorthsideIndependent School District
kids. But what led my parents tothink this way? Was it just in

(00:52):
my parents imagination thatthere might be some opportunity
differences and variations inthe quality of education we'd
receive simply based on the zipcode we lived in? Of course not.
In fact, it's not justopportunity gaps in schooling
that exist from one neighborhoodto the next. But things like
city infrastructure, types ofbusinesses, quality of sidewalks

(01:12):
and streets, safety of livingenvironments, access to healthy
food, and even access to healthcare can vary a great deal
within a city. In San Antoniothere is a twenty year gap in
life expectancy between SouthSide and North Side residents.
That's not hyperbole though itmay sound as if it must be. And

(01:33):
as we're faced with startlingstatistics like these not just
in San Antonio, but all over theUS, we're left with the
question, "What do we do aboutit?"
From the H.E.Butt Foundation,this is the Echoes Podcast. On
today's episode, we're welcomingDr. Lyssa Ochoa. She's a board
certified vascular surgeon inSan Antonio, and after
recognizing the gaps in care byzip code, Dr. Ochoa founded the

(01:56):
San Antonio Vascular andEndovascular or SAVE clinic. She
works to improve access andcompassionate care for diabetics
across the city and haspartnered with other
organizations to developamputation prevention programs
and raise awareness forequitable access to health care.
We recently featured Lyssa in anEchoes Magazine article, and
we're thrilled to have her heretoday.

(02:16):
I'm here with my co-host, MarcusGoodyear. Welcome, Lyssa.

Dr. Lyssa Ochoa (02:20):
Thank you so much for having me, Camille.
Marcus. It's such an honor.

Marcus Goodyear (02:23):
Yeah, we're so glad you're here.

Now, I know we have lots to dig into, but
perhaps the best place to startis with that alarming statistic
we shared that there is a twentyyear gap in life expectancy
between San Antonio's South Sideand North Side residents. Can
you tell us more about that?

The fact that lifespan varies can vary up to
twenty years north and south hasa lot to do with everything that
you just mentioned in thebeginning. But when we want to
look at, you know, the thingsthat most people think about is
direct access to health care.And that means two things. One
of them is access to healthinsurance. So the reality is
that Texas has the mostuninsured patients.

(03:06):
We rank last in the country asfar as how many uninsured we
have. And there's no doubt thatlack of access to health
insurance is part of it. Buteven so, of access to healthcare
itself is very different Northand South. And what happens is
we don't have enough primarycare doctors. We don't have
enough pediatricians.
We don't have enoughspecialists. And what's

(03:28):
happening is that our patientson the South Side, I say our
patients, our community, ourpeople on the South Side begin
to suffer chronic mentalconditions very, very early in
life. So I am seeing patientsthat are in their early thirties
and forties with uncontrolleddiabetes, high blood pressure,
high cholesterol. They'resuffering heart attacks,
strokes. They are going intokidney failure, needing

(03:51):
dialysis, are going into heartfailure.
And the conditions that, orcomplications that we are used
to seeing in an elderlypopulation of more maybe 70s and
80s, we are seeing in our 30 and40 year olds. And so it is the
combination of all of that. Nothaving insurance, not having
access to healthcare, healthliteracy.

Wow.

Intro (04:12):
Texas is last in health insurance. How? I mean, how did
we get there?

Well, I think one of the issues is Texas has
not expanded Medicaid. And whenthat happened during the ACA,
the federal government wasgiving states extra funding to
expand Medicaid. And so, thereality is we have a lot of
patients, a lot of communitiesthat can't afford private health
insurance that maybe are notemployed. And they fall in

(04:41):
between kind of a window of whatthe ACA or the Affordable Care
Act has that you can get onlineat HealthCare.gov, and then what
qualifies them for Medicaid. Andit's that gap that makes it
hard.
But the reality is there'sanother gap. Not only is there a
gap in do they qualify for somekind of health insurance, but
what I have seen in the SouthSide, when I see patients, I've

(05:01):
had some that have come withoutinsurance. What I've learned is
once I pair them with just theright navigator, someone who
will sit with them, see whattheir finances are, see what
their medical needs are, andreally find how to pair them and
guide them step by step to get aplan that's best for them. In my
personal experience, I'd sayover ninety percent of those
patients are still insurable.

