"Direct Connection" is made by MPT to serve all of our diverse communities and is made possible by the generous support of our members.

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Live from Maryland Public Television, this is "Direct Connection" with Jeff Salkin.

>> Jeff: Good evening, and welcome to your "Direct Connection."

Coming up tonight, disparities in maternal mortality rates.

We will find out how doctors in Maryland are making a difference.

But first tonight, while you may think you have heard of all of the threats to the Chesapeake Bay, as part of MPT's Chesapeake Bay week, tonight we have a new one, and it is massive.

Joining us now from Annapolis is Allison Colden, senior fisheries scientist at Chesapeake Bay Foundation.

Dr. Colden, thank you so much For joining us.

We've heard of snake heads and other invasive species in the Chesapeake Bay.

What is a blue catfish?

>> Blue catfish is a species of catfish that is native to the Mississippi delta and made its way to the Chesapeake Bay over the last 50-60 years and is a real threat to the Chesapeake Bay ecosystem.

>> Like the invasive shoe fly what we have on the picture.

Thank you for persevering.

>> This what you have on the shores of the Chesapeake Bay.

>> And wouldn't we like to be outside there right now.

How did this thing get into the Bay?

And how did it become the problem that it is, and how big of a problem is it?

>> It's a huge problem for our native species in the Chesapeake Bay.

Blue catfish were originally introduced intentionally in Virginia's James river in the 1970s and 80s in order to develop a recreational fishery.

But since that time they've made their way in every tributary Throughout the Chesapeake play watershed.

>> And the problem with that is is that they eat a lot?

>> Yes.

So they are a voracious predators they will feed on anything they can find in the river they are living.

What concerns us the most, the Larger they grow they eat fish Species including our native Fish, striped bass known as rock fish, shad and blue crabs.

>> Explain if you would, the idea that they outcompete other species.

We are looking at other pictures and you know, they look like white sharks.

They are gigantic.

So when they get that big, I guess you can imagine how they can outcompete something else.

But when they are little, there is a lot of fish in the bay, right?

>> That's true.

There are a lot of fish in the bay.

And these species actually grow very, very quickly.

They grow much more quickly than some of our native species which means on a daily basis they are eating a lot more by body weight than our native species to put on the weight quickly and grow to the large sizes.

Blue catfish can grow up to be 100 pounds, almost 4 feet long.

Can you imagine for a blue catfish that large roaming throughout the rivers and streams of the Chesapeake Bay as it comes across juveniles of all of these commercial fish species that we like to harvest, it's eating those and it's also feeding with food species for top predators like striped bass, blue fish, weak fish and other species.

Not only is it directly preying on the juveniles of these species who we know and love but it's competing for their food sources.

>> Now, there is a focus on creating a new natural predator for the blue catfish and that natural predator would be us?

And catching them and cooking them and eating them.

Does that seem like a good Strategy?

>> Over time, I would say that humans have been one of the most prolific predators for fish species throughout the world.

So we're hoping that in this case, if we can't beat them we can eat them.

So we are hoping that harvest of the blue catfish will help knock down their numbers to the point we can minimize the impacts they are having on the ecosystem and our Chesapeake Bay regional economy which depends too much on water men who make livelihoods from harvesting fish on the bay.

>> We have a new program week this Thursday on eating blue catfish.

With recipes I suppose.

Between us, I mean, I like Catfish.

Sometimes blackened and you need spice on it or blue catfish kind of similar to regular catfish?

>> No, blue catfish are a much more delicious fish, delectable fish because they are feeding on Fish and crabs and all the things you and I like to eat.

So that's what they're eating.

Some folks used to eating catfish that are farm raised or living near the bottom where they are feeding off of the mud that is not the case for the blue catfish being a top predator in the bay they are going to taste like what they eat.

I found they are a delicious fish to eat and we're hoping that will help wet people's appetites and increase the harvest of the blue catfish out Of Chesapeake Bay.

>> We'll start seeing them on menus.

Let me remind our viewers.

If you have a question about the catfish anything else related to fisheries in the bay call the number on the screen.

Where you can e-mail a question to live questions at MPT.org.

What is happening with other fisheries in the bay?

We think of the things you mentioned, the crabs, the oysters, the rock fish, what is up, what is down?

>> So one of the things that has us really concerned here at the Chesapeake Bay foundation is the current status of our blue crab population.

Everybody knows the blue crab is an icon of Maryland and the Chesapeake Bay region.

