Support for Arkansas week provided by the Arkansas Democrat Gazette.

The Arkansas times and Kuer FM 89.

Hello again everyone.

Thanks very much for joining us.

It is Mid May.

And if the coronavirus curve maybe flattening in Arkansas may be flattening, the danger persists, especially in what we have learned to call congregate settings, churches, and especially prisons.

And in communities of color and among the low income.

When the outbreak reached Arkansas, it initially presented pretty much along the states existing ethnic demographic.

To the surprise of no one in Medison that changed.

While African Americans make up barely 16% of Arkansas's population, their share of the states confirmed COVID-19 cases is more than double that.

Well, to tackle that subject and other aspects of the virus in Arkansas, we are joined remotely.

My doctor, Susan Ward Jones, the CEO of the E Arkansas Family Health Center at West Memphis.

Doctor pebbles Fagan, director of the UAMS Department of Health, behavior and education.

And also from you AMS doctor Brian Gittins, who's vice chancellor for diversity and inclusion.

Doctor Jones, let me go first to yubi cause you are in Crittenden County, over there on rivers edge, as it were, you are kind of on the edge.

You're not just Crittenden County, but you're part of the state.

Includes several of the hot spots.

Does any of this demographic data.

Come as a surprise to you.

Up no, it does not come as a surprise to me.

I've been practicing in the West Memphis area for some 20 three years and I think that this pandemic is just putting a national spotlight on just a social inequities that have been tired to race, class and access to healthcare.

So of course this is no surprise to me.

Earlier today you were telling me doctor Jones that you have seen more than one patient, to put it mildly, that has tested positive.

Is there what about their outcome?

What about their their overall state of health when they do present to you?

Well, we're in a community Health Center and typically we see those that are on in underserved, uninsured, and those that have Medicare, Medicaid, and of course a lot of comorbidities.

So many of our patients have the cobra abilities of hypertension, sio PD, asthma, coronary heart disease, and of course obesity that lends itself to complications if they contract covert on 19.

So we've had a few deaths and those that have contracted those that we have.

You know, diagnosed and then also the other ones that a fair number have had to be hospitalised to?

You know, make sure that they are OK, so we've had about probably 50 to 60 patients that we've diagnosed.

Or you know, with the Cobra 19 as well.

George Jones if you would a patient presents in your office with all the symptoms.

Soon enough the test is conclusive.

How much more difficult is it for you as a physician and for the clinical community as a whole to address the virus when an individual man or woman is, say, has hypertension, has diabetes?

Well, I will say for us we were at a community Health Center so we are.

We have a few number of resources and of course we've changed our whole office setting in terms of getting those folks in and we're doing more drive through testing, but it we've used a lot of Teller health, particularly those that are diagnosed and not necessarily needing to go to the hospital.

But we use Telehealth to make sure that we can check on them and make sure that they are OK and make sure they have pulse oximeters at home to make sure if they do get in trouble.

We can readily get them, You know, to the hospital to make sure that they're taking care of Reagan as a as a practitioner and a professor and a scholar as it were of adverse behaviors.

Let me put it that way.

This can't be.

A terribly unusual scenario, or maybe an unusual scenario, but this is to be expected, is it not?

Yes it is I mean, we know that um, many populations such as communities of color and people who live in poverty, often experience multiple disparities.

So it shouldn't be a surprise to us that you know with this particular pandemic that we would see similar patterns.

I mean the challenge that we face in our state is at 17% of the people in the state live in poverty.

But among African Americans, about 30% of people.

Live in poverty.

A man that is more than twice the rate that you see among whites in the states who about 13% of them live in poverty.

So when you think about factors such as social, what we call social determinants of Health, things such as poverty, being medically underserved, BN geographically isolated, having issues with food security.

Those things combined with other risk factors such as smoking.

And obesity and these populations put them at a greater risk for being susceptible to Cove it, and not having adequate access to health care because they didn't have great access to healthcare before the pandemic.

Now you add the pandemic on top of that and tools that we have to reach these populations, such as our digital health technology are extremely helpful, but these populations do not.

And have access to broadband.

They may not have a smartphone and they may not have the minutes to put on their phones to accommodate appointments that they need with their providers.

If they were to get sick and it to just manage their current comorbid conditions that they have, so we shouldn't see this as a surprise, but it is an unfortunate situation that we're facing.