So advocacy. You're seeing advocacy
is key here as well.

Advocacy and helping people get insurance.

Now I mentioned that you work a lot
specifically with diabetics. AndI'm wondering if you can tell us
a little bit more aboutdiabetes, because I know there
is often confusion between typeone diabetes, type two diabetes.
Some people, you know, are like,are you causing your problems?
Or, you know, that that kind ofthing. Or didn't you get

(05:50):
yourself here kind of deal?
Can you just unpack that for usand kind of shed some light?

Sure. I'm actually gonna unpack it a
little more because I'm avascular surgeon. So inherently,
my patients, I don't take careof diabetes myself, the
condition itself. I take care ofits complications. And so the
reason that I see a lot ofdiabetics is that diabetes
affects all the blood vessels inthe body.

(06:15):
And so the difference betweentype one diabetes, which means
that you actually don't produceany insulin at all, they say
this is the one that you like,when you get when you're
younger, I think is what mostpeople think of it as. But
usually it's some kind ofautoimmune thing that shuts down
your pancreas and you don'tproduce any insulin. And so
you'll hear doctors call theseas a brittle diabetic. Meaning,

(06:37):
it is like the on and off switchwith insulin. Like if you eat
something, you definitely needinsulin.
You turn it off, you can't.Where type two diabetes is
actually a result of insulinresistance. Initially, you
produce insulin, but your cellsdon't respond to that insulin.
And what that means is, soinsulin is a signal that tells
your cells, hey, bring thatsugar into the cell to use it,

(07:00):
whether it's a muscle cell or afat cell, and it's unresponsive
to that signal. And so that'swhy there's so many different
more medications to eitherstimulate producing more
insulin, or to make it morereceptive to that signal.
And so type two diabetes is whatwe call an acquired condition,
meaning over time. The reasonthat these patients, both type

(07:22):
one and type two, end up seeingme, is diabetes affects every
blood vessel in the body. And Itry to explain to patients that
it affects the small tiny microvessels in the body. In
diabetes, it usually affects thelarger blood vessels in the feet
and works its way up the leg.And the larger blood vessels in
your heart, they can cause aheart attack.
The blood vessels to yourkidneys that can begin to damage

(07:43):
your kidneys how they end up ondialysis. Blood vessels to the
brain that can cause a stroke.And then, like I mentioned, the
small vessels in the eyes andthe retina and diabetes is a
leading cause of blindness andvision loss in San Antonio.

Wow. In San Antonio?

Yes.

Wow.

And that's the most leading cause of the reason
people are on dialysis in SanAntonio. Now, for example, in
other areas, a hypertension orhigh blood pressure may be a
bigger cause for people to endup on dialysis. But in San
Antonio, it's diabetes.
We have on the South Side veryhigh rates of diabetes. Overall
in San Antonio, Oliveira County,I think the average is now about

(08:22):
-fifteen percent, which is stillhigh. But if you focus in those
zip codes and those populations,we have diabetes rates up to
twenty percent -thirty percent.

Wow.

Wow. That is a lot of information, but
very, very illuminating forsure. And so I know that you're
speaking a little bit to this,but much of your work that
you've mentioned previously,you've spoken about amputations.
And what are the disparitiesyou're seeing specifically with
amputations and what leads tothat disparity?

Well, the disparity in the amputations is
the same that we've been talkingabout. And so the end stage
complication of having badcirculation to a foot that
produces a wound that mayprevent infection in the bone,
the end stage is an amputation.One of the biggest issues that
I've surveyed my patients, whydon't you show up to your
appointments? Or what is yourchallenge? And the number one
thing is actuallytransportation.

