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OneRouge Community Check-In - Week 126



Week #126

This is a a special topic on ‘Health Literacy in BIPOC communities’ featuring speakers with lived experience to share with the coalition:

Enlight, Unite, & Ignite!

Quick Links: Notes, Zoom Chat, Community Announcements


Speaker Notes

Pepper Roussel: We are continuing our month long discussion of celebrating Hispanic Heritage Month. Today we are gonna be centering health literacy. And since health literacy is not just for non-native speakers, we are going to hear not only how it impacts all minority populations. So whether that be LGBTQ black people, black women in particular, and Latin Latino communities. We are going to hear from some of the I say it again. The most accomplished, most incredible women that I know. So we are starting with Katie Jennings, and I am going to step back and allow each of you to show up and to present yourselves, however it is that you want to be seen today. Katie, let us know who you are, what you do, and how we can help. Hey,

Katie Jennings: Good morning everyone. Yes, love the the energy. A great way to start a Friday and just appreciate being a part of what looks like to be a lovely, great group. Appreciate Pepper's invitation. Don't know that I'm expert, but I can tell you who I am, what I do, and how health literacy definitely affects my daily work. So I am the manager of behavioral health social worker by trade, but at a center community, PCP driven community center called Absolute Care. We serve I was gonna say primarily, but actually it's exclusively a Medicaid population. And what I can tell you is that before working in the, on the community side, I worked, also worked in a major hospital here in New Orleans for about 10 years. And health literacy and really. Lack thereof. People I see on a daily basis. And I think that it's important to talk about health literacy separate from just someone being able to read. Because what I've under, what I've also come to understand is that sometimes people can read the words on their kind of, for a hospital, like an after visit summary that's supposed to tell them what their next steps are and how to, overall just better their healthcare outcomes. But if they can read it but still not process it and understand it in a way that makes sense to them so that they can make the necessary changes or follow whatever course of treatment is being recommended then there's a real disconnect there. We know that there is an America, I think, and somebody, I'm sure there are multiple people on this call that can correct me if I'm wrong. But I think in America itself, we have over a 30%, Percentage of people who struggle with literacy to add health, health related issues and all of the big medical terms, all those Latin based fund, medical terms that come up makes it even more difficult. And I know that the number is even higher for the population that I specifically work with every, which is a Medicaid population. Obviously we've got the socioeconomic related issues that that generally overlap with the Medicaid population. So that, that's who I am and what I do. Work I supervise a group of social workers. And oftentimes they come to me and they're saying, Hey, like this person, this member we call of our patients members, but our members they'll come and say they just discharged from the hospital. They have a new diagnosis of diabetes. They had no idea that they had to refrigerate their insulin. Like just simple things that really can make a huge difference. And if you don't have that full understanding and ability to fully grasp what's being told to you and what's being relate is important then there's a real struggle there. And giving people the opportunity to understand and to we try to do what we call like a, almost like a teach back. So we will educate, we'll say, give some sort of direction and then ask. For people to say. So tell me what you got from that. Tell me, can you tell me in your own words what you know what you're gonna need to do when you get home? And we find that to be more helpful than to rely on giving somebody a piece of paper and basically expecting that they're gonna understand because you don't know you can't tell what someone's literacy level is, number one. And then again, health and healthcare literacy is even a step beyond that sometimes. So that is, that's I'm not sure if I said enough said too much or anything, but feel free to ask questions or correct anything.

Pepper Roussel: Wonderful. Thank you so much, Katie. I appreciate that and I appreciate you. And there are a couple of things that you said really do resonate with me, and that's part of the conversation we had last weekend, which is about understanding what health literacy is and how there is such, this disconnect between what we think people can do and or rather while we project onto others what we believe that they should be able to do and not really take the time to step back and to understand where they are and how they're showing up in a space. So I'm gonna ask Dr. Daffney to level set us. If you don't mind. Please help us understand not just you, who you are, what you do, but you're a teacher by trade or birth, I don't know, which I've known you for four years and every time I talk to you, I learn something new. If you can start with. What is health literacy and why as Katie was just saying, it's super important and we don't give enough credit, but what does that even mean? What do these words mean?

