- Globally, healthcare is widely considered a human right but here in the United States access to healthcare isn't guaranteed.

And for those in the LGBTQ+ community, it can be an uphill battle.

I'm Kylie Ambu, and on today's "Mutually Inclusive" we're taking a trip to the doctor's office to learn more about what health equity and affirming care looks like in West Michigan.

(upbeat music) For years, the LGBTQ+ community has fought for space within American society, from the right to gay marriage to anti-discrimination policies in the workplace.

However, the nation still seems to be at odds over the right to equitable healthcare.

A lot of rhetoric that we've seen lately as a nation has centered around health rights of transgender or gender non-conforming patients.

And while important this isn't the first conversation that's sprouted up when we look at American healthcare and the LGBTQ+ community.

Did you know that until 1973, around 50 years ago, homosexuality was actually considered a sickness or a mental illness by the American Psychiatric Association.

And during the 1981 HIV/AIDS epidemic, LGBTQ+ folks faced heavy stigma and prejudice with the disease being referred to as gay cancer.

But it also led to a wave of queer-activism since US officials were making little movement to prevent or research the disease, which heavily impacted Black and Latinx gay men, as well as transgender women.

All this to say the fight for equitable affirming healthcare continues to knock on America's doorstep, and we wanted to find out what that looks like for West Michigan.

So we partnered with the Grand Rapids Pride Center and Corewell Health system to explore today's health landscape, where it's at and where it's working to go.

(upbeat music) West Michigan is home to a robust set of healthcare options.

It holds the state's largest federally qualified health center, and after a recent merger also plays host to the state's largest health system.

In the city of Grand Rapids, the strip dubbed Medical Mile is renowned as a world-class healthcare destination.

But providers say these may not be the only reasons patients are flocking to the area.

- Definitely have had people moving from other states to Michigan because of certain laws that are in those states.

- [Kylie] As the nation continues to grapple with policies surrounding LGBTQ+ protections, healthcare has taken center stage with at least 19 states having laws restricting gender affirming care and at least seven states allowing doctors to turn away LGBTQ+ patients altogether.

Healthcare providers and advocates say these barriers can increase the likelihood of anxiety, depression, and suicidal ideation in this population, specifically transgender non-binary patients.

- We get calls every day of the week from people from Texas and Florida in particular calling to say we're in the process of moving up to Michigan and want to know about XYZ.

A lot of it really is like, okay, so medical care there, therapists there, because we're uprooting specifically for safety but specifically for medical care.

Like my kid needs to be able to get on hormones.

There's doctors there that are gonna prescribe hormones for my kid, right?

- [Kylie] While Michigan isn't currently designated as a refuge or shield law state protecting access to healthcare, it is widely considered a safe place to land for gender affirming treatment.

- So these are just some pieces of flare I like to call 'em but this is kind of a badge buddy that is rainbow themed for the LGBTQIA community pride flag.

It has my pronouns on it below it.

Another kind of button here that also indicates that as well.

- [Kylie] Dr. Christopher Palazzo is a board certified physician with Corewell Health.

He specializes in family medicine and is identified as an LGBTQIA+ safe and affirming provider.

- Affirming care starts before you even get into the office.

It starts at the front door.

There's a lot of percentages out there that you can find of specifically trans patients who have been rejected care or harassed in a medical environment which leads to barriers, it leads to walls.

These patients are afraid to even seek emergency care because they're afraid that they're not gonna be treated properly.

- [Kylie] One type into a Google search will show gender affirming care rights have been at the center of discussion in 2023, particularly in relation to the treatment of minors.

While Palazzo does work with puberty blockers and gender affirming hormones, he says this realm of service or procedure isn't the only issue on the table when it comes to equitable healthcare.

Just feeling comfortable or welcome in health spaces can be particularly difficult for LGBTQ+ patients.

- So especially with things like pronouns, CIS patients don't ever have to think about being misgendered on a day-to-day basis.

So that's something that's super important for getting a dialogue with a patient and getting their trust is getting the pronouns that they use right.

