Public Health Matters: Disparities in Health Care - How Did We Get Here?

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Christina Madison, PharmD, FCCP, AAHIVP, sat down with Noha Aboelata, MD to discuss her journey opening clinics and importance of health equity.

Christina Madison, PharmD, FCCP, AAHIVP, the Public Health Pharmacist interviewed Noha Aboelata, MD, CEO at Roots Community Health Center on her journey opening clinics and importance of health equity. Aboelata discussed issues that were raised throughout her journey— finding more questions than answers. Aboelata emphasized the need of creating a friendly, warm and welcoming environment that can help promote individuals to seek medical attention. Additionally, Aboelata discussed the importance advocating for structural issues in health care that are being uncovered to this day.

Christina M. Madison

Hello everyone, and welcome to another episode of Public Health Matters. I'm your host, Dr. Christina Madison, also known as the Public Health Pharmacist. This is part of Pharmacy Times, Pharmacy Focus podcast series. I have another incredible guest with me here today, Dr. Noha Aboelata, who comes from us all the way from Oakland, California. I say that with a little bit of a funniness, because she's very close to me. I live in Las Vegas, and I could literally get on a flight and be where she is probably within under an hour, so she's very close. I'm just really excited to talk about the work that she's doing in her community. Fun fact, we met because we were both part of a summit that was conducted at the White House last year. So, all things health equity—this particular seminar/workshop that we did, there was a poster session at the White House. Our symposium really focused on COVID-19 and how specifically her clinic — the Roots Health Care Center, and some of the work that I did, really focused on health equity and getting care to those who are underserved.

Without further ado, I'm going to go ahead and let Dr. Aboelata introduce herself and then we're going to dive into some questions about her unique clinic that's located in Oakland, California.

Noha Aboelata

Thank you so much for having me, it's great to be here. I am Noha Aboelata, and I am a family physician by training. I'm the founding CEO at Roots Community Health Center. We're headquartered in East Oakland, and we serve Oakland and San Jose, so the Greater Bay Area,

Madison

Tell us a little bit about your journey to opening up your own clinics, specifically in this area and your connection to the area. As another woman of color — for those of us who are watching versus just listening, I was really inspired by the work that your clinic did when I met you, in November last year. Part of it was realizing that we have physician colleagues that are really not just talking the talk, but walking the walk, and understanding the need for caring for communities of color. I would love to just hear how your journey started how you came to open the clinic. Obviously, we'll talk a little bit about the impact that you guys have made, in spite of the fact that you probably don't get as much funding as you probably should.

Aboelata

Thanks for that. The feeling was really mutual when we met in DC. Just knowing that we have pharmacists and colleagues that are doing this really critical public health work and how folks were really able to mobilize in the height of the pandemic. But also, how we've been doing this work long before the pandemic as well. I was born and raised in Oakland, and I went to Oakland public schools and went on to college and figured out I wanted to go to medical school late. In college I realized that I really always loved science, I'd always gravitated towards science. But I did not really care to be in the lab, I really liked interacting with people. I was a tutor — I'd been a tutor since high school, and I just loved being able to translate hard things to people. I had an aha moment at some point, like that's what doctors do, or at least that's what we're supposed to do. From there, I decided to go to medical school. I went to Howard in DC and then I did my residency training in Pomona Valley Hospital Medical Center, one of the UCLA affiliate programs. I felt that what I was most interested in was everything— I loved emergency and adults and kids and everything. I went into family medicine and really felt like that was going to be the best way for me to really engage with what I knew I wanted to do, which was community health. My cousin reminds me that in high school, I had talked about a health village or something like that —you could go get go to the doctor, but you could also go get a healthy smoothie or something like that. We don't quite have the village yet, but it's funny to think that all the way back then I was like, this would be great.

Madison

Put that on a t shirt.

Aboelata

Okay! Exactly. We'll get there, we're getting there, I think.

