Women's health is often under-researched, leaving many without the diagnoses and treatments they need and the impacts of having to settle or life changing.

I can come to my visit, but I can't do the ultrasound I need for my diabetes and my high blood pressure.

Kansas City PBS In partnership with American Public Square and Shirley's Kitchen cabinet, presents beyond the symptoms, a town hall addressing these pressing challenges.

Join us as we hear from expert panelists about the path forward for stronger health care solutions.

Thank you all so much for joining us this evening for what is likely to be a very inform and of an insightful discussion on a very important topic.

Again, my name is Michelle Watley.

I'm the founder of Shirley's Kitchen Cabinet, is named for the one and only Shirley Chisholm can get a round of applause.

We know Shirley Chisholm is in the Shirley Chisholm is the first black woman to run for president on a major party ticket.

She's also the first black woman to be elected to Congress.

And in her legacy, we work to amplify the voices and power of black women so they can be better advocates on behalf of the issues that matter to them.

Shirley Chisholm was known for one, saying if they don't give you a seat at the table, bring a folding chair.

But because of our partners APS, and KCPT, we don't have folding chairs today.

We don't need them.

We have some great women who have brought themselves to the table, experts that are revered in issues surrounding health care, not only here in the Kansas City region, but across the nation.

And so I'm going to give just a couple of minutes for these experts to introduce themselves and then we'll jump right in.

Hi, everybody.

I'm Dr. Robbie Harriford.

I'm the chief medical officer at Samuel U. Rogers Health Center.

I'm a family medicine physician, but I've kind of chosen the subspecialties and I just do women's health.

I'm Carla Keirns.

I and faculty at the University of Kansas.

I'm a historian and ethicist of medicine, and clinically I practice palliative medicine and do ethics consultation.

So while I'm here to speak to the history of women's health, if I get involved in the care of a pregnant woman, something has gone terribly wrong.

Hi, my name is Megan Madrigal.

I'm your friendly neighborhood gynecologist, so I practice clinically.

And then I also am an assistant professor at the University of Kansas with the School of Medicine.

Good evening, everyone.

I'm Hakims Payne.

I am the founder and CEO of Uzazi Village.

Uzazi Village is a nonprofit organization.

Now, in our 12th year, our mission is centering black and brown families in maternal and infant health.

My background is nursing and my masters prepared RN working on my Ph.D. in nursing as well, and excited to tell you a little bit about what we're doing here in the Kansas City community around maternal and infant health.

And I'm excited to have you.

We're all excited to have you your insight and your expertise for this important discussion.

I'm going to get started with you, Dr. Keirns.

Historically, women's health has been understudied and misunderstood, particularly regions right here in Kansas.

In Missouri, for example, a study by the Community Wealth Fund, a health care nonprofit and research group, found that Missouri and Kansas right at the bottom, the worst state in the nation for women's health care outcomes, with higher rates of preventable deaths among women compared to the national average.

Dr. Keirns As a historian and a physician working in the intersection of health disparities and quality improvement, can you share how the historical treatment of women's health has contributed to the current gaps in disparities that we see today, Despite there being major advancements in medicine in the health care field?

How long do you have to you know, when I when I think about that question, the first thing that comes to mind is that we have vulnerable rural populations who are underserved.

Much of Kansas and Missouri are maternity care deserts, where women have to travel long distances just to access maternity care.

We also have in both states, urban communities that are underserved in other ways.

And my colleagues here can speak better to what they see on a daily basis.

But when you think about maternity care, maternal health, women's care was fundamentally the job of mothers and of midwives until the 19th century.

And in the 18th century, male physicians started to want to get involved.

Started in particular to want to do operative deliveries, things like caesarean sections.

But even when they started doing that, when they started using forceps, they would keep the forceps design secret and you had to train with that person.

They didn't share that knowledge, and they pushed the women professionals who had been in that work out of of work.

So by the beginning of the 20th century, most of maternity care was provided by men with medical degrees, except for many of our rural women who were still delivered by midwives who had generations of experience.

But that changes, whose voices are heard.

We also see in the last generation the women's health studies, both of maternity care, but also of things like heart disease and cancer.

We start to see those changes where it was women senators who pushed to have an NIH focus on the care of women.

In a world where most medical research had been done on men.

With that doctor Harriford Can you speak to the current state of health care with your experiences at the Samuel U. Rogers Health Center?

