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Public media are made possible by PNC and the United Black Fund of Greater Cleveland, Inc.. Hello and welcome to the City Club of Cleveland, where we are devoted to creating conversations of consequence to help democracy thrive.

It's Thursday, October 17th.

And I'm Ariana Smith, educational engagement manager here at the City Club, and I am pleased to introduce today's forum, which is the Medical Mutual of Ohio Endowed Forum on Health Care.

Today's speaker, Dr. Ala Stanford, knew she wanted to be a doctor by the time she was eight years old.

But role models were few and far between in her working class North Philly neighborhood.

Her teachers were dismissive and the realities of racism, sexism and poverty threatened to derail her at every turn.

Nevertheless, thanks to her faith, family and the sheer strength of her will.

Today, she is one of the vanishingly small number of black women surgeons in America and an unrelenting force in the fight for health justice.

In her new book, Take Care of Them Like My Own, Dr. Stanford shares an unflinching account of her story explaining how her experiences on both sides of the scalpel have informed her understanding of America's racial wealth gap, which takes a devastating toll on black communities across the country, affluent and underserved alike.

Dr. Ala Stanford is the founder of the Black Doctors Consortium, a national leader in health equity and a health care policy adviser and a formal regional director of the U.S. Department of Health and Human Services of the mid-Atlantic, where she was appointed by President Joe Biden.

Today, we will hear about the power of communities working together to take care of one another and the importance of fighting for a health care system that truly fulfills its promise to all Americans.

Moderating today's conversation is Dr. Edward Barksdale, professor of surgery at the University of Chicago and chief surgical officer at Chicagoland Children's Alliance.

Dr. Barksdale has been an inspirational leader and champion of racial equity and health care throughout his career.

He his advocated against structural violence, and he characterizes this as being the root of health care problems in northeast Ohio.

If you have questions for our speaker, you can text it to 3305415794.

Again, that's 3305415794.

And the city club staff will try to work it into the second half of today's program.

Members and friends of the City Club please join me in welcoming Dr. Ala Stanford and Dr. Edward Barksdale.

Dr. Stanford, Ala.

Yes.

Welcome to Cleveland.

This is a city that I have often described as being at the precipice of hope.

But this is where I hope hope abounds.

And although my job is in Chicago, my work where I hope to add value is here in Cleveland.

So with that as a backdrop, Dr. Stanford, we've known each other for more than a quarter century.

And in fact, you know, almost half your life.

You have moved from being a protege, a to a colleague to someone that I look up to.

But one of the things that I would like you to talk about to this audience, if you would, is the quote that I think I gave you a long time ago that nothing splendid has ever been accomplished except by those who feel that they are superior than their circumstance.

Not superior to people, but superior to circumstance.

Please talk about a place and how it might influence who you become as a person and how you develop your purpose.

Wonderful.

Dr. Barksdale.

Dr. B has always been the wordsmith.

Always.

But I believe what you're alluding to is where you're born.

Does not dictate what you can do and what significance you can have in the world.

And I'm saying that specifically to the young ladies I saw in the bathroom that are going to change the world.

They're like, What?

Me?

Yes, you over there.

Because I see when I see them, I see so much of myself.

And I'm from Philadelphia, born and raised in an impoverished community and where sometimes the expectations for a child in that environment were nonexistent.

But my exposure to achieve great things came from my mind.

And because I did well in school, I was exposed to other things.

And the more I saw that people were learning and thriving, I wanted that.

I also recognized that my teachers tended to pay attention to me more when I was doing well in school.

And so I say that to say that there are in Cleveland, like in Philadelphia and everywhere in the nation, young people, I'll even say more senior people that need to be nurtured, that can be diamonds in the rough to be polished.

And you never know how they may impact the life of you or the world.

And I believe I'm an example of that through God's grace.

And fortunately, because I was nurtured by someone right here very young in the beginning, where I came into an environment where not many people looked like me and their expectations were sort of nonexistent because they didn't know.

But I was fortunate to have someone like Dr. Barksdale in my corner reminding me of what I was capable of.

Just through watching him.

So thank you.

I don't want this to be self-aggrandizing.

I know I do.

So said you know, when we first met.

And I don't mean just myself, but others of your mentors when we first met and that city with a down south, that's a bad word here in Cleveland.

We were so moved by your grace, your courage and your intention.

And what most impressed me at that early age is that you could see things.

You could feel things that many of us could not or would not see with regard to the future.

How did you cultivate the vision for creating something that wasn't in many people's minds?