A lot of times in healthcare over the years, a lot of our minorities, marginalized communities have been wronged and there's a fear that that's something that's gonna continue to happen and that's a barrier to care for a lot of patients in the LGBTQIA a community - [Kylie] These concerns and lack of trust in health systems are sentiments the Grand Rapids Pride Center knows all too well.

- Two-spirit LGBTQ+ folks do have really high needs for mental health support because discrimination and the stress and impacts of that are really high.

The other side of that, of course, is finding an affirming therapist.

Finding someone who isn't going to blame your identity for why you have mental health concerns or stress.

- [Kylie] Aaminah Shakur works as an accessibility and healthcare coordinator.

One of their many jobs is to bridge the gap between the center's members and safe, reliable care whether it relates to physical or mental health.

- Having an affirming therapist makes the difference between whether or not that therapy is actually good and useful and helpful to you, or if it is doing further harm to you.

And far too often it is doing further harm.

- [Kylie] The center's therapy assistant program connects LGBTQ+ community members with vetted affirming care providers.

It's also designed to ensure individuals can access these professionals by breaking down some of the financial barrier.

- Two-spirit LGBTQ+ folks often do not have the same financial access as wider community.

And of course, we know that in Grand Rapids there's a lot of financial disparity in general.

So LGBTQ folks often run into issues where they do have insurance but the copay is going to be a barrier.

If you have to pay $25 or $50 every time you see your therapist, you're being like, eh, yep, can't go this week because need to put that into the gas tank.

So we're able to pay for a certain amount of sessions.

- While Shakur says there are affirming care providers in the area, they add the pool of options isn't very expansive, especially when it relates to people of color and other intersecting identities.

- It's really hard, and it's disappointing to say that Grand Rapids does not have a lot to choose from.

When it comes to overlapping identities, it is so difficult.

Excuse me, I am a multiplicity of things.

So when I come into your ER, I experience Islamophobia, and racial misidentification, and racism, and ableism, and homophobia, biphobia, and transphobia all at the same time.

- [Kylie] Research shows discrimination in healthcare settings is widely experienced by the queer community.

And a 2019 study in the National Library of Medicine found more than one in six LGBTQ+ adults reported avoiding healthcare due to anticipation of discriminatory practices.

Whether it's individuals putting off doctor's appointments or being unable to access care, Palazzo says patients face dire effects.

- Some of the statistics say that especially trans community, 40% have thought about or attempted suicide in their lifetimes.

And that's huge compared to the general population, especially in a marginalized community, that's a huge number.

So it is truly life or death that these patients get affirming care, that they feel valued, they feel heard, and their needs get met.

- [Kylie] He says, Corewell Health has committed to a vision of quality healthcare for all.

The group, which merged industry giants, Spectrum Health and Beaumont Health is now the largest health system in Michigan, serving more than 1.3 million patients.

That's something Palazzo says can carry weight in this conversation.

- So Corewell believes in equity of care for all people.

And our big goal right now is to make that accessible and available no matter where you receive care through Corewell Health.

So if it's in the hospital, if it's in a specialty clinic, if it's in our primary care office, it doesn't matter, it doesn't have to be one clinic that focuses on LGBTQIA healthcare, it should be something that's your clinic that you go to regularly.

So that's really the stance right now that we're really working towards is to implement that and make sure everybody's on the same page with that mission.

- [Kylie] So how does every employee get on the same page, particularly in a system like Corewell, which boasts more than 60,000 team members at hospitals across the state?

- So at Corewell, we're doing modules that currently are voluntary but a lot of people have done them.

And on our website, we designate physicians, providers that are safe and affirming if they've completed all the modules.

And if a full office, everybody in the office from the front desk to clinical staff takes these modules then you're deemed a safe in affirming clinic.

We have improvement teams that work specifically on LGBTQIA care that meet monthly or every couple times a month that focus on issues that are pertinent to roll out through the system.

We've also rolled out an LGBTQIA patient navigator which is a position that is able to find resources or care that patients need.

- [Kylie] Palazzo admits Corewell is still growing in its approach to equitable healthcare, saying there's always hurdles to change.

