Re-Imagining Trust: Engaging Hearts and Minds in Communities

How do we ‘re-imagine trust’ such that we effectively engage the hearts and minds in communities throughout America?  What is our responsibility as professionals within Public Health?  What are the things the we need to talk about when we talk about 21st century community engagement? Our efforts to Re-Imagining Trust: Engaging Hearts and Minds in Communities Throughout America must create more practical and effective solutions, drawing on the listening of diverse groups.  Our efforts should improve citizens' knowledge and skills through immersive experiences. Our task is to begin the conversation that generates these outcomes. 

Episode Summary and Highlights

Welcome to Profound Conversations. This is program number four of this season and we have been looking at justice, equality and all of the things that we need to balance out. And over the last few weeks as we saw the verdict in the Ahmaud Arbery case, it gave us an opportunity to reset. Everyone got a verdict that says that there can be justice there can be fair, and people have good hearts will make a choice that says despite race, an injustice has happened, and those perpetrators must go to jail. A gleeful sound came out across the country, because it was a big deal. When case after case after case before this did not end in the same level of result of the Mr. Arbery verdict allowed us to reset as a nation or have the opportunity to reset as a nation and also begs the question “Is it time to reset in the medical and public health field?”

-I really appreciate the thought about co workers and collaboration. And I think I really want to and that's not something I hear enough about when discussing trust.

-I've learned to think about the healthcare system in the past few years, is materialist. Like economics money, right, so much of our healthcare system has to do who does or who doesn't have money.

-And I think that faith in the system would be better and possibly, people wanting to donate more, could be an end result of that, knowing that they're getting good information across the board, transparent information, and they're being treated fairly and presented all options.

-I think if we looked at things much like Dr. Berger said that we were actually coworkers. And we were not competitive or in separate organizations that we were all one, I think that the system would be so much better.

-I think it's always useful to try to teach my colleagues and people about listening to patients listen to everybody and to be more compassionate.

-Really working with people involves conflict and dispute and, and, you know, working well as a team doesn't mean everyone obeys.

-And I've been really inspired recently about the history of community health care and solidarity based health care in the US.

-Maybe it's starting at a city level of county level, and then moving to a state level. And maybe it is those small grassroots steps that are more connected. Not just in your one little town, but that little town that looks like you in Maryland, or in California or in Missouri, they have a network to connect, and then all of a sudden these these voices can grow.

-Yeah, I also kind of wondering, you know, Aren't there other models out there that exist in other countries that are successful, that maybe we could learn from a little bit more?

-But a lot of that when you get into the community is in the African American community. The questions, the mistrust, is this Tuskegee all over again. And are you really trying to help me Are you experimenting with me again?

-I think a lot of the issues relating to COVID and vaccinations are pre existing, and not the disease itself.

-What would it mean for an organization to allow open conversations about pay rates for the least paid workers? Right? That'd be a real conversation.

-I mentioned one win where institutions giving more money to its community.

Profound Conversations Executive Producers are the Muslim Life Planning Institute, a national community building organization whose mission is to establish pathways to lifelong learning and healthy communities at the local, national and global level.   MLPN.life

The Profound Conversations podcast is produced by Erika Christie www.ErikaChristie.com

Full Transcript

Joia Jefferson Nuri

Welcome to Profound Conversations. I'm Joia Jefferson Nuri and I am your navigator for today's program. This is program number four of this season and we have been looking at justice, equality and all of the things that we need to balance out. And over the last few weeks as we saw the verdict in the Ahmaud Arbery case, it gave us an opportunity to reset. Everyone got a verdict that says that there can be justice there can be fair, and people have good hearts will make a choice that says despite race, an injustice has happened, and those perpetrators must go to jail. A gleeful sound came out across the country, because it was a big deal. When case after case after case before this did not end in the same level of result of the Mr. Arbery verdict allowed us to reset as a nation or have the opportunity to reset as a nation and also begs the question Is it time to reset in the medical and public health field, there have been a lot of disparities that have caused quite harm to people of color and national origin that was not American. So now we have this reset button that we have or possibility to do it. In our earlier episodes that we have affirm the few salient factors, I'm going to read them to you. One lack of trust creates inconsistency in the delivery of care and influences patient, family choices and outcomes. We also came to the conclusion in previous episodes that coalition modeling containing co work principles successfully established trust among people within organizations. And for our two guests today, Dr. Zack Berger, and Miss Kelly Ranum. They are experts in the public health field. And I'll go through their backgrounds in just a moment. And if you want to know more, you can go to our website, and that'll be available for you. In this reset that burger. And Kelly, we have the opportunity now to say something different and do something different. And I just mentioned a co work a co what do they call it co work principles, the co-work principles were laid out in one of our programs by one of our guests. And fundamentally, it is taking a real assessment of who you are. cohorts are, who the co workers are. And then the co workers can be your colleagues. The co workers can be a connection of organizations that you're you're working with? How do we work together with all of our co workers, when we have a history of mistrust of obviously not just the police system and the justice system, but a mistrust of the medical system. A lot of African Americans are leery of, you know, experiments that left black men with syphilis just to see how it was going to go. There's a killer, you know that there's a big fear of being an organ donor for fear that the hospital would let you die, so they can harvest or gather your organs. So we're here in this place. And we want to start to articulate what we do. How do we build this trust? Now that we know that it's possible in our time that people can see things differently? And I'm going to start with you Dr. Berger.