Dr. Daphne Ferdinand: Thank you and thank all of you. You all seem to be a really live and fun group to be with, so it's good to be here this early in the morning with you all. I am a registered nurse by profession 45 years I have some age on me, right? Cuz I've been around for a while and my main focus and my life has been caring. Caring and taking care of people and making sure that they are able to be in a position to improve their health. So I look at myself as a vehicle a vessel, to help them. to get to that level. So as a nurse, I have been inundated with dealing with health literacy all my life, all my adult life, and I've come in contact with this issue with patients as well as with community all the time. So when we are looking at health literacy, in addition to what Kay had just stated, which was very good, and I agree wholeheartedly is that it's not just about being able to read, although I have come in contact with patients who cannot read a word of English at all whatsoever, and you wouldn't know just by talking to them. It's also about being able to write the language and be able to understand and receive as well as to interpret. to analyze that information so that you now have a wealth or toolkit in your person to be able to be informed, informed to make those decisions and take command empowered over your health. And to the extent that you are lacking in those skills, then we are going to have a a wealth of problems here. People may not be compliant with their instructions from their provider because they don't understand and they may have not have been communicated properly with regards to the information about their healthcare. And that can be misinterpreted that this person just doesn't care about themselves. When they may be compliant, they may not understand how to take their me. On a regular basis. And then what happens with that? The condition gets outta whack, they start having complications. What else can happen with that as a result of having those complications? They may have to end up in the emergency room or the hospital. So now what do we also have an increase in the cost of healthcare that could have probably been prevented or avoided? Had this patient or this, just community member or client had known ahead of time very clearly about what's going on in their health condition and what action they should be taking so that they can play a part of the team, the healthcare team in caring for themselves. So health literacy is not just a personal issue, it's an organizational issue, and that's what I think is very important that we go beyond ourselves and look at the organizations that interface with patients, with people who are at a disadvantage because of their health and what responsibilities do they have on themselves to play a part in helping our community, our patients, because all of us are patients, right? Hopefully each you are a patient and that you are in care with a provider. Even if you do not have any issues with your health, we should still see providers so that we can maintain our health and make sure that we are on the right track. So just think of yourself as a patient as well. Even though you may not have heart failure, you may not have diabetes, you may not have any other type of illness or disease condition, you are still a patient because we still need to maintain our health and wellness for wellness checks. So organizations have responsibility like the CDC and how they print out the information so that people can understand it at their level. The American Heart Association also is a health entity. They create educational information and guidelines, not just for patients or for laypersons to understand how to take care of their health, but also for the privileged educated. Okay. We are all the educated privileged here on this call. I do. Okay, so we have some responsibility and humility that we need to deal with our privileged education and how we relate to laypersons and our responsibility in helping them to understand at their level everything that she, they need to know about how to take ownership advocacy and empower themselves to manage their own healthcare. That will drop cost of healthcare too. Keep people outta emergency room versus going to make their visit at their primary care doctor. Increase the level of medication, death, and disability. So we all have a responsibility here for health real literacy. We don't have to be a healthcare provider to do that cuz we are the educated privilege. Right. Okay. And how do we use that privilege of education and how we help our fellow human being? How to understand and be a part of the system. Always come in with a word first. Sing in the morning. Dr. D Birdman, Thank you very much ma'am. So we've talked a lot about, or heard a lot about how there are these barriers.

Pepper Roussel: Mariana we're gonna switch to you and help help let you help us to understand what these barriers look like and how they manifest themselves as you are attempting to care for and to provide support for for folks who don't have the health literacy that we might expect them to. Who are you, What do you do? And how can we.