Perhaps you can provide a snapshot of women's health integrated Kansas City area and speak specifically to some of the more pressing disparities that you see today.

So in terms of what we're seeing here, it really just depends on who you're going to ask.

So someone like me who's working at a federally qualified health center, we see some of the most disparate problems that you're going to have.

You talk to somebody who's going to be in Johnson County.

It's probably going to be a little bit different right?

So, for instance, if you are from Wyandotte or Jackson County, if you are black or brown, if you have Medicaid versus commercial insurance, those are all things that are going to make your care a little bit harder to obtain.

And the data shows this.

The most recent Morbidity and Mortality report shows that those particular types of people are the ones that are suffering the most.

When we think about who's suffering the most and the history of how we've gotten to the point where there are certain communities that are suffering the most and suffering more than others.

I'll turn it over to you, Hakima.

What are some of the disparities that you see, and how does that connect to the historical context for the communities that you serve?

In my community now, there are still great disparities.

We see that African-American women are much more likely to receive inductions or to end up with surgical births, Caesarean sections.

They're more likely to see increases in both morbidity, which is sickness and mortality, which is death.

We see that in our black infants as well, that they're more likely to perish before their first birthday.

So the disparities are numerous, and we really have to ask ourselves if we want health outcomes to be dependent on some of the factors that Dr. Harriford mentioned, that we want that to be dependent on zip code or the type of insurance you have or the color of your skin.

Is is or are we going to look at health care as a human right and where those resources are equally distributed so that there's equal and equitable potential for positive health outcomes for all of us would have brings to mind for me immediately is thinking about the stories of women like Serena Williams, the tennis champion who talked about complications and giving birth.

Beyoncé the one and only Beyonce and having the similar complications.

In your opinion, what are the key systemic issues that lead to these type of tragedies and what is specific interventions have you seen or have you employed that can help improve outcomes for black mothers in black infants?

Systemically, there's so many, many issues.

There's social and political determinants.

There's economic socio economic issues.

At Uzazi Village, we really focus on culturally based innovative care models.

We're primarily interested in how culture impacts the experience of health care.

And so in our clinic we create what we call a safe space where African American families can come and feel, heard, feel listened to.

So that's sort of been the corner of our experience creating this container for African-American families that as unique as their experience of health care, and that takes into account their cultural experience of of accessing health care.

What have we seen as a result of that?

Folks, experience is very different.

And you the the bigger question of health outcomes really takes years to determine.

We track our data carefully, we watch our outcomes, and we'll certainly publish our data.

But we also we don't just look at the numbers.

We also listen to the stories, how families feel about the care that they receive from our clinic and and how they experience health care in in our facility.

You spoke, Michelle, of notable women who have fame and means, but we also lose women in our community and babies in our community and an alarming rate.

We just had a death last week of a community woman who was pregnant.

And so with her demise, her baby died with her.

So we see these they aren't famous.

They don't have names that she would recognize.

But we absolutely live with the burden of knowing that the folks who come to us for care are at much greater risk.

We at Uzazi Village create what I call adjacent systems.

So where we're trying out these culturally specific approaches to health care, but we know we're also sending women into the traditional health industrial complex where their care won't be as sensitive and as focused as the care that we provide.

And so a part of our work is also reaching out to those systems, trying to create relationships with those systems, trying to share the lessons that we've learned with those systems and trying to create systems transformation.

I think it's important to note the role of systems, because when disparities are bred within systems, it impacts different communities in different ways.

According to the Missouri Department of Health, Hispanic women are twice as likely to experience complications during pregnancy than white women.

Birth complications remain high not only with black women, but indigenous women in the Greater Kansas City region, particularly in underserved and black, indigenous and women of color communities.

Women face systemic barriers to access to quality health care.

With that, Dr. Harriford, how do you see this manifest or play out in your day to day work as Samuel Rodgers And what are the long term consequences not only for these communities but for women as a whole?

Sure.

So for those of you who aren't familiar with Samuel Rodgers, we serve primarily refugees and immigrants.

Roughly 62% of our patients are best served in a language other than English.

Spanish is number one, English is number two.

But we also have people who speak Somali, Swahili, Burmese, Korean.

So the cultural barriers that we encounter on a day to day basis are pretty large.

That's kind of just like the refugees.

But if you look in that immigrant side, we have like documented and undocumented as well, the disparities that we really see in terms of that are just like the insurance coverage.