Dr. Zack Berger

I really appreciate the thought about co workers and collaboration. And I think I really want to and that's not something I hear enough about when discussing trust. And I went run to really explore that. And thinking about what different kinds of collaboration are possible in our healthcare system. And just thinking about the people I work with every day. And what would it mean to really collaborate on equal level and eliminate our hierarchies? Just thinking about my institution, not not blaming my institution. Specifically, this is unfortunately characteristic of most academic medical centers in the US that the certified medical assistants, the community health workers, On whom so much care of our patients depend, don't get paid enough. It just is very honest right to say that these are vast majority of these workers are African American. Alright, the mass majority of these people, specifically, actually the community health workers are hired because they live near our patients. And they're treated justice, probably their patients are in the sense that many of these institutions have a great deal of money that they don't share with those around them. So a real coworker shares equally in your costs and benefits, I think. So that's one thing I want to say the other thing is seeing a patient as a co worker, as also, I think, a farther distance, but I also really necessary thing, what would it mean to work in actual collaboration with the patient to do what they want? And to again, have them share equally and benefits and, and risks? What if they were paid for their time? What if all these things come to mind about what true collaboration would look like? So I'm really glad you brought that up.

Joia Jefferson Nuri

Yes, thank you. And for our audience. Dr. Berger is an associate professor in the Johns Hopkins division of general internal medicine, and core faculty at the Johns Hopkins Berman Institute of Bioethics. Thank you for that. I'm wondering wanna before I get to you, Kelly, I want to follow up on something you said. You asked the question, what would it look like? If you were a co worker? With a patient? What would you think that would look like?

Dr. Zack Berger

Yeah, well, I think, you know, so much of how I've how I've learned to think about the healthcare system in the past few years, is materialist. That means that's sort of you know, that I mean, that in the like, the specific sense of the word, like economics money, right, so much of our healthcare system has to do who does or who doesn't have money. So if you're someone's co worker, and you're really in a collaborative workplace, say it's a co owned business, right? People share in the profits, right? People share on the resources, and you don't treat people differently if they have less money or more money. So that's what that would be one step. And the other step is a real co own work environment is people work together to figure out what the goals are. So in our system, so often, there are metrics that institutions aim at to maximize the revenue, and it's not really what the patients want. And we we, that we tell ourselves that it's good for the patients, that's not the same thing.

Joia Jefferson Nuri

You also Kelly, I will get to you, but that you also said, if you were to work with the patient in order to do what they want, what would that look like?

Dr. Zack Berger

Yeah, I mean, I think it really depends on the patient. But I think you know, so often, I'll, I'll tell you about one, one group of patients that is really, that we've really presented with challenges, and we've we've made them jump through hoops. And that is, and I'm sure you all know, because it's a very common condition, people with chronic pain, right. And there are a number of treatments for chronic pain, and they're all not really good. They're all sort of moderately good. And many patients unfortunately, have need of of opiates of narcotics, which can be effective in certain people, and like any medications have pluses and minuses. And our institutions as a general rule, have decided that opiates should not be given to people with chronic pain. There are some exceptions, but people are made to jump through hoops. And that can lead to real patient harm. So working with patients to understand what they find helpful for their pain on an equal level, I think would change how our institutions see things. Now, I'm not saying would solve all problems, because pain is difficult to treat, and demands a very broad approach. But seeing patients not as suspicious characters, but as co workers, I think would would be appropriate.

Joia Jefferson Nuri

Thank you very much for that. Kelly Kelly is the Chief Executive Officer, the Louisiana Oregon procurement agency. Kelly, the question goes back to you the same question, coworkers expanding the idea of, of course you work with other organizations and you do collaborative work with other groups, but to be a co worker with everybody involved, including the patient and the patient's family.

Kelly Ranum

If you're in our field, we do have to work really with everyone so from the corner medical examiner's funeral homes, hospitals, donor hospitals, the families and the transplant centers, which is just another faction of the hospital itself. and it is often I, I think if we looked at things much like Dr. Berger said that we were actually coworkers. And we were not competitive or in separate organizations that we were all one, I think that the system would be so much better. And I think that faith in the system would be better and possibly, people wanting to donate more, could be an end result of that, knowing that they're getting good information across the board, transparent information, and they're being treated fairly and presented all options. And I think that's not what we do at all. And it's, it's unfortunate, and there's just so much to do. And I really didn't even think about the certified nursing assistants. Like you were talking about Dr. Burger. And I think that is such a valid point. And for us in the in the organ procurement side, the donation side, we tend to focus on the nurses. But when I stepped back and look through your lens, I think it is it is the housekeeping staff, it's a security staff, it's, it's those, see this, the the nursing assistants that are there day to day with those patients in those families and spend more time there the faces that are familiar to them, they're the faces they're comfortable with. And yet, they're pivotal to our process. They're pivotal to the care that that patients get in the hospital, maybe not the direct bedside medical piece, but the feeling of part of their being taken care of. And I think sometimes when I look back at some of the things I've experienced as a nurse, first off, but then also, as a coordinator, these two cases, they were my go twos, and, you know, the security staff that the nursing assistants, because they knew, and I felt like I got better answers from them. And I just never really kind of put that together until this moment about the disconnect in pay. And yet, you know, there probably are very pointed reasons for why they're hired and for the roles that they're hired in, but you're not really giving them the credit, financially or otherwise for, for actually that pivotal role that they play. In, in healthcare and, and in providing some form of trust at a hospital level. And I think that, you know, for me walking out of here today, I'm absolutely going to embrace working with more people in the hospital and explaining that they do have a role, even if it's not at the direct bedside, to helping the community. And then you know, when I kind of flash it forward a little bit more. If if those people that work in the hospitals, the nursing assistants, or dietary staff, housekeepers, if they're mistrustful of what they see on a day to day basis, and that goes out into the community. That's what the community hears. And why should I believe you nurse when you know, people that I go to church with people that I live near are telling me something different? And I think that's absolutely where more community and collaborative and co worker relationships would really come in handy. And I, I loved listening to karimun you know, community work is messy. And I 100% agree with her. And I think it's time for us to get messy.