I came back home essentially, after my training with the goal of working within a community health center. I knew this is the type of medicine I wanted to do, community medicine. I worked in a couple of different federally qualified health centers. Those are safety net institutions that really provide an amazing and tremendous amount of care to folks who are uninsured or underinsured. I got into leadership within those organizations, and I still kept feeling like we are not going to be able to get ahead of all these disparities I am seeing. While I am looking at the patients in front of me, I am still looking at what's going on in the community overall. I am seeing my hometown of Oakland is always lining up on the map for all the things that you don't want to see. Then particularly the areas of East Oakland and West Oakland at that time, which was every map, every indicator, everything that I looked at was why are African American people dying 15 years younger, if you live in East Oakland, compared to up the hill? What is going on with all of these indicators like diabetes and asthma? Why is it always the same neighborhoods? What is really going on here? It was more questions than answers, as far as I'm concerned because for me in the exam room — I felt good, don't get me wrong. I am helping people, I am making connections with my patients, but also, you never had enough time to really understand how do we get here? Is this even sustainable if we are treating one person after the other, but we don't have time to say, how did we get here? What were the things that led to this premature heart attack, or diabetes at a young age — or how could we have prevented these things? Realizing that it had as much or more to do with people's environment and the community that they lived in, then a number of other different factors. This process led me to driving around the areas that I was seeing lighting up on the map. I knew the areas, but with a different lens now because I have come back with my training. I am trying to understand what's going on — do we not have enough doctors? Well, of course, the answer was not because we have a shortage of doctors — now, that is a challenge, and in some areas more than others. But you could put 100 doctors in East Oakland, and we were not going to solve the issues that we were seeing. I said no, we have to go find the people that are not coming into the doctor's office.

Madison

Absolutely. When you don't make the environment friendly, warm and welcoming for people to come to, they're not going to seek medical attention. Then, that's how you unlock with all these acute issues, versus preventing those things from happening. People delay seeking care until something's really wrong because they don't feel comfortable accessing the traditional healthcare system.

Aboelata

Absolutely. 100%. At that time, it was also before the Affordable Care Act, which was an absolute game changer. Of course, again, getting coverage is not also the same as access and it's also not the same as access you feel comfortable taken advantage of. At that time, when we first started, it was like 2008 and me and nurse Ophelia long. The two of us were this two-person volunteer operation. We were just driving around East Oakland. We were going to places where we knew people who were not getting care. People who have come out of incarceration, people who were maybe in substance use rehab, but really were not receiving or accessing primary care. Folks who were essentially really receiving their care, as you were alluding to in the emergency department, because they were not accessing care. We really just started going and literally doing house calls — going and delivering care on site to folks where they were staying, and learning. Coming with more questions and answers, like why are you not able to access care, why are you not accessing care? A lot of things had to do with at the heart of it, s really not being empowered to do so. Feeling like I might be mistreated, I might be told no, I might not get any help, I might be judged. All of these things led to avoiding the whole entire health care system, until something's so bad that now you're going to the emergency room, where again, you'll be judged, mistreated— you waited too long, why didn't you do this, you were told to do this, but you didn't do it, now you're non-compliant.

Madison

Being medication seeking because now you're in excruciating pain, and they think that you are somehow just there for pain medication, right? Even though we know that black people thought that they can tolerate more pain, that their skin is thicker, all of these horrible misnomers that, unfortunately still perpetuate through medical education. You still, unfortunately, hear those misnomers. I have been a victim of being denied care because I am a woman of color. So I get it, when you go to seek the care, even when you think you are supposed to get the care that you deserve — and you are, you are not even getting that even when you chose to only go when you thought it was an absolute emergency.

Aboelata

Exactly. Those stories stick, they pass down through the generations. I was fortunate to have trained at Howard, which is a sickle cell center. I trained under some of the most amazing people and really learned about the pain that is incurred. I also found myself having to later fight for my patients with sickle cell because they know what pain medication is going to touch that excruciating pain of a crisis and they are labeled everywhere they goas drug seeking. It is a horrific thing to be inflicted with that type of pain, and then be labeled on top of that, and not be able to even get the help you need because of it. It is one example but like I said, those stories make it around the world and certainly pass down. Folks do not trust because people they love— people in their family have been mistreated. People talk about Tuskegee, and things like that, as if nothing has happened since back then. But we know that is absolutely not the case. Unfortunately, whether it's explicit, or whether it's implicit, there is bias in healthcare. There are structural issues in health care that we're uncovering to this day. We are right now advocating and fighting to get the pulse oximeter devices fixed.