He cites the discomfort some physicians may feel about adopting new practices, the learning curve of implementation, and the frequently changing political policies.

- I think that there's a lot of work still to do to make things more cohesive.

And that's something that we work every day in some of the committees that Corewell has, and I'm a part of.

The biggest thing is this care to provide a safe space for patients.

It's very rewarding.

It's something that you can see smiles on faces of patients who initially were timid and shy afraid to come in to seek healthcare.

And that's the most rewarding part and that's why we do what we do.

- [Kylie] When asked about the long-term blueprint for equitable healthcare, Palazzo says it's about centering the patient, addressing barriers, needs, and culturally responsive care.

- The future is kind of unknown politically as far as what that's gonna look like for this care.

But I think this is a question about medical necessity, it's not a question about politics, and it should never be.

(upbeat music) - The conversation surrounding what affirming care looks like and how we get there is continuously developing.

And groups in our own backyard have been together to chase this vision.

Today, WGVU's, Jennifer Moss is in the studio with Jenny Knight from the Grand Rapids LGBTQ Healthcare Consortium to tell us more about this effort.

(upbeat music) - So we wanna thank Jenny Knight for joining us today.

You are of course the Executive Director of the Grand Rapids LGBTQ+ Healthcare Consortium, so we welcome you today.

- Thank you.

It's lovely to be here.

- So today of course we're talking about the Healthcare Consortium and the need for such an organization.

Tell us about your mission.

- Well, our mission is to address the gaps in care that LGBT community members face in healthcare.

And it came about in 2017, excuse me, when Dr. Grace Hessinger started looking at the gaps in care that LGBT community faced specifically she was focused on HIV prevention.

And was finding that a lot of the providers in the Grand Rapids area weren't comfortable and weren't prescribing prep, a pre-exposure prophylactics medication that prevents people from contracting AIDS.

And so she started trying to find out why and how to make that more accessible to the community.

And that's just kind of expanded since then into this full-blown consortium that we currently are.

- Where is the disparity?

Is it with the healthcare system overall or is it with providers knowing how to treat or what is needed in the community?

- It's more about their education and their knowledge.

Because if you talk to providers and healthcare systems, they all want to provide high quality, appropriate healthcare for everybody in their community.

But when you look at education, most providers that if they've been out of med school more than a couple of years, they probably didn't get any education around LGBT healthcare.

If they did, it may have been a case that they reviewed of somebody that maybe had HIV.

So the education has changed, is in the process of changing over the last five years, at least locally.

But I think for the most part it's lack of education and training and understanding what some of the disparities are.

- Okay.

And what is the Healthcare Consortium doing to combat that?

- We're partnering with anybody and everybody.

So we work very closely with MSU College of Human Medicine.

We've had an amazing collaboration with them for the last two years now.

We look at ourselves as like a convener and a conveyor.

So we bring people together to talk about stuff that the community is talking that they need, and we're sharing that information with healthcare providers and systems and vice versa.

So we have a monthly meeting where we bring all of these folks together and share information.

And we also do a yearly health experience survey.

So we're asking community members what experience have you had with the healthcare providers and what do you want them to know?

And then once we gather all that, we share it with the systems.

And we're hoping that that's making an impact because they're not only hearing the stats, and the statistics, and the data and all that, there's often also patient stories attached to that.

- All people who need medical care should, as we talked about be able to see their doctors without worrying about being mistreated or harassed.

The Affordable Care Act did help address some of these issues, but you still find that there is pushback in certain areas.

- Oh, absolutely.

And especially in the last year, there is so much anti LGBT conversations going on across the country that if someone's mental health is not impacted by that right now they're kind of living in a bubble.

Because the last time I checked which was a couple days ago there's over 500 laws being debated across the country that are focused on LGBT community members.

And some of it is about healthcare for them and it makes people feel targeted.

There's a lot of fear but also there's things happening like in California, a woman was just killed because she was flying pride flag.

She was an ally, she wasn't a member of the community.