Dr. Zack Berger

This if I could if I could add something I think a friend of mine by the name of Josh Gruen is a societal sociologist in Wisconsin came up with a very useful term which I which I want to share with healthiness trust. And why is that term useful? Because so many people, you know, I think it's really important. One thing I have to remind myself of everyday as a clinician is people, people's choices are constrained by their circumstances. And people generally try to do things for reasons, right? People aren't, you know, even things that we might find hard to understand people when they don't want to get vaccinated. They have reasons, right when they don't go to the doctor, they have reasons. And if they're not trusting the system, it's often because the system has done them wrong. So you know, if you're in a relationship and it's a hurtful relationship, you're not going to trust that other person. Unless it's figured out there's some sort of concrete change. So that's that's this is a healthy mistrust, right, that people demonstrate.

Joia Jefferson Nuri

You know, the title of this particular episode of Profound Conversations is reimagining trust, engaging hearts and minds in community throughout America. The term on healthy mistrust DR is an acknowledgment that people aren't making this up. People have real reasons not to trust. I have a dear friend who was hospitalized in Atlanta. He's in his early 70s. When he went to the hospital, he's in jeans. And, you know, it's it looks like people look like when they go to the hospital on Saturday. And he's diabetic and nothing aligned with his level of blood sugar levels were at 300, when 100 is normal, but he didn't have any kidney failure, he didn't have any internal damage at all. And when they got the sugar levels down, the blood sugar levels down, his joints started to ache. They kept telling him there was no relationship between his blood sugars and his joints. And it's sort of being a co worker with him. They kept telling him he was imagining it. And you know, he's a man in his early 70s. But what they, the doctor treated him, like, you're dumb, the doctor nearly dismissed him. And a doctor actually said to him, I know more than you. Oh, goodness. And he said, I'm smarter than you about this. But he looked at an elderly 70 year old man and categorized him until my dear friend said, I have two Harvard degrees, I run a million dollar, a $2 million business, you're just looking at my physical. Now you have an oath to do no harm. And you just did that. What was most appalling for that was one that doctor assumed and the doctor was arrogant enough to say that out loud. But I don't think that would have happened. Had my friend not look like an old elderly black man in jeans and a dirty shirt. I mean, because he went to the hospital Saturday afternoon. On Saturday afternoon, and why did he have to prove now the doctors attitude completely changed. attitude completely changed their cabinet for a few more days. And really looked into this because my friend throughout a credential if we're going to co work with each other, and if we are going to, as we say in this reimagine, reimagining trust. How do we do that? From both of your perspectives? How do we do that? And you Kelly, we're talking about reimagining the trust with the people who are on the front lines. And so did you Dr. Berger. And so if we if you have to reimagine your trust with the frontline people, because when I've been in the hospital, that guy comes in with a mop, he's probably the friendliest person I see. He stands and asked to see if I'm okay, if I need anything, you know, so from the guy with the mop to the doctor who I only see for 15 seconds. Okay, how do we reimagine trust, where a doctor would never say that to his co work patient, no matter what he looked like, he didn't need the Harvard credential. My

Dr. Zack Berger

first answer would be so part of it is about power, who has control, right? And if certain people have control and certain people don't have control, that's going to affect people's care. And just to be explicit, right? Like, you know, black people have not been given control of health care, right. And there have been efforts to change that, thinking of the the history of free clinics in 20th century in the US, which start with, with the Black Panther Party, right, and they're free clinics. And so you have to redress disparities of control. That's part of it. Another part is, and I'm gonna throw out another term, which I like speaking to the story of your friend in the hospital, that the term is epistemic injustice. And for those listeners that might not know what that means epistemic means having to do with knowledge, right? And that means you are discounting the knowledge of the person you're talking to, in an unfair way. So what would it mean to really listen to people and really take their knowledge into consideration? Well, we tend to fail to listen to people who we consider lessors to us, right? So it requires so some of us, you know, as a piecemeal strategy, I think it's always useful to try to teach my colleagues and people about listening to patients listen to everybody and to be more compassionate as are great things. I'm not discounting that, but he really needs systemic solutions that have to do with distributing power and resources. More equally.

Joia Jefferson Nuri

Oh, how how important is humility in that equation?