So we have a very large self-pay population.

We also have a very large Medicaid population.

And as I had mentioned before, with both of those you get, you're more likely to see issues getting your care.

So people come to us because we won't turn you away.

We're going to see you no matter what.

But what ends up happening are those those patients are extremely scared.

They don't know where to go.

Imagine if you aren't from this country.

You don't speak the language.

You don't know where you're supposed to do.

You're going to wait even if you're feeling bad.

So what I've seen before, I've had a patient who knew she had a breast mass.

She's undocumented.

She waited until the last second.

And when she opened up her her gown, I mean, I literally gasp because you could see the cancer right there.

And I asked because she had been seen three years prior with a normal mammogram and she knew what was happening.

She was like, I didn't know what to do.

I didn't know where to go.

I knew something was really wrong.

I wasn't able to get the treatment, but it was causing her so much pain.

She finally came in.

So those are the situations that we deal with on a on a daily basis.

At my clinic.

And we're trying to do things that we can to help help with that.

But it's it's a lot it is a lot of setup we could talk about for hours on end and still not cover everything.

But I want to take a minute to turn it over to our rover.

Reporter The one, the only Kynala Phillips to ask the questions that are in the audience and Kynala I'll turn it over to y Okay.

Thank you.

Hi, everyone.

So we have an audience question in this question says has the renewed focus on abortion rights impacted your work either positively or negatively?

The renewed focus has definitely impacted my work and unfortunately I think it's impacted it for the worse because it stirred up a lot more attempts at more restrictions and it's you know, because a lot of this comes from individuals who don't understand the medicine of it and know that there is an association to an abortion with a certain medicine.

And now we're getting into the realm of medicines that I use on a daily basis to help make sure that my patients aren't hemorrhaging or bleeding out after a delivery or medicines to help manage a miscarriage and is starting to spill into other areas.

Countries section which would have nothing to do with the termination of a pregnancy.

So with the renewed interest, I feel a lot of support from people in my circle and in my world.

In my actual day to day job, I see more and more roadblocks going up.

That's making it harder and harder for my patients to not only get the care that they may want or need, but sometimes to even have that conversation or to follow through on a plan that we've made because there's a misunderstanding at the pharmacy.

And they didn't fill a needed medication because they thought it was for something else.

So it's been quite an impactful couple of years since the Dobbs decision came out and there's been lovely happy moments seeing, you know, some protections get put back into place.

But there's usually also a wave that comes right after that looking to find a different way around it.

We'll sounds like, again, between systems and policies, there are a number of obstacles to women getting care to address issues immediately, that there's time gaps and lapses between when an issue may arise and when it may get diagnosed.

The conditions like PCOS endometriosis, menopause, hormonal imbalances often go undiagnosed for years.

So this is seemingly common.

Research shows that women with endometriosis can average seven years wait time before they actually get diagnosed.

With that being, said, Dr. Madrigal, from your experience as OBGYN spoke to this a little bit already.

Why are these conditions so frequently misdiagnosed or underdiagnosed, and how does this impact women's health overall and their quality of life?

I think a lot of things go into it.

One, a lot of these conditions just at baseline medically are pretty nebulous.

They're not going to be the exact same thing for every single person who experiences it.

And so one person's endometriosis symptoms are going to be different than another's.

And so they can be in and of themselves just a difficult medical diagnosis to begin with.

Additionally, it requires listening to your patients and hearing what they're telling you and what they're going through.

And it's, you know, not uncommon for women to not be heard at the same level as men, whether it's in the exam room, in the boardroom, at national conferences.

You know, I'm more likely to be called Megan than I am.

Dr. Madrigal.

That's that's just a reality of our world.

The other side of it as well.

And speaking to systems issues is also the medical education.

You know, they're complex issues.

And so if you don't deal with them, they can be difficult.

Even if you deal with them every day like I do.

But if you don't deal with them every day, it can be, even if you are listening harder to pinpoint what's going on.

And, you know, if you look at your internist that you see, they maybe did two months of women's health care and their medical schooling and then went on to do their specialized training.

And so there's systems issues with that, that women's health care, education is minimized, minimized, minimized.

And two months in today's world is actually quite a long time.

There have been cutting that back even more.

A lot of places get six weeks.

Some places get four weeks.

Okay.

Should we be asking our doctors how long is going to get care?

Hakima, How does it show up in your work or your practice, The misdiagnosis and or the time gap between diagnosis for major issues?

