1 00:00:07,410 --> 00:00:09,790 Hello and welcome to Perm Pods. 2 00:00:09,790 --> 00:00:12,265 I'm Dr. Imelda Dacones 3 00:00:12,265 --> 00:00:14,050 president and CEO of Northwest 4 00:00:14,050 --> 00:00:16,390 Permanente. In honor of 5 00:00:16,390 --> 00:00:18,070 World Health Day as 6 00:00:18,070 --> 00:00:20,065 well as Black Maternal Health Month. 7 00:00:20,065 --> 00:00:23,470 I am thrilled and pleased to be joined by 8 00:00:23,470 --> 00:00:25,720 a very special guest this morning to 9 00:00:25,720 --> 00:00:28,794 talk about the healthy birth initiative. 10 00:00:28,794 --> 00:00:31,330 Let's start with you, Dr. Davidson. 11 00:00:31,330 --> 00:00:33,250 Yes. Hi. Thank you. 12 00:00:33,250 --> 00:00:36,355 Dr. Dacones, My name is Autumn Davidson. 13 00:00:36,355 --> 00:00:40,060 I am an OBGYN doctor at Kaiser. 14 00:00:40,060 --> 00:00:42,025 I worked at East interstate. 15 00:00:42,025 --> 00:00:45,590 My formal specialty is in family planning, 16 00:00:45,590 --> 00:00:48,665 but I do a lot of general work as well 17 00:00:48,665 --> 00:00:50,570 and also work closely with women 18 00:00:50,570 --> 00:00:52,565 with substance use disorders. 19 00:00:52,565 --> 00:00:54,965 I've been working to help get 20 00:00:54,965 --> 00:00:57,050 the healthy birth initiative 21 00:00:57,050 --> 00:00:57,770 up and running at 22 00:00:57,770 --> 00:00:59,060 Kaiser it so thank you 23 00:00:59,060 --> 00:01:00,590 for letting me participate in 24 00:01:00,590 --> 00:01:03,455 this podcast and I look forward to 25 00:01:03,455 --> 00:01:06,830 our conversation that you're on. 26 00:01:06,830 --> 00:01:08,315 Hi, Dr. De conus. 27 00:01:08,315 --> 00:01:10,700 Thank you so much for having me here. 28 00:01:10,700 --> 00:01:12,155 My name is Roberta hand. 29 00:01:12,155 --> 00:01:14,780 I am a assistant professor in Child, 30 00:01:14,780 --> 00:01:16,925 Youth and Family Studies at Portland State. 31 00:01:16,925 --> 00:01:18,320 I am a researcher 32 00:01:18,320 --> 00:01:20,420 and I am a client 33 00:01:20,420 --> 00:01:21,740 of healthy birth initiative, 34 00:01:21,740 --> 00:01:24,290 a two-time client and got 35 00:01:24,290 --> 00:01:27,005 to work with healthy burst initiative around 36 00:01:27,005 --> 00:01:29,975 racism related stress and how 37 00:01:29,975 --> 00:01:33,245 it impacts how black women talk about 38 00:01:33,245 --> 00:01:36,380 its impacts on our pregnancies and how 39 00:01:36,380 --> 00:01:40,445 HBI helps as a mitigation against that. 40 00:01:40,445 --> 00:01:41,480 Great. 41 00:01:41,480 --> 00:01:43,205 Again, thank you both for joining us 42 00:01:43,205 --> 00:01:46,565 today to really educate. 43 00:01:46,565 --> 00:01:49,040 And I'll forgive us an update on 44 00:01:49,040 --> 00:01:51,230 where healthy birth it's going. 45 00:01:51,230 --> 00:01:52,655 And for our listeners, 46 00:01:52,655 --> 00:01:54,260 if you might be wondering why are we 47 00:01:54,260 --> 00:01:56,585 talking about that as you know, 48 00:01:56,585 --> 00:01:59,270 in our KP strategy 49 00:01:59,270 --> 00:02:01,280 as well at Northwest Farm strategy 50 00:02:01,280 --> 00:02:02,990 for social practice and 51 00:02:02,990 --> 00:02:04,670 really incorporating 52 00:02:04,670 --> 00:02:06,500 social determinants of health. 53 00:02:06,500 --> 00:02:08,975 Everything we do, whether in terms of 54 00:02:08,975 --> 00:02:10,700 providing the holistic care 55 00:02:10,700 --> 00:02:11,960 for our patients and members, 56 00:02:11,960 --> 00:02:14,945 but certainly in partnering with 57 00:02:14,945 --> 00:02:18,815 Q towards wildlife in their path to wellness. 58 00:02:18,815 --> 00:02:21,110 It also kicks and tie to 59 00:02:21,110 --> 00:02:25,100 our equity inclusion diversity strategies. 60 00:02:25,100 --> 00:02:29,780 And lastly, we really begin to 61 00:02:29,780 --> 00:02:34,024 integrate more the total health perspective 62 00:02:34,024 --> 00:02:36,260 for our patients and members. 63 00:02:36,260 --> 00:02:38,300 And I love the healthy birth initiative. 64 00:02:38,300 --> 00:02:39,950 I know HBI for some of 65 00:02:39,950 --> 00:02:42,425 you mean hospital-based Internet. 66 00:02:42,425 --> 00:02:45,530 And we're going to say HBI here for a moment, 67 00:02:45,530 --> 00:02:47,600 is an executive summary. 68 00:02:47,600 --> 00:02:49,700 For example, the highlight 69 00:02:49,700 --> 00:02:52,460 the reproductive oppression among 70 00:02:52,460 --> 00:02:54,560 black women and the mission to 71 00:02:54,560 --> 00:02:57,575 combat oppression to produce, 72 00:02:57,575 --> 00:03:00,545 to lead to reproductive justice. 73 00:03:00,545 --> 00:03:02,690 So maybe Dr. Frank, 74 00:03:02,690 --> 00:03:05,135 he could speak to what 75 00:03:05,135 --> 00:03:08,120 HBI is to you and really to 76 00:03:08,120 --> 00:03:10,520 the project and the y 77 00:03:10,520 --> 00:03:11,750 between you and Dr. 78 00:03:11,750 --> 00:03:14,255 David Finland and why we're doing this. 79 00:03:14,255 --> 00:03:15,245 Great. 80 00:03:15,245 --> 00:03:18,905 Thank you. So healthy birth Initiative 81 00:03:18,905 --> 00:03:22,865 is a acrocentric program. 82 00:03:22,865 --> 00:03:24,755 Nurse there was a Nurse-Family 83 00:03:24,755 --> 00:03:25,985 Partnership Program 84 00:03:25,985 --> 00:03:27,635 from NOMA county. 85 00:03:27,635 --> 00:03:31,460 And it started to really address 86 00:03:31,460 --> 00:03:34,355 disparities around black maternal health 87 00:03:34,355 --> 00:03:36,710 and black infant morbidity. 