And so that does create a lot of fear and a lot of distrust and a lot of anxiety.

And that does put people at risk because by the time they do engage in healthcare then it's often farther along in the disease process.

So it's becomes more expensive, more timely to be able to treat that.

And it's not always the best outcome for both the patient and the community.

- And the Healthcare Consortium is trying to work through that, what is your ultimate goal, Jenny, as you look to the future for the Healthcare Consortium and and what you might want to accomplish in the community?

- Well, if we were looking at Nirvana and Grand Rapids, was it, it would be that everybody regardless of how they identify, regardless of how they look, regardless of where they come from, they feel like they belong here and they feel like they're valued here.

Because I think we're missing that a lot.

Not everybody feels like they belong here and not everybody feels like the community values them.

- And you told me in a conversation we had earlier respect is your default.

- Absolutely.

- And that's what you want to get people to.

- Yes.

- Respect.

- We need to get back to that because when people say respect is earned, that's not true.

If you have to earn it then you're starting from a place of disrespect.

But if you come to conversations as default of respect I respect your values and beliefs, that doesn't mean that you and I can't have a conversation even about something we disagree about that I may learn something about.

- That's very true.

Very true.

That respect starting base right there.

Jenny Knight, Executive Director of the Grand Rapids LGBTQ+ Healthcare Consortium, thank you so much for joining us today.

- Thank you.

It's been a pleasure.

- We appreciate your time.

(upbeat music) - When we talk about the future of healthcare, we know it rests in the students today who will become the healthcare workers of tomorrow.

With so much movement in the health landscape and knowledge about best care practices, we want to know how it's being translated in the classroom.

"Mutually Inclusive" got to sit down with staff from Grand Valley State University's Kirkhof College of Nursing to learn more.

Fingerprints are everywhere.

Small impressions, each unique and personalized.

They can be used to identify you in an emergency or just get into your iPhone.

But for Dr. Jay Knight, fingerprints hold a special purpose, telling a story of their healthcare journey.

- So before I was a teacher, I would touch on a given shift, maybe eight to 12 patients in the emergency department.

Now that I'm a teacher, my fingerprints are on all of these other students in the way that they deliver care to their patients.

So if we think about that and as it relates to delivering affirming care but also as it relates to closing gaps in knowledge and addressing stigmas, we see those fingerprints and it starts in the classroom.

- [Kylie] Knight has around 20 years of experience in healthcare during which time they attained a doctorate of nursing practice with the goal of being able to teach.

They landed at Grand Valley State University's Kirkhof College of Nursing, educating tomorrow's health workers as an assistant professor.

- I'm excited to be a part of this work and to not only be able to lean into my passions as far as addressing health disparities and giving back to the profession of nursing, but also leaning into helping the next generation of nurses, then it's a good spot to be in.

- [Kylie] While certain principal practices may be the same, Knight says today's training is different than what they experienced as a student.

It's more expansive when it comes to patient identity and affirming care, specifically as it relates to the LGBTQ+ community.

- Thinking about my education journey in nursing, I had to go hunting for the LGBTQ stuff.

I put it upon myself to go learn the things because I was part of that community.

I knew as I gained more clinical experience, I knew, okay this is impacting all of these things downstream.

And we look at the last five-ish years, we're seeing societal demands and patient experience.

They are seeking that and expecting that from their care team and rightly so.

So then that bleeds over into our students demanding and expecting that expertise and that level of comfort which then feeds into the faculty need to have that.

- [Kylie] Over the last few years, there have been achievements in LGBTQ+ care, but historically, healthcare for this population has been suppressed, which leads to gaps in knowledge around affirming, trauma responsive, and culturally responsive practices.

Knight says their team wants to jump forward.

- For instance, I see here at K-Con, we have a group of nursing faculty working on research specifically related around addressing LGBTQ education gaps in the classrooms.

So that's one area where our own faculty are doing research and seeking to understand and close those knowledge gaps.

- [Kylie] Students within the Kirkhof College of Nursing have state-of-the-art technology at their fingertips inside its interprofessional health simulator, helping learners get hands-on experience administering care.