Well, it shows up a lot.

And I first want to go back and address the audience question.

Even though that the village cares for childbearing families so folks don't show up at our doorstep who are seeking abortion care.

It definitely has had an impact because the same political climate that has made abortion services inaccessible has done the same for contraception and contraception.

And so our community members have a hard time accessing what they need in a timely manner when they need it.

Do I see what Dr. Madrigal describes all the time, which which speaks to one of the other issues as a systemic driver of health inequities, and that's provider bias that a black or brown woman will be looked at and her symptoms might be attributed to something more nefarious than what it really is.

That happens commonly that happens.

A lot of clinical decision making is driven by provider bias.

It can delay the care that you really should be getting and your situation can get worse.

In the meantime, I spend a great deal of my time when we're working inside of larger health systems, helping providers see and understand how their bias shows up in the care that they provide to their patients.

Whether that's their intention or not.

The city, Kansas City is one of a number of cities across the nation that is named racism as a public health crisis.

And so what you see is the intersection of health care and policy impacting how we go about providing health care services to funding and resources and the like.

Dr. Keirns, can you talk about how historically policy has shaped or driven health care outcomes for women in particular?

Yeah, The biggest issue, as we've already heard, has to do with health insurance and the funding of institutions.

So we hear about folks like like Serena Williams and Beyoncé, where this story is clearly a situation where they present with symptoms and they are not heard.

Serena Williams said, I've had a prior blood clot and I think I have a blood clot in my lung.

It doesn't seem like it would take rocket science to make that diagnosis.

But but she was heard because she had resources and a voice.

And a lot of our policies create a situation where the doctors who provide the care to our most vulnerable patients have the fewest staff, the fewest resources of other kinds.

And so we have a system where both bias because women are not heard, and systematic distribution of resources means that those women's care is more difficult to provide, even by the most dedicated providers.

Can I just add on to that?

Yes, and please, because we had information.

So where our clinic is, it's very interesting when you're in Kansas City, Right, Because we straddle the state line.

Right.

So what happens in Kansas has a direct effect on Missouri and vice versa.

In the state of Missouri, if you're pregnant, you get Medicaid.

It does not matter your citizenship status.

You may not be able to get the full postpartum part of it afterwards.

You won't get the full 12 months, but you're still getting your pregnancy, taking care of Kansas.

You walk to streets over and if you're undocumented, you don't get that coverage.

So when we have patients that are coming to us on the Kansas side and they're not understanding why they can't get coverage or having to talk with them about, well, this is just going to cost you $125 and we do ten plus visits.

So do that math.

It makes it even harder.

So then you're further having those issues with our patients not wanting to come in because they can't afford to do that.

At the end, you're coming once a week, 125 times four.

You already have three or four kids.

What are you going to choose?

So just another instance of how where you live makes a difference and what you're going to be able to receive in those outcomes.

Well, not only where you live, but access to financial resources to get access to quality care.

We know that women's health care is not only underfunded, but it also comes at a higher cost.

Deloitte reported that women face 18% higher out-of-pocket costs than men.

Excluding pregnancy care and pregnancy related expenses.

So if you take that out, just your regular, regular health care expenses are going to be 18% more than it is for men.

Additionally, women face the tampon tax, having to pay sales tax or reproductive and a period products and the pink tax where women's products are automatically taxed higher.

It could be the same deodorant.

One will have old wooden ship and one will have flowers and the one with the flowers.

It's going to cost you more because it has flowers from your perspective as a OB-GYN.

Dr. Madrigal.

And again, any question I ask all of you, welcome to answer and add information to an insight.

How do these economic disparities affect women's access to health care, particularly for reproductive health?

And if any of you have any stories or experiences where you've seen this play out in real time, that would be helpful to illustrate what it's like for women facing these issues.

I've seen it a lot, unfortunately, and for a lot of those instances that we've talked about, whether it's a pregnant patient who has a limited amount of funds that she can put towards her prenatal care and now she is choosing that I can come to my visit, but I can't do the ultrasound I need for my diabetes and my high blood pressure.

Or in that situation, you know, I've had patients where they weren't feeling the baby move or were having some bleeding.

And I said, I really need you to go to the emergency room to get checked out, like on our labor and delivery floor.

That's a separate cost outside of their self-pay package.

They don't have that money.

And so they didn't go.