And then I want it to get to you.

How did the pandemic stimulate that?

So one thing, and I will say this to young and old is I don't compare myself to anyone.

I set my own bar for myself.

I think comparison is the thief of joy.

And when you're just working on being your best self, I believe everything else will come.

And it's hard, especially young folks now, and everything's on social media and you're trying to outdo and whichever.

But I honestly believe that.

And I didn't know what my purpose was, but God had moved me from so many challenging things in my life and my upbringing that I didn't believe he had brought me there to leave me.

And so when I had tough days, I mean, I used to recite Psalm 91 every day when I walked into the hospital every day as I walked in.

And that's where a lot of the the resolve, I would say, and the tenacity came from.

Yeah.

So, you know, often when we come to events like this and when we look at people who have achieved as greatly as you are, you see them on the top of the mountain and we praise that ascent.

You've been very transparent in this book, and I've known you when it seemed like there was no light and there was no joy.

So tell us about the valley, the valleys in your personal and professional life.

And what did it do for you that you could communicate to others that would help them be stronger?

So I'll talk about one personal and some professional.

I'll do the professional first, because the personal is harder to talk about.

The professional was more.

You're working, you're working, you're working, and someone says, Great job.

You did a great job.

I'm so proud of you, blah.

But then when it's time for you to get your evaluation or your report card, what's written, what last says needs remedial teaching would not advance and things like that.

And so if you didn't pay attention to what you were reading and you just signed it, it would in essence say you agreed with what was there.

And so I went through that a lot.

And it can rock your confidence, make you feel like maybe you really don't belong here.

But again, I just went back to God, didn't bring me this far because I knew what was waiting for me at home in Philadelphia, which was a whole lot of not at the time positive things for me to go home to.

I didn't want to be a statistic.

I knew I could do something more.

And so I pressed.

I pressed.

I cried a lot.

Not in public.

I prayed a lot.

Not in public, but, you know, I'll just.

So the person going up, the growing up, you know, my parents were young and they worked like I felt like my mom went to work when it was dark.

She came home when it was dark and it left my brother and I alone a lot without supervision.

Literally, we had our keys around our neck.

You know, we took public transportation.

He would get and I would get in fights for him after school kind of thing.

That's back when you had a fair one, not when people had knives and guns, but you literally fought.

And then then it was hopefully over.

But there were people who came and our space that touched me in ways they shouldn't.

And I was I mean, it's even hard to say.

I wrote it on the paper, but molested as a young child before.

You really know what that means.

Like you're not supposed to feel certain things before you're ten years old.

Right.

And it's very confusing.

And and then I think sometimes when you grow up in certain situations, children protect their parents.

And it's not supposed to be that way.

Parents are supposed to protect their their children.

And so then it became this.

Well, why didn't you say anything?

Now that we're all grown, you know.

But back then, it was you I was trying to protect my mother.

And so I you know, I did things and I talk about them sort of graphically in the book.

And the reason I do is because that's a lot of people's reality.

But they don't talk about it and it impacts relationships.

It impacts, you know, intimacy, how vulnerable you can or can't be.

And for me, when I was in medical school, you had to learn how to treat someone who was a pedophile.

And I'm in my class and I'm doing psychiatry and income's this person who was a pedophile who was justifying his urges and I had suppressed that part of my life.

And now I'm sitting in class and I'm having all these flashbacks of this time in my life.

And it was tough for me.

I had to I mean, I couldn't sleep because every time I went to sleep, I would see it.

It was just mentally and physically exhausting.

And it forced me to address it for my personal just mental health and well-being.

And again, I mention it because I have friends or you hear people talk about not moving beyond, but I was able to move beyond.

And that's why I put it in the book, because I was.

But then it forces you to have relationships, conversations with the people who were supposed to protect you once you get older.

And that's tough stuff, but that's the real work.

So let's move forward and think about how this made this person that I admire and so many in the world admire.

The CNN Hero or the George Bush Award.

As you know, I'm very fond of the Hemingway quote.

My grandmother would read to me that the world wakes everyone.

Yeah.

And afterwards, many are stronger than the broken places.

And that combined with this kintsugi artwork, which, you know, I have these broken pots that are filled with liquid gold to make them more beautiful.

You epitomize that kintsugi art.

So even though you were broken, there were people who I think were purveyors of hope for you.

Could you talk a little bit about the importance of mentoring and sponsors in helping to heal a person who was fractured, who the world doesn't see as necessarily fractured?

