E-mail a friendDr. David Satcher
airdate March 7, 2006
Nobody thought 2-year-old David Satcher would live. But he was tough. With the help of a dedicated Black doctor, he overcame whooping cough and pneumonia and went on to become the 16th U.S. Surgeon General. He also served as the first Black director of the Centers for Disease Control and Prevention. Now at Morehouse School of Medicine, as the Interim President and Director of its Center of Excellence on Health Disparities, Satcher champions healthy lifestyles, especially in underserved communities.
Dr. David Satcher
Tavis: Pleased to welcome Dr. David Satcher back to this program. He is, of course, the former U.S. Surgeon General who is now the director of Morehouse's Center Of Excellence On Health Disparities. He's also serving as the interim president of the Morehouse School Of Medicine. His new book is called 'Multicultural Medicine And Health Disparities.' He joins us from tonight from Atlanta. Dr. Satcher, it's always nice to have you on the program.
Dr. David Satcher: All right, Tavis, great to be with you again.
Tavis: I want to talk more about this text here in a moment, but I first want to talk about the health challenges that we are facing in New Orleans, even as we speak, with folk trying to make their way back home. Let me read a quote that I found absolutely stunning the other day when it came across my desk. I want to get your thoughts on it.
The quote says, and I read here, there is not a sign outside of New Orleans saying if you are poor, sick, elderly, disabled, a child, or African-American you cannot return, but there might as well be, close quote. What do you make of that?
Satcher: Well, based on our experience there, I would say that it means that people will not find those resources available to them yet in New Orleans. Now, also, Tavis, we have to remember that many of the evacuees didn't have good healthcare before they left New Orleans. The Kaiser Family Foundation survey shows that a large percentage of evacuees who were minority and poor, primarily Black, did not have insurance coverage, and especially if there were not parents or elderly.
So we know that they didn't have it. We also know that many of the physicians who did serve people who were Black and poor are no longer there. Their offices were destroyed. They may be in Atlanta, they may be in Houston, but they're not in New Orleans.
And a part of what we are struggling to do is to try to rebuild that health infrastructure. So the situation there is difficult. We did hold a health fair in New Orleans about two and a half weeks ago; 18,000 encounters. Very clear that the needs are great among the people who are there. But there are not a lot of resources available for people who are poor and minority in New Orleans right now.
Tavis: I want to talk more about the resources, or lack thereof, in a moment. But while you're on this, let me ask to you go a little bit deeper and explain a little bit more for me what you mean to suggest when you say that the resources are not there. What are the challenges, put another way, as we speak?
Satcher: Well, there is not a healthcare infrastructure. A lot of the physicians, especially Black physicians, and physicians who served minorities and the poor, had their offices destroyed. The medical records were destroyed for a lot of people. So there were paper records, they're no longer available. And so, the needs are great among those people, especially the new mental health challenges.
But we also know that cardiovascular disease, asthma, diabetes, those are major health problems in the populations displaced by Katrina. And the resources to deal with those are not in abundance in New Orleans right now. It's going to take a while to rebuild the healthcare infrastructure there. It's sort of overwhelmed; even the hospitals and other infrastructures. The people there are doing a great job of trying to deal with the needs, but they are great.
Tavis: Environmentally, how challenged are persons who live there now, given their health condition and the environment that they are forced to live in? We've heard, of course, we read so much about what the area is like, what the water is like. Talk to me about the environment, how that's impacted the challenge that already existed, to your earlier point, before the storm even hit?
Satcher: Well, clearly, as you know, houses have been destroyed; power is not available in many communities. Fresh running water is not available. So, while there is no evidence that people who are there are being exposed to major toxins, the C.D.C. has looked at that very carefully, we do know that in the aftermath of a hurricane like that, there are dangers in the environment, especially for children.
And even though those are not evident just for people passing through, people are not comfortable returning with their children until the communities are rebuilt and the infrastructures of those communities.
Tavis: What do we say to the persons, though, who are there? If you are - I feel for the persons in New Orleans, because it seems like a Catch-22. On the one hand, you want to get back home as quickly as you can. On the other hand, going back home means that you are going to be lacking so many of the resources that you need to live a healthy life, starting with a job. Your physician is gone; your records are missing. And yet at the same time, we're trying to encourage folk to go back. It's almost as if you want to say go back to what?
Satcher: Well, the temptation is to say go back to what. But we've also been trying to work with the health department in New Orleans. Lot of committed people, lot of committed public health workers are still there. Some of them are actually staying on ships out in the river, because they don't have other places to stay.
So clearly, the health infrastructure there is very challenged. And yet, if people want to go back and rebuild, then I think the health department is making a tremendous effort to try to be available for them. The emergency rooms have been set up in the convention center. I think they moved recently to another site. But they were trying to make sure that emergency care is available. It's a very difficult situation.