They just chose the unknown and hoped it was going to be okay because they couldn't afford that.

They had to provide for their families.

In other reproductive sites, I have a lot of patients who unfortunately come in and want, you know, infection screening for pelvic infections, and then the costs of the labs add up and they have to pick.

Well, okay, I'll test for this one and this one, but not these or I really want this type of birth control, but that one's not covered and that's $40 a week.

And I can't afford that.

It's it's sadly it's you know, not every now and then it's it's a daily occurrence.

I mean, I've seen something very similar.

I think the one that we see a lot in our clinic is just the fact that when that pregnancy Medicaid runs out, if they hadn't already received their tubal ligation, we've seen several people come back within six months and they're pregnant because they didn't know what method they wanted to get.

They knew that they wanted that get their tubes tied so they would not have any more kiddos.

But then when that lapsed, they weren't able to get what they wanted and then they're back.

So it's kind of this whole revolving door situation and, you know, nobody should have to settle for a type of birth control that they want.

Well, and the impacts of having to settle are grave life changing, not having access to the reproductive health care that you need so that you can either choose when you want to become a parent and when the best time is for you or whatever that may be.

Not having access to that can mean, you know, having to move or it dictates the type of job you can have.

It impacts your personal relationships.

So it's harrowing to see how something as simple as having access, being able to get access to certain birth control can have long lasting impacts on a woman's life.

And those that are, you know, around her and those that love her and care for her.

The report that I mentioned earlier, the Commonwealth Fund also noted that Kansans, women of reproductive age were less likely to have health insurance compared to the national average, and many struggle to afford even routine checkup.

So we're not talking about, again, health care around prenatal care or birth or, you know, different events, just regular checkups.

How do these challenges impact women's long term health issues?

And we've touched on that a little bit.

But what role, again, does policy play And maybe addresses some of these issues, particularly in light of Kansas not expanding Medicaid?

So one of the things that we see is because of pregnancy related Medicaid, but not having Medicaid eligibility to other times, women are more likely to have undiagnosed and untreated hypertension, diabetes and other chronic illnesses when they come into pregnancy.

And we know that those are risk factors for preeclampsia, which is still correct me if I'm wrong, one of the four leading causes of maternal death.

So women are coming into maternity care, but also at life, times of care.

Without those things, what we know is that in the last 50 years, we've been able to improve the rate of heart attacks, strokes and other cardiovascular diseases, as well as cancers with cancer screening to extend life by ten and 20 years for people who are getting the standard of care.

But if you don't have access, then you don't get those benefits.

We have communities where the mortality rates from those diseases have not improved in 50 years.

Policy has a profound impact.

And even though I'm on the front lines every day as a researcher and a clinician, I spend way too much time in Jeff City and Topeka because of the decisions that our legislators make and the decisions that our health policy folks make.

So that division of health and senior services in Missouri, 68 on the Kansas side, the decisions that they're making at those levels absolutely trickle down and impact our communities and and what families can access in the way of care and what they can't.

I've been happy to see lately that because sometimes it seems like Missouri and Kansas are in a competition to see who can produce the worst health outcomes.

And I'm really happy to to report that both Kansas and Missouri have very recently supported the Medicaid reimbursement of Doulas, which which is a policy choice that again, will trickle down and have a positive impact this time.

It's not the only thing they should be doing in the state houses and in the state legislatures, but it's a move in the right direction.

So we pay very close attention to what's happening policy wise.

Well, and I imagine your voice is a large part in why that was able to happen.

If you look at what goes on in the Capitol, in the statehouses, oftentimes legislators that are making decisions on behalf of your health care needs and health care policies are not personally impacted by those issues.

Do not have the expertise and background to address those issues through policy.

And so hearing from members of the committee and experts like yourself really has an impact in making sure that those leaders, whether they do so willingly or have to do so because the community has mobilized to push those legislators to make better policy choices.

When you are engaged, you get to see that type of change take place.

And in our work to share this kitchen cabinet, we to spend a lot of time in the Kansas State House, the Missouri State House, and the city council chambers across both states.

So we know firsthand the power of mobilization and amplifying your voice and power.

And with that, I would love to have Kynala Phillips again amplify her voice and your questions.

Happy to have you, too.

Okay, So this question is from Becca, who is from the KC MO side.

And they are wondering when a female begins Menstruation at a young age, thinking 10 to 12 and is experiencing symptoms that cause disruptions in their lives at school or other activities.