Mariana Montero: Good morning. I am Mariana Montero, originally from Ecuador, and I am the Foundered and Executive Director for Evolving Change. Yeah, my background, I, am know, really help complete, but my heart is helping the community educating and inform about all these prevention programs and different areas in health. Golden Change was founded in two 10 to empower the, A community providing tools to prevent violence and educated, everything that we can do and help. I, listening to these two presenters, they are, I agree 100% with the health, Health, eh, it university. For us personally I can say that in as a Maria coming from another country here, do I speak in the language because I learn English as a second language here and, was very hard to understand all this information that was provided to me in health. But one thing that I, we do as a golden change is just that. And I had opportunity now with the being in partnership with the NIH and all of us research program where I am not only learning about how to get all this information and learn about what is. , But also for me, it is a blessed to bring all this information to the Latino community, to the Hispanics because my purpose is educate and inform about research. That what I do is, bring in the facilitate to the best way to understand the information I am providing. And we know it is very important. It's not only the person who receive a message, we have to have a conscience about a health, eh, literacy, but also who send a message. Because we as educated, we as providers or prevention educated, we have the responsibility to pay attention to that. Because for example, I have in world of when I Star was a song pictures that didn't identify Latinos that was really looking for that because the way that you can educate the Hispanic community is like bringing leaders who are Hispanic who are talking about health. The other thing that was that for example, that we have information that has to be in different language, not in Spanish, is different. Diversity here in Louisiana in this case, and that was another way, Language is one of the main thing to communicate and make, people to understand not only with the language, the English language, but also the way how to communicate that. That is for me as a Hispanic, is a challenge even. Speaking in Spanish is a challenge to bring the message and educate people and help because, the Hispanic community are not involved in research. Lesson research is, they are not really involved in medical, eh, treatment. So medical, eh, visit because we have no language. We had also others barrier that they have to fail. The education is so important, for them that is another barrier. But really a, what I talking about is, may me understand that they, everybody are in the same page. Everybody really want to. I care about others, about different people, and I am so happy that being Hispanic, I'm inviting to this group. And I can let how, eh, how happy we are with all these programs in the United States providing all this information to the Latino community and welcome the Latinos to this country. The three things they will say when they ask me what, how we can really, eh, put down this help A literacy one is translation. Everything has to be translated to other language. In this case, just Spanish. And the patient navigator has to have that sympathy, has to know more about culturals. And another thing is community. Organization has to be increased involving in this to learn most about, more about different other groups. Thank you.

Pepper Roussel: That's something that you could say actually really made me think that. And I wanna make sure that, to get to Katie first, cause I know you gotta pop, gotta jump soon. Making sure that things are written in a language that folks understand is important. Yes. But with with not all communities have the same level of comprehension and understanding. Katie, can you help me? Can you help us with the communities that you serve and the community, the people that you see and the members that belong to your group? Is there. Just a natural understanding, like once it's written in English or is there some level of of language that we need to be looking to achieve? At one point it was, I wanna say it was eighth grade that we needed to target, and then I heard it was sixth grade. Now I'm hearing it's different levels. So what would be useful for folks who need help?

Katie Jennings: Yeah, no that's a great question. So I do think that to your point I think we spoke about this past weekend, like the grade level is actually gone down. I think, and again, let me know, but I believe I've been told when I'm writing anything that's gonna go out to our members, that it really should be at about a third grade reading level. So that there's understanding across the board. And yes, obviously getting information in. People's native language is hugely important. And it is obviously in Spanish. I know at the hospital, specifically in New Orleans, we Vietnamese was also some, one that we would try to have on hand whatever possible for, that differs depending on where you are in the United States of what languages are most prevalent in that area. But yeah, I think that simplicity and just really using, being direct at anything that's directions related in terms of giving instructions, just I, what I find best, simple language I do think it's third grade level. Somebody can please jump in if they know otherwise. But I'm pretty sure that Medicaid do Medicaid, anything that goes out from Medicaid at this point is supposed to be at a third grade reading level. And that's, and again, it's about the processing as well. So we try to spend, we have what we call in high touch. So we try to get our members in front of their providers and in front of their case managers as frequently as possible. And we try to focus a lot on healthcare education. So we're asking them, we're asking the people sitting in front of us, this is, how you were given this sheet of paper. What does this mean to you? How are you, what are you going to do when you go home with it? Just really trying to figure out in practice, when they leave our doors, what they know to do. Cuz that's really important. They can in front of us, we can help them and we can assist them, but when they go home and they have to read a medication bottle or they have to pick up a prescription. Or, and even when we talk about, a lot of times we have people who need support. So we need to make sure that their healthcare supports, that their, their children, their mothers, whomever is helping provide the healthcare, the health support in their home also has that understanding. So it's working with our members support system as well and making sure that they also understand enough so that they're getting they're doing the instructions as the provider is is prescribing them. And so that, and if there's, sometimes there are things that are altered if we feel like maybe, Maybe somebody can't do an IV antibiotic, and that's, and there's struggle there, whatever, then maybe we're gonna do something and figure out can it be a PO antibiotic instead? But taken by mouth. So sometimes there's, when possible, we can make changes, but when we can, we just try to provide all the support we can in order to have the best outcome for the patient, for the member.