Dr. Zack Berger

I think it's very important. Right? So knowing that knowing what you don't know, you know, there's a famous curve at the beginning, you don't know we get don't know, right? And then and as you practice for a number of years, you begin to know you don't know, right. And so you have to, that's a accumulate, it takes time to learn. And I think I've made so many mistakes and learn so much that I feel pretty confident. I think. So. So, you know, that's, I think that's an important ethical trait. Yeah, as you as you can tell, I'm pretty conflicted about whether ethical traits are enough? I don't think so I think that when we say, when we tell people to be more ethical, we take the system off the hook and put put it on individual. So even if we were all the best people possible, right, that would redress power and resource imbalances. But on the other hand, I do believe that a human that a humble doctor or nurse is a better doctor or nurse.

Joia Jefferson Nuri

Thank you, Dr. Berger, Kelly. Um,

Kelly Ranum

I, you know, it's odd in that, as nurses, when you deal with doctors, you see a level of what you just described to your friends, right? You don't know I'm the doctor. MD means my decision kind of thing. And haven't heard that yet.

Dr. Zack Berger

No, I have, I thought, I thought it was gone the way of the Beatty some.

Kelly Ranum

So, I do think that, you know, in working with physicians, particularly surgeons, I can't imagine what it is to have a heart in my hands or a brain in my hands. And I think that humble has to go out the window and surgery right in this overconfident test to come in to be able to do the job. But how do you learn to take that hat off out of the bar and have the bedside manner outside of that, oh, our but I think that it, it just comes to all of us understanding diversity, and whatever that is, whether it's age, whether it's religion, whether it's race, whether it's, you know, socio economic status, and I think that that's kind of where we miss it, we, we know who we are, and, and all the people like us, and, and you have to want to work hard to understand something different and understand differences. And I think that doesn't necessarily get brought into med schools, nursing schools, maybe you get a little basic sociology class or a psychology class, but I don't think we spend enough time on it. And I've found here in my own organization, actually really talking about diversity and equity and inclusion, and that it's not one color. It's not one religion, that there's so many variables. And if you have a class, you're not done with that you have more continuous and you don't just get a four hour lecture and all of a sudden, you're an expert, and that you have to be humble that there's humility and not knowing right? And you have to be smart enough or, or vulnerable enough, maybe not smart enough, but vulnerable enough to to be able to put yourself out there. I mean, there are just times when I say something and then I think, can I say that the right way? And I don't want to offend anybody. But I want an answer. And I don't know which way to go. And I think that that's the kind of that's what we need to learn as human beings. How can we interact and learn and grow from each other without these preconceived notions. And I think in healthcare in particular, it's never really a big focus of the education that you get when you're going into these, these roles. And

Dr. Zack Berger

yeah, I think that's really reset it really well. And I want to pick up on something you said earlier, which is that this is messy, and thinking about how to co work with people and how to listen to people. I think that's an important point. It's not like Kumbaya, you know, everyone holds hands and everyone feels good about it, and everyone smiles at each other. Right? Like, really working with people involves conflict and dispute and, and, you know, working well as a team doesn't mean everyone obeys. Everybody, it means people have differing opinions. And that seems like a cliche, but I do think sometimes organizations like to paper over disputes. And this is why for example, organizations Generally or often don't want to see workers organized right or don't want to see unions, because that implies that people aren't getting paid enough. And bosses are making mistakes. Right? So protection. That's right. Absolutely. Right. That's right.

Joia Jefferson Nuri

Right. Kelly, you said something you said, you should be continuously learning that you don't just take a four hour workshop, and then all of a sudden, you're an expert on the AI or anything. Okay. We continue learning. And what struck me when you wrote that, when you said that I wrote this down, it's that I'm thinking I'm asking both, should we not also be continuously vigilant about our biases, our arrogance and our superiority? Yeah, either one can answer that, should we not be constantly vigilant as an organization? And as individuals who have some measure of say, so power in our community? Should we not?

Dr. Zack Berger

What were the things you said after biases either to other thing?

Joia Jefferson Nuri

Arrogance, and sense of superiority?

Dr. Zack Berger

I mean, I guess I would say, I think it's important to be aware of one's personal biases, I have to say, a lot of the DEI language recently has been window dressing, you know, I, you know, obviously, obviously, you have a clinician, you have a worker, you have a patient that says something racist, right? That's bad. You don't want that to happen. Right. And, and we've all learned in the public sphere, what happens when leaders match their course language, their course policies, so it doesn't make it better if you have course language, it makes it worse, right? So it's the conflict between ethical behavior and systems behavior and changing policies. So I don't I don't, I don't think it's the case that if everybody were to eliminate their personal biases, and arrogance, everything would be solved. Like, that's not even a first step. That's sort of a parallel track. Right? I saw Yeah, I want to make sure I'm saying I'm behaving as an excellent collaborator. And right and acknowledging my privilege, and, you know, you know, this is the way I am. And so I'm coming from particular place. And so I'm, there's a lot of things I don't know, I want to acknowledge that. On the other hand, like, the fact that our health care workers aren't making a livable wage, that doesn't have much to do with me being a nice person or not being a nice person, right? Doesn't matter much. So So again, these parallel tracks.