88 00:03:36,710 --> 00:03:39,650 And so what it does, 89 00:03:39,650 --> 00:03:43,025 the criteria for being in HBI 90 00:03:43,025 --> 00:03:44,855 at the moment is that you need to have 91 00:03:44,855 --> 00:03:47,000 what NOMA county address. 92 00:03:47,000 --> 00:03:48,020 You need to be black 93 00:03:48,020 --> 00:03:49,280 and you need to be pregnant. 94 00:03:49,280 --> 00:03:50,720 Because what we know is 95 00:03:50,720 --> 00:03:52,730 that black people who can, 96 00:03:52,730 --> 00:03:54,035 who can become pregnant 97 00:03:54,035 --> 00:03:56,495 regardless of their income status, 98 00:03:56,495 --> 00:03:59,990 experience disproportionate health outcomes 99 00:03:59,990 --> 00:04:03,740 in pregnancy and postpartum. 100 00:04:03,740 --> 00:04:06,965 And so they bring nurses, 101 00:04:06,965 --> 00:04:09,575 black nurses into the home. 102 00:04:09,575 --> 00:04:12,290 And from when someone is pregnant. 103 00:04:12,290 --> 00:04:14,645 So at any point in someone's pregnancy, 104 00:04:14,645 --> 00:04:16,415 they can be connected with 105 00:04:16,415 --> 00:04:18,710 a healthy birth initiative nurse 106 00:04:18,710 --> 00:04:20,120 or community health worker. 107 00:04:20,120 --> 00:04:21,665 And that nurse, 108 00:04:21,665 --> 00:04:22,910 our community health worker will 109 00:04:22,910 --> 00:04:24,140 meet with that person once a 110 00:04:24,140 --> 00:04:27,650 month as they go through their pregnancy 111 00:04:27,650 --> 00:04:31,445 and once a month for 18 months after birth. 112 00:04:31,445 --> 00:04:34,820 And the HBI provides goal planning, 113 00:04:34,820 --> 00:04:38,285 transportation, respite care, advocacy, 114 00:04:38,285 --> 00:04:39,694 family planning, 115 00:04:39,694 --> 00:04:42,560 mental health support, breastfeeding support, 116 00:04:42,560 --> 00:04:44,450 father engagement opportunities, 117 00:04:44,450 --> 00:04:46,640 multigenerational involvement, 118 00:04:46,640 --> 00:04:48,335 childbirth classes. 119 00:04:48,335 --> 00:04:49,520 And I I really, 120 00:04:49,520 --> 00:04:51,350 I give like major props to 121 00:04:51,350 --> 00:04:53,300 their childbirth classes because 122 00:04:53,300 --> 00:04:55,865 those childbirth classes are about education. 123 00:04:55,865 --> 00:04:58,040 But they're also really informing people of 124 00:04:58,040 --> 00:04:59,420 their rights as they 125 00:04:59,420 --> 00:05:01,280 come into the birth experience. 126 00:05:01,280 --> 00:05:02,765 And also working with us 127 00:05:02,765 --> 00:05:05,930 around what can go wrong, right? 128 00:05:05,930 --> 00:05:07,010 What are the things that we need 129 00:05:07,010 --> 00:05:08,360 to pay attention to? 130 00:05:08,360 --> 00:05:10,250 What, what, why do we need to think about 131 00:05:10,250 --> 00:05:11,930 blood pressure if we're going 132 00:05:11,930 --> 00:05:14,090 into a birth and we want one kind of birth. 133 00:05:14,090 --> 00:05:15,710 But why do we need to make 134 00:05:15,710 --> 00:05:17,180 space for other things to 135 00:05:17,180 --> 00:05:20,510 happen while also holding our birth plan. 136 00:05:20,510 --> 00:05:22,775 And really thinking about 137 00:05:22,775 --> 00:05:25,580 how the experience of birth 138 00:05:25,580 --> 00:05:27,470 and postpartum can be 139 00:05:27,470 --> 00:05:30,755 empowering as opposed to disempowering. 140 00:05:30,755 --> 00:05:33,140 They, and they are also working 141 00:05:33,140 --> 00:05:35,600 directly with social workers and 142 00:05:35,600 --> 00:05:38,210 doctors to help people 143 00:05:38,210 --> 00:05:41,780 get the best wraparound care that they can. 144 00:05:41,780 --> 00:05:45,440 Wow, that's incredible. I deck you Davidson. 145 00:05:45,440 --> 00:05:49,910 I know that you are essentially imported that 146 00:05:49,910 --> 00:05:52,370 are integrated that in collaboration and 147 00:05:52,370 --> 00:05:54,860 through our drive local initiative, 148 00:05:54,860 --> 00:05:56,450 I can eat the queue. 149 00:05:56,450 --> 00:05:58,745 How we're connecting the dots with 150 00:05:58,745 --> 00:06:02,900 our community partners into KP Northwest? 151 00:06:02,900 --> 00:06:04,280 Yes. Thank you. 152 00:06:04,280 --> 00:06:05,630 And I will do want to 153 00:06:05,630 --> 00:06:07,425 just kind of give credit to 154 00:06:07,425 --> 00:06:09,770 Nicole freedmen because she has also been 155 00:06:09,770 --> 00:06:12,350 the one who did the nuts and bolts of this, 156 00:06:12,350 --> 00:06:14,420 but I was kind 157 00:06:14,420 --> 00:06:15,680 of advocating and tickling 158 00:06:15,680 --> 00:06:16,640 for this to happen. 159 00:06:16,640 --> 00:06:18,770 So thank you. Yeah. 160 00:06:18,770 --> 00:06:21,920 I would really highlight kinda going 161 00:06:21,920 --> 00:06:25,430 on what DR. dr. Hahn Ted mentioned. 162 00:06:25,430 --> 00:06:28,025 She gave a really good background of 163 00:06:28,025 --> 00:06:32,195 why healthy birth initiatives exists. 164 00:06:32,195 --> 00:06:36,485 And as a white OB-GYN provider, 165 00:06:36,485 --> 00:06:39,320 I am keenly aware of 166 00:06:39,320 --> 00:06:43,010 the racial disparities in health outcomes, 167 00:06:43,010 --> 00:06:45,334 both maternal and infant. 