Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-host Dr. Tamika Perry and former television broadcaster Gina Galaviz will share information to improve your health and well-being. And now here are Gina Galaviz and Dr. Tamika Perry.


GINA GALAVIZ EISENBERG
Welcome to the award winning Docs in a Pod presented by WellMed. I'm your host, Gina Galaviz Eisenberg. Ron Aaron is on special assignment today. I'm so pleased to have you with us. Our program is available on podcasts wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida. Each week, we talk about a variety of health and wellness issues that impact Medicare eligible seniors and others. Our Docs in a Pod co-host is Dr. Tamika Perry. Hi, Dr. Perry, how are you?


DR. TAMIKA PERRY
Good. I'm great. I am so excited about today's show. But I'll let you finish first before we start talking about it.


GINA GALAVIZ EISENBERG
Oh, you're the best. So I'm just going to toot her horn because she's just an amazing person. If you're already a patient of hers or you're not, she's someone you need to talk to. She's an associate medical director at WellMed. She oversees several large clinics in the Optum Care North Texas region Southern sector. As associate medical director, Dr. Perry's goal is to support the providers at these clinics as they deliver quality care and a compassionate patient experience. She also helps the organization live out its mission of helping the sick become well, and helping patients understand and control our own health. It is a lifelong effort at wellness. She's been with the organization for more than seven years through the acquisition of her private practices. So please welcome to the show co-host Dr. Perry.


DR. TAMIKA PERRY
Yes, Gina. Thank you. I'm doing a show today with one of my favorite Eisenberg's. I am so interested in today's topic about rural health because I come from a long line of people who live in rural areas, all of my extended family, and I've always lived in the city. This topic is very interesting to me so I am excited about our guests.


GINA GALAVIZ EISENBERG
Texas has a lot of rural areas, as does Florida. Let's just talk about this health care crisis that's facing millions of families in rural areas of our country. It's a crisis that can really mean life or death, so I would like to introduce Dr. Temukisa Young Henley. She is our guest today, and let me toot your horn because you're doing a lot of wonderful things as well. You hold a Bachelor of Arts degree in biology from Oakwood University, an HBCU, and earned her medical degree from the University of Florida. You've got over 25 years of experience dedicated your career to practicing medicine in Central Florida, and you've been spending the last eight years at Optum Medical. Dr. Young Henley specializes in managed care. She's focused on serving patients with fixed and low incomes. She has held several positions, such as medical director at Rosewood Health and Rehab and vice chair of the family practice department at ORMC, and she's now a distinguished partner at Optum. Welcome. How did you get involved? How did rural medicine attract you?


DR. TEMUKISA YOUNG HENLEY
Well, actually, I have personal experience where this is definitely a testimony. My parents were missionaries in Africa, and at that time my mom became ill, and we had to seek care. It was very difficult at that time because you had to cross borders and the nearest hospital was four hours away, and there were a lot of issues with getting across the border at that.


DR. TAMIKA PERRY
What part of Africa were you guys in?


DR. TEMUKISA YOUNG HENLEY
We lived in Arusha Tanzania.


DR. TAMIKA PERRY
Wow. How old were you?


DR. TEMUKISA YOUNG HENLEY
I was six when we arrived there.


DR. TAMIKA PERRY
Oh, that is so awesome. I'm going to go tell my mom you should have done better. We didn't do enough.


GINA GALAVIZ EISENBERG
And happy Mother's Day, right?


DR. TAMIKA PERRY
Right. Happy Mother's Day, mom.


GINA GALAVIZ EISENBERG
Once you got back, what attracted you to medicine? I guess that had a huge impact on you wanting to help people.


DR. TEMUKISA YOUNG HENLEY
I did. Just dealing with my mom's illness and coming back to the United States. We actually left early because we had to seek medical care. She was given 24 hours to live, so we flew back to California. Just through working through all of that. She ended up getting a renal transplant at chance, and that's actually where I ended up in med school. So, it's kind of a full circle story.


GINA GALAVIZ EISENBERG
What do you find are the obstacles, besides accessibility to medical care, what are your patients facing?


DR. TEMUKISA YOUNG HENLEY
Well, a lot of it has to do with the location that some of my patients live in. It's geographical isolation. Being so far away from the clinic. Trying to get transportation to the clinic. Not having that all the time. The financial needs, which leads them to miss appointments.


DR. TAMIKA PERRY
I was reading that the CDC says that there are high rates of poverty and social determinants of health in rural areas. Different than inner cities. For example, there are higher rates of cigarette smoking in rural areas. Do you think this directly contributes to the decline of health in rural America?


DR. TEMUKISA YOUNG HENLEY
Oh, definitely. When you take a closer look, they have less access to a lot of things. Even substance abuse disorders, there's not a lot of care out here. OB’s, anything mental health related, they have to travel very far to get these services.