How can parents school nurses and other loved ones help advocate for their child?

That's a great question.

Yeah.

The fact that there would be people around to be supportive and listening is the first step and having that good support structure around my thing would be to say that many gynecologist like myself are also very happy to see people that fall into the pediatric population.

And there's actually an entire subspecialty of my field for pediatric gynecology that can help navigate the is this normal?

Is this not even if it is normal, are there things that we can do to make this a better thing?

But knowing your friends and resources and who and knowing that there are those resources out there that exist to help navigate that period, be my if it comes to me.

Thank you.

Thank you for that.

Great question.

So we have laid out all of the opportunities for improvement in women's health and health care, not only in the region but nationwide.

Dr. Keirns, you shared the historical treatment of women's health and has contributed to the current state inequities.

What can we learn from history?

What can we learn from this history of women's health to improve outcomes for women in the region going forward?

So the first thing I would say is that women's voices are critical.

We know that a lot of the first major changes in recent history happened when women have gotten together and advocated for change, both from within the helping professions and outside.

Until the 1970s, the standard of care for a woman with a lump in her breast was to go to the operating room, be put under general anesthesia, have an external biopsy.

It would be sent to the pathologist.

And if it was cancer, then the surgeon would go talk to her husband in the waiting room and he would consent for the mastectomy without ever waking up the woman.

That is unthinkable today.

And thank God, because women's women's work in advocating the kind of work that you all do has really changed the landscape.

The the folks in California have also done a lot of important work on maternal quality care improvement and have created toolkits, have looked at what kills women and what can we do so that we have the tools at hand to be able to manage the situation.

A pregnant woman at term can bleed to death in 5 minutes.

Yeah.

Yeah.

I lost a liter and a half of blood when I delivered my son in, you know, just a couple of minutes and having a cart at hand with all the tools you need.

So you're not sending a nurse out to go get something that you need when you need it.

What else could we be doing in terms of making things better?

It's going to be a cliche, but vote.

And that's because we're talking about like, you know, 50 years ago history.

But we've also seen in recent history, in the last two years, for instance, we have evidence that women's health care has declined, that morbidity and mortality has gone up, that perinatal death for the mother gone up.

You know, we have names of women out of Texas.

We have names of women out of Georgia.

Just because we don't know the names of the women in Missouri does not mean that they're not there.

Just because we don't have the names of the women in Kansas.

It doesn't mean they're not there.

So it feels cliche saying, but we've watched it happen on the Kansas side.

I am really hopeful for this Missouri this November on the Missouri side, because it's the bare minimum for us to say that people can have a choice.

Regardless of what your ultimate decision is, you should be able to make that choice for yourself.

So mine would be to vote so that I can have honest and frank discussions with my patients who are allowed to make medical decisions that best suit them and their family and whoever they include in those decisions moving forward.

And Dr. Madrigal, we talked about, again, the efforts to further restrict access to women's reproductive health care.

Are there specific policies that you've seen that you would like to see passed, or do you think that could help address those issues or models of policy or legislation that you've seen implement in other cities and states?

Yeah, the expansion of Medicaid is a big one.

I'll allow people in the door, you know, and then in expanding the postpartum period to include more than 60 days up to a year, that's what we track maternal mortality and morbidity timeline.

And yet we cut off health care at a fraction of that.

And then, you know, taking some of the limitations off of for me and this is obviously a very gynecologist bent on this, but like contraception and and access to birth control to remain a medical choice for a patient and their physician to make that open and access.

And then that would also spiral into it.

I won't get into this about insurance coverage for all of that, because even when patients are are in a local municipality or state that has access to that, a lot of times we get back to that cost concern and it becomes prohibitive in that sense.

And again, we're back to the gap of access and that gap is widening.

I am shocked to say that in the past couple of years, even in our city, here in our area, we have lost maternity beds because hospitals have closed or or limited their maternity care access.

The one birth center that we have here in our community is closed.

Midwives have left our area because of practice restrictions, which is all regulatory.

We are we are actually losing the battle.

Things are getting worse and continue in the discussion of possible solutions.

Dr. Harriford, what are some immediate steps that can be taken at the provider level to improve health care access and outcomes for women, women and disparate communities and others who are in need of having these gaps closed?

So I think the first thing is to recognize that there's a provider shortage right now.

So in terms of primary care, we need more.

That starts with also diversifying the workforce.