168 00:06:45,334 --> 00:06:47,600 Unfortunately we have in 169 00:06:47,600 --> 00:06:50,120 this country just a really long history of 170 00:06:50,120 --> 00:06:52,430 medical racism that results 171 00:06:52,430 --> 00:06:54,620 in these racism related disparities. 172 00:06:54,620 --> 00:06:56,720 And also, I can 173 00:06:56,720 --> 00:06:58,790 see with my interactions with clients that 174 00:06:58,790 --> 00:07:01,280 there is some level of distrust 175 00:07:01,280 --> 00:07:04,625 between people of different races, 176 00:07:04,625 --> 00:07:06,110 particularly because we have 177 00:07:06,110 --> 00:07:10,190 a primarily white provider, provider force. 178 00:07:10,190 --> 00:07:13,610 And so I can explain how this kind of came to 179 00:07:13,610 --> 00:07:15,125 my doorstep and why 180 00:07:15,125 --> 00:07:17,705 I found this to be so important. 181 00:07:17,705 --> 00:07:21,200 My experience with HBI started just last 182 00:07:21,200 --> 00:07:23,030 summer when I had 183 00:07:23,030 --> 00:07:25,940 a patient who was referred to me. 184 00:07:25,940 --> 00:07:29,090 She had had a prior C-section 185 00:07:29,090 --> 00:07:30,590 and who was really interested in 186 00:07:30,590 --> 00:07:32,525 having a vaginal delivery? 187 00:07:32,525 --> 00:07:33,920 I'm she had a couple other 188 00:07:33,920 --> 00:07:35,570 medical conditions, 189 00:07:35,570 --> 00:07:37,895 notably diabetes. 190 00:07:37,895 --> 00:07:40,340 Incidentally, she also had a breech baby 191 00:07:40,340 --> 00:07:41,450 which can make it harder to have 192 00:07:41,450 --> 00:07:42,710 a vaginal delivery. 193 00:07:42,710 --> 00:07:46,400 But she came to me around 35 weeks and she 194 00:07:46,400 --> 00:07:48,410 wanted to talk about 195 00:07:48,410 --> 00:07:51,349 her likelihood of having a vaginal birth. 196 00:07:51,349 --> 00:07:53,900 We spoke and we did our regular I 197 00:07:53,900 --> 00:07:56,420 did my regular consultation with 198 00:07:56,420 --> 00:07:57,680 somebody who is interested in 199 00:07:57,680 --> 00:07:59,450 having a vaginal delivery after 200 00:07:59,450 --> 00:08:02,120 a prior C-section and then sent her back to 201 00:08:02,120 --> 00:08:04,910 her to her regular routine providers 202 00:08:04,910 --> 00:08:08,150 and was surprised about two weeks later 203 00:08:08,150 --> 00:08:10,760 she came into my clinic again and this 204 00:08:10,760 --> 00:08:12,545 time she had her 205 00:08:12,545 --> 00:08:14,690 healthy birth initiative nurse advocate 206 00:08:14,690 --> 00:08:15,740 there with 207 00:08:15,740 --> 00:08:22,474 her to participate in our in her visit. 208 00:08:22,474 --> 00:08:23,570 And I was really 209 00:08:23,570 --> 00:08:26,120 surprised because her advocate spoke up 210 00:08:26,120 --> 00:08:28,355 and explained to me that 211 00:08:28,355 --> 00:08:30,364 this particular patient 212 00:08:30,364 --> 00:08:32,030 was really concerned because 213 00:08:32,030 --> 00:08:34,460 her primary goal was 214 00:08:34,460 --> 00:08:36,680 to have a vaginal delivery and she 215 00:08:36,680 --> 00:08:39,200 had a number of barriers that we're 216 00:08:39,200 --> 00:08:40,490 going to make it harder for her 217 00:08:40,490 --> 00:08:41,900 to have a vaginal delivery, 218 00:08:41,900 --> 00:08:43,550 but that's really she wanted 219 00:08:43,550 --> 00:08:45,590 that experience and her reproductive life. 220 00:08:45,590 --> 00:08:48,035 This was going to be her last pregnancy. 221 00:08:48,035 --> 00:08:49,100 And it was really 222 00:08:49,100 --> 00:08:50,660 important to her that she did 223 00:08:50,660 --> 00:08:53,599 everything she could to maximize 224 00:08:53,599 --> 00:08:54,830 the chances that she 225 00:08:54,830 --> 00:08:57,200 would could avoid a C-section. 226 00:08:57,200 --> 00:08:58,550 And what her healthy birth 227 00:08:58,550 --> 00:09:00,110 initiative advocate explained to 228 00:09:00,110 --> 00:09:03,425 me was that she felt 229 00:09:03,425 --> 00:09:05,840 that in her interactions 230 00:09:05,840 --> 00:09:07,130 with the other providers 231 00:09:07,130 --> 00:09:09,680 that really the focus was on out some of 232 00:09:09,680 --> 00:09:12,410 her other medical co-morbidities. 233 00:09:12,410 --> 00:09:13,700 There was a huge focus on 234 00:09:13,700 --> 00:09:16,400 her diabetes and she had 235 00:09:16,400 --> 00:09:18,440 some other medical conditions and she 236 00:09:18,440 --> 00:09:19,520 really felt like this 237 00:09:19,520 --> 00:09:20,810 was not being addressed. 238 00:09:20,810 --> 00:09:23,480 Her perception was that 239 00:09:23,480 --> 00:09:25,880 this wasn't being taken seriously. 240 00:09:25,880 --> 00:09:27,410 And so when I heard that it made 241 00:09:27,410 --> 00:09:29,570 me really kind of heighten 242 00:09:29,570 --> 00:09:31,220 my concern and we worked very 243 00:09:31,220 --> 00:09:33,590 hard to work with it. 244 00:09:33,590 --> 00:09:37,040 Inpatient team with the nurses and the docs 245 00:09:37,040 --> 00:09:37,850 that we're going to be on 246 00:09:37,850 --> 00:09:38,690 at the time when she 247 00:09:38,690 --> 00:09:40,580 was coming in for her delivery. 248 00:09:40,580 --> 00:09:44,480 And ultimately, against all odds, 249 00:09:44,480 --> 00:09:47,090 she had like a three-day induction. 250 00:09:47,090 --> 00:09:49,610 She had a breech baby that was turned 251 00:09:49,610 --> 00:09:51,320 despite her diabetes and 252 00:09:51,320 --> 00:09:53,345 despite her prior C-section. 