GINA GALAVIZ EISENBERG
Before we go on, I like to reintroduce you to our listeners. If you just joined us, you're listening to the award winning Docs in a Pod with our co-host, Dr. Tamika Perry. I'm Gina Galaviz Eisenberg. Our podcast is available wherever you get your podcasts. Dr. Temukisa Young Henley is our special guest. Continue talking about rural health care.


DR. TEMUKISA YOUNG HENLEY
Just having to deal with the distance and being isolated. It means that you get delayed diagnoses and treatments, especially if you have an urgent condition. So, there's a lot of barriers that you’re dealing with. There's not a lot of health care professionals in rural areas, and then subspecialties are even fewer. Now we're dealing with hospitals closing down in those areas. Over the last few years, about 4% of those hospitals have closed down. That means that these patients, on average, are having to travel an additional 20 miles on top of that to reach urgent health care. So, there are a lot of barriers. Way back when I started in medicine, I thought, oh, that would be a great way to reach and to be available and to give people access, but in rural areas, they just don't have broadband access. 17% of people there don't have it versus 1% in cities.


DR. TAMIKA PERRY
17%?


DR. TEMUKISA YOUNG HENLEY
Yes.


DR. TAMIKA PERRY
That's a high number. My teenage daughter would die. I mean, she would just instantly go into some type of internet free coma, you know what I mean?


GINA GALAVIZ EISENBERG
I agree.


DR. TAMIKA PERRY
That's really high. The other thing that I noticed that happens, and I say this because I have as an adult done medical mission work in rural Honduras, and unintentional injuries are really, really high. So, a lot of the work that we would pay people for, we have access to people in the city. I'm not going to work on the rooftop of my house. I'm not equipped to do it. It’s scary. I don't even know how to use a ladder. But if you're in a situation, you may have to do that yourself, or your job may be a job that puts you in injurious situations. So, unintentional injuries are high in the rural population. And on top of that, it takes 911 two hours to get there. The nearest hospital is four hours away. Dr. Young Henley just told us that 4% of the hospitals in rural areas are closed.


GINA GALAVIZ EISENBERG
How do you encourage people to come get a checkup to make that first visit so at least you have a benchmark you can start seeing as they progress in age. How do you encourage them to come in?


DR. TEMUKISA YOUNG HENLEY
Well, you definitely try to meet their needs. It's kind of easy when it's your patient and you can actually speak to them on the phone and find out exactly what the issue is as to why they can't come in. Is it a transportation issue? Is it that their daughter got a full-time job and now she’s not available to bring you? So, sometimes if you're able to find out exactly what the issues are, you can address that specifically. But, you think about transportation for these patients, it's longer to get to the appointment so there's more time off work to get there. It's a cost whereas when you're in the city, you have access to public transportation. You can take the bus, the train or Uber. When you're out in these rural communities, it's not that easy. So, a lot of what I'm hearing from my patient population is that it is a transportation issue.


DR. TAMIKA PERRY
Now, transportation is an issue sometimes even in the city too, because it's just social determinants of health. People say, I just don't have the money to even get on the bus or I wasn't privy to the programs that allow me to get on the bus. So, me and my team will do home visits for a patient. Do you or anyone on your team? Is that a viable option? Do you guys drive out? I don’t know how many patients you can see if everyone lives 30 miles away but is that a viable option?


DR. TEMUKISA YOUNG HENLEY
We have actually done some home visits. I'm a solo practitioner. I’m the only one here at the office. There are things that patients absolutely need, especially if you haven't seen them all year long because of issues like that, we have them home visits. Our company also has the option of getting out a referral to another company that will do home visits for us. So, in those extreme cases.


DR. TAMIKA PERRY
At least between telemedicine and home visits, we can close the gap somehow if it's feasible for the patient. Did you ever practice in the city?


DR. TEMUKISA YOUNG HENLEY
Yes.


DR. TAMIKA PERRY
What are some big differences that you see between city and country? In terms of disease states.


DR. TEMUKISA YOUNG HENLEY
The chronic illnesses are usually worse. They usually are uncontrolled diabetics, uncontrolled hypertension. I think just because it has been harder for them to get help and they're the ones that have missed appointments and ignored a lot of medical symptoms along the way, they're the more difficult cases. We're also a little bit more limited. I think the insurance plans out there, because there's no competition, there’s just a few available, they have higher deductibles and higher co-pays. The free services that are in the city, I’ve seen you can get free gym memberships. You may have some transportation available through your insurance. In the rural areas that's not available.


DR. TAMIKA PERRY
I've never seen a Whole Foods in a small town. I could be wrong, but I've never seen a Sprouts in a small town or LA fitness. So I can totally, completely understand that.


GINA GALAVIZ EISENBERG
We're going to take a short break. We're going to continue our discussion in just a moment. We are talking about barriers to accessing quality health care in rural communities. We will be right back.