(09:16):
And number two is actuallyfinances. So even when they have
some resources, it's challengingfor them to get to doctor's
offices. But everything elsethat goes along with that,
right? I tell my patients, Iwant you to go home and I want
you to walk. Walk is greatexercise, they said, but I live
in a place that doesn't have asidewalk or the sidewalks are

(09:37):
broken or, you know, it's kindof dangerous to walk outside.

Oh, no.

And so, it's hard for me to expect them to do
something basic like walking andexercise to help prevent
complications when those are theneighborhoods that they live in.

The things we take for granted. I'm just
thinking the things that I takefor granted of feeling safe as I
take a walk.

Yeah. Yeah. I mean even just the parks down at
the end of my street and thingslike that. Do you think this is
something most people realize?Is this something most doctors
realize? And that just, like theword isn't out?

I can tell you that unless you've come to the
South Side Of San Antonio andreally kind of invested yourself
in this community, they don'tknow. I tell my colleagues from
the North Side, "Did you knowthat we have diabetic amputation
rates in some zip codes that aremaybe 15 to 20 times higher than
that in other zip codes in theNorth Side?" And they have no

(10:35):
idea. Which is why I say it's soimportant that we need to spread
the message and continue talkingabout it, not just around
Diabetes Awareness Month orHeart Healthy Month. This needs
to be a topic all the time.

I mean how do they feel when you share this
with them?

Most of them sound surprised. Some say,
"What? I've lived in San Antoniomy whole life. I was born here.
I was raised here. I went tocollege here. I work here. I had
no idea that that was happeningon the South Side."
To this day, right now, as faras access to acute care in San
Antonio, meaning a hospital youcan go to for a heart attack, or
pneumonia, or diabetic footulcer, on the South Side of San

(11:13):
Antonio, we have only onehospital with only 100 hospital
beds for over 700,000population. On the North Side,
have over 4,000 beds for1,500,000. And when I tell my
colleagues who work solely onthe North Side, they're like,
"What? Really? I'm so surprisedthat there's not more access
down there."

(11:33):
And so when you really put anumber to that statistic, the
statistic we follow is how manybeds do you have per thousand
population? Currently on theSouth Side, we have 0.14 beds.
The North Side, have 2.94 beds.
And so that is just such a verylarge disparity. And so in May

(11:55):
of 2023, there was a South Sidehospital called Texas Vista,
previously called SouthwestGeneral, that had shut down. It
had maybe 250 to 300 beds, andthey had some mental health beds
as well. Three to four monthsafter that hospital shut down,
in my practice alone, I saw athreefold increase in diabetic

(12:15):
amputations in people youngerthan 50.

Camille Hall-Ortega: This is startling. (12:18):
undefined

It was. Like this one thing where that
hospital shut down and created avacuum of acute care. It made it
harder for people to go to anemergency room, to get to a
hospital. And in my world, wesay time is tissue. If you have

(12:41):
a diabetic foot ulcer and it'sinfected, the amount of time to
get to care is critical.

I'm just having a lot of personal
realizations, right? Justthinking about what I mentioned
in the opening that it's notperhaps just that my parents
moved across town and improvedmy schooling, but that there's a
possibility that they increasedmy life expectancy by twenty
years. Just thinking about thatis really rattling me, but not

(13:09):
everybody can do that. Right?Like not, not everybody can just
move.
What do you see people doing totry to improve the conditions?

I've met a lot of people and a lot of
organizations and who are doinga lot of different things in San
Antonio. I'll give you oneexample that actually had been
published in New England Journalof Medicine. Dr. Roberto
Trevino, he was a critical caredoctor long time ago and
realized that diabetes wasaffecting his community where he

(13:38):
was from in the West and SouthSide Of San Antonio. And he
created a program to educatemiddle school children about
nutrition, exercise, andunderstanding how sugar is
processed in the body.
He helped train teachers, gymcoaches, cafeteria workers,
parents. And he actually showedthat with this $10 to $15

(14:02):
program, we could preventchildhood diabetes and prevent
child obesity and diabetes inthe long run.