So can you talk about mentorship?

Yeah.

So and this is where representation matters.

When I left Brooklyn and I got to Pittsburgh, I was fortunate that there were many attending surgeons that looked like me, like it was the only place in the United States where I landed.

And it wasn't like, you know, people saw me and say, Hey, how you doing?

You're black, I'm black.

Less hug.

It wasn't like that.

It was just seeing someone in the hall and then seeing you.

Right.

And because they were there and this was like nineties 2000, and they were the first, I knew that everything I did reflected on them, too.

And so there was this tough love, I would say not Dr. B, but my other mentor.

I didn't think he liked me for like ten months.

Like I don't think he smiled in my direction or anything.

That other mentor who was my best friend.

Yeah, we're all figures, but I didn't.

I was like, I know he brought me here, but I don't think he really likes me, you know, kind of thing.

But they were striving for excellence in everything.

And there was this motto that I used to have from my church that said, Excellence honors God, and God honors excellence.

And I thrived with that.

And as I watched you and I watched Dr. Ford and I watched others, I was like, that's what I want to emulate.

And so when I had challenges, you could talk about a lot of things, but you couldn't talk about my work ethic.

You couldn't talk about my standardized score that I received after I learned how to take a test which had to be taught to me how to teach because I didn't learn in my public school education.

I thrived.

And again, it wasn't you know, people think that there's like a secret handshake and it's all this stuff, but it's just literally seeing someone else clear hurdles that you're trying to clear that lets you know.

You can also do it.

And so I had that through my mentors.

I had it through my church family, I had it through my family where I was the bright light that everyone was like, Wow, look at Ella.

Wow, Look at Ella.

You know, quick story.

When I graduated from medical school, my dad, my dad rented a bus, a Greyhound and a driver, and he parked it in the parking lot in the mall and one of our neighborhoods so that people didn't have cars or whatever, they could get a bus to the parking lot or they could park their car and not have to worry about paying for parking all day.

And my whole family and neighborhood, they all got on the bus when I graduated.

And they were great.

They were so proud.

I feel like because I was the first doctor in our family and it was like when I walked across the stage, they all walked across with me.

And when I was in college and I would come home for Christmas and Kwanzaa, I remember, you know, I would give these reports for this year.

I learned this and this year I learned this.

And I was saying, I got to take this test.

This test called the market.

And it's hard and I don't understand it.

And I need to take a class.

And the class cost 1500 dollars, which was a lot of money.

And I remember someone in my family just taken off their hat and pass it around the room and everybody put in $5 and coins and checks and all of this.

And I took that back to Penn State and that's how I paid for my class.

And obviously it worked out well for me.

But yeah, so that's my yeah, my family.

So so I think I'm in trouble for expose going to make you so vulnerable in front of my friends.

But it's that vulnerability that has always made you human to those of us who've mentored you.

I'd like to move a little bit forward toward thinking about health and health care and thus health disparities.

Yeah, it is not alien to anyone in this world.

That's Cleveland.

Much like Philadelphia suffers heavily under the weight of the social determinants of health.

And for those of us like me, who are so heavily by biased toward children, I think some of the disparities start in childhood.

Can you talk to us a little bit about health disparities from your perspective and your experience and toxic stress and what we can do to address them?

This is a mouthful, but but if you could in a concise way, because I want to then get to give us time to talk to what would make a pediatric surgeon think that a global pandemic, that she could leave her practice.

So don't get to that.

But I want to.

Okay.

Time.

Okay.

That's the laughing at me is only what I want to make sure that we.

So but if we can talk about toxic stress children because of health disparities.

So Philadelphia is a great example of this.

When I grew up in Philly and some of this is still true, we had two children's hospitals.

We have Saint Christopher's Hospital for Children and we have Children's Hospital of Philadelphia.

And many of you have been to Philly.

Saint Chris is in the hood.

It's not uncommon for people to get their cars broken into and so forth.

And shop is like this booming metropolis.

And there's buildings and skyscrapers everywhere.

There is like restaurants in the in the lobby.

I mean, it's just it's a beautiful, palatial place.

When you're born in Philadelphia, depending on the type of health insurance you have dictates which hospital you can go to.

So when you talk about health disparities, it's like when you're in the womb, it's before the baby even comes out that you walk into as a parent, into one hospital where there is beautiful artwork hanging from the ceiling.

There's a radio station in the lobby where you can do a podcast.

There's all these things, and then another place is struggling to make sure they have all the supplies and the folks are stressed because they don't have all the resources.