253 00:09:53,345 --> 00:09:55,280 She wound up with a vaginal delivery 254 00:09:55,280 --> 00:09:56,540 and she was so happy with that. 255 00:09:56,540 --> 00:09:59,210 But really, after that experience, 256 00:09:59,210 --> 00:10:00,680 I was able to connect with 257 00:10:00,680 --> 00:10:04,280 the HBI nurses and realize that 258 00:10:04,280 --> 00:10:05,510 they are one of 259 00:10:05,510 --> 00:10:09,110 the huge assets to this organization, 260 00:10:09,110 --> 00:10:12,170 to this, to this group is that they really 261 00:10:12,170 --> 00:10:13,880 focus on education and 262 00:10:13,880 --> 00:10:16,445 advocacy on behalf of black women. 263 00:10:16,445 --> 00:10:19,205 And just kind of 264 00:10:19,205 --> 00:10:21,410 threw that encouragement is Dr. Hunt was 265 00:10:21,410 --> 00:10:22,610 saying through that education to 266 00:10:22,610 --> 00:10:24,950 the advocacy are really able to 267 00:10:24,950 --> 00:10:27,050 hone in on helping women 268 00:10:27,050 --> 00:10:29,240 decide what is it that is 269 00:10:29,240 --> 00:10:31,970 important to them and how can we realize 270 00:10:31,970 --> 00:10:35,775 those experiences in their reproductive life. 271 00:10:35,775 --> 00:10:38,560 Wow, thank you. Thank you for those specific. 272 00:10:38,560 --> 00:10:40,915 And I might turn now to Dr. 273 00:10:40,915 --> 00:10:43,630 haunt again about, you know, what? 274 00:10:43,630 --> 00:10:45,520 There are many recommendations and 275 00:10:45,520 --> 00:10:48,385 learning from the experience 276 00:10:48,385 --> 00:10:51,640 far with HBI and I 277 00:10:51,640 --> 00:10:55,915 wonder if we were to bucket it in Q3 thing, 278 00:10:55,915 --> 00:10:57,700 what would be your most 279 00:10:57,700 --> 00:11:00,100 salient or toppled mind? 280 00:11:00,100 --> 00:11:03,205 Perhaps prescription Dr. Hahn for 281 00:11:03,205 --> 00:11:04,960 prediction clinicians who are 282 00:11:04,960 --> 00:11:07,585 listening to the Secondly, 283 00:11:07,585 --> 00:11:10,870 in terms to advocacy and policy. 284 00:11:10,870 --> 00:11:12,805 And then lastly or thirdly, 285 00:11:12,805 --> 00:11:15,129 society and the whole. 286 00:11:15,129 --> 00:11:21,725 How we lean in lie, or those who, 287 00:11:21,725 --> 00:11:23,960 who are black, how 288 00:11:23,960 --> 00:11:27,560 to support others and 289 00:11:27,560 --> 00:11:29,120 really support them felt. 290 00:11:29,120 --> 00:11:30,875 All right that did the kindness. 291 00:11:30,875 --> 00:11:33,030 As a big question. 292 00:11:33,700 --> 00:11:35,390 Well, maybe we can 293 00:11:35,390 --> 00:11:37,115 relate Brit corruption, physician, 294 00:11:37,115 --> 00:11:39,815 clinician, you know what your coupled mine, 295 00:11:39,815 --> 00:11:43,385 pretty good plan for them to be advocates, 296 00:11:43,385 --> 00:11:46,940 allied and really helped us for this period. 297 00:11:46,940 --> 00:11:49,415 So one of the things that I want physicians, 298 00:11:49,415 --> 00:11:52,325 everybody to hold is 299 00:11:52,325 --> 00:11:53,450 the four tenants of 300 00:11:53,450 --> 00:11:55,295 sexual and reproductive justice. 301 00:11:55,295 --> 00:11:57,440 So that is supporting 302 00:11:57,440 --> 00:12:00,275 the bodily autonomy as people. 303 00:12:00,275 --> 00:12:03,410 The right to not have a child, 304 00:12:03,410 --> 00:12:05,900 the right to have a child, 305 00:12:05,900 --> 00:12:07,670 and the right to parent the children, 306 00:12:07,670 --> 00:12:09,365 rehab and sustainable 307 00:12:09,365 --> 00:12:11,195 and safe environments free 308 00:12:11,195 --> 00:12:15,320 of coercion and community violence, right? 309 00:12:15,320 --> 00:12:16,865 So one of the things that 310 00:12:16,865 --> 00:12:18,680 HBI is really holding very 311 00:12:18,680 --> 00:12:20,840 central is that black people 312 00:12:20,840 --> 00:12:22,295 deserve to be parents. 313 00:12:22,295 --> 00:12:23,930 And if they want to be apparent, 314 00:12:23,930 --> 00:12:26,105 they want to work with them to do so. 315 00:12:26,105 --> 00:12:28,610 Right? And on one hand you think, oh, well, 316 00:12:28,610 --> 00:12:30,995 you know, yeah, everybody's holding that. 317 00:12:30,995 --> 00:12:33,050 And the reality, our children are taken 318 00:12:33,050 --> 00:12:35,210 away from us at very young ages. 319 00:12:35,210 --> 00:12:37,910 Our children are killed through 320 00:12:37,910 --> 00:12:40,970 police brutality and through youth violence, 321 00:12:40,970 --> 00:12:43,730 which is really a systemic manifestation 322 00:12:43,730 --> 00:12:46,085 of racism and disenfranchisement. 323 00:12:46,085 --> 00:12:49,820 And so coming into the medical experience, 324 00:12:49,820 --> 00:12:51,710 black people are scared. 325 00:12:51,710 --> 00:12:54,455 And we don't necessarily 326 00:12:54,455 --> 00:12:57,440 trust that the doctors who are 327 00:12:57,440 --> 00:12:59,510 working with us and the medical people 328 00:12:59,510 --> 00:13:01,070 that are working with us are seeing 329 00:13:01,070 --> 00:13:02,540 us and hearing us or 330 00:13:02,540 --> 00:13:03,845 validating that 331 00:13:03,845 --> 00:13:05,315 when we say something's wrong, 332 00:13:05,315 --> 00:13:07,400 that something is wrong, right? 333 00:13:07,400 --> 00:13:09,470 So I think on one hand, 334 00:13:09,470 --> 00:13:11,360 absolutely, looking at issues 335 00:13:11,360 --> 00:13:13,505 of implicit bias is critical. 