So not just relying solely on physicians, but having nurse practitioners, physician assistants, midwives.

All that comes into play.

The more you have, you can increase that access.

I think also just kind of diversifying how you provide that care.

So, you know, telemedicine is something that maybe not everybody can access.

But if some people can that be great?

One of the things that we're offering at Sarah Rodgers is postpartum telemedicine.

So imagine you just gave birth.

You have three kids at home.

Do you want to leave your house necessarily to have this checkup?

So if you're a low risk patient, that should be an option.

I mean, working with different advocacy groups, that's going to be huge.

Well, just so we can get that funding to increase things that you need once people actually show up doing what you can in a visit.

So at our clinic, if people are self-pay and I know that they're not going to able to pay that 125 again or even the $35, I'm going to do whatever I can during that visit to ensure that they're getting the most out of that visit.

And with that being said, I have one question.

This going to be a rapid fire question, and I'm to let you all answer starting to my left.

The doctor here first.

We've talked about the role of physicians and doctors, health care institutions, policy makers and other leaders.

What are steps or actions one that women can take to be better advocates for their own health when they're in front of their doctor at home talking with their loved ones?

What's one action they can take to advocate for their health?

Ask me questions point blank.

Yeah.

I mean, I'm thinking the same thing.

You know, one of the things I worry about, though, is not everyone's advocacy is heard in the same way.

And so thinking about how we can make sure that when women ask questions or when women come with their symptoms, that they are taken seriously, that they're listened to, that they're heard.

Are there avenues for that?

If I, for instance, because I've had this happen to me, if I go in because I'm having sinus issues and my doctor is asking me about heart palpitations and other things that have nothing to do with my chart, and she eventually asks me if I'm a 63 year old woman and I cannot go now because she's not hearing me when I say that I'm having sinus issues and the conversation is not moving forward, are there actions that I can take, people that I can talk to to ensure that I am heard in that moment?

Yeah.

So the in that moment question gives me pause, because if you're in that situation, how do you redirect that provider?

How do you gently ask?

I'm sorry I came in for this symptom and see if that redirects the discussion.

If you're in a health system, we have advocates, childrens has advocates, Q has advocates the larger systems.

You can call someone whose job is to talk to you about what your experience was and how we can make it better.

Sometimes that's going to mean a different provider and a different visit, but other times trying to to again redirect their conversation in a way that if the provider feels threatened, sometimes that's just who they are and you got to leave and you can be like, this isn't going to work.

But I'm worried about that $125 to it's not the patient's problem.

If the provider is distracted and so it could be their senior partner, it could be their office manager, or it could be someone else.

What else would you do?

It?

To your question, or if I'm going off this, I'll let you choose.

I mean, I would say to the initial question, I definitely recommend asking, watching my own friends and family go through the health care system.

I know being in it, I don't realize it as much, but watching from the outside, I see how often people are just like, Yep, okay, that's what we do.

Like, yep, you're the expert.

Like you.

Please feel empowered if you're like, That doesn't really make sense.

Why are we doing that?

Anybody should validate that question and have an answer to it, because it might be like, why I'm asking palpitations because I'm concerned about X, Y, Z, or it could be, Oh gosh, I'm in the wrong chart.

I'm so sorry.

The computer ask that questions.

And then I really the other pivot off of that would be I would really encourage talking with people in your village, whatever that is, because there's a lot of room for misinformation as social media and the Internet expands and expands.

And in many ways that access of knowledge is a great thing.

But when you get that misinformation out there, it also permeates so quickly as well.

And that can often start us down.

A more difficult track.

And asking a question often helps me and my patient get to the same point and where they ultimately want to be faster.

I would answer your question by saying, one, Take an advocate with you, so don't go alone to a health care visit and kind of in the same vein as voting, vote with your feet.

If you aren't getting what you perceive to be adequate care or humane care or good care.

If you have the option, go go elsewhere.

Sometimes you have to stay and advocate for yourself where you are.

But but sometimes you have the choice to to vote with your feet and choose another institution or another clinician.

Yeah, there's nothing wrong with getting a second opinion on something too.

If you have questions or concerns like I will never take offense.

If a patient is like, Do you mind if I go ask something else?

And I'm like, Great, come back and let me know.

Like if it worked out or not.

It's kind of like a dating game.

We're trying to find like a doctor, you know?

It's like you have to have that kind of connection.