Madison

We had a black female physician, who basically died in the hospital, and told them repeatedly what she needed and when she needed it. Then after, the hospital blamed her for her old death— told the media with the statement that she bullied that. I'm like, how is this possible in 2021, how is this real life?

Aboelata

These are things we have seen. We have seen them; we have experienced them— where advocating for yourself is now combative or you are bullying. We see these labels. The way these labels get applied, I don't think people realize how damaging this is because once the thing is in your medical chart for the next physician or provider to see, it changes the nature of that. You say 'oh, this person is not compliant,' that means they are not going listen to what I'm going to say anyway so I am not going to try as hard, I am not going explain it as thoroughly, and so on. All of these labels — and it is shameful to see that happened. She is a physician and she still ended up getting this label, then come to find out as myself and colleagues, were here locally and in our county seeing African Americans dying at double the rate of everybody else from COVID —why?

We partnered with a local hospital system, and we were seeing that after you accounted for underlying condition, because everyone wants to say, oh, it's this oh, it's that, oh, is this —no, let's look at the data. Once you accounted for socioeconomics, you accounted for underlying conditions, there was still a disparity. We were on a mission to try to figure out what is going on here. That is when all of this information around the pulse oximeter came about because you will recall that the pulse ox device that clips on your finger— that was the only objective measurement that we were using to decide, do you go to the hospital? Does the ambulance take you to the hospital? Do you get admitted? Do you get oxygen? Or do you get sent home to that?

For that device to systematically overestimate oxygen saturation in people with darker skin tones is criminal. I say criminal because it was known before all of this happened. Now how many people did we lose? We lost so many people. We know that if your reading looked fine, if it is systematically three or four points higher. Let's say you are above that threshold — we didn't have enough hospital beds at one point, we didn't have enough oxygen in some places, we had lines out the door and ambulances in some places. That was easy, no, you don't get to come in, you get to go home and die. This was happening disproportionately. Once I started to really do the digging, I saw that there were actually academic papers on this topic in 1999 and nobody cared enough to do anything about it. We know that if roles were reversed, this wouldn't be the case. When you talk about systemic racism in health care, that does not exist, or back in Tuskegee? No, we have contemporary examples. Here is one right here that resulted in real loss of life. Keeping all of those things in mind, and it's important that we keep those in mind — we have to take ownership. We all have to take responsibility because sometimes things are not quite right. There is so much to do, there is so many sick people to take care of, there is so many prescriptions to fill. I think part of our work at Roots, in addition to providing the direct service and surfacing some of these issues is now we have to fight because if we don't advocate around it, it will be another decade and another pandemic, and we will have the same problem. We will have never addressed or fix this issue. I think we have to take ownership and understand that the work we are doing not only has to be good, but it also has to be culturally responsive. It has to be excellent; it has to meet people where they are, it has to overcome a legacy of absolute distrust. It has to really overcome earned distress.

Madison

People are like we're 'oh, well, I just don't understand where this comes from?' I am like, let's think about the historical trauma that has been perpetuated for decades, on people of color —obviously, in particular, black people. Sometimes when I get asked this question — because I am sure you get this question too from your colleagues, they are like, 'Well, I just don't understand, what do you mean?' When I think about all the different examples and not just examples of things that have happened in the past, but in modern times. Like you mentioned, we have real world examples from now — not from Tuskegee, from now where there has been mistreatment. Even just now seeing the thought process around trying to reconcile some of those wrongs. Seeing the judgment with this new settlement with Henrietta Lacks this family, you are seeing now the identification of the enslaved women that were experimented on by Dr. sins. All of these things that are trying to get healing and reconciliation, but not quite making the mark because you still do not have people who understand that, that is just the tip of the iceberg.