- When you think about the learning environment is an opportunity to make mistakes and to practice.

I mean, we have simulation labs all over the place and certainly sometimes they look like a hospital setting and other times it's a simulation and it's a critical conversation with a patient and it's practicing language.

- [Kylie] There's a large focus on communication with patients but it's not all bedside manner.

In addition to creating a trusted environment, Knight explains the importance of understanding the layers to different patient's needs.

- For instance, somebody who is gender diverse, so let's say that they are a transgender male, they still have the capacity to get pregnant, have ovaries, uterus, et cetera.

What are we doing to make sure we don't misstep?

We think about clinical decision support tools.

These are little popups that remind you or clue you in as a care team member, hey we need to be on the lookout for fill in the blank, for instance, pregnancy perhaps, we need to get a pregnancy test for this patient.

Sometimes those rules if you go upstream are built on legal sex which might not be appropriate.

- [Kylie] It's widely understood that this kind of personalized healthcare is particularly important when serving patients who have overlapping underrepresented identities such as communities of color, populations which have been adversely impacted by prejudice.

But what about healthcare workers who also belong to these communities?

- That minority stress and kind of describing how that contributes to burnout.

And we think about, especially right now with COVID and staffing demands, burnout in healthcare is huge, right?

The number of nurses that are leaving the profession after the first year is skyrocketing right now.

- [Kylie] Healthcare, like many industries is seeking diverse talent to bring a multitude of understanding, viewpoints, and ideas to the table.

And in the wake of nursing shortages coupled with tense political climates, Knight wants to ensure these essential workers are supported.

- One thing I don't think we are doing an adequate job of is ensuring that those that are in the field doing the work, for instance, if they identify as part of the black and brown community and part of the LGBTQ community, all of those various identities that folks bring with them they come with a price as it relates to stigma and potentially bias.

If we add in the static as it relates to not being able to be a 100% authentic, having to potentially if their patient asks, so what's your husband like?

Well, I don't have a husband, I have a wife.

Or what do you mean your pronouns are they, them?

And having to correct, having the loneliness of loneliness that adds weight to each and every shift.

- [Kylie] Knight says with multifaceted problems come multifaceted solutions.

And while nothing may change overnight, there are tools at play promoting equitable care.

- Any of the health systems have the ability to collect sexual orientation and gender identity information and then act on it.

So within their electronic health records where they're collecting all kinds of information about you, well ,now they have the ability to collect your gender identity, potentially the sex you were assigned at birth, also taking a look at what organs you may have, and using that information then to drive clinical decision making on if that pregnancy attest alert comes up or not as opposed to just relying on your legal sex which may or may not be in step.

- [Kylie] As for the future, Knight knows their fingerprints will multiply every day, sending a chain reaction of inclusivity they hope will carry forward.

- I'd like to see it become more regularized, demonstrating the skill in a variety of ways and that being the norm as opposed to exceptional.

So like we think about our virtual meetings and you've got your name on there, do you also have your pronouns displayed including your pronouns and your email signature line?

This isn't just for the LGBTQ community, it's for instance the Jamie's and the Chrises out there that maybe have gender neutral names and now you're setting others up for success to address them in a way that they feel safest.

I would like to see more intentionality to help build resilience across the board, recognize them and empower their authenticity so that they're not having to devote energy to covering and turning down the volume.

(upbeat music) - My head's a little dizzy because we covered so much today.

- [Jennifer] We really did.

- [Kylie] And I know we say this every single time but we do wanna be transparent in saying that we know, we know we cannot possibly cover this entire conversation of health equity in one show.

- [Jennifer] But what we can do is connect you to resources so you have the tools to keep that conversation going.

And so we have that in this episode of course as well, post it to our website.

You can also follow our WGVU Facebook and YouTube pages, right?

To stay up to date with all the new information.

- Absolutely.

And we are always excited to learn about these important topics with you by our side.

So we do hope to see you next Wednesday.

And as always, thank you so much for watching and for helping us be mutually inclusive.

(upbeat music)