Care available?

I mean, we're several years now into the Affordable Care Act, which may have taken at least some of the financial edge off care.

Is there more care available and they simply poor people simply can't access it or?

Dwell on that for a second if you would.

Yeah, I mean, we certainly with the Affordable Care Act, we were certainly able to get more people signed up on Medicaid.

We did the Medicaid expansion in our state.

You may also recall that we went through a time period where there were people over 18,000 people who were actually kicked off of Medicaid and we've been trying over the last year to get those people back on and so.

We still have some challenges that we face, even with people taking advantage of the Affordable Care Act.

Because think about it, you know if you're poor, you know and you don't have transportation.

You know.

How do you get to a healthcare facility?

Your bearing, the additional burning of the cost of getting there?

And if you're living in rural counties such as where Doctor Jones works, I mean getting access to care is still difficult.

Even when you have.

Health insurance and so we still have many challenges that we have to overcome even with the Medicaid expansion that we have in our state.

If I make any of this, I would assume much of this resonates with you.

Absolutely, absolutely.

I think that this pandemic has really exasperated, allowed the health care disparities.

As you know, we start talking about.

Social determinants of Health Associate Conomiques are huge part of that as well.

When you consider that a lot of our minority population working these frontline jobs, these service or the jobs that are very public facing, millions don't have the privilege of working from home and teleworking like many of us do.

You know we're doing today as a matter of fact, so there's so many factors associated with this disproportionate both mortality rate.

As well as positive infection rate, do the process of color.

What's the solution here?

I mean, obviously this is not going to be one overnight but, but where?

Where are the gaps that we as the doctor indicated octagons indicated?

Uh, well, I think all of you did there.

There are some some pretty serious policy implications here failures.

Dashiegames will begin with you.

Russia.

Have the answer if I you know if you have a very rich man.

If I had all the answers, but I think that a huge part of it is some of the work that we're already doing with regard to trying to improve access, trying to mitigate the barriers to access to quality care.

Other partnering with the Arkansas Medical Dental Pharmacy Association along with the minority Health Commission to for outreach efforts, getting the word out in the word out in different languages, we've worked really hard.

KUMS as you may be aware, to get mobile testing units out, understand that the minority Health Commission and the health Department starting to get mobile testing units out as well just trying to penetrate those areas that have been underserved, but it's tough because historically as you may be aware, we also have people just distrust of health care.

And that's the top went to overcome because there's some historical roots in that where people aren't getting healthier aren't going to doctor until they're very, very sick to cutie levels.

Very, very high, and often times too late to do anything about it, but I'll defer to the physicians on the panel to discuss that in further detail.

Doctor Jones, you in particular have art long argued for a more holistic wants, a holistic, but certainly a multidisciplinary approach to minority health care.

I have an an I will I will say representing community health centers of Arkansas.

We we certainly do offer comprehensive care even in our West Memphis site.

We have access to medical, dental, pharmacy, optomology, case management, transportation and to really try and come back.

All of those issues that Facebook that face folks in trying to access healthcare particulars relates to transportation.

We saw a need and we have transportation and.

It is.

It is utilized heavily, but I think as a public health basically physician that my role is to make sure that people receive, you know, just clear, concise, frequent education which I think is the key constant education.

I spend much of my time in office visits now educating about Cobra 19 but also cover 19 apparently is going to be here and we cannot.

You know look aside from all the other comorbidities, the hypertension and diabetes is CHF.

And the lung cancer in the colon cancer.

We cannot take our eye off that then.

Also I think we have to make sure that we are connected with the faith based sector also with businesses and education and transportation.

It is my job to link people to services.

The comprehensive services to make sure that they have access to their medication that can get specialty care and you know to make sure that we are culturally competent to understand the plight of the minority population.

And also make sure that we use evidence based guidelines and everything that we do.

Or the broadcast anyway, about the delivery of healthcare, access to healthcare and framed it more or less through the communities of people of color.

But it's really not.

It's not restricted that by any means we're talking about income, social status, socioeconomic status.

I should say as well doctor Fagan.

Yeah, absolutely, uh.

And then you know, doctor Gittins pointed something out earlier, which is occupational class because we're talking about people who live in poverty and people who have low incomes were also talking about our wage workers and so and people do do not have flex time like some of us do to work at home.