Pepper Roussel: Thank you. That's wonderful. Mainly because there are very few people who move through this world completely alone. And to have their personal support system brought in to the conversation is amazing and so useful and so necessary. The work that Dr. Ferdman and Mariana have done and do around education is useful and impactful, and it is so necessary, not necessarily in just in non-native speaker language or communities, but also with women in particular. I know Mariana has worked with domestic violence and what I'm curious about to hear from both Mariana and Dr. Daphne , how, or does the information that we give to folks, does it matter depending upon what their home life looks like, right? So coming from who is supporting you and how are you being supported? Does it matter if you are the unstable or if you're housing unstable or insecure? Help me understand. What does health literacy look like in practice?

Dr. Daphne Ferdinand: In terms of, was thinking about that. I would like to share even, go even a little further with that. Health literacy, low health literacy, I'll say that transcends all levels of education. If any of you all have to have to navigate through the healthcare system, no matter what level of education that you have, I'm more than sure that at least one of you, if not more, have encountered some barriers and some difficulties and challenges doesn't make a difference. If you got a PhD, you can still suffer from health literacy. Okay. Despite that, and that's. I'm gonna put the owners on, the people in my profession, we have a lot of responsibility here in terms of how we communicate to our patients, to our clients, and just the community at large. Even when you walk into a hospital and you're trying to find where are you supposed to go in order to even register and go to that x-ray department or to that lab department, there's no one there who can help you or even give you directions. That has a lot to do with understanding and communicating the written word as well, and even your lab results. How many of you have been told that your blood pressure is fine, but you were not giving the number? What your actual blood pressure is it? One 50 over a hundred or is it one 10 over 70. But you told your blood pressure is fine. That, that, that goes into health literacy. Okay. Because you have not been informed as well as to be a part of this healthcare team to take and manage and take control over your life. It is your health, it is your body, it is your life. We are only here to guide you, to give you information and to help you to help yourself. We don't own you or your medical information. So when we talk about the family, especially if you have family members that do have challenges, what should you always have when you go to that provider or to that healthcare center An. , you need to have a family member or a friend who is an advocate who can support you because you are going to encounter it. You're going to encounter providers that will have the arrogance, that will have the educational privilege that you should meet me where I am and not where you are. Okay? So I've encountered that myself, even as a nurse, because I don't want you to know what I know when I come to see you as a provider. I wanna see if you gonna treat me as a human being who has a responsibility here to know what's going on with my health. So that's a take home message that I want everybody to know on this call. If you have a family member who is challenged. Or is adage disadvantage and you're not sure whether or not they wanna get the right information and ask the right questions so that they would know what's going on with their health so they don't go home, have a heart attack, have a stroke, didn't take their medications the right way because they were not clear and understood about the information that they supposedly received. So how can that affect the family member? Now we have a double whammy, so bring the advocate with you to the facility if you feel your family member or close friends may not have the wherewithal to be in control of the information and make the accurate interpretation. Or just to have the information to make an informed decision about whether or not they're ready to go to get a surgical procedure. And then they find out afterwards, Oh, I didn't know that they did that on me. So advocates are important when we talk about health literacy with our family members who may be ill or ill informed about information, but also that advocate needs to take a stand and try to allay the fears of that healthcare professional is being the God or the the person who has total control over my life, which that person does not. This is your life. And it's important for us to inform our family that they have the power and control and this is their body and their health. and I'm only here as the provider to guide you, to give you information and to support you and give you some recommendations based on my education and training, but be, are working on this together. Here? Here. Mariana, do you wanna jump in on that before I, Cause I saw Marcella had her hand up a minute ago.