So that's just one example of what it looks like systemic, what it looks like.

The other is an ambulatory care center or a subspecialty, a medical office in your community.

So where I live in the suburbs of Philly, you know, I can take my kid to get a cardiology appointment to get an MRI, to see a GI specialist and everything walking distance from my house.

I could walk.

I could ride a bike.

If you live in an impoverished community, those places don't exist.

And it's largely because the institutions invest in communities with better payer mix.

Right.

So it's one of those things where, yes, I have insurance, but how does your insurance reimburse?

And if it doesn't reimburse at a high level, then you're not going to get all these specialty places in your community for children.

The toxic stress part is why young black men at 16, 17 and 18 already have hypertension.

It used to be that high blood pressure was a result of having, you know, calcified blood vessels and and coronaries and cholesterol from eating, you know, steak and McDonald's and and all this kind of stuff.

But now it's just a toxic environment and stress because they haven't lived long enough to have that built up.

Right.

It's why we have, you know, premature babies being born.

It's why now I believe that you're seeing certain cancers more rapid.

And so what that looks like, in addition to having better facilities in your communities, I think would work towards eradicating health disparities.

It's also removing the bias that we know exists and how the health care is delivered.

And when people ask me how we get there, it's by taking care of them like your own.

Like the title of my book is How We Get to the Best Health Outcomes, is that you're caring for someone like your brother, your sister, your spouse, your child, not like an other person, but more like someone who is like you that you care for.

So you know that that's phenomenal.

Know, this is a very special place for me, the City club, because a long time ago when I didn't know about this place, there was a speech given here the day after Martin Luther King was assassinated by one of my most favorite political figures.

And she got it correct.

RFK, RFK, jr. And in the end of the quote, the quote reads this way and I want to use this as the lead in to why you thought you could change the world in Philly.

And that quote from RFK and forgive me for reading it.

I should have it committed to memory for those in another kind of violence.

Slower, but just as deadly, destructive as the shot or the bomb in the night.

This is the violence of institutions, indifference and inaction and slow decay.

This is the violence that afflicts the poor, that poisons relationships between men because their skin has different colors.

This is a slow destruction of a child by hunger and schools without books and homes without heat.

Use this often in my talk.

So can you address why when a global pandemic occurred that you took that message that actually kind of occurred here in Cleveland, metaphorically in this place, and it became a call to action for you to at the indifference.

And just as a.

That's a fascinating intro.

We didn't plan.

We didn't plan.

So I love that the indifference and what I saw in Philadelphia and you heard born and raised, you know, growing up as an adult in Philly is totally different than a kid.

Like, I'm experiencing things now that I didn't even know existed in my city because you just don't have access to it when you're younger.

When people were getting sick in March of 2020, they were all calling me because I was a doc that they knew and they were saying, I went to the hospital and they sent me home.

I said I needed a test and they told me I wasn't sick enough and all of these things.

And I was calling my friends at the hospital like, Are you really turning people away?

And they said, Well, they're docs not on staff here or, well, you know, they're not coming.

We don't take their insurance or, you know, or they walked or took a bus and we're only taking people in cars.

I'm like, Do you hear yourself?

Like this is, you know, or we could only test the parents, but not the children.

And that indifference or lack of a sense of urgency is what made me say, I'm asking people to do a test so that they can support themselves, so they they can not spread it to others and do the best they can to have the best chance.

That's all we had in our armamentarium.

And after I asked enough people and I was getting nowhere, I said, Well, I'm a surgeon with my own practice, with accounts, with lab core and quest.

I'm just going to go to where the people are.

And because it was black people that were dying at a rate three times greater than everyone else in the city, I went to where black people trusted, and that was the black church and the mosque.

And through my pastor, reached out to other pastors and said, All she needs is your parking lot.

Can you give her the parking lot, electricity in the bathroom for her team?

And with that, we started testing 400 to 600 people a day.

And meanwhile, the hospitals were doing nothing until the CARES Act was passed.

Then the CARES Act brings money and there's $640 million coming into the city.

And now Jefferson and Penn and Temple are having all these pop up places.

But prior to that happening, they did nothing.

And I can't imagine I shouldn't say they did nothing.

They didn't do a lot.

And I can't imagine that I had more money in my bank account.

Child on public assistance growing up, who is new generational wealth, if you will, and I wouldn't even say that yet.

But anyway, had more money than all of these institutions.

And so why I did it is because I knew that I could.