336 00:13:13,505 --> 00:13:16,000 And really for providers to, to, 337 00:13:16,000 --> 00:13:17,945 to really work on checking 338 00:13:17,945 --> 00:13:20,810 their assumptions around who is, 339 00:13:20,810 --> 00:13:22,115 who they are seeing. 340 00:13:22,115 --> 00:13:23,915 Because medical racism, 341 00:13:23,915 --> 00:13:27,620 biological racism is also an underpinning of, 342 00:13:27,620 --> 00:13:30,950 even though there's so much work to take 343 00:13:30,950 --> 00:13:35,195 racism out of the way we understand the body. 344 00:13:35,195 --> 00:13:38,540 And yet it's still there, right? 345 00:13:38,540 --> 00:13:40,010 And so really looking to 346 00:13:40,010 --> 00:13:42,980 challenge biological racism and, 347 00:13:42,980 --> 00:13:44,480 and seeing 348 00:13:44,480 --> 00:13:46,490 the full person who's coming to you. 349 00:13:46,490 --> 00:13:48,920 So one of the, I think one of 350 00:13:48,920 --> 00:13:50,030 the benefits have 351 00:13:50,030 --> 00:13:51,845 been building a relationship. 352 00:13:51,845 --> 00:13:55,805 Racial concordance really helps for Black 353 00:13:55,805 --> 00:13:57,635 pregnant people meeting with 354 00:13:57,635 --> 00:14:00,365 a black care worker. 355 00:14:00,365 --> 00:14:02,030 Often the HBI work or 356 00:14:02,030 --> 00:14:04,490 maybe the only black person that they engage 357 00:14:04,490 --> 00:14:05,689 with throughout 358 00:14:05,689 --> 00:14:08,975 their pregnancy and, and beyond. 359 00:14:08,975 --> 00:14:11,315 So I would say that for 360 00:14:11,315 --> 00:14:13,670 the health care providers from 361 00:14:13,670 --> 00:14:15,200 the women that I did 362 00:14:15,200 --> 00:14:16,940 focus groups with talking about 363 00:14:16,940 --> 00:14:19,430 racism related stress and 364 00:14:19,430 --> 00:14:21,920 its impact on pregnancies 365 00:14:21,920 --> 00:14:23,240 and how to address it. 366 00:14:23,240 --> 00:14:26,735 One, providers need to be aware that 367 00:14:26,735 --> 00:14:30,920 racism affects mental health and that you, 368 00:14:30,920 --> 00:14:33,035 as in within the medical system, 369 00:14:33,035 --> 00:14:35,405 you are engaging in the medical moment. 370 00:14:35,405 --> 00:14:36,800 And on one hand you can feel like, 371 00:14:36,800 --> 00:14:38,270 well that's just one moment. 372 00:14:38,270 --> 00:14:39,730 But they're 373 00:14:39,730 --> 00:14:41,960 experiencing racism when they leave. 374 00:14:41,960 --> 00:14:44,165 And, and so that 375 00:14:44,165 --> 00:14:45,350 it's experiencing 376 00:14:45,350 --> 00:14:46,700 could be interpersonal racism, 377 00:14:46,700 --> 00:14:48,275 could be structural racism. 378 00:14:48,275 --> 00:14:52,955 And so what we really want to think about is, 379 00:14:52,955 --> 00:14:55,130 and all of this has mental health. 380 00:14:55,130 --> 00:14:57,035 All of this weighs on us. 381 00:14:57,035 --> 00:14:58,565 And in weighing on us, 382 00:14:58,565 --> 00:15:00,455 it also causes weathering of our, 383 00:15:00,455 --> 00:15:02,030 of our organs, right? 384 00:15:02,030 --> 00:15:04,070 The, the weathering process 385 00:15:04,070 --> 00:15:05,330 is also what makes 386 00:15:05,330 --> 00:15:08,405 us more susceptible to illness. 387 00:15:08,405 --> 00:15:10,190 Postpartum preeclampsia, 388 00:15:10,190 --> 00:15:12,380 which I experienced diabetes, 389 00:15:12,380 --> 00:15:14,360 generational, gestational diabetes, 390 00:15:14,360 --> 00:15:15,695 and so forth and so on. 391 00:15:15,695 --> 00:15:18,170 So one of the things 392 00:15:18,170 --> 00:15:20,645 to really think about is 2, 393 00:15:20,645 --> 00:15:23,435 understand the need for holistic services, 394 00:15:23,435 --> 00:15:26,165 including advocacy on behalf and alongside 395 00:15:26,165 --> 00:15:28,700 black women and incorporating 396 00:15:28,700 --> 00:15:31,055 advocacy skills, training for clients. 397 00:15:31,055 --> 00:15:32,855 People need to know their rights. 398 00:15:32,855 --> 00:15:35,480 And the more that people can be empowered to 399 00:15:35,480 --> 00:15:38,105 know what is available to them, 400 00:15:38,105 --> 00:15:40,595 to know the different options that they, 401 00:15:40,595 --> 00:15:41,960 that they have for their care 402 00:15:41,960 --> 00:15:43,910 to be informed about 403 00:15:43,910 --> 00:15:46,490 why the medical system wants to do 404 00:15:46,490 --> 00:15:49,145 certain things like a flu shot, right? 405 00:15:49,145 --> 00:15:51,935 Or COVID or family planning. 406 00:15:51,935 --> 00:15:53,510 That to really think about, 407 00:15:53,510 --> 00:15:54,920 what does it look like to partner 408 00:15:54,920 --> 00:15:56,390 with as opposed to 409 00:15:56,390 --> 00:15:57,860 just giving someone something 410 00:15:57,860 --> 00:15:59,405 and saying, well, you're black. 411 00:15:59,405 --> 00:16:00,560 So therefore you're probably 412 00:16:00,560 --> 00:16:01,370 going to get diabetes, 413 00:16:01,370 --> 00:16:03,125 so you should do this. 414 00:16:03,125 --> 00:16:06,455 Um, and unfortunately, 415 00:16:06,455 --> 00:16:09,905 that experience happens, right? 416 00:16:09,905 --> 00:16:10,550 Yeah. 417 00:16:10,550 --> 00:16:12,170 So regularly seek 418 00:16:12,170 --> 00:16:13,790 education about the impact of 419 00:16:13,790 --> 00:16:15,200 non-health care systems on 420 00:16:15,200 --> 00:16:17,075 the health of black women and families. 