Mariana Montero: Okay. You know I am. It is through the difficulty that we presented that Latinos here is normally it, to speak the language, but also to fill it out all this form. They write because many people, they don't, not only, like I say, you speak the language, but it's not the same when you fill it out a form. That, that is another thing that we really, as a advocacy, we try to teach only the person with a patient, but also the person who is the advocacy. Cause that person need to have more cultural competence to know more about about the language, about the culture, about, different, other areas that involve this to sympathize with these people. Cause sometimes, the frustrate frustration come from the provider, offer the advocate because they can the patient, the person who need information didn't getting on time. So I think it's very important also to focus not only in the patient for the health leader. But also in the providers because they need to know more about cultural companies to have that facility to provide that information. As I say before, it's not only the pro and the person who receive information, but it is the most important part is the person who sent information, the person who provide information. Then for me, as a Hispanic, I'm being involved in this now because I was a prevention educator in, domestic violence, but now helping all these people who are involved in this because they are scared not only about the, the law here in this country, but also about to go and talk to in hospitals and not having insurance, not having insurance. It's very hard for these people get frustrated as inside, they got to the hospital because they cannot communicate first. Second, they don't have insurance. They don't know about the financial part. So that is very scary for them, that when they go and see the doctor with all this fear they are bringing, it's so hard and blocked for them, toand, their own health. That what we are doing is to do education outside before they go to the medical centers, before they go to look for services and help. That is something that is working for us in, in all these projects that we have right now because I am part of different organizations participating and helping them to understand the culture the compet, the culture of competent that we had to really pay attention. Again, thank you for letting me bring all this uh, thank you for being involved in this and think about us and I helping.

Toni Bankston: I really appreciate this conversation. I really appreciate it because this week I was asked by a family members as often social workers are, when they have a dilemma with Medicaid or some other crisis in the family, they'd call their family social worker. And I got one of those calls this week for a member. Benefits were being threatened to be cut off by Medicaid, and she's totally disabled in her seventies as a result of a car accident through the family into a panic. And so my uncle who called me, has a degree in engineering, but I was just thinking about how he was really, I guess in some ways illiterate when he was reading these papers and trying to make sense of all the language and poor guy, he was so overwhelmed. But toward the end, we did come to an understanding that we need an advocate and there was going to be a hearing. And so without having had this conversation, I said, You need an advocate other than me. And so my question to this group is who makes a good advocate? What do you look for? Who are the, Do they need to be a lawyer? Do they need to be like a nurse, they need training, or is it just somebody who is, has a lot of courage and is able to speak well? What are your thoughts on.

Mariana Montero: We were talking about advocacy, that person has to be, the one said, doesn't matter, is that I don't know. I think I am knowing the medical education. I am engineer too, and I had to be learning this. And for me was, that passion that, that love to help people has to be there. And when this advocacy are, receiving, adding customer service about helping these people to guide in the medical field, they have to be prepared for that. They had to get educated, they had to understand what is cultural company. They have to be more, pay attention first to educate first themselves before they will help somebody else. I think anybody can be somebody who support it or help. To go through this process.

Dr. Daphne Ferdinand: I think we have some social workers on the line and typically whenever, I would encounter any issues that's related to insurance home situations anything that may be related to our social determinants of health. I tend to run to the social workers because they have the skills and the knowledge and the wherewithal with navigating that system in helping bringing the total care together, for the client. Home insurance resources, other resources that would support, their health. Transportation, all of those issues. I tend to refer and try to consult the social workers who are within that system of care for that client. And they may wanna speak to that, you know who, if they're on the line too.

Pepper Roussel: I just, Oh, there you are. So before we get to that, I got a series of questions that I wanna get asked in the chat. Katie, thank you so much for being here. I do know that you have to go, I just wanted make sure that how much I appreciate your voice this by morning.