You have to have that trust in order to be able to continue on with that relationship, because it is a relationship, whether you like it or not.

So you have to make sure you guys are both comfortable and like, I may not get along with you and I can see that as like a barrier to care because we're just just different with how we see things and that's okay.

There's going to be somebody that you're going to be able to find out there, and I will help you and I will send referrals and everything else.

So don't be afraid to get that second opinion if you need to.

Well, I appreciate you framing it as a relationship because doctors are so well-educated and experts in their field.

I imagine that most people hear what a doctor has to say and they take their word as it and they don't vote with their feet, so to speak, and seek other care when they've been given information that may counter what they believe because they're the expert.

But looking at it from the frame of a relationship that I choose you as much as you choose me, helps to affirm the power that we have within to make sure we can advocate for and dictate the journey of our health care needs.

Dr. Keirns So I have a child with disabilities, and when I talk to moms who have kids with disabilities, the thing I say is, look, the doctor may be the expert in that area of medicine, but you are the expert in your child and you are the expert in yourself.

And so if you're not getting answers that make sense, I love the why question.

I love bringing an advocate, but also just recognize you are the one with everything at stake.

And so asking questions, voting with your feet, all the things we've talked about are so critical.

Well, I have one last question, and that will be closing out what has been a very informative discussion.

So what now?

What now that we have laid out all of and explored all of the challenges, disparities and even opportunities that women face in health care here in Kansas City and beyond, Can you each share one practical solution or action or hope that you have for the future of women's health care in the Kansas and Missouri region and beyond?

And I'm going to start at the other the panel with Hakima Payne, thanks.

I yeah given a great deal of thought to so what now what and when you speak of health care being a relationship that is certainly aspirational that is what it should be.

What it often is is transactional.

And a lot of the work that we do recognizing villages is looking at how to build the relationship back into health care so that it's not so transactional.

And that involves back to transforming systems.

That's my that's my hope for the future.

Yeah, I thought about this quite a bit and it was tough to settle on just one area.

And I think for me, I kept coming back to the things that are immediately in front of us and I mentioned it earlier, but I my one or immediate ask would be to vote this November.

The overwhelming majority of people don't vote, and that means somebody else gets two, three, four times the amount of amplification for their vote than what represents the whole.

And so I think there's a lot on the ballot.

I live on the Missouri side.

There is a lot of the battle on the Missouri side beyond just Amendment three that goes to us taking care of each other as a human race.

And and we've talked about, you know, human rights.

I think there's a lot of that on the ballot.

So my ask would be to vote.

And if I have a second one, take a friend with you community partners is what I've seen over and over again.

Make change where health care providers, public health organizations and grassroots organizations get together at a table as equals and say, what is the problem and what are we going to do about it?

And I've seen tremendous change happen that way a lot with this one.

I mean, I echo every single thing that's been set up here.

I think a big win for me just with my line of work and where I'm actually working is just fostering more of the collaboration parts.

And when people are more willing to be innovative, I think that makes a big difference in taking a chance on new ideas.

And so that's what we're doing at Sam Rogers in our maternal health department.

You know, we've also started doing stuff with doulas, bilingual doulas especially.

We're going to be doing a do a pipeline program, instituting integrative behavioral health.

So trying to think outside the box.

And so far it's been working and we've been getting support for that.

So I think when people recognize innovative ideas, they do anything they can to help what's going on That gives me hope.

And my one hope is that women amplify the power that they have within to advocate for themselves, not only in the moment that you're engaged with a health care professional, but engaging with the entities that are making decisions on behalf of the institutions, the funding, the resources that are related to these different power holders.

And that includes not only voting, but knowing who your elected officials are and speaking with them after they've been voted in about the issues that matter to them.

You'd be surprised how many elected officials never hear from their constituents at all unless there's a major issue.

And taking one or two or four of you in office and talking about the issues of health care to your city councilperson, your county person, your state legislator, your congressman or woman has a lot of impact.

So that's my So what now?

What?

And with that, I would like to thank our esteemed panelists, Dr. Robbie Harriford, Dr. Carla Keirns, Dr. Megan Madrigal, and the one and only Hakima Payne.

I'd also like to thank our Roamimg reporte Kynala Phillips for what was a wonderful discussion you for your time, insight and gifts and all that you do everyday to ensure that women can move beyond the symptoms, to enjoy and live a vibrant, healthy and thriving life with the health care that they need.