Aboelata

I think we can do important meaningful gestures or ways to try to compensate for these things—that is important. I think we have to understand that the structure remains and the business of the structure of health care churns on and so there is a lot of work that would need to be done. When we talk about health equity, we get worried that it just becomes this buzzword that people stay without really doing it. But when you are actually utilizing that framework, you are saying we need to take the people who have been the most harmed, the most pushed to the margins, and put them in the center of our work and develop around that. That is not what health care is doing. It does not matter how much you say, equity or what have you —equity is not a project. It is not an office off to the side and the base of it. It has to be central and core to the work that we do. It is not just about structural issues in health care. I mentioned the maps — those maps, if you go back to 1929, the same areas are red from the redlining map. This is basically by design, essentially, you have entire neighborhoods and areas where people were systematically locked out of economic opportunity. Bad actors and industry polluters were brought in, allowed in, welcomed in. Then now I am like, why do we have such high asthma rates? Well, it is how you have built the environment.

Madison

It is where their homes are located, because they cannot purchase anything outside of those areas. They were told that they were not allowed to purchase houses in the clinical white neighborhoods. Even after it was outlawed, it was still being done— the banking system was still doing it. You see it with the undervaluing of homes that are in certain zip codes because those were traditionally the houses that were part of black neighborhoods. I am sure you probably saw the story that aired about the family who had one estimate of the home, and then they had their friends come in. They put up all pictures of their family, same home, same everything, and the value of the home went up for 20%. The only difference was that they had themselves, which were a black family versus their friends that came in were a white couple. It is still happening; it is just how do we help from a community basis — which is what you are really involved in.

Another thing too, that I wanted to touch on because this is part of public health that maybe does not get as much attention is carceral health and the thought process around recidivism and people coming back into society. A lot of times, why people reoffend is because they do not have access to health care, or to mental health services, or access to food transportation because there is no one there welcoming them when they come out to try to help them to get back into society. The initial goal behind being a part of that carceral system is that you have paid your debt to society and once you leave, you should be able to reintegrate into society, but we do not allow for that. A lot of the challenges that occur are directly related to health care. You see that with mental health problems, you see it with a lot of our patients that are HIV positive, not having access to meds once they leave the carceral system. I do not know if you want to talk a little bit about the work that you guys are doing in this space, but I do think it is really important to mention that carceral health is actually part of public health. When we think about public health as an umbrella, that is definitely one of the factors and one of the main portions of the system that we really need to provide good health care to people.

Aboelata

Yeah, no, absolutely. It is funny. I was about to go there next, because as you were talking about the homeownership and how that has really robbed people of the opportunity to develop generational wealth. When you look at the redlining map, that is also the same map as the number of arrests. We know that there has historically been racial profiling, over policing, inappropriate policing, and oftentimes criminalization of behavioral health issues — which disproportionately is towards men of color, especially black men. Where you have a behavioral health issue and instead of getting routed to the assistance that you need, it is looked at through a different lens of being criminal, and then that person is getting incarcerated and repeatedly incarcerated. This is not unique to Alameda County, but this is across the country where our prisons are our largest mental health providers. This is, again, a systemic choice, essentially, that we have made around how we are addressing people with behavioral health challenges. But also, what we are choosing to criminalize. There was not that long ago where black young men were being incarcerated around cannabis and now you have these young entrepreneurs trying to come into East Oakland buying a property in order to have their legalized now, where those people's lives were affected and sometimes really destroyed.

Madison

Completely away from them for minimal amounts of something that is now a billion with a B dollar industry. I also live in an area where cannabis is huge. It first started off with medical, and then now recreational, and now we have cannabis lounges where people can come in and patronize the strip and also get their cannabis ... Think about all these people that were criminalized. It was also a way for policing as well. One of the things that they would say was that they smelled something—like that was a means for searching search and seizure that was done oftentimes. Now you see this being such a huge industry. I think we definitely need to talk about it — the first step is knowing that there is a problem. They say, knowing the problem is the first thing—calling it out. You cannot fix what you cannot name. That is a big thing as well, having programs like yours, in particular, where you are warm, welcoming, very much a fixture of your community, you said. You guys have been doing this since 2008, I do not know how long you have had your brick-and-mortar location. I do think that like having that sort of beacon of hope and light in your community is just so important. We were chatting right before we hit record, but having a unicorn of this facility, I think is so important. However, I do want to say that although you may be unique because you have decided to focus on what traditionally has not been seen as profitable, I do not think that means that it cannot be replicated. With that being said, I know you guys have strong pillars and strong values. What is the number one thing that you would say if a clinic or another health care facility wanted to start doing some of this work? What would be one of the things that you could say that they could do today, to just start on that journey to be more community minded and really community centric?