Or if they miss work, they don't get paid for that time.

So when we're talking about different classes of people.

Such as those people who are called.

We're working on our front lines.

Those people who are working in grocery stores and at Walmart or were and working in the factories.

We have to have solutions that help to bring them back to work safely.

We understand and everybody has to have income, but we want people to get back to work safely.

So one solution is that we really need public health infrastructure, not just within our healthcare systems but within our workplaces as well.

So that when people go back to work that those workplaces are providing safe social distancing so that those workers are not getting sick again, being sent back home, and then they're missing out on income and then spreading this contagious virus to other people in their homes.

And so when we talk about public health infrastructure, it expands beyond the health care system into the workplace is of our.

Populations that are disproportionately suffering from exposure to the coronavirus.

Say again, is that that's going to be exceptionally difficult in some occupations.

Some industry, some workplaces, is it not.

It is, but you know what I'm doing right now, even for my own workspace, I have put together a plan of how we could social distance and how.

We also think about alternate shift work that would keep people safe.

And so I think what needs to happen is that you need a group of people who are going to sit down and come up with some creative ideas.

That's what a lot of these places are doing, but it's incumbent upon us to do it.

If we want to make sure that this economy keeps thriving and that the health of our workers continue to thrive as well.

All of our three doctors here.

We talked a second ago about.

We've been talking about failures of the Policia Stablishment now not to take up necessarily for the the policy establishment or play devil's advocate.

But individual responsibility comes into play here as well.

I mean, it has been what we're now into the what the six month basically of this pandemic, and a lot of people are not doing what the medical community tells them.

They very much need to be doing, whether it's mask, I think.

Washing hands go ahead.

But now I think that's a great point.

In an earlier was mentioned about.

Cultural competency with regard to messaging with regard to communications in there like.

I think that leveraging our faith based leaders, as well as other influences in the community to ensure that the messaging is getting to people in a way that they understand away, that connects to them and from sources that they believe in.

Because again, if we accept the premise that there is a gap with regard to trust between sort of official healthcare establishments and some of them at least.

Then the messaging is not going to be received the same way as somebody who is on the ground in the community.

So it definitely takes that community partnership and people working together to get the right messaging in front of people so that they can comply with the various standards to given by the Arkansas Department of Health as well as their medical professionals.

Again, to any of the three doctors, we are obviously governor, Hutchinson's himself has acknowledged there is pressure from commercial interests to get going to open up the economy.

Again, do you fear that we are moving too quickly to do so?

Doctor Jones will begin with you.

Well, I I I understand the need to to reopen the reopening get back to some sense of normalcy, and the economic, you know issues that are at hand.

But I think that if you know people are not adhering to you, know guidelines that perhaps you know we're gonna have a bigger problem.

You know later on, I think the most tanks that I have is that age group of 18 to say 30 that just don't believe that they can get this or.

Particular minority population were told somewhere along the line that they could not, you know, contract this virus and I think it has to be constant education.

There is a way to go back in, but we have to be, you know, you know, individually responsible to make sure that we're doing what we can in terms of social distancing, hand washing, face mask and all those things.

Then I think the key is the trusted resources that people can turn to that they can.

You know, believe in.

In fact, if I'm reading the demographic data correctly, the focus much of the focus is on those 65 or 70 and older.

But Arkansas would appear to have a substantial number of individuals as doctor Jones indicated, in the age range of, say, 2025 to 4045.

Yeah, absolutely, and I think one of the things we have to make sure we do is be clear about our messaging.

I mean I think we have confused are public audiences quite a bit?

First we told them not to wear mask.

Now we're telling everybody to put on a mask and it's important that we do that because we protect each other.

When everyone has on the Mass.

But when you talk about personal responsibility that are confusing messages.

Uh, make people somewhat sceptical with regard to personal responsibility.

Also, we have to make sure that everyone has access to a mask and so you know.

We're telling people to to make mask at home.

That's important, um, but does everyone in the household have access to a mask when people go back to work, do they have access to a mask and other personal protective gear that they need to thrive in the workplace?

And in our young people need to really understand that protecting themselves protects other people and.

It's a tough battle for us because young adults already feel that they're invincible, and so we have to keep doing the messaging to those communities to help them understand this is a really serious thing.