Marcela Hernandez: Actually not a question, it's a statement. When we talk about healthcare I truly believe that we need a comprehensive healthcare reform. When we talk about healthcare in general, we're not only talking about expanding Medicaid, we're not only talking about those issues, but we need to be aware and we need to be very careful. Now, I wanna invite you to also take in consideration the confidentiality issue. So this is something very serious because in many cases, A lot of people are forced to bring interpreter, unofficial interpreters their neighbors, their friends. And as much as we want our community members to have someone to support them and to obtain that piece of information that they don't understand, we have to be extremely careful to those who are, we are opening the doors in our in, during that conversation. Sometimes we put our patients or our clients, depending on what your area is, in a very uncomfortable situation. If we are dealing with mental health we need to be thinking about that confidentiality piece, and we wanna, we don't wanna share that information with their neighbor or their friend. Same thing with just general. Medical conditions. We just need to be very, extremely careful to that. Now, I also wanna invite you to make you think about children, because in many instances, because of the lack of support that we have from the hospitals, what's happening is that they're bringing their children, and children are having a humongous pressure. Imagine if you guys don't understand what the doctors are telling you, can you imagine a 10 year old or a 12 year old interpreting to their parent? It is ridiculously to just think about bringing someone into the picture, a 10 year old or a 12 year old that can interpret medical conditions or mental health situations. So those are two things that I wanna point out. So This is an advocacy process, and I think that this is not a responsibility of each client or patient. This is the responsibility of hospitals, and we need to make sure that they offer quality services and that they take in consideration all of this issues in regards to education language, and also the fact that many people are afraid of saying no. So this is a cultural barrier. A lot of our community members, minorities, they're afraid of saying no. So there's a, there's this huge, it's a huge mountain of challenges and solutions and I don't think that we can we could talk about this forever, but definitely confidentiality and inclusion of children is something that we need to take in consideration and be extremely careful when we're dealing with people who don't speak English. Or even for those who speak English, who do we really bring into the plains? Do we wanna bring these people because there's no other resource? So thank.

Pepper Roussel: I hadn't even thought about that, That those are absolutely true and valuable, which is why we have these cross-sector collaborations. So there's a chat that, Excuse me, a question. The chat that came up really early, and I wanna make sure to get to it because it leads to a whole nother series of questions that come after it. What strategies are used out the patient use and electronic health record? So since the onset of electronic health records, there's probably been a lot of challenge around how you get in, how do you navigate, what do you do? Do you all know if there are any strategies? And if there aren't or if there, if they do exist, where can they be found?

Dr. Daphne Ferdinand: What I would say about that is that the technology has really gotten better. It's whether or not our patients or our clients can access this technology. Okay, in terms of understanding more about what's going on with your condition since providers now are sharing that information. So now some of the hospitals if you do see a provider in a context of the hospital system, has a patient portal, many of them do, especially here in New Orleans. The LCMC hospitals have a patient portal. Two-lane has a patient portal as well. Ashner has the patient portal where we as patients can access our medical record, but there's some labor, that's going to call for, to do that, and that's gonna be a part of literate aspect of learning more about your healthcare through this technology. The systems do not do a very good job of helping clients to accomplish that. So be, I'm computer literate, so I, it is very easy for me to do that and also go to the, or either get on the phone and call someone, at the healthcare organization and said, I need a link in order to access my patient portal since I do have an account. So organizational health literacy is very important is Marcella alluded to, and we need to do more work with that. But we as clients, as community have the responsibility for letting those healthcare organizations know what they need to do to improve that, so I can have access and be able to learn how to access that. Because now they have to share all of our information. Okay? It's no longer my chart. It's not your chart, and you have to pay a fee in order to get a copy of your medical record. Your medical record is available to you and it should be available to you for three. So the technology is here, but we need to be, we need to get assistance with learning the technology and we need to ask for it.

Pepper Roussel: Agreed. So there's also is there, do y'all know whether there is any sort of information? That's available around intake forms and maybe making those easier specifically, so if you're answering questions, and sometimes you, it's not really clear what they're trying to get to, and there's this underlying fear that if I say the wrong thing that my rates are going up. Do you'all know if there's any sort of support or if there's any sort of movement that would help not only educate, but maybe change those forms or Mariana I know that you're doing education around health literacy now, so what are those things that you're teaching?

Mariana Montero: What we do is we volunteers as far to educate, how to fill it out the form and to know what is the information appropriate to get it. Eh, but I don't work directly with the hospitals. For example, I am part of the director of clinic in Look clinic, or we have is people, eh, who are. Training to, to help them and they speak their language. One of the main things that we found to help the Latino is to feel like comfortable with the person who speak the same language. That make it easy for them to have the patient to understand. And was also is like the, like feeling more comfortable for the person who is receiving the information. That is a, we pay attention a lot to have people in their own groups. We have a education day for Latino where we have people who speak. The language is, we have for the Vietnamese, we have people who speak the language and that we do. That is the best way we can really help these people to communicate with others. Even though some Hispanic people, they live here for all their life and they are not familiar with all these different. Eh, areas or worries that most of the Latino who just arrived to this country, but they, we pay attention to that and educated person to be sensitive to these new people because we have to recognize that they don't have some time level of education of it's simple. They don't know anything about medicine. And what we do is have people training these people who are going to help with being very sensitive to the culture and also learning how to disclose all this information. And they were talking about privacy. Latinos are so scared to give information because they don't want they think that would be useful for other things, but they are very , they don't want to give their own information that you have to have somebody who really. No. About the culture in order, are they to provide information?