Woah.

He's actually written a book about it and he's
published in the New EnglandJournal of Medicine that this
works. Those low cost,widespread interventions work.

I'm realizing that we talked a bit
about amputations, and I don'tknow that we talked about the
gravity of that. You talk aboutsome of the realities for
amputees and what that evenlooks like and some of the
ripple effects?

Well, having an amputation, as you can imagine,
is life changing. And, I have totell you, this is why I'm here.
One thing I've learned about inthese communities is that they
are resilient. Okay. I'm goingto start with, they are
resilient and our goal is tokeep them walking.
Our goal is to keep them walkingwith a prosthetic. But the

(14:58):
reality is once they have anamputation, they're probably in
the hospital for two to threedays. Ideally, if they have the
insurance plan that allows themto, they get to go to an
inpatient rehab where for two tofour weeks, are taught how to
transfer, how to keep theirother, legs strong, how to use

(15:19):
their arms and really trying tobecause the reality is you need
1.5 to two times more strengthto walk with a prosthetic than
to walk with two legs.

Wow.

You actually have to build strength and
balance that wasn't therebefore. Depending on how fast
they heal, the staples come outin four to six weeks. If
everything goes smoothly in fourto six weeks, they get referred
to the prosthetic company tobegin to fit them for a
prosthetic. And that's a processin itself. Because as that stump
heals, it first swells, but thenbegins to come down.

(15:51):
And so there's a lot of changesin the volume of their stump. I
do have some patients who themoment they get their
prosthetic, they're up andwalking. I have some that it
takes months to find theirbalance, to get that strength,
to get that comfort, to get theright fit. And not just the
patient themselves, but we don'tsee in between there are the

(16:12):
support that they need to getthem places, keep them in the
right mental state, to transportthem to all their doctor's
visits, to keep them doing theirphysical therapy exercises at
home. That's where family,friends, and the people around
that patient really are affectedas well.

It's almost as if the same systems that put
them in this situation are goingto make it harder to recover.

It definitely can be. So some of my patients
have lost a job once they'vegotten an amputation. I still
have some that say my goal is togo back to my job. But that
still takes a process. It's,challenging because we see the
amputees in the hospital andmost people don't see them

(16:58):
afterwards.
And I am fortunate that I see mypatients for their entire lives.
I see them until they pass away.I tell people I'm like the
primary care of vascular.Vascular of all the blood
vessels in the body. So I see mypatients until they die.
Unfortunately, some of them goon to lose the second leg. And
the reason for that is, like Imentioned, once we get to the

(17:20):
point of just a diabetic footulcer, their first diabetic foot
ulcer, that's a sign of systemicdisease. The reality is the one,
three, and five year survivalrates after a patient's first
diabetic foot ulcer is ninetypercent, seventy percent, and at
five years, less than fiftypercent.

Wow. I think for me, such good
information. Even, you know,obviously at the foundation,
we're exposed to some of thisinformation from our
initiatives, but I'm justlearning a lot. Just thank you
for, for all you do. I alsowanted to have us tap a little
bit into this notion of thedifferences in zip codes and how

(18:02):
we know that there are likelysome historical roots there.
We have spoken about in thepast, and in our article where
you're featured in Echoes, wetalk about redlining. Can you
tell us a little bit about whatyou found out about the
connection between redlining andtell us more about that term, of
course, and then what therealities are in in the present.