Last year's survey, that is carried out every year by Maryland and Virginia cooperatively showed the lowest abundance of blue crabs on record since the survey began in the early 1990s.

So that could be due to a number of things.

It could be due to our To environmental changes, loss in habitat, pollution leading to reducing oxygen levels within the Chesapeake Bay.

But one thing we know that is not helping is the blue catfish.

For example in the lower James river where these blue catfish were first introduced in the 70s and 80s, one study from From the Virginia institute of marine science found that these fish were eating more than two million crabs per year.

So although it may not be the only cause of the blue crab decline we're seeing going on, In the Chesapeake Bay, we certainly believe the proliferation of the blue cat catfish is not helping the issue.

>> I recall a similar issue with rock fish.

The rock fish population was decimated I'm thinking a decade plus ago.

Crabs did well at that point of time.

And then there was a moratorium on rock fish.

The rock fish came back and they started eating juvenile crabs is that about right?

>> Well, actually where we are now is the rock fish population Is also down.

So in this case I'm not sure we can point the fingers for blue crabs at the rock fish population.

We are currently trying to rebuild the striped bass or rock fish population from a very low abundance that we're seeing right now.

Again, there's probably a lot of factors that are going into what we're seeing.

One of the things most concerning about the rock fish population is multiple years in a row of low reproduction.

Every year the Maryland department of natural resources Measures the young of year fish, meaning the juvenile fish born in this year, in the past three years, that has been far below the long-term average, which means we are seeing some sort of environmental change or change in the rock fish population.

Which means we're going to be seeing some big holes in the rock fish population as the fish grow up and become a size that can be fished.

Either commercially or recreationally.

>> What is happening with oysters?

>> Well, that may be the one point of bright spot of good news.

And I know folks have heard for many, many years about the dissemination of the Chesapeake bay's oyster population, which suffered tremendously over the years from historical overfishing, pollution, sediment pollution as well as nutrient Pollution and disease, Which caused knock backs of the oyster population in the 1950s again in the 80s and early 2000's.

Fortunately over the past two to three years those environmental conditions have been positive for oysters.

And we have seen record reproduction or near record reproduction we've seen in recent years.

And that has been above average for two to three years.

Maryland's waterways adjoin a Water men have been enjoying a record harvest in 2021 and I hear that may continue into 2022.

So as you can see, with the conditions that we're experiencing now, there's some Winners and some losers.

>> You probably advise caution when it comes to taking advantage of any surplus of oysters at least in the non-aqua culture areas of oyster harvesting?

>> Yes, absolutely.

It's important to keep all of this in context and compared to the size of the historical population or what we can infer from historical harvest levels, we are still at a small fraction what the oyster population used to be in Chesapeake Bay.

We are a small fraction of achieving what oysters can achieve for the Chesapeake Bay for providing habitat for fish and crabs and filtering the water and making it clearer and cleaner.

It's important to remember that Context although we're high relative to recent years we are much lower than what we could be.

And what we have seen in the past, is that these short-term booms in abundance for oysters can often be knocked down quickly as more folks try to enter the oyster fishery and rightfully so take advantage of the abundance we see in the bay.

We have been encouraging a bit of a cautionary approach to this current period of abundance to make sure that we leave some of those oysters on the bottom so they can help reproduce the next generation.

>> Viewer email question, Greg wants to know, where can we purchase blue catfish.

Haven't seen it in the local grocery store yet.

>> Well, thanks for that question.

It is a great one.

I will say there are a few local grocery stores that carry it.

I have seen it in the Annapolis area in giant and whole foods.

Check out those grocery stores.

But here is another suggestion.

If you don't see it in your local grocery store talk to your seafood market person and ask them for blue catfish.

If they know people want to eat blue catfish they will start ordering blue catfish.

1: Make sure you talk to people about it.

If you are a fisherman or angler there is no limit, there is no number of blue catfish that you are limited to in terms of harvest.

And any day of the week in the Chesapeake Bay you can drop a line and catch yourself a blue catfish.

We absolutely encourage you to look for it, ask for it at restaurants, ask for it at your local grocery stores.

And if that does not work drop a line and have a nice day on the bay and catch your own.

>> That's a plan.

What happened to snake heads?

Because there was an invasive species the big headline a few years ago.

Is it still as big a concern?

>> Northern snake heads are another invasive species and yes, they remain a significant concern.

They are native to Asia and we're introduced illegally to Maryland were found in the potomac in 2004.