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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. I'm Gina Galaviz Eisenberg. Our focus today is on the health crisis in rural America, and why all of us should really care about this. I mean, it's important. You move to the country from the city for peace and quiet and beautiful and green spaces, but it can really affect your life expectancy because of access to health care.


DR. TAMIKA PERRY
Absolutely.


GINA GALAVIZ EISENBERG
How do you balance it out? The peace to being healthy. Either one of you jump in.


DR. TAMIKA PERRY
I'm going to let Dr. Young Henley take that because I'm a city girl. I like access.


GINA GALAVIZ EISENBERG
I do, too. But I also love peace. Dr. Young Henley, what do you think?


DR. TEMUKISA YOUNG HENLEY
There are some initiatives that are out there that they're trying to do. They're looking at delivery models, so they're putting in a few more rural ER’s. A few places have community paramedics that work is kind of like primary care. And then they have community health care workers that will help to, as liaisons, to try to manage getting patients that have chronic medical illnesses to the providers. They do have some mobile units out now that are available. And then of course, where they do have internet access, there is telemedicine that is available. But there still needs to be more legislation and policies and things that need to be done before this can truly be addressed.


DR. TAMIKA PERRY
My mother lives in a rural area. She's very much a country girl. She gets her chronic care here in Dallas. Even though she lives closer to Houston, she feels more comfortable coming to Dallas. So, once or twice a year, she'll come for her chronic checkups. Anything that we need to do in between it will be via telemedicine. A lot of the seniors in her rural community in which she lives, they do the same thing. Most of them drive to Houston once or twice a year or have a family member drive them to Houston once or twice a year, and then in between, with the assistance of someone young in the community, will help them with telemedicine. Not that a senior can't do it because they very well can. But, they will have a system with telemedicine. The problem that I have encountered that I get nervous for my own mother is that when there is an emergency in the community, it does take EMS long time to get to their houses. That is a big concern of mine. So, I'm interested to see what the legislation says. How are we going to bridge this gap? Dr. Young Henley, have you noticed the difference in the rates or the types of chronic diseases such as cancer in the rural versus the city life?


DR. TEMUKISA YOUNG HENLEY
Oh, definitely. I looked at a study recently and it was basically saying that the top 10 diseases for mortality are increased by like 20% when you look in the rural areas.


DR. TAMIKA PERRY
So is it really peace in mind, Gina?


GINA GALAVIZ EISENBERG
Yes.


DR. TAMIKA PERRY
Honestly, 20% is really, really high. Do we know why? Is it simply because of access? Is it because of the environment? You would think the environment would be better. But what if you're in a rural area and there's a factory around? Why do we think that is?


DR. TEMUKISA YOUNG HENLEY
I think it's a combination of a lot of things. The things that I think that we can fix are the things we should probably focus on, and I think access should be our primary focus.


DR. TAMIKA PERRY
There's this opioid epidemic, and it's really plagued rural America. Why do you think that it's really plagued rural America versus urban centers?


DR. TEMUKISA YOUNG HENLEY
Well, how we screen here is patients come in for preventative type visits, and we screen for substance abuse. In rural areas, you don't have that opportunity to do those screens. If for some chance you do get to a primary and are screened, to see somebody for substance use abuse, it's very hard to travel with.


DR. TAMIKA PERRY
One of the theories that I had was screening most certainly. We are hounded to screen people and we want to do it. That's part of our job. But because of the unintentional injuries that happen in rural areas and people are in pain, and of course they want to go back to work and etcetera, etcetera, we give them what makes them feel good. And sometimes we miss prescribe, and even if we don't miss prescribe, there's an easy transition to addiction in that scenario. A lot of documentaries and studies I've read say that that's a progression that goes. But ironically enough, when I was in Honduras, because of the economy, poor access to health care, not a lot of money, when someone has an injury that's musculoskeletal that requires surgery, they get an opioid the day of and then you go home with Tylenol or naproxen. I have yet to have a patient complain, and I've done several of these medical mission trips. That is just the culture there. The people are more concerned about getting back to work than my pain is still at a 10. Not that pain should not be addressed, and pain is real, but I think that we probably over address it in this country. The opioid epidemic really affects the rural population. Do you see it in your population?


DR. TEMUKISA YOUNG HENLEY
Yes, we do, but I think the biggest difference is because we do focus on trying to get those patients in and at any cost, we do the screens.


DR. TAMIKA PERRY
Yes, absolutely. Now, in terms of high blood pressure, because once again, this is what the CDC told me, so I have a tendency to think that they're probably correct. High blood pressure, cigarette smoking is increased in these rural areas. The genetics aren't any different between me and my country counterparts, so why is there pressure higher?


