- [Narrator] Funding for this program is provided in part by the Minnesota Arts and Cultural Heritage Fund and the citizens of Minnesota.

(bird chirping) (upbeat music) - As we enter into the summer months of 2020 with hope for a world free of COVID-19, we know that the pandemic has left a lasting mark.

Vaccination rates have plateaued across the country as states begin to reopen, and yet social and health inequities laid bare by the pandemic persist.

According to the CDC, race and ethnicity are risk markers for other underlying conditions that affect health, including socioeconomic status, access to healthcare and exposure to virus related occupation.

So with us today to discuss racial disparities, COVID-19 and what lies ahead for community health in a post pandemic world is Dr. Stephanie Low.

Welcome to the show, Dr. Stephanie Low.

- Thank you so much, Nicole.

I'm very excited to be here with you all today.

- So by way of introduction, Dr. Low is a family medicine physician and the medical director at Community Health Service Inc. She oversees the medical staff and manages the clinical operations for their four clinical sites and two mobile units.

Dr. Low hails from the Windy City where she completed her medical degree at Loyola University, Chicago and her family medicine residency at West Suburban Medical Center.

After finishing her residency, her husband, Chris Low matched into an ENT residency at the Mayo Clinic, landing them in the even windier, Rochester.

Since moving to Rochester, they've welcomed two sons into their lives and enjoy spending their days as compassionate physicians and their nights chasing around their busy and joyful toddlers.

Dr. Low has a passion for health equity and for promoting diversity and inclusion in the workplace and she's committed to engaging the world of community health centers in these topics.

So Dr. Low, over the last year, we've heard a lot of numbers regarding COVID-19 and racial disparities.

Black Americans are about three times more likely to be hospitalized and about twice as likely to die of the disease.

Similar rates can be found in Native American and Alaska Native communities and similar as well in the Hispanic and Latinx communities.

So the big question that a lot of health workers have been asking is why.

So what do you think are the key factors that have led to these disparities during the pandemic?

- So (clears throat) I think thinking back to your introduction where you outlined a lot of social drivers of health, so we know the term social determinants of health, which has recently changed kind of towards the language drivers of health, racial inequities in our country have been here since the very beginning and COVID-19 really has just served as a conduit for highlighting them.

So black and brown people are disproportionately affected by these social drivers of health, housing, instability, living in crowded housing situations, working in essential jobs that have higher exposure risk to the virus, and then on top of that all, having an adequate access to healthcare, living in communities that might be far from healthcare, or not having healthcare coverage from their job, or just having the inability to gain health care coverage in the United States.

And all of those factors combined, obviously, when you add in a very virulent disease are going to disproportionately affect communities that are affected by social drivers of health.

So it's not a surprise.

We knew that communities of color were already being disproportionately affected by chronic disease.

And when you add in a global pandemic, we know that that's gonna also affect those communities more.

- Clinician like you, it wasn't a surprise when all of these things were laid bare during the pandemic.

And you work in a Federally Qualified Health Center, CHSI.

I misspoke, my apologies.

Can you talk a little bit about the role that Federally Qualified Health Centers have played during the pandemic?

- Yeah.

So community health centers, Federally Qualified Health Centers really were born of the civil rights movement.

So they were formed at a time when social programs really needed to be created to address the health needs of black and brown communities.

But they knew that just the creation of social programs, wasn't gonna be accepted by the community in general.

So they used the umbrella of health centers.

No one's gonna argue with providing diabetic care for communities, but we used it as a conduit to also provide those social needs.

So community health centers for over 50 years have been really a center of social change, providing access to those wraparound services that really affect the whole health of a community.

So obviously, you can't be at work if your diabetes isn't controlled, but you also can't be at work healthy if you don't have a good housing situation.

So I think FQHC has really have played a critical role during this pandemic by providing those additional services and understanding that this is not just an isolated, like, "I have COVID-19, I'm struggling to breathe.