Dr. Daphne Ferdinand: I'm looking at the question right now. I really don't believe that there's any way to streamline the process to access into re and to deal with these forms. They are here. Like Marcella said, I'm gonna go back to cuz she made some very good points. We need reform. It's gonna have to deal with policy, especially when we are dealing with governmental agencies. Unless we complain to the representatives who are in the hospital organization or whatever healthcare organization that our patients are receiving services from, it's really going to depend on us, the public. , it's always going to be us who are gonna have to make the change and advocate for our health, which means that advocating for our health, we also are advocating for a systems change as well. The only thing that we can do right now, and I do understand because I come across the same situation because I'm a patient too and I have to fill out forms. Sometimes they have 'em on their little iPad for you to fill out, which can make it even more complicated, because now you gotta try to scroll and deal with the technology. So think about a senior citizen that may be there by themselves and not always have that family member, that daughter or that niece or a granddaughter that's bringing them to their provider. Not everybody has a family member who's an advocate for them. Okay. So just think about all of that. So that means it is incumbent upon the receptionist or that representative behind that front desk that's handing me that tool to help me. And they do have some organizations that will do that. I did I was asked because of my gray hair. Do you need any assistance? Okay, . So that will happen. Sometimes you also need to ask, we have to help our people to ask and speak up for themselves. It can be challenging, especially if they're not used to doing that, during their lifetimes. But we have to work on that as.

Pepper Roussel: So incredibly true. Yeah, there's so many questions over here in the chat. I'm gonna combine a couple of these and ask the question around which I'm not sure that our speakers will know. And so I'm just gonna leave this as an open ended, chew on and we'll come back to the answer. Since we know that we do have these gaps, and thank you Dr. Tuck for We're mentioning that we have it is our superpower to find the gap. How is it that we can start filling them? How do we reach across not only organizations, but communities in order to make sure that we do have what we need for those folks who are living with us as neighbors? Just gonna put a pin. Sit that right back there in the back of your head. But more specifically, there's a question about accessibility around education comprehension, but also actually getting to the pharmacy to follow up appointments. Caregivers do they have access to do the things that need to be done? Do we have, not just advocates, but also services that would allow folks to support their loved ones in physical, meaningful ways? Not just interpreting, not just holding a hand, not just being there to make sure that, but to get where they need to go. Is that something we already do? Is that something we don't, that we need to do? How do we get to where we need to be

Mariana Montero: okay. Yes. We, as organization, we really are fighting with this information be provided by the big organization who requests our services. For example, in this case, all of us research program provide all the education to people be involved in. This is, I think the way that we come do is like putting more boys and bringing this to the representative. To have a niche organization, people who really are, are able to have the people who doesn't speak the language. But in this case, for example, we, I feel very proud of part of all these programs they am now that all of us and other product, they training us, they are really pay attention to have somebody who speak the language. There is, but the main thing when you say is like that we have to get together and bring more services to this. That is, I didn't understand what was the paper? What was the question you say? As a Hispanic, we had to raise our voice and look for the organization to have more more offering more services to the community.

Pepper Roussel: Are we providing services? Do we have the services or resources available to physically move people if we need to, Not just to give them a piece of paper and send them on their way. Okay.

Mariana Montero: We need more. That is definitely, and we have some organization that they have, but really, we really are in need for DSA health and we have to request, like I say, for me, as a golden change being all this organization, I come ask and request for more help and really putting more voices getting this together with other Hispanic organization in this case will be fantastic for us to get all this help.