Oh, in full transparency, when I first moved
to San Antonio, had no idea whatredlining is. Major was
chemistry and minor in biology,and then it was medicine my
whole life. But when I firstmoved to San Antonio, it didn't
take long because I did work inhospitals all the way north to
Northeast Baptist and NortheastMethodist, all the way downtown
to the South Side. It didn'ttake me long just to see the

(18:46):
disparate care, the differencein demographic, the difference
in the quality of care,realizing that I was doing more
amputations in certain areasthan others. And at some point,
I'm like, I'm a private practicesurgeon, I would not think that
this is what I would be seeing.
Why am I seeing geographicdifferences? And that's when I
met Dr. Christine Drennan, who Ithink we all know. She's of

(19:08):
Trinity. She is who taught meabout redlining.
And so redlining was a practicein the 1930s that during the
Great Depression, the federalgovernment wanted to figure out
how we help American familiesrise out of poverty. And they
thought, well, if we helpfamilies finance the home and
the land that they live on, theycan build equity. And with that
equity, maybe they can buy a carso they can get a better job on

(19:31):
the North Side, or they can sendtheir kids to college, and
really was kind of the basis ofbeing able to rise out of
poverty. What happened at thesame time though, is the federal
government went into every largecity in the country and
delineated certain areas aseither attractive to London or
hazardous to London. It is nosurprise that if you look at a
1930s red lined map of DowntownSan Antonio, it is the near

(19:55):
west, south, and East sideswhere our black and brown
populations were, that wereredlined.
And it wasn't not just becauseof poverty or lack of finances.
I mean, if you look at the EastSide right now in San Antonio,
you'll see those old mansionsand realize that there was some
real wealth on the East Side,and they were still redlined
neighborhoods. And so, what wassegregationist and racist in the

(20:18):
1930s and was intentional hascreated systemic policies and
lack of investment in theseneighborhoods that result in
what we see today. And so, Ihave a presentation where I show
a map of a redlined neighborhoodSan Antonio. I show a diabetic
amputation map of every zipcode.
It looks exactly the same. Ishow a map of the hardship

(20:39):
index, which aggregates socialissues like educational
attainment, poverty, crowding ina household, and compares one
zip code to another, how hard itis to live in that zip code, it
looks like the same map. Andthat's why I believe that we
have to use the same energy andintentionality to be able to,
let's say, fight to reversethat, reverse those practices.

(21:01):
We have to focus our strategy.Actually, I use that map of
diabetic amputations to say,"Where am I going to put my
clinics?" Because I'm going toput my clinics in the zip codes
with the highest diabeticamputation rates, so hopefully I
can have a bigger impact.

So in a sense, you're investing in these
communities that did not receivethe historic investments that
some other communities mighthave received that were deemed
good investments to lenders.

That's right. And so it's interesting you
said, yes, I have chosen toinvest in this community. I've
been told by several like, oh,you're in the wrong area. You're
not in a place that's going tomake money. My practice and my
husband, who is theadministrator of my- we've built
the only Medicare accreditedsurgery center in all of South
San Antonio.
That's because we wanted tocreate that access for specialty

(21:52):
care like ambulatory care. Andso our dream is to create this
surgery center that attracts allthose specialists so that we can
provide the care here closer topatients in their neighborhoods.

You're talking a little bit about it
already, but I'd love to hearmore just about the SAVE clinic,
what led you there, you'vespoken about that a bit, and the
impact that you've seen.

The reason I started the SAVE clinic is
really because for the first sixyears of practice here in San
Antonio, I was witnessing thatdisparate care preventative
human suffering on a dailybasis. When I sit there and I'm
telling families that I need todo an amputation on someone in
their 30s and 40s that areyounger than me, just really

(22:35):
tears at your soul. And I knowit needs to be done, but I
really couldn't stop and witnesson a daily basis preventative
chronic illnesses andcomplications being suffered by
communities when I knew it waswrong. I can't just keep doing
the vascular surgery. I reallyhad to figure out how do I use

(22:56):
my experience as a vascularsurgeon and what I'm witnessing,
for advocacy and to changethings upfront.
And upfront is way before theycome see me. Upfront is when,
they're in elementary school andmiddle school, when their
neighborhoods are being built,do they have healthy grocery

(23:16):
store with healthy fruits andvegetables? Do they have good
tree coverage for not only forclean air, but we actually know
that the more amount of greenenvironment you have, the less
risk of cardiovascular diseaseyou have.