Yeah, I think part of it and In addition to having access to the mass is wearing them correctly.

I can't count the number of times I've been to the grocery store or other retailers and their mass on peoples chance or not covering their noses and things like that, and as a form of rain.

That's the type of thing that I look to leadership in these cases managers and general managers are these a stab Lishman to ensure that employees are protecting themselves as well as their customers as well.

So I think there's some behavior accountability sort of things.

That can be done by the community at large as well.

Well doctor getting.

So let me stay with you for just a second.

There would appear to be well as one of the other our other guests indicated.

There seems to be conflicting there.

There are conflicting messages from some of our commanders on the subject.

Obviously there's beginning to be a political pushback against the clinical advice that's being heard at the national level.

Your thoughts on that?

if I may ask?

Yeah, I think there's attention.

Uh, as you stated earlier, between opening the economy is getting back to a sense of normalcy and public safety.

So I think that we have to continue to look at the science.

Continue to look at the models, can continue to look at how this virus is transmitted and guide our policies procedures based on that.

Well, doctor, let me go to Doctor Fagan.

There were many college campuses anyway.

Are already planning to reopen for the fall semester.

That's just a couple three months away, really.

And there's great pressure on to open public schools again.

You have reservations about that.

Well, I think again we have to plan appropriately and so do those college campuses have a plan in place or safe social distancing to deliver their education and even in our school system.

What is the plan that each of those school systems have in place to protect children from the harms of Cove?

It, and so if there is a plan that protects the health of all people?

In those educational environments, then we should move forward with it, but we should not move forward just because we want to open things back up.

Yeah, I agree that we have to be delivered in what we do I have a 19 year old that attends College in New Orleans and he's anxious to go back and was no mighty upset that he had to come home.

But obviously in in the hot spot there.

I'm a particular concern, but you know we have to weigh the economics but also move into that very carefully based on the you know public.

I mean in terms of the advice from our experts.

There are looking at the numbers and you know we just have to come up with a plan.

I'm interested with.

My son goes back.

What's the plan for you know re entry into college?

Do you test him?

You know when all the students get their, you test them every week.

Just kind of what the plan is and I think everyone scrambling trying to figure out what that needs to look like.

Well, I would ask all three of our doctors there is to I'll refine the question just a little bit.

There are obvious discontent at some high levels of government with.

With clinical authorities such as Doctor Fouchy, some of the others at CDC, other experts at CDC and the other government health agencies.

Do you despair at that?

I'll start with Doctor Gittins.

Is repeated question for me?

Yeah, I mean, there's obviously some political obvious open, some of it's even caustic criticism.

For example, Doctor, Fouchy others at the CDC and other government health planning agencies.

Yeah, yeah.

So I was saying like I said earlier, um, I think Doctor Kaufman said this is that the disease or the virus is going to determine the timeline when we get back to a real sense of normalcy.

And I'll defer to that.

I mean, I think that in terms of our being able to get back and open up the economy and get back to the life, the way we know it will have to have a plan.

But to be safe about it, that would be smart about it, because literally lives are at stake.

Doctor Jones Yes, I would agree.

I think we always have to rely upon our experts.

Doctor Patty, of course is well known and followed him for many years.

Doctor Burks and you know, we just don't wanna get back in society and have to revert back again.

You know go back where we started.

So I think you know this pressure, the economy and you know everyone saying that the that the cure is worse than the disease and I'm well aware of that.

But we must be mandated by the numbers and.

Experts in move very cautiously.

We have about 30 seconds remaining.

Doctor Fagan.

I want you to have them.

Yeah, you know I I'm a scientist, so I believe in allowing a science to inform the policies that were making.

And as this a pandemic continues to involve.

Evolve I think we have to just make sure that we're taking the proper steps to protect our public.

This is so critical as we move forward, we don't want to continue to make mistakes an sacrifice.

The health of our public because of that in particular are vulnerable populations.

We are a state with 17% of the people who are poor and we are a state with a lot of wage workers.

And you know, we want Arkansas to be healthy and we want our citizens to thrive.

Doctor war Jones.

Doctor Gittins Doctor Fagan.

Thank you so much for being part of the broadcast.

And good luck to all.

We'll see you next week.

Support for Arkansas.

We provided by the Arkansas Democrat Gazette.

The Arkansas times and Kuer FM 89.