421 00:16:17,075 --> 00:16:18,350 So when people were 422 00:16:18,350 --> 00:16:20,450 talking about their needs, 423 00:16:20,450 --> 00:16:21,770 their experiences 424 00:16:21,770 --> 00:16:23,945 with racism and the medical system. 425 00:16:23,945 --> 00:16:26,570 They're also talking about their fears for 426 00:16:26,570 --> 00:16:29,315 their other children who are going to school. 427 00:16:29,315 --> 00:16:32,930 Right. And one woman talked about when she 428 00:16:32,930 --> 00:16:35,525 engaged with the medical system 429 00:16:35,525 --> 00:16:36,890 that went okay. 430 00:16:36,890 --> 00:16:39,050 But at her child's school, 431 00:16:39,050 --> 00:16:40,850 they called CPS on her 432 00:16:40,850 --> 00:16:43,220 and said she wasn't beating her children. 433 00:16:43,220 --> 00:16:46,430 And she was she she was feeding her children, 434 00:16:46,430 --> 00:16:47,915 she taking care of her children. 435 00:16:47,915 --> 00:16:51,800 But at in that experience of giving birth, 436 00:16:51,800 --> 00:16:53,360 the other children that 437 00:16:53,360 --> 00:16:55,190 were threatened, right? 438 00:16:55,190 --> 00:16:56,630 And so I think there's 439 00:16:56,630 --> 00:16:58,970 this place where for black women, 440 00:16:58,970 --> 00:17:02,420 how can we be that we feel 441 00:17:02,420 --> 00:17:05,870 vulnerable at different points and are 442 00:17:05,870 --> 00:17:07,700 constantly trying to defend 443 00:17:07,700 --> 00:17:09,665 ourselves against a system 444 00:17:09,665 --> 00:17:11,120 that doesn't believe in 445 00:17:11,120 --> 00:17:13,940 our ability to manage our own lives. 446 00:17:13,940 --> 00:17:15,815 And what she said was, you know, 447 00:17:15,815 --> 00:17:18,410 I needed support, I needed 448 00:17:18,410 --> 00:17:21,410 care, I needed responsiveness. 449 00:17:21,410 --> 00:17:24,725 I didn't need some stranger to call 450 00:17:24,725 --> 00:17:28,460 CPS and threaten my family, right? 451 00:17:28,460 --> 00:17:30,500 So really thinking about 452 00:17:30,500 --> 00:17:31,730 black women and their health 453 00:17:31,730 --> 00:17:33,560 within larger social contexts, 454 00:17:33,560 --> 00:17:35,900 including racism and need 455 00:17:35,900 --> 00:17:38,120 for long-term stable resources. 456 00:17:38,120 --> 00:17:40,940 And I do discuss 457 00:17:40,940 --> 00:17:42,470 holistic needs and be prepared 458 00:17:42,470 --> 00:17:44,450 with information and resources. 459 00:17:44,450 --> 00:17:47,630 Invite key members of pregnant families and 460 00:17:47,630 --> 00:17:50,750 communities to support perinatal care, right? 461 00:17:50,750 --> 00:17:52,970 Like I think for a lot of black folks, 462 00:17:52,970 --> 00:17:54,380 it's not just our 463 00:17:54,380 --> 00:17:55,670 relationship with our doctor, 464 00:17:55,670 --> 00:17:57,200 it's our relationship with 465 00:17:57,200 --> 00:18:00,530 our community and making space for that. 466 00:18:00,530 --> 00:18:03,440 I think the more that healthcare providers 467 00:18:03,440 --> 00:18:04,520 can make 468 00:18:04,520 --> 00:18:05,870 deliberate outreach efforts 469 00:18:05,870 --> 00:18:06,800 to black communities, 470 00:18:06,800 --> 00:18:08,480 it's important implementing 471 00:18:08,480 --> 00:18:10,010 trauma-informed care and 472 00:18:10,010 --> 00:18:12,050 conflict resolution practices 473 00:18:12,050 --> 00:18:14,750 really work on de-escalation 474 00:18:14,750 --> 00:18:17,570 and relationship building, right? 475 00:18:17,570 --> 00:18:19,160 Because I think when people, 476 00:18:19,160 --> 00:18:21,470 a lot of times if people are coming into 477 00:18:21,470 --> 00:18:23,990 these medical moments, it's scary. 478 00:18:23,990 --> 00:18:25,490 People may be defensive. 479 00:18:25,490 --> 00:18:27,515 It can be hard to hear each other. 480 00:18:27,515 --> 00:18:29,825 So really working on like just 481 00:18:29,825 --> 00:18:34,670 de-escalating and, and listen. 482 00:18:34,670 --> 00:18:36,695 I think one of the things that, 483 00:18:36,695 --> 00:18:39,080 that I think as an ally, 484 00:18:39,080 --> 00:18:43,595 I am not so much interested in allyship. 485 00:18:43,595 --> 00:18:45,200 I am interested in us 486 00:18:45,200 --> 00:18:47,060 collectively working to dismantle 487 00:18:47,060 --> 00:18:49,790 racism and white supremacy because 488 00:18:49,790 --> 00:18:53,180 the reality is that it is killing all of us, 489 00:18:53,180 --> 00:18:54,980 but we just don't get it. 490 00:18:54,980 --> 00:18:58,250 And so I think the, 491 00:18:58,250 --> 00:19:00,515 the experiences that 492 00:19:00,515 --> 00:19:03,380 black women are experiencing, 493 00:19:03,380 --> 00:19:05,150 trust black women listened to 494 00:19:05,150 --> 00:19:06,830 black women and work 495 00:19:06,830 --> 00:19:10,055 with black women for change, right? 496 00:19:10,055 --> 00:19:11,810 I find when I talk about 497 00:19:11,810 --> 00:19:13,430 maternal health or when I talk 498 00:19:13,430 --> 00:19:14,330 about some of the issues 499 00:19:14,330 --> 00:19:15,335 affecting black women, 500 00:19:15,335 --> 00:19:17,510 white women will say, Well, yeah, I mean, I, 501 00:19:17,510 --> 00:19:19,050 I had a stillbirth or I, 502 00:19:19,050 --> 00:19:21,155 I had something happen. 503 00:19:21,155 --> 00:19:23,540 And and, and they'll say and they'll 504 00:19:23,540 --> 00:19:24,890 even talk about an experience 505 00:19:24,890 --> 00:19:26,405 where they were mistreated. 