Joia Jefferson Nuri

Do we start that? I totally agree that me eliminating my biases is not going to change the injustice? Is that happen all along the systems that we live in? But Dr. Berger, where do we start? We're going to reimagine. Where's the reimagining start?

Dr. Zack Berger

Yeah, well, that's that's a tough one. You know, if I, if I had the solution to that it'd be I don't know, may not be a profit or something. But I think I mean, I think it's a large part of the question. I really, I think it really starts with organizing people, organizing people to share resources and build different structures than the ones our governments have, because our government structures are often failing us. So it means bringing people together in groups to try and remake things. And I've been really inspired recently about the history of community health care and solidarity based health care in the US. You know, there's a community Muslim clinic, I've been reading about Montgomery County, Maryland, there's the Black Panther parties. clinic, which I've been, which I mentioned earlier, there are Native American clinics. So healthcare that's owned by the patient, is maybe one way to go. That org, it's all it's all about organizing people and trying to use the power of the people.

Joia Jefferson Nuri

I remember that phrase, I'm old enough that have been a normal. I remember that was a goal at some point. And yeah, right. Young people's political movement Power to the people. Yeah. ask you the same question. Where do we start the reimagining?

Kelly Ranum

I think, you know, in some degree, you do have to start with yourself so that you can so that you can realize what's not fair and equitable out there, right where you need to start. And, and I 100% agree, it can't just stay with just you that's not going to change everything. And I think that that knowledge that these systems are broken, and why they're broken, and how do you start even if it is just that people, you know, a community owned clinic that actually the community will go to, because there's some faith there and some trust whereas if you just pick Got them plop down, you know, the John Hopkins clinic or here in Louisiana, the Ochsner clinic, you know, those same biases that exist for the hospital are going to carry over into that community clinic too. So, you know, maybe that's a great first baby step is connecting with the community to meet the community's needs and use the community to inform how you do that, and give them the resources. And I think for me, the frustrating part is all this money is thrown in all these different directions. And yet, nothing's happening. And I think it's been that way for many years, probably all of my 50 plus years in this world. And so, yeah, where do you just put that hammer down and say this is we're just going to start doing it, we're going to quit talking about it, we're going to quit politicizing it. And we're going to try this and see if it works and go from there. And I think that's really, we just have to start acting and not just talking.

Joia Jefferson Nuri

How do we redirect that money? I mean, how Dr. burgers like people come together, community clinics, but there has to be somewhere in this reimagining that you're right, Kelly, it's not landing where it needs to land, the frontline people are not being paid well enough by big institutions like Johns Hopkins and above. And in these community clinics, we can imagine nobody's getting a salary they live on. So we're how do we, Kelly, what do we do to help redirect the money?

Kelly Ranum

That's a great question. After spending some time in DC, I don't know that that's the answer. There's so many forces, you know.

Joia Jefferson Nuri

In DC.

Kelly Ranum

Maybe it's starting at a city level of county level, and then moving to a state level. And maybe it is those small grassroots steps that are more connected. Not just in your one little town, but that little town that looks like you in Maryland, or in California or in Missouri, they have a network to connect, and then all of a sudden these these voices can grow. And hopefully, if there's some modeling, and it shows that it's successful, then you start listening, right? People start listening, particularly if there's money saved, meaning you're not having repeat people in the hospitals for conditions that could have been taken care of better on the front end. So maybe that's a first step. I don't think I'm the first person to even say that. But you know, you're right. How do we actually make it happen?

Dr. Zack Berger

I love I love what you're saying about networks. I think that's really important building networks. And I think one way to think about is where the money come is coming from, you know, sort of sound like a broken record, but I'm a firm believer of redistribution, right? So there's no reason for there to be billionaires, right? So there needs to be redistribution of those resources. And there's no reason for healthcare institutions. I'm talking about mayo, Harvard, Cleveland Clinic, you know, Hopkins, not to pay their fair share of taxes, right, so So to mention a little bit of good news, I just saw a report and a New Haven publication about how Yale and New Haven have negotiated a deal where Yale is giving more money to the community. And that's a way to build trust. And I'm not even saying rebuild trust, because I know something about the relationship between town and gown in New Haven and other cities, right? There might not be any trust rebuild, but you have to build trust, right? So it's about having institutions with a lot of money that was not given them for cleanliness of soul, right, but a way to redistribute that resources to the people that need it. And that means paying a fair share of taxes. So that's one way of thinking about it.

Joia Jefferson Nuri

I'm wondering if another way to think about it and throwing it out for either one of you to answer is to go for the fountains and money and ask them to do better. Then Kellogg Foundation is very dedicated to nutritional health for children. And they give money but are we sure that that money is earmarked to make sure they're better salaries, better conditions, better facilities, better distribution of the health care? Are they just looking at a proposal and granting money? Would that help if foundations we got if, if networks could get to foundations to say this is what we actually need? We know that your your mandate is to do this, but this is what we actually need.

Dr. Zack Berger

I think that's something worth thinking about. I think a lot of the issue or the barrier and thinking about that, and thinking that way about foundations is similar to the issue about thinking about DC, right? Foundations, like a lot of nonprofit organizations, like a lot of elected officials are not necessarily accountable. So they have to be pushed. Right? And how do you push them in the right way? Um, but yeah, I mean, if you if you're, you know, where's you know, what, what the, what the robber cyber ask why he robbed Rob is banks, right? Because that's where the money is. So you have to go where the power is, right. And that's the foundations. And so you have to, you can't you can't say I don't have to deal with money. I don't have to deal with all this, you have to figure out how to how to move that. Yeah.