There are another voracious predator and feed on our native species.

One of the reasons why folks may not hear about northern snake heads as much as we do blue catfish is because they are slightly less tolerant of salty Water, meaning they have been more effectively confined to some of the fresh water areas like marshes and impoundments than blue catfish that surpassed expectations in their ability to companioned fresh water areas into saltwater and throughout multiple tributaries in the bay.

Because there is a lot more overlap with some of our commercial fishery species that is why people mostly hear about Blue catfish.

But snake heads are a concern and proliferating in size and abundance in the fresh water areas throughout the bay.

>> Dr. Allison Colden is the senior fisheries specialist joining us from Annapolis and we appreciate your patience with the wildlife there.

Thanks again.

>> Thank you so much.

>> And remember to tune in this Thursday at 8:00 P.M. for the new MPT special eating blue catfish-- lots of ideas and recipes and for information on that and all of the Chesapeake bay week programs go to mpt.org/bay week.

[♪♪] >> Joining us now to talk about your health is Dr. Kitessa, Obstetrician, gynecologist and assistant professor of the Maryland School of Medicine.

Thank you for joining us.

>> Thank you for having me.

>> Maternal mortality.

Tough topic.

Got a lot worse during the pandemic.

Why was that?

>> So I think there's several factors.

One is Covid-19.

So just as we saw that many people in the United States were affected by Covid-19, pregnant women were not immune to that.

Part of the issue why it was worse in pregnancy and exacerbated maternal mortality is just some of the changes that happen in pregnancy.

That make women more susceptible To have more severe disease and more likely to be hospitalized.

And that contributed partially to the rate of maternal mortality increasing since the pandemic started.

>> Apart from Covid what, are the top reasons that someone would die near or during delivery?

>> Yes.

So the kind of top reasons for maternal mortality in the United States one is cardiovascular disease.

Namely high blood pressure or hypertension.

lastly, another major cause is hemorrhage or post-partum hemry.

In addition to that, I think we have to talk about health disparities.

Black women are almost three times more likely to die in pregnancy and around pregnancy in the United States and that's a contributing factor as well.

>> It's black maternal health week.

What are the factors that go into that?

That is an incredible disparity not like 10% higher or 20% it is a factor of 100% or 200% higher.

>> It is a significant disparity.

And one is access to care.

But that doesn't really answer Really the full reasons for why.

So access to care is an issue.

But that doesn't explain it because even for black women who have a college degree or higher their rate of maternal mortality is higher than white women with a high school degree.

So other factors include Structural racism, implicit bias among healthcare providers.

These are other factors that contribute to the disparity in maternal mortality.

>> Implicit bias among healthcare providers meaning a Lack of attentiveness maybe?

Somebody is exhibiting symptoms and the provider somehow is not as tuned in?

>> Right.

By nature of being human beings we all have implicit bias.

But implicit bias impacts some groups more than others.

So for Black man and women in particular in this case, it is a major factor and part has to do with stereotypes.

Some of these stereotypes stem all the way back from slavery, that stereotypes, because black women during slavery were disproportionately forced into child bearing.

They were forced into harsh conditions working in the fields.

They had higher rates of pregnancy loss.

They weren't able to take care of their children.

And that kind of directly links to some of the stereotypes that exist of black women today; that they're hyperfertile; that they don't want to take care of their children.

That they experience pain less than white women do And all of these are contributing factors into implicit bias as to how black women are treated and their symptoms may not be listened to, or heard or addressed sometimes.

>> Within your practice, and as you are training the next generation of doctors how do you address those things?

>> I think a big part is talking about it.

So in my medical training, these weren't things that were discussed as much as they are now.

And as you said, I teach at the School of Medicine, and there are sessions with students on health equity or health inequity.

There are sessions to discuss these things.

And that is something I think we need to continue in all of our medical training and our medical care when we are taking care of patients.

When things come up, we need to Talk about it and reflect and think about what are our biases and by starting to do that, then we can work to try and change things and overcome them.

>> If I leap from that to thinking if I am a black woman delivering a baby I want to see a black doctor on the other side.

Am I wrong?

>> Yes, that is true.

And I've seen that in my own practice.

More black women coming to see me and seeking out black physicians to take care of them.

And there is data that shows not specifically in OBGYN and data For babies in the NICU that the mortality for-- mortality rates for black babies, are lower if they're taken care of by a black physician.