No.

I also, now because I can't breathe, I can't go to work and I have to quarantine for two weeks and now I've lost my job as an essential worker now where I was already struggling to feed my family.

I can't feed my family now, and I don't know what the resources are in the community or how to access them, or if I qualify for them."

And so FQHCs are really there to stand in the gap to connect people with resources, to advocate.

If I need to get on the phone with an insurance company, even for my insured patients and say, "Hey, you need to make sure all of these tests are covered."

Because the patient doesn't know how to advocate for themselves, that's where we come in.

And unfortunately, just bigger institutions don't have always the time and ability to do that same advocacy and so really just providing a critical safety net during this pandemic.

- Beautiful.

Your clinic serves not just Rochester but other areas within the Southeast Minnesota region.

And you spoke a little generally about some of the ways in which, and you've said it so beautifully.

Dr. Low, you sort of stand in the gap and be at the intersection between sort of the health inequities and the health inequities that your patients are experiencing.

To the extent that you can, could you talk a little bit about specifically what communities you work with and then if you could share a story of how what you just talked about, you saw it, you experienced it with a patient or group of patients?

- Yeah.

So our clinic was actually founded to treat migrant and seasonal farm workers in the area.

It was shown to be a critical need and a critical access point.

And so we were funded originally just for that purpose.

So we still do see quite a large majority of seasonal and migrant farm workers, mostly Latinx, mostly Spanish speaking, but we also do see quite a few uninsured and under-insured patients throughout Rochester in Southeast Minnesota.

We have a large population coming from Austin, from Albert Lea, from St. Charles.

We do see quite a few members of the Amish community as well, all communities that either are uninsurable because of the laws in our country and in our state or for religious and cultural reasons don't have access to certain health systems or just transportation barriers, all of those things.

So a very underserved and marginalized population I would say is what we tend to see coming through our clinic.

We also do see quite a few family members of Mayo Clinic patients who are coming internationally, who don't have any healthcare coverage while they're here.

So I think my biggest, most impactful stories that I've heard during COVID have really been my patients who are essential workers, so either working on farms or in the factories, they've been just so disproportionately affected by this pandemic.

Multiple of the factories have shut down during the pandemic for COVID outbreaks.

But during those times, a lot of our patients who are seasonal or migrant farm workers are living in a very congregate setting.

So the housing is usually either apartments that they get set up with or trailers and they're often living multiple people to one unit.

So as you can imagine, social distancing is not possible.

So one person in the family gets sick and the whole family gets affected.

We had patients whose children were taking care of the entire family, because they were the only ones who were able to work, who have legal status to work and find other employment outside of factory jobs.

And so we have 18 year olds taking care of an entire family of five or six, which is not something that they should have to do at their age.

And then just not having access to those other critical needs while they're there in quarantine.

So like we did a lot of drives just trying to get toiletries and even things like when they're living in these congregate settings, they don't always have access to like washer and dryer to wash clothes, which we know like everyone had their whole sanitary process, like we don't even think about the little things that we're privileged to have.

Like I can come into my house and go to a clean spot and take off all my dirty clothes and feel like I've like cleaned myself to be able to interact with the rest of my household and not even having that ability is, again, another risk factor.

And so providing them with toiletries, underwear, sanitary products, all of those was something that we really tried to focus on for our patients' populations that were really disproportionately affected working in the factories.

- No, thank you for sharing that, Dr. Low.

I think the term essential worker certainly had encompass and always meant to encompass the people that had to continue working like the factory workers and the migrant seasonal workers, people that were providing our food and essential services.

I think there's also, however, sort of it kinda got more picked up as sort of essential workers being the healthcare workers to you were already working with these communities before the pandemic and then the pandemic sort of came, it exacerbated a lot of things.

You were also an essential worker.

You're a black woman, you're a black physician, you're working amongst these communities.

How was the pandemic for you as an essential worker in health?

I mean, how did you navigate that?