Kelly Ranum

I do think with, you know, the foundations, it is a spot that has, you know, the finances that you can actually directly go to and apply for right, versus trying governmental funds. And, but I think sometimes, maybe if it was true community activists from the community that were the ones that were listened to, for this funding, and then not just give the check, but how about giving them some assistance on how to set the business side of things up, maybe you have this brilliant idea of how you can help your community, but you don't have a college degree that how to establish an entrepreneurial business and how to set it up and what the HR things are, and what are the legal things. And so I mean, I think not writing a check, but really helping people to do the work, or providing the resources to them to do the work. Because they are connected, you know, the more money I agree power money, they have connection they have. They have the knowledge that, you know, sometimes people that just want to do good work don't have. And I think that would be very powerful to connect it.

Joia Jefferson Nuri

Mm hmm. So to have mentoring, along with the check, it comes in manpower, along with the check that sounds really empowering for the community that would that would empower any entrepreneur, maybe more small businesses wouldn't fail, and there would be more money in their community, you know, since small businesses fuel our economy, but people don't know how not to get tripped up by the IRS or not to be tripped up by Bank of America. So they don't know what they you know, they don't know what the doctor said. They don't know what they don't know. Until somebody who knows what they don't know, can come in and and help them. It seems like we what we've done in this nearly 45 minutes we've been on the air, we've expanded what coworker looks like, you know, really beyond what I listed in the beginning, with the co workers, co working has to have so many different lead layers. Oh, any comments on that?

Dr. Zack Berger

I think understanding that we're all working. You know, we're all workers and in a capitalist economy, and patients, you know, this is an important point that Victor Montori, who is a researcher and clinician at the Mayo Clinic has made a lot that being a patient is uncompensated labor, is the amount of effort it takes just to like, just think about diabetes, right? It's checking your sugar all the time and managing your diet and picking up your meds and seeing the doctor and a specialist. Right. And that's a compared as a chronic disease. That's not all that exotic, but the amount of work, right. So thinking about what it means to collaborate with people, and recognizing the value of their uncompensated labor, I think is a really important point.

Joia Jefferson Nuri

Exactly. Exactly. Kelly.

Kelly Ranum

Yeah, I also kind of wondering, you know, Aren't there other models out there that exist in other countries that are successful, that maybe we could learn from a little bit more so off your question, but just sort of popped into my head? It just seems like we always think we have to have the answers. And we try to stay within the confines of what our system already is, instead of looking outside of what it could be.

Joia Jefferson Nuri

So I don't know. Doctor, Dr. Berger, do American does American medicine go look for models from around the world that you've heard of?

Dr. Zack Berger

I guess the short answer is no. Not generally not. I think there's a lot of I just take the example of Medicare for all or single single payer health care. There are plenty of countries doing different things right. And, and in certain political circles, it is really not allowed to talk about Canada or the UK or France or Germany, right or Singapore or right? Or, or, you know, a number of countries in Africa or Australia where we can't can't mention them.

Joia Jefferson Nuri

Is that because everybody thinks they suck? Or we're just politically? We're the best? We're the best. We're number one. We're number one.

Dr. Zack Berger

Yeah, that's a good question. I think. Yeah, I think there's a lot of exceptionalism, right, like the US is better, even though they've never say we're not. Right. So I think that's definitely part of it.

Joia Jefferson Nuri

Yeah, yeah. There's a quote that came to me in the research from our producers that I want to read to both of you and see what your response is. It's by Well, Sandro Gala, Dr. Gallia. So Sandra Gallia, the pieces called well, to overcome the challenge of special interests that work against the conditions that create health, we need to extend the sphere of what we talk about when we talk about health. So that our conversation includes factors like money, power, love, hate, culture, the environment, and politics. So I think I should have read this earlier, because I talked about all of those things. But it seems that you two aren't the only ones thinking about this. Obviously, there are other people in the medical profession are thinking about this. I still remain only a patient, not a healthcare provider. And I still remain What did you call it healthy? I have healthy mistrust of the people who care for me. And I'm reaching an age where I need either to have an advocate with me, not that I can answer at all, but I always walk away from a doctor's appointment, 12 questions, you know, because I can only see the doctor for six minutes. So there have been times when the doctor went to leave the room and I grabbed her arm. But now I pay a lot for this insurance. Right? To have world class health care in this country.

Dr. Zack Berger

So difficult of you.

Joia Jefferson Nuri

I just don't know what's gonna cost but I need six more minutes to laugh and she stayed. You know, like, I'll write you a check any more time. Right. So I do have that healthy mistrust. I just I know we're running short on time, we want to get to audience questions. But I want to bring in the Covid 19 vaccine. I live in a community of people who are skeptical of it. I've had both shots, I'm skeptical of a booster. And people are not getting their children vaccinated for fear of this is not really a vaccine. This is because there's no live virus in it. And in this healthy mistrust, in in reimagining the trust, or the lack of trust we had, what does this period of time mean to both of you when the vaccine is the number one political issue right now. And I'll start with you, Kelly, and then go to you Dr. Berger.