DR. TEMUKISA YOUNG HENLEY
I think that still boils down to the access and trying to get to a primary care physician, and pushing to get screened and get your vitals done and get your blood pressure checked. Then you wonder because a lot of these areas pharmacies are spread out, too. So, if you get to a provider, can you then get the prescription? So, there are a lot of factors that affect chronic medical illnesses that rural areas are seeing.


GINA GALAVIZ EISENBERG
Just diabetes. How do you manage that if you don't have access?


DR. TEMUKISA YOUNG HENLEY
Right. That's extremely difficult to manage, especially when you want to have regular blood checks. You want to check your A1C every three months for someone who's not out of control. Lab core isn't going to go to their house and draw their blood. So, how do we do this? I guess this is where things like those continuous glucose monitors, Dexcom and Freestyle would come into play. But once again, the patient still has to get it. They still have to be educated on how to wear it. What does it mean? So, we're advocating that everyone moves in the city. No, I'm just kidding. We’re not advocating that.


GINA GALAVIZ EISENBERG
It makes me think that there's a generation out there, and hopefully they're listening to Docs in a Pod, to come up with some ideas on how to take medicine to rural areas, because there is definitely a need.


DR. TAMIKA PERRY
Well, hopefully mail order is being utilized like it is in the city. A lot of my patients who have access to the pharmacy or even the office, not only what I come to them in certain instances when I'm doing a home visit, but their medicines will be delivered to them. I would like to think that the U.S. Postal Service is the one thing that can get out to the people in the country in rural areas.


GINA GALAVIZ EISENBERG
I took a survey recently, so I'm hoping that this is going all over Texas, where you have drones delivering medicines and Amazon and things. They were asking my opinion about deliveries., and what if it's two miles from you? Or what if it comes door to door? It's amazing what is actually out there on the horizon and what is being thought about. So, perhaps that's one of the keys to getting medicine to folks in the rural areas.


DR. TAMIKA PERRY
Sounds like there’s hope for the future. I saw a drone. Well, it wasn't a drone. It was like a little robot going down the street in my old neighborhood. I just moved to the inner city, but I used to live downtown, but it was going down the street front, coming from Whole Foods to deliver something to someone's house. And it was a little robot. I was like, look at that.


GINA GALAVIZ EISENBERG
Yes.


DR. TAMIKA PERRY
I've actually seen cars in my neighborhood that have no people driving them. That's the weirdest thing to see.


GINA GALAVIZ EISENBERG
Yes, that's scary.


DR. TAMIKA PERRY
Right? I'm like, oh, I don't know if I'm ready for that part yet.


GINA GALAVIZ EISENBERG
No, but part of the question was like, would you be worried if a drone was flying over your house or flying over you? This thought, I mean, it's there because now it's going out there. But just think about years ago, we didn't think we could FaceTime. It was very like The Jetsons. Oh yeah, you're going to be able to see somebody you're talking to. So, perhaps there is hope for rural areas.


DR. TAMIKA PERRY
You talked about how there are some teams who go out to your patients. You talked about how we can deliver medicines to them. And you've talked about how we can do FaceTiming of the patients. I mean, if all else fails and we can't do any of that, do you think maybe some of this asynchronous interaction with the patient where maybe they fill out information online and there's somebody in the background who can pick it up. Because sometimes even in the city, when I'm trying to do a FaceTime type interaction, I'll get a flash across the screen saying, your patient's internet isn't strong enough. So, perhaps maybe the patients can fill out some documents, and there's always somebody who's monitoring those documents and say, hey, we need to send somebody out there because they are having intermittent shortness of breath with exertion. Just trying to think about all the possibilities that we can go through to help get access to rural health care.


DR. TEMUKISA YOUNG HENLEY
Yeah, especially for those acute situations. I think any time we get information or data that you can use to make a decision to go out, that would definitely be a way to do it.


GINA GALAVIZ EISENBERG
We're winding down. So, someone's planning to move out into the country. What should a mental checklist should we be thinking about to prevent illness or to manage our illness? What would you say in about 35 seconds?


DR. TEMUKISA YOUNG HENLEY
Well, first, I would definitely make sure you know what's in the area, like where the closest hospital is. Is their primary care close by? Is there a pharmacy close by? Know exactly where your resources are so that should something happen, you know exactly what your options are. If you're one that does not have transportation out there, I would look to see what the options are. Is there a neighbor nearby? Do you have a family member that you could call? Is there phone service? Because there are some areas that don't even have phone service. So, just look to see what your options are and your resources that are available.


GINA GALAVIZ EISENBERG
So, plan ahead. That's the way to take care of our health. Thank you so much. We're out of time. Again, thanks to everyone listening today on the award winning Docs in a Pod. I'm Gina Galaviz Eisenberg along with Dr. Tamika Perry. Thanks to our special guest, Dr. Temukisa Young Henley. In the words of the late Charles Osgood, I'll see you on the radio.


OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.


DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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