Intro (23:28):
Wow. Wow. What's the connection?

It's one, the clean air and it's just about
being around nature also. Has acalming effect. So there's no
doubt that everything, any kindof inflammation and stress can
lead to more cardiovasculardisease. And so it's when I
realized that that happened,needed to use a safe clinic one
as a model, to figure out how dowe address delivering quality

(23:53):
care to underserved areas, andhow do I show all my medical
community that it's possible,that it's financially viable,
that we are fulfilling ourmission to take care of our
patients, and why we went intomedicine, and that we are making
meaningful change in thesecommunities. And I was always
told and trained by the surgeonswho trained me as a surgeon

(24:16):
you're the leader in anoperating room, but you're the
leader in a community.
And it is your responsibility togive back and lead where you see
change that needs to happen. Andso I thought at first that by
creating SAVE and puttingclinics out in the areas that
needed that I would make achange. And I'm going be very
honest, I haven't seen thisrobust change in diabetic

(24:37):
amputations. It's when Ireflected and realized it's
because eighty percent ofhealthcare outcomes are affected
by the social determinants ofhealth and only 20% direct care.
So, I can do all the surgery Iwant to do and I'm not going to
have a big impact.
What we really need to addressis how we got here in the first

(24:57):
place. And we need to figure outhow we help our communities be
healthy communities without themhaving to move to the North
Side. So how do we createcommunities where there are safe
places to walk and exercise,that there is clean air, that
there's tree coverage, that theycan go to their public school
and get a quality education andknow they have the opportunities

(25:21):
to programming and pathways justlike they do on the North Side?
That we create transportationthat's equitable.

Well, hearing about the importance of
community, hearing about all thedifferent things that go into
health from education to theenvironment to understanding of
food to the infrastructureitself of healthcare reminds me
of a clip from the Laity Lodgearchives. This is from a fairly
recent retreat from 2020. It wasactually the last retreat we had

(25:51):
before the pandemic shut thingsdown. And it was called
Neighboring Together, and thisis a clip in which
Michelle Lugalia-Hollon istalking about the idea of
beloved community, which issomething she will explain. So
we're gonna play this clip, andwe'd just love to get your take
on it. Tell us what you think.

Michelle Lugalia-Hollon (26:12):
I learned about beloved community
through the work of MartinLuther King. Some of us are very
familiar with the quote that myliberation is bound in yours.
When I'm not free, you're notfree. When you're not free, I'm
not free. And he recognized thatthere was an inescapable network
of mutuality that binds all ofus. And when we do work in

(26:34):
isolation, we fail to recognizethat we have ripple effects
across all of those communities.And therefore our work should be
about transformation so that wecan achieve the beloved
community.

When you hear that, what resonates? How does
that feel like it applies to thethings we've been saying?

Well, I'm gonna start with Michelle
Lugalia-Hollon is a good friendof mine.

Oh, how fun.

We've interacted much and she speaks
to my soul, right?

I know right.

If only I was as eloquent as she was.
But I can tell you the idea thatwe are all connected and that we
all affect each other. I thinkthat's an important message for
all of San Antonio. I have heardsome people say ridiculous
things like, "Well, I don't wantto pay for someone else's health

(27:26):
insurance. That's not me. It hasnothing to do with me."
And so the reality is that thehealth of all of San Antonio
should matter to all of us. Andthe reality is that the
foundation of San Antonio arethose blue collar workers who
may be construction workers whomay help clean our hospital
beds, who are the cafeteriaworkers that help feed our

(27:49):
children. They're the ones whoshowed up during COVID. They had
to. They're the ones who bear alarger burden and a bigger
sacrifice to take care of theirfamilies.
And they affect us all. And soif we don't have a healthy South
San Antonio, East Side, SanAntonio, West Side, San Antonio,
we're not going to have ahealthy economic development for

(28:11):
all of San Antonio. My messagefor people are that you should
care that our students on theSouth Side get a good education.
You should care that we haveaccess to healthcare because
ultimately in one way oranother, it does affect us. And
so, go on with that example, I'mnot going pay for someone's
healthcare is some comment Iheard from somebody.