Kelly Ranum

So we are seeing it in community here. Shortly. Louisiana has some very low vaccination rates. And I think people like to blame it on us being a red state per se. But a lot of that when you get into the community is in the African American community. The questions, the mistrust, is this Tuskegee all over again. And are you really trying to help me Are you experimenting with me again, and, and I, we've seen it and it's actually has a negative effect on the donation side too. So that when we are in the hospitals, there's this whole COVID Miss trust piece, and then we get put into the mix. And you know, in cases where it's it's possible to be a donor. And we're finding now where we didn't see, you know, in 2019. We're seeing these declines in in our African American authorization rates on donation. The staff haven't changed. They have more training, actually more years under their belt, the hospitals are the same with their staff only now there may be not as one on one or time given to patients. And really that one factor is COVID and all of the mistrust that surrounds it as you know as a virus and then the vaccine itself. I see it within my staff So it is it is bringing up some old thought processes. And at least in my view, it's making that Miss trust even greater.

Joia Jefferson Nuri

I think it said that people don't want to give the gift of life because of the mishandling of the information around this.

Kelly Ranum

Yeah, they're they're tying, tying it together,

Joia Jefferson Nuri

Tying it together. Dr. Berger, your response about COVID. And this vaccine and the missed healthy mistrust. And what do you see?

Dr. Zack Berger

I mean, I think a lot of the issues relating to COVID. And vaccinations are pre existing, and not the disease itself. But people's willingness, or as I mentioned, before, the constraint on their choices that that makes them choose certain things. You know, you mentioned that the political discussion is all about vaccines. That's absolutely right. And that's a real shame. Because, as we learned back in 2020, which seems like an age ago, but was only 2020, right? There's lots of things that can shoot the pandemic, right? If you have to work, and you can stay home, right? If you're taking care of somebody who's sick, if you yourself can't take time off work, if you don't have enough food, or if your housing is unstable, or you can't make it to the doctor, right, all these things, right. And there was a brief time there where politicians were actually talking about economic stimuli and sending people checks. But that seems to have been forgotten. Right? I'm not hearing that. They got tired, right? That's exactly right.

Joia Jefferson Nuri

Thinking about it, so that's exactly right. No, no, you're, you're right on MSNBC help you economically anymore, because...

Dr. Zack Berger

That's right. And that's why the line is the vaccine matters the most even when you hear even Omacron, right, the new variant that we're all scared about and rightly worried, I think Biden's responses. We have a plan as more boosters. Yeah. And he has some other things in the plan, too. It's really vaccine centric. So. So I think people understand really, when you're telling them to do something, go get vaccinated, but you're not offering them anything. Right. There's a mismatch. There's a mismatch.

Joia Jefferson Nuri

Before you want me to go get vaccinated, and then you tell me a month and a half later, I need to get vaccinated again, you're nuts, right? We everything that I know to make an intelligent choice. I'm gonna I want to open it up now. Thank you both very much. I want to open it now to our audience. And Erika, Do we have questions from the audience?

Erika Christie

Yes, we do. Our first question, can those that refuse vaccination get on the donor list? If not, do you have thoughts about this? And how does this impact trust?

Kelly Ranum

So on the donation side, we actually doesn't vaccination status really isn't even looked at if you're a donor. Now, an active case of COVID, depending on the time frames, could rule you out for organ donation. But there are more and more transplant centers that are starting to transplant some of the organs particularly liver and kidneys, on a patient that you know, hadn't had the infection, but it's not in that 1014 day window. And their test results are show a lower level of the virus present. So on the transplant side, I have heard that, you know, there are various transplant centers, I don't know that it's reached every Transplant Center, but that if you're not vaccinated, you won't be listed. And it comes to that. I don't think I don't know if it's universal just yet. But that has been talked about and certainly seen some media pieces where people wouldn't be listed because of it. But I you know, I they're immunocompromised when they do get the organ, it's such a rare gift. And, you know, should you do everything to take care of that kind of wax and wane. I hope that when people do get organs, that they do everything that they can to take care of it for themselves. And then you know, there's a little selfish part for me, because I really post on my donor families all the time. But I don't know that in my mind that that's a reason not to be transplanted or not to be listed. Just don't think that that's fair.

Joia Jefferson Nuri

Dr. Berger, do you have any response to that at all? Any comment on that at all?

Dr. Zack Berger

Obviously, I don't have the expertise in the transplant world. But I would say there's a law, a pretty significant literature on what makes somebody a good recipient candidate. And oftentimes, what we think makes someone not a great candidate turns out not to be the case. So I'm thinking about people that have substance use disorders, right. There's a lot of literature about If you're still drinking, right, you shouldn't get a liver. Right. And there's, there's similar to indicate that's not necessarily the case. So trying to understand where people are coming from. I got I am a big believer in vaccinations. And I think it's a, it's an it's an easy call from for me personally. And I'm a big believer in trying to make them easy rather than trying to before trying to make them mandated. But so that's that's my thoughts.

Joia Jefferson Nuri

Thank you. Erika, do we have any other questions?

Erika Christie

Yes, we do. From your experience, what would be a recommended forum for all participants within the healthcare system to begin the process of CO work? And can we level the playing field to get the conversation started?