How did that land for you?

- I think for me, I felt privileged to be able to be in a position where I could make a significant change.

A lot of the pandemic just left us feeling powerless.

And I feel like working for an organization that really is seeking to serve the needs of the community and also just kind of change the fabric of this nation and really help people to understand how much of a right healthcare is and how not having that right really strips you of dignity.

So for me, I did really feel privileged to be able to be a part of that.

I also felt exhausted seeing the loss and not having a lot that could be done to change that loss besides supporting and coming alongside the communities.

So I think, especially as a black woman trying to advocate, educate, keep myself and my family safe on top of making sure that my patients had what they needed, I definitely, I felt tired.

I still feel tired, (laughs) but I try to lean into hope that the rest of our nation becoming more aware of these disparities may lead to some significant change, some structural change that really can make an impactful difference.

So that's where I have to land in order to keep moving forward, I think.

- Thank you for sharing that.

I mean, you mentioned that hope, and as I mentioned at the top of the interview, the COVID rates are dropping, vaccinations are readily available.

We've also lived through sort of the racial reckoning of 2020, and so this is sort of on the forefront of people's mind, whereas people didn't speak so much about health or think so much about access to healthcare in the mainstream, and then people weren't thinking about racial disparities at all these different levels and how these things were connected, at least it's part of the conversation now, at least there's a little bit of a window being opened.

But then there's also this idea that as things are sort of quote, unquote, getting better, this might be a thing of the past and we're sort of gotten over it.

So my question for you is how you think that community and maybe specifically within the context of the organization that you work with, you can continue to address the health disparities in disadvantaged communities moving forward.

- I think that we need to continue to view this as, like I said before, like a systemic problem.

(laughs) Again, this isn't something that is just really good to have discussions and education about, it's something that we need to make actual community level, state level, federal level changes for.

So thinking about the ways that we can advocate on a community level, like what are the things that we can do with our local council member, our local government to help create equity in the workplace, equity in accessing healthcare?

Can we reduce some of these barriers that patients have to accessing specialty care?

A lot of our black and brown patients now that have suffered from COVID also have disproportionate circle layer of disease, so more severe disease with now chronic disease.

So again, if you can't continue getting the care that you need beyond that initial treatment, how are you going to continue being a thriving member of our society?

So coming together and not just having conversations, I would say, but having actionable steps towards change is what we need to do to continue this conversation.

It's not gonna end for me, it's not gonna end for you tomorrow, it's not gonna end for these communities.

- At least, so what I'm hearing is we can have that conversation at first in education, and then there needs to be actionable steps moving forward and that those steps sound like they're pretty comprehensive and I think the COVID in terms of the different sectors of our society that need to be involved, I think the conversation keeps sort of focusing on what healthcare institutions can do, what is their role and they certainly have a role.

But you mentioned city government and council members.

And one thing that was so interesting with the pandemic, I think was the way in which we kinda realized that like local governments have a lot of power to make whatever changes they want to for better or worse, however you feel about that.

Have you thought a little bit about what local community leadership could do to address some of the healthcare disparities in communities like here in Rochester?

- Yeah.

I mean, I thought a lot about Rochester is such a interesting community because we on the surface look very upper middle class and very well-resourced but we have this large population of people who can't access the care that they need in this like very medically seved area with a world-class medical institution.

So I certainly think we could think about a system that would provide universal healthcare access to our residents of the county of the city that is based on income that allows access to specialty care and primary care.

And it could be be supported by this community.

We have the resources to be able to do it.

I also think that there are some critical structural changes that could be put in place to protect essential workers in the workplace to ensure that workplaces are welcoming and friendly, that there is equal access for advancement and opportunities for career building.

I think there are just so many ways equitable housing.

I worry really about so many of our patients who will be facing eviction very soon and how we put things in place for residents that don't have any access to these government programs that are protecting housing and giving stimulus checks and monetary support.

- Thank you.