506 00:19:26,405 --> 00:19:27,800 But they will treat it like 507 00:19:27,800 --> 00:19:29,435 well that that happened. 508 00:19:29,435 --> 00:19:31,550 Like girl, get mad, 509 00:19:31,550 --> 00:19:34,370 get Mad, get active, right? 510 00:19:34,370 --> 00:19:37,580 Our country is not performing as 511 00:19:37,580 --> 00:19:39,050 well as it needs to 512 00:19:39,050 --> 00:19:40,970 in relation to maternal health. 513 00:19:40,970 --> 00:19:43,715 Like get it and work together. 514 00:19:43,715 --> 00:19:44,280 Yeah. 515 00:19:44,280 --> 00:19:45,980 And we will need to talk more. 516 00:19:45,980 --> 00:19:48,260 I mean, some of 517 00:19:48,260 --> 00:19:50,000 the condition clinic and 518 00:19:50,000 --> 00:19:51,770 listening to what you get. 519 00:19:51,770 --> 00:19:54,110 Essentially outline it prescriptions for 520 00:19:54,110 --> 00:19:57,260 action or them to own that plane. 521 00:19:57,260 --> 00:19:59,630 It blowing up minds right now. 522 00:19:59,630 --> 00:20:03,530 So on that note, before we close, 523 00:20:03,530 --> 00:20:06,365 I do want to give our friend and colleague, 524 00:20:06,365 --> 00:20:10,175 Nicole Friedman a patient's story 525 00:20:10,175 --> 00:20:12,680 to maybe knit it all together for us. 526 00:20:12,680 --> 00:20:14,240 Some of the things that we 527 00:20:14,240 --> 00:20:16,640 talked about today. Nicole. 528 00:20:16,640 --> 00:20:17,180 Yeah. 529 00:20:17,180 --> 00:20:18,650 Thank you, doctor, to kindness 530 00:20:18,650 --> 00:20:20,390 and thank you so much Dr. Hahn and 531 00:20:20,390 --> 00:20:22,550 Dr. Davidson for being on and 532 00:20:22,550 --> 00:20:25,190 sharing this important work to follow. 533 00:20:25,190 --> 00:20:26,930 This will be a one-pager 534 00:20:26,930 --> 00:20:28,610 for all the physicians who think they 535 00:20:28,610 --> 00:20:29,990 may have a patient who's 536 00:20:29,990 --> 00:20:32,465 eligible for this wonderful program. 537 00:20:32,465 --> 00:20:34,070 And we have a team of 538 00:20:34,070 --> 00:20:36,290 community health navigators and 539 00:20:36,290 --> 00:20:38,360 resource access specialists who have been 540 00:20:38,360 --> 00:20:41,000 trained from our healthy birth initiative, 541 00:20:41,000 --> 00:20:43,580 peers and team on 542 00:20:43,580 --> 00:20:45,020 how to outreach to patients, 543 00:20:45,020 --> 00:20:47,120 how to connect them to the services. 544 00:20:47,120 --> 00:20:48,560 And one thing that we are doing at 545 00:20:48,560 --> 00:20:50,360 Kaiser Permanente is we're not 546 00:20:50,360 --> 00:20:52,250 just referring the patient 547 00:20:52,250 --> 00:20:53,855 to healthy birth initiative. 548 00:20:53,855 --> 00:20:56,120 We're doing a standardized social health 549 00:20:56,120 --> 00:20:58,100 screening first so that we can 550 00:20:58,100 --> 00:21:00,440 understand kind of the holistic needs of 551 00:21:00,440 --> 00:21:01,595 the patients from a 552 00:21:01,595 --> 00:21:04,160 social and health equity perspective. 553 00:21:04,160 --> 00:21:06,050 And we had a patient Refer just 554 00:21:06,050 --> 00:21:08,525 yesterday for healthy birth initiative. 555 00:21:08,525 --> 00:21:10,865 And our Resource Access Center. 556 00:21:10,865 --> 00:21:12,410 A woman named Maryanne reached 557 00:21:12,410 --> 00:21:13,970 out to the patient to get our connected 558 00:21:13,970 --> 00:21:15,920 to the services and learned 559 00:21:15,920 --> 00:21:18,020 and their conversation that yes, 560 00:21:18,020 --> 00:21:19,130 she definitely wanted to be 561 00:21:19,130 --> 00:21:21,020 connected to healthy birth initiative. 562 00:21:21,020 --> 00:21:23,480 But she what she was most worried about today 563 00:21:23,480 --> 00:21:25,940 was for utility, assistance needs. 564 00:21:25,940 --> 00:21:27,590 Her she was at risk 565 00:21:27,590 --> 00:21:29,585 of having some of her water turned off, 566 00:21:29,585 --> 00:21:31,775 and she was also very behind on rent. 567 00:21:31,775 --> 00:21:33,290 So that was very stressful for her, 568 00:21:33,290 --> 00:21:34,985 unlikely for her pregnancy. 569 00:21:34,985 --> 00:21:36,710 So working with through 570 00:21:36,710 --> 00:21:37,970 our Thrive local network, 571 00:21:37,970 --> 00:21:39,455 we were able to provide 572 00:21:39,455 --> 00:21:41,150 emergency rent relief and 573 00:21:41,150 --> 00:21:43,520 utility assistance in addition 574 00:21:43,520 --> 00:21:44,630 to getting this patient 575 00:21:44,630 --> 00:21:46,340 connected to healthy birth initiative. 576 00:21:46,340 --> 00:21:47,930 So taking that kind of 577 00:21:47,930 --> 00:21:50,300 broader social health equity lens and 578 00:21:50,300 --> 00:21:52,790 approach is really what we 579 00:21:52,790 --> 00:21:54,200 need to do and is 580 00:21:54,200 --> 00:21:56,150 helping us build trust where we will 581 00:21:56,150 --> 00:21:57,620 not always have trust with 582 00:21:57,620 --> 00:21:59,990 the patient that we can get them 583 00:21:59,990 --> 00:22:00,710 connected to 584 00:22:00,710 --> 00:22:02,360 their immediate service needs and 585 00:22:02,360 --> 00:22:03,470 services to support 586 00:22:03,470 --> 00:22:05,375 their healthy pregnancy journey. 587 00:22:05,375 --> 00:22:07,625 So we are open for referrals. 588 00:22:07,625 --> 00:22:08,930 The team is ready and we're 589 00:22:08,930 --> 00:22:09,950 working very closely 590 00:22:09,950 --> 00:22:12,170 with our healthy birth Initiative partners 591 00:22:12,170 --> 00:22:14,420 to optimize the referral pathway 592 00:22:14,420 --> 00:22:16,955 to get more people connected to this program. 