Dr. Daphne Ferdinand: I think sometimes. Look would just feedback on Mariana, I think so. That we are just as consumers, we are just not aware of what's out there. And I don't know exactly how you figure that out. Exactly. My, my organization does not do that. We do health education programs and not provide services, per se. But if we there's services out there, but I don't know if everybody knows how to adapt into them. And like Mariana said, we don't have enough. We don't have enough. That is true. We, but how do we get access to what's already in existence? And a lot of people just not, are not aware of that. So we don't do a very good job of helping people to access services that do exist and how they can qualify and become eligible. There are people who are eligible and have the continents to, to be a part of some of these resources, but just may not know. And here we go back to this literacy thing again. How do we get people informed? How do we get people to understand and be able to be aware and have the knowledge about some of these programs and resources that do exist?

Pepper Roussel: Speaking of advocacy and programs that exist, there is a clear intersection or overlap with immigrant communities in our Carceral system. And you could, if you were listening to the news recently how it is that we hold immigrants and asylum seekers in jails and instead of well anywhere else, but how is it, or do we know if there are any ways that family members, friends, communities, and neighbors can advocate for health of their of their loved ones who are in these carceral systems who may be somewhere in between?

Marcela Hernandez: All right, I'm actually just gonna narrow down what I believe are the solutions for all of the questions that you're saying because I absolutely think that it could take us years to, come up with a specific solution. But here I go. I believe the first thing we need to do is that we need to change our own perceptions and our own stigmas in regards to certain individuals. If we change ourselves, then we can start creating impact on other people. So we, first of all, we need to reflect on our own internal thoughts in regards of why people don't access healthcare. In regards why people are not taking their medication, not attending to appointments. So first of all, we need to change within ourselves. Secondly, I think we need to promote a cultural awareness within our own organizations, within our own staff, and to make sure that we are educating our organization in regards those specific challenges that we are talking about today. Then after we do that, we educate our family as well and we explain them about those specific challenges. So then we will continue meeting and creating this platforms. This is the reason why I absolutely love this group because we are creating a platform where we are creating an awareness and we're talking about things that you probably don't think on a regular basis. So we must continue creating this type of platforms and including not only immigrants. This is an issue that I think every single person deals in the United States. And then of course, we need to target those organizations that are really, that are already advocating for changes in a local and national level. The organization that I work for that's part of what we do. So not only targeting organizations that are working within the Bat Rouge City, but also what's happening in our state, and then what's happening in our country, because this is, at the end of the day, if we don't. Like I mentioned before, a comprehensive healthcare reform. This is not going to change. So it needs to start from something as little as yourself and what are those thoughts that you're having in regards to the challenges and the situation with the individual. But then at the same time, we need to advocate in a local, national level. And we just need to remember that healthcare is a human right and we need to make sure that every single person knows that every your child, your husband, your cousin your organization, your ceo, every single person needs to understand that healthcare is a human right. And this is a matter that impacts us all, not only immigrants. This is something that impacts us all.

Pepper Roussel: It does impact us all. All right folks. There was something, and I wanted to, Is Mary Stein still here? Where am now? Maybe we're not sure. Where are you? I don't see your face. She is. Ah, there you are. So I do have a question, right? So you put in the chat that the libraries are working on telehealth. What does that look like? And it's important for those of you who don't know, it's super important for those who don't have computers at home or who don't use their computers in a way that the folks on this call might. So if you can give us a little bit of information, I would love to hear about the telehealth initiative.

Mary Stein: Sure. It and it's not done yet. Like I said, we're working on it and so we're fighting each other about how it's gonna roll out, whether we're just going to make devices available in the 14 physical libraries and maybe on the bookmobile where the device is already kinda platform ready for the basic big platforms. And we'd also have the blood pressure cuff and the scale and the oxygen thing and a few other devices that healthcare providers often as you to self-report about during. And that someone would come in and use one of our spaces cuz there's a space at every library. There are small meeting rooms, there are large meeting rooms. It just depends on the library. So that's the lowest hanging fruit that we would have. The laptop or the Chromebook or something that's already set up where it's pretty much press and go. Or we would have something that you could take home. Your little kit where you take home the blood pressure machine and you take home the little tablet that's already set up. We already started circulating hotspot. We have 500 hotspot currently in play now out in the community. We hope to get fi 500 more in the spring to make it easy for someone who's in a digital desert. To