There was a study looking at primary care physicians in counties in the United States and counties were a greater proportion of black physicians, the disparity in the life expectancy was less between black and white.

And so these are all things that then I think extend probably to other specialties as well.

The other thick is more diversity in the physician field and the healthcare setting.

Right now, there are about 5% of physicians in the United States Are black whereas 12% of the population is black.

So bringing greater diversity into the pool of doctors in this country, also brings more diversity of experience, brings these issues to the table more because they are bringing their lived experience also.

So that's important I think as well.

>> We know Morgan state university about to open a Medical school.

So you work in a highly regarded facility in an urban environment.

And I'm certain with a very diverse staff.

Are these things as a group you and members of your team have to be conscious of in the practice of medicine?

>> Yes.

It's really important for To be conscious of these things and to talk about these things.

And myself, I am the director of our department's program on diversity, inclusion and women's empowerment it is a big part of what I and my team and our department under our chair work on as well.

This is black maternal health week and we had a town hall discussion about the state of Black maternal health here and in Baltimore and in our department to try to have these conversations on a regular basis and address these issues.

>> Anything surprise you in that conversation?

Any points brought up that you might not have expected?

>> I think the point I think was really-- that made me feel good people expressed how much they were happy we had that discussion and they wanted to have more discussions like that.

And that was really-- I was Really glad to see that.

>> How much is access to care a factor in pregnancies going badly?

I think about a couple of things.

We hear about food deserts you Know.

You can live in a section of town where there is not good grocery stores and maybe there is not good primary care, either.

And then when somebody winds up without a lot of advanced care, in labor, and you know, you wind up in a situation where maybe you don't have insurance.

And maybe as a group or those people discriminated against as well.

>> I look at access to care in different ways.

One is access to insurance or access to be able to get to a hospital.

Here in Baltimore we have a lot of hospitals physically structures.

And other parts of the country that is not necessarily the case.

And in many places hospitals are closing due to lack of resources funding.

>> Indian reservations prime example.

>> Absolutely.

And many rural areas in the south.

Access to care you can think about in other ways you mentioned food deserts and part Of it is, are people working jobs that don't allow them to take time off of work to go to doctor's appointments.

Are people have issues with transportation and that makes it difficult for them to make it to doctor's appointments.

Often patients-- people want to get care and they want to have good health.

But there are lots of other factors related to socioeconomic status that can negatively impact that.

>> I bet if you ask the next 10 people you see on the street how does the United States do compared to other countries in the safety of labor and delivery of maternal mortality, everybody would think we are at the top.

And we're darned close to it and that is not true.

>> Sadly that is not true and the United States has the highest rates of maternal mortality when you compare to other high income countries.

So sadly that not the case here.

>> Similar factors?

To the national problem that we have?

>> Yes.

I think that is similar factors to the national problem that we have.

In other countries the healthcare system and healthcare is supported by -- there's universal healthcare.

And it's structured in a way that primary care is emphasized and that as much how our system is emphasized.

There's a lot of factors but that is just one.

>> And the disparities that we're talking about when it comes to maternal care are not limited to maternal care this happens in plenty of other fields.

As a medical profession which is getting more diverse is there anything else we could be doing?

you think about the standard of care in medicine you want the standard of care why do we fall short within your field and beyond?

>> I think a big part of it is we're having not as many physicians going into primary care and other countries there is a bigger emphasis on primary care.

Here it is not reimbursed as much and not paid as well.

So people are less likely to go into it.

But a strong primary care system is really what helps in preventing disease complications.

>> Lastly, if anybody is watching who is fortunate to be Expecting a baby, maybe an expecting grandparent, what thud she know in the black community and beyond about doing all the right things to give the young mother and the young baby the best chance?

>> If you are thinking of becoming pregnant going to see your OBGYN before to make sure if you have medical problems they are well controlled.

If you are pregnant seeking care early is really important to mitigate any complications that might happen.

Still getting vaccinated for Covid-19 is still really important.

As I said pregnant women are more likely to have severe illness and hospitalization and other complications.

And particularly for black women, and all women but particularly black women because of the disparity it's important to seek out a provider that you feel comfortable with, you feel like is listening to your concerns is answering your questions and is making you feel comfortable and positive about the experience that you are having.

>> You can find the doctor and her team at the University of Maryland medical center.

Thank you for being here.

>> Thank you so much for having me.

>> that is "direct connection" for this week.

For all of us at MPT, thank you for watching and have a good night.