(28:32):
Well, someone who doesn't havehealthcare, you still pay. That
patient ends up at the endstages of illness, critically
ill in a hospital, in the ICUwhere there's the most money,
and those hospitals do getreimbursed for that care, and
that's our taxpayer money. Andnow, the $15 we could have spent

(28:53):
in middle school to prevent thisfrom happening, we are spending
tens of thousands for acritically ill patient, that
could have been prevented. Andso, my message is we all have to
care about each other. We allhave to understand that we are
all connected.
And I do like this, that simplesentence. "When I'm not free,

(29:15):
you're not free. And when you'renot free, I'm not free."

Oh my gosh. All it's just so important. I am
just wondering some takeawaysfor our listeners. At the
foundation, we highlight theimportance of being a good
neighbor. How can we be betterneighbors when it comes to the
topic of health accessdisparities?

That's a good question. You know, I do a lot
of, community talks and Ieducate, you know, seniors and
patients. One thing I tell themis, you know, when you're here
listening to this informationabout peripheral arterial
disease, you know, this is notjust for you because how many of
your friends and families oryour neighbors do you know have

(29:57):
diabetes? Do you know haveperipheral arterial disease? I
want you to share this messagewith them and teach them.
I alone am not going to get thatmessage out. And so I think it's
both not only empowering thosewho are able, but empowering our
communities themselves becausethey can help their own
communities by educating theirfriends, their families with the

(30:19):
things that they learn, andconnecting them to resources
that maybe someone has connectedthem to. I always tell people
that, look around you and lend ahand, you know, when you can.
Sometimes most people will notask for help. So offer it
upfront.

Yeah.

And if you offer it upfront, I'll tell you,
most people don't take it, butthe ones who need it will. And
so one example of that is everypatient that I see gets my cell
phone number. And so I get veryfew phone calls. And I tell
them, you know, this is not soyou can call me or we can chat
in the middle of the night.
This, this is for an emergency.And when you can't get ahold of

(30:59):
them, I will always be here foryou and I will answer that
phone. I don't get many phonecalls because most of my
patients say, we don't wannabother you. We respect you and
your time, and we just don'twanna bother you. But there's,
there is something in, thatsecurity of knowing that if they
need help, someone will answerthe phone.

Such a good message. So a big takeaway for
us is look for need, ask folkswhat they need, and then be
there if you can meet the need.

Well said.

Yeah. Yeah.

So Camille, I mean, that's what Mary Holzworth
Butt did, right?

Exactly

Marcus Goodyear: She would just listen to what (31:34):
undefined
the community needed. And thenno matter what it was, she would
try to help.

Yeah. Lyssa, thank you so much for
being here. Thank you for thebeautiful work that you do and
for sharing with our communitiesabout the needs that we can
really come together and try tomeet. Thank you. Appreciate you.

Well, thank you, Marcus and Camille.
It's been a great conversation.And I think we need to have more
of them.

Yes.

Yes. Yes. Absolutely. Thanks so much.

Thank you.

The Echoes Podcast is written and produced
by Marcus Goodyear, RobStennett, and me, Camille
Hall-Ortega. It's edited by RobStennett and Kim Stone. Our
executive producers are PattonDodd and David Rogers. Special
thanks to our guest today,doctor Lyssa Ochoa. We recently
featured Lyssa in EchoesMagazine, and you can read the
article online atechoesmagazine.org.
While you're there,consider subscribing. You'll

(32:29):
receive a beautiful printmagazine each quarter, and it's
free. You can find a link in ourshow notes. The Echoes Podcast
and Echoes Magazine are bothproductions brought to you by
the H.E.Butt Foundation. You canlearn more about our vision and
mission at hebfdn.org

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Does Your Zip Code Determine Your Life Expectancy? | With Dr. Lyssa Ochoa