Aboelata

Thank you for that question. That is a great one. I think the first step is definitely a commitment from the highest level to say, we are going to take responsibility not only just for disease care and preventive medicine, but actually to broaden our lens to say, what is it that is keeping our patients from experiencing the best health. In our case, where it was, primarily poverty being shut out of the workforce, oftentimes because of a record. Having been formerly incarcerated, we realized that what we needed was a support structure for people, including those who are coming back from incarceration. For example, we have navigators who are basically like community health outreach workers, they have been impacted by incarceration themselves. They have a panel of members that are coming out of jail or prison that they are helping navigate. This is something that has absolutely improved, patients coming to their medical appointments and getting their prescriptions filled. This is going to serve your purpose as a clinic and as a primary care provider, but it also means doing things a little bit differently. It is not only about medical personnel, but also about hiring from the community — people who share life experiences with the people that you are serving. If nobody in your office understands what your community and your patients are going through, it is going to be a lot harder to get them to do all the things that we are trying to ask them to do.

I think the other part of the commitment and focus that has been critical is to understand that in health care, we are going to have certain things we are focused on. I want my patients with diabetes to have their diabetes controlled and I want people to get all of their preventative screenings on time. But if people are struggling, the only thing I care about right now is getting custody back of my child, or I am living in a car right now, I need to get a roof over my head before I am going to go get a mammogram. I think it sounds like a no brainer, but I think what health care has done is that they did not get the mammogram, not my not my problem. That is not compliance, that is them not following through. I get that we are busy. You have a lot of people to take care of, but at the end of the day, the goal is to improve health outcomes. That means that we are going to have to do more than just passively wait there for people who have needs to come in and get what they need.

Then I think the last thing would be for us, we really take a neighborhood approach, we think about the neighborhood that we put ourselves in and what the needs are. We are constantly responsive to those needs. In other words, we are not just saying whoever walks in the door, we are saying, who needs us most? And how can we go get them? How can we encourage them to come in? We see it in the data, we are keeping people from going back to jail, we are keeping people from going back to psychiatric emergency or to the emergency department. Why? Because they have a place in the community that they trust that they can come to get what they need. Whether that is food, or whether that is just a kind word from someone who looks like them, or it is from their community, or whether it is a doctor's appointment, or mental health appointment, or maybe it is a job training. We ended up developing to social enterprises where we train people who have been marginalized from the workforce because if the biggest barrier to good health in our community is poverty, what are we doing about that? How are we helping people to mobilize? I know that that can sound like a lot, especially in traditional health care delivery. But I would say starting small. What is the biggest challenge that you are facing? What is the biggest challenge that your patients are facing that is keeping them from good health? What is maybe one person that you can hire from the community and support so that they could support them. With the new community health worker benefits that are out there now with the restructuring, especially in California around cow aim, and covering things that are not traditionally thought of as health care. Those are things that can be tapped into, but I think it really does start with that commitment and that willingness to truly be part of the community that you are serving.

Madison

I think those are all fantastic suggestions. I know that there are probably people are like, man, that is so many things. That is a lot of different ways that I can help my community. But I do know that the funding side is always the pink elephant in the middle of the room. When we are talking about why we are not doing these things, and I think a lot of times funding or being reimbursed for services, you are talking about the restructuring around community health workers. Then being compensated for their services, I think is super important. In addition to hiring people from the community, maybe even thinking about investing in grant writers or people who understand what I would consider unique payment models so that you can think about ways that you can get people trained for a job or access a nice outfit so that they can go for a new interview for a job. This is stuff we do not think about a lot of times. I had a patient one time, when I was still doing work with one of our community hospitals, where they kept coming in with diabetic foot. When it came to find out he just didn't have a good pair of shoes. Obviously, the diabetes was impacting his ability to feel, but part of the reason why he kept having these infections is because he kept getting cuts because he did not have a proper pair of shoes. Can you imagine you leave the hospital with no meds like, here is just a nice pair of shoes —a pair of shoes that will keep you clean, safe, and warm, just the little things. I wonder how do we get here as a society to where we cannot think about caring for those who have the least? That is such a measure of a society. I just think we are failing, and I am so thankful for programs like yours, because I know that you are making an impact—data talks.