And the answer I was looking for, I was equipped to have and we just kept going and kept going.

And then when the money ran out, all those places shut down again.

And we were the only ones that stayed open because the community had come to rely on us because we were present and we were persistent and we went to them as opposed to saying, We're open if you want to come in, get health care, you can.

We're open 24 hours a day.

No, we went to them because we recognize the trust factor that's important and is often lacking.

And I never say people of color don't trust the health care system.

I say the health care system has been untrustworthy to people of color.

And that's why you have to work hard to earn the trust.

And so that's what I, I now I feel like am teaching.

I'm a catalyst for that.

More people are like, okay.

LA, You know, you got that right, you know, And yes, we could have done more and I hope it serves as an example.

So people stop making excuses and putting up unnecessary scary barriers when they don't have to be there.

And so that's the lie.

Well, that's great.

Well, we are at our point where we're at 5 minutes, but then I just have one thing to add before we open for audience questions.

Is that you have always been a ferocious warrior, and I think this audience would recognize that.

And, you know, as a as it's been said, that the real warrior fights not because of the hate for the enemy in front of them, but the real warrior fights with the people they love behind them.

So I want to thank you for being that ferocious warrior that stopped looking at the racism and structural violence, but started looking at the people who needed someone like you to step forward and not just to defend them, but to care for them like they were your own.

Thank you to you.

I think we are about to begin the audience Q&A for our livestream audience or those just joining us, I'm Ariana Smith.

Education and engagement manager here at the City Club.

We are joined by Dr. Ala Stanford, founder of the Dr. Ala Stanford Center for Health Equity and author of the book Take Care of Them Like My Own Faith, Fortitude and Insurgent's Fight for Health Justice.

Moderating the conversation is Dr. Edward Barksdale Jr, professor of surgery at the University of Chicago and chief surgical officer at Chicagoland Children's Alliance.

We welcome questions from everyone City club members, guests, students and those joining us for a live stream at City Club, Dawg.

If you would like to text a question for our speaker, please text 2330541579 for.

Again, that's 3305415794.

And the City Club staff will try to work it into the program.

May we have our first question, please?

We have a text question.

Just this week, Walgreens announced they are closing 1200 stores.

This is on the heels of Rite Aid filing for Chapter 11 bankruptcy, closing almost every single store right here in northeast Ohio.

Can you talk about how these closures are impacting low income communities and the role of access to pharmacies?

Has in your health justice work?

It's devastating and it has happ We are working on bringing a pharmacy into my ambulatory care center.

But for seniors, especially in the young, that have to take multiple busses to get to a place to fill their prescription.

And this is I mean, everything is governed by money.

It drives me crazy.

It's no longer about the care that the person needs.

So CVS, because they're the main ones that are buying up and the only that are still viable have started, you know, doing shots, doing therapy, doing all these extra services, not just delivering medication.

And but they're all in affluent communities.

You're not going to find any CVS in a place where the life expectancy see is low.

And so I even looked into buying a CVS and they won't allow.

You can't franchise a CVS.

Right.

I looked into that.

And so it's a real concern.

What I would say for the people in this room is that as you're discharging your patients from the hospital or as you're seeing them in clinic and you're writing a prescription to make sure they can get it filled, if you can get it in the hospital to give them a week's supply at the time, at a time.

So they pay for it and come back in a week.

You got to do that.

So it's no longer that you write the script, give it to them and say, Good luck getting it filled.

We that's what I mean when I say we have to take that extra step and ask, Is there a pharmacy that's open near your house that accepts your insurance?

And if not, that person doesn't leave your office until you have a solution for them.

Knowing what I know, you'll have some CVS franchises.

I'm working with them.

I am trying.

It's hard.

It's hard to break into.

You'll break them down.

All right.

I'll keep going.

We've got another text question.

They're rolling in.

Okay.

Do you think the universal health care would solve the disparity?

Problems in the delivery of quality health care?

No, but no.

That's where the providers and I mean everyone from the receptionist to the nurse to the nurse practitioner, physician, assistant doctor, surgeon and CEO and CMO of the hospital have to look in the mirror of how they are delivering care.

You can't teach someone to treat someone.

Let me back up.

You can teach someone.

Some of it is innate to treat someone like they matter.

And they're not just a bottom line for reimbursement.

So you get to your bottom line.

And so having access to care or that you can schedule an appointment doesn't make someone treat you with respect.

That's the you got to look in the mirror.

And I keep saying, if you're trying to figure out what to do, take care of them like my own.