Tavis: Let me ask you, then, what your idea is for what ought to be done short term and what ought to be done long term to address this crisis.
Satcher: Well, I think in the short term for people who are there, and I would even say for many of the evacuees, we need to begin to establish health records. For many of the people who came to the health fair, we were able to develop what we call thumbprint electronic health records. What that means is that using the health department centrally, people will have records available.
And these are the kind of records that cannot be destroyed by another hurricane. So right now I think we ought to be screening people. And we ought to set up systems of surveillance to make sure that we identify health problems that are in immediate need of care, and that includes mental health. I want to emphasize that.
The mental health problems resulting from an experience like Hurricane Katrina tend to be really difficult. So we ought to be in a position to identify people who are at risk with severe depression and other mental health problems. We ought to make sure that we have ongoing screening and surveillance so we can be on top of diabetes or cardiovascular disease.
Because many people don't even really know their diagnosis if they lost their records. They don't know all of the health problems they had. They don't know what medications they were taking. So we're trying to just get all of that back in shape. And that needs to be done very soon. And in the long run, of course, we have to make sure that we somehow get people associated with primary care physicians. So we're trying to make sure that whoever comes to health fairs for screening also gets connected to ongoing care with primary care providers.
Tavis: I want to ask you a question about the book before I let you go. Before I get to the new book, though, 'Multicultural Medicine And Health Disparities' that you've authored here. Before I get to that, though, one last question. How do I wanna phrase this? When you were talking a moment ago about the fact that so many health records were lost and physicians, of course, don't know the back story now on many of their patients because of that devastation, what did, or what should the health community learn out of this tragedy so that we can avoid this in the future?
You mentioned a moment ago that you are getting thumbprints now, so that these records will never be lost again. I think you know what I'm getting at. What did we learn here? What should we learn here to make sure that we don't have this kind of crisis again where these records, at the very least, are concerned?
Satcher: Well, hopefully we learn, again, the inadequacies of our present healthcare system. The fact that on the one hand, so many people are left out, so many people are uninsured. But even among people who are getting healthcare, they have not in the past had the kind of medical records that would sustain a Hurricane Katrina.
In the future, we have the technology to do better. Medicine has to catch up with the technology of today, and that means that we ought to have electronic health records on all people. We've got to do a lot of work. We have to train physicians. There are many physicians who are not comfortable using electronic health records.
So training is going to be important. There are many physicians who can't afford them, so we're trying to make sure that we get the resources to develop these electronic health records. We need a healthcare system in this country, which assures continuity of care. And we have the technology to do that, and we ought to invest in it.
Tavis: You talk about continuity of care. Let me close by talking about culturally competent care. It's one thing to have continuity, another thing to have culturally competent care. In this new book,
'Multicultural Medicine And Health Disparities,' I assume that you raise the kinds of issues in this text that we saw or see in real life on display in New Orleans.
Satcher: Yes, I, along with my colleagues. I had some outstanding colleagues to co-author this book and to write chapters on areas like diabetes, organ transplantation, cardiovascular disease. One thing is very clear. That people experience health problems in a way that is consistent with their culture. The way they respond to health problems is related to their culture. And in many cases, when and where they seek treatment relates to culture.
And we have to be aware of that. We have to be aware of what it takes to get people to seek care early. And but also what it takes to get people to really comply, if you will, with a regimen of controlling diabetes or hypertension. We also have to understand that those of us who are providers have our own culture, which we bring to the table.
Now, the culture of medicine in this country is primarily White European. That has been a major problem for a lot of the people affected by things like Hurricane Katrina. So, this book was intended to say to people, and especially to medical schools and other health training schools, is we need to make sure that all of our graduates are culturally competent to deal with different cultures. And as a minimum, that they know their limitations and reach out to people who can help them be more culturally competent.
Tavis: Are you confident, then, that it in the most multicultural, multiracial, multiethnic America ever we'll get some traction on closing the gap in these health disparities where our system is concerned?
Satcher: Well, I'm confident enough to keep working hard, Travis. We have a lot of work to do. We're not there yet. I appreciate the way the American Association Of Medical Colleges, for example, has responded. To say to medical schools we want you to really implement culturally competent programs.
Appreciate the way a lot of the nursing schools have responded. So, I'm confident enough to keep working because I see people responding to the message. It is a long road ahead, but the important thing is to keep moving forward.
Tavis: Former Surgeon General of the United States, Dr. David Satcher. The new book is 'Multicultural Medicine And Health Disparities.' As always, Dr. Satcher, thanks for the insight. Nice to have you on the program.
Satcher: Great to be with you, Tavis.
Tavis: Up next on this program, New Orleans-based filmmaker Royce Osborn. Stay with us.
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