You mentioned housing and I was just gonna ask you, we talked a little bit about sort of occupation and employment and work, a citizenship status, immigrant status, those factors.

And I'm wondering if you could talk a little bit about your experience sort of at the intersection of working with your patients and housing, ways that you've had to work with them around navigating housing in the community?

- Well, a lot of my patients who arrive here from their immigration journey don't really have any idea of what they have access to.

So number one is information.

And so they get here and they're staying, again, either CouchSurfing, staying with different relatives or friends of relatives and living in crowded situations.

But the number one thing is there's just not access to affordable housing for the majority of our patients for the wages that they're making.

I have some patients who are making well, well, well below minimum wage and their entire paycheck for the month would be going to just paying for their housing without even thinking about food to cover that.

And so we need to do something to think about fair and equitable housing resources for our essential workers that are really supporting this community, helping to construct our destination medical center and all the new businesses that are popping up, the housekeepers.

Yeah, we need to figure out a system.

- It's a weird place that we're in this summer 2021, where it's so different than summer 2020, at least to start with.

(laughs) We don't know how things will end up in the next few months, but I'm wondering if the CHSI was sort of at the forefront of being able to provide vaccines when they were first made available.

Have you been able to get the vaccines out into the community that you work with?

So it's a two part question.

So have you been able to vaccinate widely, and then two, have you seen vaccine hesitancy amongst your patients?

- Yeah.

We have been very fortunate to be able to vaccinate widely.

We've gotten a lot of support from community partners.

The Good Samaritan Clinic has been an essential partner for us and male med students honestly have helped us run evening clinics which have provided additional access for patients from the community, honestly, who had not known of us before, other like the Khmer community and Cambodian community have come through and the community navigators that Olmsted County has supported have been critical in that infrastructure as well.

I have seen vaccine hesitancy and some misinformation, a lot stems from mistrust in our government, mistrust in our health systems, which is not unfounded.

It's very founded, literally very founded, but the conversations I am having is like, "I don't believe that a government would give you something for free (laughs) and not have an ulterior motive."

And that's literally like where we have to start (laughs) helping people to know that people have their best interest in heart, that our country has their best interest at heart.

Like they don't believe that.

And yeah, when we talk about trying to change systems, like it has to start there, like people really believing that other people care and like believe in their worth.

That's at the root.

- As we're wrapping up here, without asking too big of a question, (laughs) I guess if you could sort of give us a vision of what your ideal kind of vision would be for community health, what would that look like, Dr. Low?

- I think in our healthy community, everyone would have equal access to healthcare regardless of immigration status, economic status and that would just be a right of every single human being and equal access, not just, you only get this slice, but you get the same thing that everyone else gets no matter what.

I think starting with that foundation would help to level the playing field a lot.

I also imagine a community in which everyone is able to pursue their desires fully for themselves and their families and is not impacted by the communities in which they live in unsafe conditions.

So if the little girl that I'm serving in clinic decides that she wants to be an astronaut, that she and her family can access the resources that they need to get her the education that she needs and her asthma is not going to be affected by the air in the community that she's living in or the drinking water is not going to give her lead poisoning, which affects her cognition and ability to continue performing well on the test to succeed.

So that is the community that I would love to see, that is the America that I'd love to see, and I hope that we can get there.

- Thank you so much for that vision, Dr. Low.

It's an America I think many of us would like to see.

So thank you so much for engaging in this conversation with me today, for sharing your stories and your expertise around some of these issues we have been experiencing them in the last year, and thank you for your service over the last year as a healthcare worker and supporting the community in the ways that you have.

So thank you again, and we hope to speak to you next time.

I'm Nicole Nfonoyim-Hara for KSMQ Public Television.

Thank you for watching.

(upbeat music) - [Narrator] Funding for this program is provided in part by the Minnesota Arts and Cultural Heritage Fund and the citizens of Minnesota.

(bird chirping) (upbeat music)