I'll get to a point where hopefully there is no my and no there.

It's just we're all existing here together.

But that you can't fight the being able to be to see a doctor doesn't make someone sit down.

When you go and see your doctor.

It drives me crazy when you see a patient sitting in, the doctor is standing up the whole time.

What that says is I have somewhere else to go, that it's not important that I sit down here and look at you eye level that are on their phone, that are on their computer, and they're not listening and they're not present.

They're in the room, but they're not present.

And so what I say to that is all of us that deliver care, that create insurance policies, whatever you do that involves a patient health outcome, we have to look at what that looks like and that's where you get to best health outcomes.

Certainly being able to have an insurance card matters and get appointment matters.

But the stuff that we really need to change is that inward look at the one providing the care.

You know, my name is Dr. Charles Modlin.

First of all, I'd like to thank Dan Cynthia of the City Club for bringing you here today to talk about this very important topic.

So I'm a urologist at Metro Health, been a metro for three years.

I previously spent 28 years at Cleveland Clinic as a kidney transplant surgeon, and I, along with a number of colleagues, were were fortunate to be able to start a number of health equity initiatives, you know, specifically aimed at minority and underserved populations to address health disparities.

And I'm particularly disturbed about a movement that actually is occurring across the nation, pushing back on DTI initiatives, specifically understanding the causes of a lot of the social determinants of health and predisposing factors to the health care disparities.

We set out to create a number of impactful programs to where we can more effectively address the health disparities and actually engage minority communities.

And in doing so, for example, some of the programs we would put the word minority on to our program.

Minority Women's Health Fair was one program that we started and a number of other programs.

But the movement that I see in the nation is actually even lawsuits.

I'm not going to go into specifics, have targeted certain programs that actually are trying to project to the community that these programs are specifically designed for for you, you know, your your specific health care needs in mind.

And they're taking the word minority off, which actually negatively impacts our ability to effectively engage these populations.

When you put a word such as minority multicultural diversity, it actually helps create a more trusting environment, a relationship between the target population that you're trying to reach in the health care providers.

So this question is directed to you, Dr. Stanford.

Dr. Barksdale.

What do we do collectively to push back on this negative movement that is going to threaten our ability to reach these target populations?

So wonderful question.

First, the reason why and you're absolutely right.

I named our organization, the Black Doctors Consortium, was on purpose because I wanted the name to connote a certain level of trust in terms of what we can be doing.

It has to be to twofold in that you need your your scholars, your lawyers to be fighting that fight.

The health people have to be doing the health work.

I think ways you get around it is it's a particular community.

So in Philly, it might be North Philly that is 70% African-American.

So it becomes the North Philadelphia Men's Health Alliance.

Right.

Okay.

If you're white and you live there, great.

If you're black, then you just have to be creative or it's, you know, a certain neighborhood alliance or the zip code alliance.

Right.

19132 or whichever alliance.

And people will get it.

I agree.

It's not the same as saying that.

But there are other ways to be strategic about it.

It could be.

Were you a such and such high school grad?

And, you know, the majority of the people that came out of that high school are the is the community that you're targeting.

You know, I was listening to an interview yesterday with Charlamagne, tha God and the vice president, and it was geared towards black men.

And someone said, Well, you're the president for everyone, and why are you just focused on black men?

And she said, Well, you know, it's known that black people in America have or a 40% less likely to own a home.

And so this program that I'm putting forth is for anyone who is a first time homeowner.

However, if you happen to be one of the people who don't own a home yet, then you can benefit regardless of what your color is.

However, in this country, wealth is linked to home ownership.

Home ownership is linked to education.

Education is linked to health outcomes.

In health outcomes are exacerbated by racial injustice.

And so it's for everyone.

The last thing I'll say is that by year 2050, half the US population is going to be people of color.

So you can decide that you don't want to focus on inclusivity and belonging programs and not pay for preventative care.

But those folks are going to need ICU care, tertiary care, when their diseases are advanced.

And there's only so many hospitals and so many doctors in this country that it doesn't matter how much money you have if you can't get to your doctor because they're taking care of all the folks that you didn't want to take care of.

Once upon a time, it'll either hit you on the front end or the back end, so you choose.

But my home is the doctors.

You keep doing your work and you get the lobbyists and the lawyers to address the arguments that are out there.

I, I, I don't have an answer, but I have a statement.

I'd like to thank you, Dr. Modlin, for being at the front of the line, the vanguard for health equity and justice in this community.