593 00:22:16,955 --> 00:22:18,680 Thank you so much, Nicole. 594 00:22:18,680 --> 00:22:20,690 And fertile again, thank you so much, 595 00:22:20,690 --> 00:22:22,595 Dr. Hahn, Dr. David. 596 00:22:22,595 --> 00:22:24,065 Thank you, Nicole. 597 00:22:24,065 --> 00:22:26,045 Appreciate the conversation. 598 00:22:26,045 --> 00:22:29,210 More a lot, lot more to talk about. 599 00:22:29,210 --> 00:22:32,000 I want to leave or listener with this. 600 00:22:32,000 --> 00:22:37,100 So earlier this week with Dr. Day, March 30? 601 00:22:37,100 --> 00:22:40,550 Yes. And and as part of my annual doctor's 602 00:22:40,550 --> 00:22:43,175 a ladder reflection of what we've 603 00:22:43,175 --> 00:22:46,100 gone through in March 30th, 604 00:22:46,100 --> 00:22:48,680 2020 and 2021. 605 00:22:48,680 --> 00:22:50,825 The pandemic, right? 606 00:22:50,825 --> 00:22:53,945 The, the social justice, 607 00:22:53,945 --> 00:22:55,670 racial justice reckoning 608 00:22:55,670 --> 00:22:57,065 that we've gone through. 609 00:22:57,065 --> 00:22:59,330 And, and I know many of our colleagues 610 00:22:59,330 --> 00:23:01,850 are ready for action. 611 00:23:01,850 --> 00:23:04,040 And I just, I just want to, 612 00:23:04,040 --> 00:23:06,680 with this wakefulness that's come upon 613 00:23:06,680 --> 00:23:10,115 a pause and reflect. 614 00:23:10,115 --> 00:23:11,930 Think about what you heard about 615 00:23:11,930 --> 00:23:13,580 today that it begins with 616 00:23:13,580 --> 00:23:15,350 implicit bias and 617 00:23:15,350 --> 00:23:18,590 really our own self awareness. 618 00:23:18,590 --> 00:23:21,110 Our own self awareness 619 00:23:21,110 --> 00:23:24,725 because we are always action-oriented. 620 00:23:24,725 --> 00:23:25,940 But before we do that, 621 00:23:25,940 --> 00:23:27,920 really understand where we're 622 00:23:27,920 --> 00:23:31,475 at in terms of racism. 623 00:23:31,475 --> 00:23:34,415 Because as you heard it today, you know, 624 00:23:34,415 --> 00:23:36,620 we all have inflicted by 625 00:23:36,620 --> 00:23:39,350 three then we contribute in some way, 626 00:23:39,350 --> 00:23:43,760 sometimes in many ways to the continuation. 627 00:23:43,760 --> 00:23:46,955 And so really the dismantle racism, 628 00:23:46,955 --> 00:23:50,135 the mantle rated them is very much in 629 00:23:50,135 --> 00:23:53,510 our lane position and condition. 630 00:23:53,510 --> 00:23:55,130 It if we didn't own it 631 00:23:55,130 --> 00:23:57,260 before to really move 632 00:23:57,260 --> 00:23:59,600 forward from this point on. 633 00:23:59,600 --> 00:24:01,685 And you hear a lot in 634 00:24:01,685 --> 00:24:03,320 healthcare policy 635 00:24:03,320 --> 00:24:05,479 and debate across the country. 636 00:24:05,479 --> 00:24:08,225 Politician, health plan, executive, 637 00:24:08,225 --> 00:24:10,730 businesses, CEO the businesses. 638 00:24:10,730 --> 00:24:12,905 But we need more physicians 639 00:24:12,905 --> 00:24:14,720 really owning and claiming 640 00:24:14,720 --> 00:24:16,835 that lane because because 641 00:24:16,835 --> 00:24:19,055 rated them not to eat, 642 00:24:19,055 --> 00:24:20,420 toxic to mental health, 643 00:24:20,420 --> 00:24:23,555 but it's toxic to biological health. 644 00:24:23,555 --> 00:24:25,160 And maternal health. 645 00:24:25,160 --> 00:24:27,335 And a baby healthy gets heard about it, 646 00:24:27,335 --> 00:24:29,300 it gets a subset of that. 647 00:24:29,300 --> 00:24:31,880 And Dr. Taylor would say to 648 00:24:31,880 --> 00:24:35,030 him, racism is intergenerational. 649 00:24:35,030 --> 00:24:37,070 It's not just we're talking 650 00:24:37,070 --> 00:24:39,410 about kids and generations to come. 651 00:24:39,410 --> 00:24:40,730 So not to be preachy, 652 00:24:40,730 --> 00:24:42,545 but get back to the thigh in Tibet. 653 00:24:42,545 --> 00:24:44,255 Get back to the fines of it. 654 00:24:44,255 --> 00:24:48,935 Racism is poison to our health 655 00:24:48,935 --> 00:24:50,570 and wellness and to 656 00:24:50,570 --> 00:24:53,780 our wealth, individuals and communities. 657 00:24:53,780 --> 00:24:56,135 So thank you so much Dr. hand, 658 00:24:56,135 --> 00:24:59,120 Nicole and Dr. Davidson for 659 00:24:59,120 --> 00:25:00,740 that glimpse into what's 660 00:25:00,740 --> 00:25:03,095 possible, what's really possible, 661 00:25:03,095 --> 00:25:05,150 and really hopefully spark and 662 00:25:05,150 --> 00:25:07,640 ignite the willingness for 663 00:25:07,640 --> 00:25:10,430 our physicians to come 664 00:25:10,430 --> 00:25:11,780 along its journey with us 665 00:25:11,780 --> 00:25:13,850 and not an ally as you tag, 666 00:25:13,850 --> 00:25:16,280 but really part of this coalition 667 00:25:16,280 --> 00:25:19,010 and movement to once and for all furious, 668 00:25:19,010 --> 00:25:20,870 they did mantle rated 669 00:25:20,870 --> 00:25:23,705 them for our own wellness, 670 00:25:23,705 --> 00:25:26,630 for our own health, and for our own wealth. 671 00:25:26,630 --> 00:25:28,670 Thank you everyone for listening. 672 00:25:28,670 --> 00:25:31,325 Look forward to more conversation 673 00:25:31,325 --> 00:25:33,455 on the topic and many more. 674 00:25:33,455 --> 00:25:35,360 And please take good care 675 00:25:35,360 --> 00:25:37,410 of yourself. Thank you.