Dr. Zack Berger

Dr. Berger? It's a great question. I think a forum has to be in the real world and the organizations where the work is taking place. I think conversations like this are very important. I think conferences and meetings are very important. But I think unless you have real conversations about with real stakes, and the places we're talking about, so just to give an example, right? What would it mean for an organization to allow open conversations about pay rates for the least paid workers? Right? That'd be a real conversation. You could get get people feeling bad, unfortunately. Right? You get people pointing fingers. Right. But that's co work. As, as my co panelists are said, right, as messy. And that would be messy.

Joia Jefferson Nuri

Yeah. But necessary. Unnecessary. Kelly?

Kelly Ranum

I yeah, I think you have to have this messy conversations in order to get past the the roadblocks we're at now. And I I do think how do you, you want to get to the people that actually want to do the work? And I think sometimes I love conferences, when they're valuable. And when I take nugget home, right, not when I just go and hear the same thing have heard over and over and over again. And so I think, and then you tend to see leadership at those conferences, and not the people that are, you know, in the, in the weeds and in the mud doing the work? And I think that's backwards, right? You know, do they even come home and spread it down? And out to everyone? And how do you make that available? So I think the conferences are great. But let's give those conferences to the people that are actually doing the work or want to do the work. And I think that's, that's the place to start. I know you have to have leadership and support and all of that that goes with it. But I think that that's where leaders need to recognize that you're not the be all and end all in this either. You need the teams, you need your staff support, you need your community support, and need the guy. Yeah, what does that look like? And I'm with you, that's the person I talked to, because I'm comfortable with I tell you, when I had my child, the only person that made me feel comfortable, and got through my tears that there that whole baby delivery thing was a certified nursing assistant, everybody else I kicked out of my room, and she's the one that stayed with me, and because she spoke to me like a human being, and just made me feel comfortable. And so I think that you overlook that human element. And I think those are the people that are going to move this process forward. That human element, the ones that aren't afraid to get dirty, the ones that aren't afraid to explain where they've been in their lives and what they see in their communities and what changes need to happen. And I think on the back end of that leadership needs to listen, whether you've experienced it in your life or not. You need to listen, you haven't, you know, been everywhere. And those, those are the staff that are really going to make the difference.

Joia Jefferson Nuri

Yeah. I love the fact that you both went back to Power to the people. Oh, we have time for maybe one more question. Erica, do we have one more?

Erika Christie

Yes, we do. So last question. We need to have communities experience wins along this journey in building trust, share a few actionable initiatives which would serve this need

Dr. Zack Berger

highly to think of some wins. So I mentioned one win where you know, when institutions giving more money to its community, I think that's a win. I think there is some real exciting work going on in the spaces of so in New York, I recently read about safe consumption spaces right. These are spaces where people with substance use or substance dependence can use the substances they need to use for their health in a protected and safe environment, I think it's an amazing thing. And you know, I, the incoming mayor of New York, for him to support that, I think that's a big thing. That's, that's a good, that's a real win for a community that really helps people living in the shadows. Take control of their own lives. And that's something that really requires you to to understand people's experiences. So that's, that's a good thing.

Kelly Ranum

I got the tough one, I think, know, whenever we have a patient that gets a kidney transplant, and it's somebody that had been on the list for five or plus years, and, and they're African American, and, you know, everything worked against them. And yet, here they are the success story. At the end of that transplant, I think we need to share more of that, you know, that there are opportunities for transplantation. And it can be successful, because I do think sometimes, dialysis patients don't see that it's ever going to be successful. Right. Like, I think that they think a life of dialysis is just what it is. And I have to live with that. And so I think maybe being able to show some, at least from the donation and transplant centers or transplantation side, that there can be wins for people, whether you're African American, whether you're Hispanic, whether you're Asian, Pacific Islander, whatever that is, that you can be transplanted, and it can work and whatever other things you think they don't exist, or maybe we can help you work through it. But it has to be through the eyes of the people that have actually experienced it, and not through my eyes, but through the actual recipient that sat at that, you know, dialysis center three days a week, and for five years and went through it and then be able to explain what it is to get a transplant because I think, you know, sometimes they know what dialysis is. They don't know what transpose transplantation is. And I think that can be scary when you're really cynical, or skeptical of anything in medicine. And so I think just showing those kinds of wins. I think being the clinics that we talked about, right, the local clinics, Boy, wouldn't it be fabulous if one of those could be established, and then you could really promote how successful I think New Mexico is actually done some things that.

Joia Jefferson Nuri

Unfortunately, running out of time, I could talk to the two of you for another hour. notebook here that has a list of other things we didn't even get to. So I'm hoping that the producers will invite the two of you together back again. I do want to thank all of our producers, Karim Ali, Samuel Shareef, and our wonderful Erika Christie, who manages all of us for being here today and for you to audience for coming in and listening and being part of our our conversation about reimagining the trust issue, the ethics issues around health and our health care givers to all of the people who live on the frontlines. A special thanks to you for that from the guy in a mop to the nursing assistant and the people who run the clinics. Special. Thank you. We thank you for your service. I'm Joia Jefferson Nuri. I was your navigator for today and it was my pleasure. Thank you all very much, and we'll see you in January.