As a physician overall, for more than three decades.

And so I just want to tell you, thank you for your work.

I thought I was taking my oral words.

When he got to the microphone, I was like, oh, I don't know what he does.

But you see, I changed my posture.

I was like, okay, I got to listen to every word because this is going to be tough.

Sorry.

Go ahead.

Good afternoon, everyone.

My name is Trey Armstrong.

I'm a second year medical student at Case Western Reserve University School of Medicine.

First, first and foremost, Dr. Sanford, I want to say that you've been a role model for me, not only because you're my mother's sorority sister, but also just watching the work that you've done over these last few years has been really inspirational for me as I've pursued medicine.

And so I just want to thank you first and foremost.

Secondly, my question is, as a future health care provider, how do you balance choosing a career specialty to provide for your family pay back your loans, things of that nature, but while also looking to reach back to your community and those who look like you?

Well, all right.

All right, young Dr. Armstrong, let's see.

Your specialty has got to be what drive to you.

And I know people see this all the time, but that you would do it for free, that you just love getting up for me.

You know, I just loved operating my sanctuary.

It's where my phone was turned off.

There was no one more important than the person on the table.

And my people around me.

Right.

And that you could create the vibe if you came in and you were in a good mood.

You put something nice on everyone's flow and it's working well together for me, the O.R., and honestly, an empty church are the two places where I have the most peace.

Yes.

Oh, that's sanctuary.

Yeah.

Where I have the most peace.

So in doing that, I was fortunate that it was enough to also take care of my family and enough to do all the things to have everything I needed.

And at this point, everything I also want.

So I would say to you, I wouldn't choose it because someone is saying you need to go back to your community.

Because honestly, if you choose not to do that, that's not do you know what I mean?

And I don't feel like the onus, the responsibility should be on you to fix a problem you didn't create.

I really don't believe that.

But if it's in your heart to do it, then you do it.

The money will come and no matter what, right in medicine.

And then and then in terms of giving back to your community, you may be the one that's grassroots or you might be the one that gives to a nonprofit with the donation.

And one is not more important than the other.

So I wouldn't let what you see me do what you see others do dictate what's for you.

It's got to be what's in your heart and makes you excited to get up every day and do it.

Oh, I did have a question, so a lot of what is happening in health care is recognizing that we need all the parts to support somebody's mind, body and soul.

And so I would love to hear your thoughts on implementing more community health workers, implementing that preventative care and that follow up care.

That is just not time manageable by physicians and by nurses.

And then how organizations, whether it be a small clinical setting or at a major hospital, can implement those.

Okay.

First, thank you for being a doula.

Thank you for being a dual.

The service that you provide for women is lifesaving for them and for their child to be a voice, to be an advocate, to be a comforter so that maybe joy comes back to being pregnant and giving birth where I feel like there's so much fear now.

So I just wanted to say thank you for that.

I didn't about it, but I built an ambulatory care center because all of the people that everyone else turned away during COVID that weren't insured when the CARES Act was passed, I could bill for them and I had enough that those $50 test, which typically wouldn't be a lot, $50, $25 reimbursement, it's a lot when you do 50,000, right?

And so I made over $1,000,000.

I took that money and reinvested it into 19132 lowest life expectancy in Philly and built an ambulatory care center in the hood.

And it is I think Doctor Barksdale has been there to visit is beautiful and my son and and said it's volunteer and it has I live in the suburbs my landscaper came and put grass all over it and everything.

It needs to be welcoming and beautiful.

Not like a sterile city clinic.

Now, in my place we have women, we have a psychiatrist, we have therapists, we have cardiology, we have primary care, we have pediatrics, we have nutrition, and we have social work.

So when we get our patients in, we try our best to take care of everything, to be one stop shopping for them and for their children.

So much So last Friday, we had our mobile mammogram unit and we when the women came in, yes, they were coming for mammograms, but we did health screening.

We did see a screen.

We diagnosed other things before they even got to their mammogram.

And so I personally think that that's how you get to it, is that people have so many other pressures and other responsibilities that when they come in to see you, you need to be ready to receive them.

And one, find out what their needs are and meet them, but also ask questions.

That's another thing, folks are you go to the doctor now.

It's like you're here for that.

Okay, you're here.

Okay, good.

That was a quick visit.

You're out for us.

I know again how hard it is to get off work, to be there, to bring your kids to whatever so when they come, we just get everybody and.

Okay.

Yes, You're here for GYN.

You need to talk to somebody about your what?