You have mentioned that multiple times. I am curious, do you have someone that is actively getting some of this information, so that you can publish it to get more resources so that you can get more funding?

Aboelata

Now we are a team, we are a big team— we are over 200 full time employees. Now we have got multiple sites throughout Oakland and San Jose, so we have grown a lot, we do have a team. We finally have our first grant writer for six months ago, up until then each of the program directors would write their own grants, myself included. I have written many. But I would say there is not a one size fits all in the way that we have approached it, which people in health care think sounds completely opposite of what we have learned. The way we have approached it is what does our community need? That's the first question, then who is going to pay for it?

That may sound overly simplistic, or super risky, but it really is not. In most cases, if we are talking about working in the safety net, there are these needs, but you may have to cross sectors a little bit. For instance, we work with the county social services department because we do so much benefits enrollment. We partner with them, sometimes we have contracts with them, so depending on what type of need there is, there often is a funder — a pot of money or reimbursement mechanism, and things can start to get complicated. I will say that we have a fairly sophisticated revenue pie. But oftentimes, if we if we decide, okay, violence is what is really plaguing our community, and this is why our young people are so frightened —we want to be able to help address these things. Can we hire someone within our office who is trained in violence prevention?I think there are a ton of different examples where this is something that is currently being actually reimbursed through MediCal. I think keeping up on these things because a lot of people do not know community health workers, we have some reimbursements now for our community health workers. It is not very much but, those of us who serve the MediCal population, we know how to stretch resources. A lot of these offices do know how to stretch resources, but it is staying on top of how to be able to do things.

You may decide, we should really become a nonprofit so that we can write grants, and we can get donations, for example. If certain communities that will work perfectly, especially if you have in a fluent community that wants to partner with you to help solve these problems. You can do things and I do not think you have to start huge. I think sometimes starting with a health bear, where people get to know who you are and you can test for things and you can bring in new patients, but also be a be an asset in the community. I think starting from wherever is comfortable, but really asking the question, like what is needed? Then who is going to pay for it? It is actually easier than it might sound.

Madison

I really appreciate that pep talk. I hope everyone is like yes, we can do this, may not look ready, but we are going to make it work. Sometimes you got to take from a little bit over here a little bit over here.

Aboelata

And partner— I forgot to say partner. Maybe you are a physician, and you can assist in a church health ministry or some other things like that. I think volunteerism is important, but I think meaningful partnership is even more critical. Those can build into things that you can really embed within your community, so it is something that people can count on.

Madison

I love that you mentioned the faith-based organizations, especially when you see communities of color. During the pandemic, they were salvation and refuge — no pun intended. I do think that when we started going and partnering with those faith-based organizations, we saw better acceptance of some of the interventions that we were trying to do to mitigate issues around COVID. We say this all the time, but meeting people where they are—where are people going? Where are people congregating? Is it the community center? Is it at the church? Is it at the park? Like, where are they going? Like what you guys did in the beginning, when you were just driving around figuring out what people were up to, and why were they not going to the doctor? You are just like me, you look people up and down, and they are like obviously, that swelling is not supposed to be there. Obviously, it has been a while since you have gone to the dentist— let's talk about how that poor dentition is probably impacting your overall health and wellness. You have always had partial teeth, tell me why that is, how can we help you? Why do you not like going to the dentist? I cannot tell you how many times I have talked to people that said, I am just frightened and that is why I do not want to go. It causes so many health problems because if you do not have proper dentition, or if you have dental caries or dental infections, it can cause so many problems with the rest of your body. Obviously, I am a pharmacist by training, but I spent a decade in a public health department. I literally got asked to do everything you could possibly think of including fluoride varnish on teeth, so lead prevention, lead screenings, and all of these things, which traditionally are harder hit and more impacted in black and brown communities. I really just think that as a takeaway, even if you are not living in a minority community, you have people that are in need. And how are you going to help those people in need, whether that is partnering with a faith-based organization, whether that is partnering with a CBO, you can do the work, and you can make an impact. It just takes very little of your time and I do think that your model and the fact that you guys have been able to grow so quickly is a testament to leading with community. You lead with the community, your first question is always, how can I improve someone's health? Then you work backwards, like, okay, what can I do? How can I make this intervention? Then you think about how I am going to pay for it versus the reverse— which is traditionally how our healthcare system works, which is pay for service fee for service versus paying for outcomes. I love that you really are focused about the outcomes and the overall health and wellness of your community.