Okay, you can go speak to our social worker.

And so it's doable and in terms of the costs social work students have to do didactic on site, you know, work.

And so right now we have social work students that rotate through students and nurse practitioner students, and they are allowing us to extend our reach And I want to ask you about your work that you're doing with the Black Doctors consortium.

Would you please talk a little bit more about how it's constituted?

I think you sit did you say it was national or.

Okay.

Could you really talk a little bit about the work that you're doing with with that group?

Okay.

Thank you.

Thank you for your question and thank you for saving him.

And I let me preface by saying I can still operate.

I don't want you to think that I can.

I did have bilateral carpal tunnel surgery, which was devastating.

And I was walking around with bandages on both wrists and people were like, you okay?

I mean, you really okay, you know.

But yeah, I operate a lot after that.

So the Black Doctors consortium, because I had my own private practice, I already had the infrastructure.

I was already in network with all of the health insurance companies and with Medicare and Medicaid and so forth.

And ten years prior, I started a nonprofit called It takes really encouraging and empowering our children to aim high.

So I was already doing mentoring and so forth in the city of Philadelphia, and that was because my chief of surgery some ten years prior said, I'm not paying you to give inspirational lectures to children, I'm paying you to operate.

So I created a nonprofit so that I could bring all my friends in and go and talk to children in schools.

And I could also raise money as a nonprofit.

All of that came together during COVID because I had my own for profit, because I had my own pediatric surgery and I had my own nonprofit that I had started some ten years prior.

And so I was able to bill as an insurer, and I was also able to apply for grants as a nonprofit, which is every health care system model, by the way.

They're nonprofit so they don't have to pay taxes, but they're for profit so they can generate revenue anyway.

I hope there's no administrative they get mad at me, but basically, you know, that's what it is.

That's how they build lots of things and they don't pay tax anyway.

So that is my model.

It is predominantly it is in Philadelphia right now.

There are other people with similar ones.

But what I hope to do now that I am at the University of Pennsylvania, Pennsylvania, is create that template that it can be duplicated across the nation.

People have similar things, but it really takes someone stepping out and being and taking all the hits and all the risk, which I have done.

A lot of folks, when you're associated with an academic institution, if they don't support you 100%, it's hard to do it by yourself.

And so that's how it's how it's created.

And thank you for listening.

That Fresh Air's Terry GROSS is is a tough interviewer.

She had me crack.

She was like, Do you need a break?

Do you need a break?

Can I just say something really quickly?

If you read the book, you won't care about who I have on speed dial.

You'll recognize that Will Smith has her on speed dial.

Yeah, I forgot about that.

Passing.

Thank you very much.

Two doctors, Ayla Stanford and Edward Barksdale Junior, for taking the time to engage in this important conversation at the city Club today.

We also extend our thanks to our members and guests for joining us, whether in person or via livestream forums like this one or made possible.

Thanks to generous support from individuals like you, you can learn more about how to become a guardian of free speech at City Club dot org.

Today's forum is the Medical Mutual Ohio Endowed Forum on Health Care, as well as a part of the City Club's Health Innovation Series.

Thanks to support from Medical Mutual, it is also part of our author and conversation series, thanks to support from Cuyahoga Arts and Culture and the Cuyahoga County Public Library, we would also like to thank university hospitals, rainbow babies and Children's Hospital for their programing partnership.

In today's forum, the City Club would like to welcome students.

Joining us from the innovative Center at Shaker Heights High School.

We would also like to welcome guests at the tables hosted by Case Western Reserve University Clinical and Translational Science collaborative of Northern Ohio Medical Mutual.

The Northeast, Ohio Black Health Coalition, Metro Health and University Hospitals, Rainbow Babies and Children's Hospital.

Thank you all for being here today.

Tomorrow at the City Club, we will hear from the Ohio State University's president, Ted Carter.

And then on Friday, October 25th, we will hear from Pro Nita Gunter, former special assistant to the president for labor and workers on the Domestic Policy Council and the Biden White House.

She'll be discussing the role of coalitions and partnerships in rebuilding the economy.

You can get tickets for each of these forums and learn more about others at City Club dot org.

And that brings us to the end of today's forum.

Thank you once again to Dr. Stanford and Dr. Barksdale.

I'm Ariana Smith and this forum is now adjourned for information on upcoming speakers or for podcasts of the City Club, go to City Club Dawg.

Production and distribution of City Club forums and Ideastream Public media are made possible by PNC and the United Black Fund of Greater Cleveland, Inc..