Aboelata

Thank you, I appreciate that. Our healthcare system has gotten so complicated. You were speaking about the mouth — it is like we have separated the mouth from the brain and from the body. It just made it so overly convoluted and complicated.I do think it helps for all of us to do that gut check, kind of soul searching, let's take a step back —why am I in health care? And if it is to improve the overall outcomes, like how are we going to get there, and that is going to be a different answer, depending on who you are serving and where you are. But being part of that solution of how we are going to get there is going to be so important.I think we have seen a lot in the last few years to understand how not thinking in this way has led us to a point where we performed very poorly for our country of our wealth in this pandemic. We really did not have only the public health infrastructure, but just the basic education. We have leaned very heavily on our technology on our medications. As we saw, they can be overwhelmed, like they can be overrun. They can get it wrong, like we saw with the pulse oximeter as well. I think taking a step back from all of that and just saying how do we as health care take responsibility for the overall health and well-being and then what do we need to get there? Besides for being effective, it is very fulfilling. We have a number of physicians that routes and who basically feel like I can be a doctor and do what I was trained to do. But I also know that this navigator going to help them get the food, the navigator is going to help them make sure they have a roof over their head. I am not just sending them back out into the street with a pamphlet and saying good luck with calling these phone numbers. I am actually able to help them achieve their own goals and achieve stability. There is no better fulfillment like as a physician that I could ask for— even if the intervention has nothing to do with a prescription. It is a referral to our work force development —a social enterprise. Now I can see them looking happy, feeling fulfilled transforming their life. I mean, it really is what we went into it for. It is good to not lose sight of that.

Madison

I tend to ask, I know, I am going to ask you a question. I did not tell you this in advance, hopefully, you will get to upset with me. I usually ask my guests this question. If you could tell your younger self, anything, what would it be? And why?

Aboelata

That is a good one. I have never been asked this question. I guess for me, Maybe this is just because I think staying focused and staying just stay true to yourself, because I think I did a pretty good job of staying focused and I think I did a pretty good job of staying true to myself. But there's moments along the way, where folks are like, why is she doing that? Why would a clinic have a soap factory? That is crazy to ask what is needed and pay for it later. That is never going to work out. I think those things, they did not take me off track, but at the same time, it does sometimes make you be like, okay, is this going to work? So just stay the course — I think it is probably just staying the course, which is what I'm telling my current self now too.

Madison

Well, and really just staying true to yourself and true to your values, and not letting the noise really impact how you choose to live your life and how you choose to impact your community. I would say the only other thing that I would add is that how incredible you are. Tell your younger self you are amazing, and you are going to make meaningful change.

Aboelata

Thank you for that. I that is a really good one. I appreciate that. That is something we don't tell ourselves often enough. I will take that to heart and right back at you.

Madison

This has been such a great conversation, unfortunately, we have to end because Dr. Aboelata has to go see her patients. Continue to make waves in the Oakland Community and continue to get people housing and fed and job security, and all of the things. With that, I will end with saying you never know who needs to hear what you have to say. So, speak up and speak often. You never know the impact that you will make. Even if it is just a small change, even if it is just showing up somewhere where you’re unexpected. To stay the course, to trust your gut, and to really lean into those instances that you have that instinct to do something without knowing what the benefits is going to be on the back end — because sometimes just showing up is the gift.

This has been another episode of Public Health Matters. I hope that for those of you who are listening, or who are watching continue to follow me on this journey as I interview incredible pillars in our health care system. I love that I am able to get incredible guests to come and talk about their journey, how they are making an impact, and really talking about why public health is something that we should be focusing on as a whole and as a society. I do think that this is going to help us to be happier and healthier.

With that I am your host, Dr. Christina Madison, and remember, public health matters.

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