Podcast 3 cultural competence

The podcast discusses disparities in healthcare equity and the impact of health inequities on individuals, using examples such as Beyonce and Serena Williams' childbirth experiences. It emphasizes the need for cultural competence and understanding in healthcare, as well as the importance of recognizing and addressing biases. The tragic case of a Hmong girl named Leah is also mentioned, highlighting the consequences of miscommunication and lack of cultural understanding in healthcare. The book "The Spirit Catches You and You Fall Down" is recommended as an important resource on the need for cultural competency in healthcare. Hello, my name is Ashlyn Knight and I'm Melissa Stegelman and today we're going to bring you to our final podcast, talking about ways to resolve and address disparities in health care equity that we talked about in this previous podcast. You know, we're definitely really sad that this is going to be our last time interacting with you guys, but we are really excited to bring this table, bring this content to the table. And we hope that you've come away knowing a bit more, feeling a bit more assured of yourself. A hundred percent. You know, in our previous video, we really pointed out how health inequities affect us as a whole, right? You saw in our previous video, we spoke about Beyonce and Serena Williams. Now when I first learned that they had had such a difficult time during childbirth, I was truly perplexed, right? Because these women are rich, you know, these are millionaires. You would think the money would supplement it. You would think that the money they were bringing to the table, the fact that they could afford better hospitals, their influence in general, we don't even know who Beyonce is. I mean, come on. I mean, seriously, it was, it was a real shock, right? And they both almost died during childbirth. And across the United States as a whole, when women are giving birth, black women who have upper level education, things like bachelor's, master's, PhDs, are more likely to die than white women who just have their GEDs. So it's nothing to do with the education, their ability to communicate. No, it has nothing to do with the MS. I think that's a great point that you just brought up. I mean, and even in this situation, we have, you know, Beyonce and Serena Williams, amazing high levels of influence, high levels of money, clearly able to communicate well. I mean, they were literally asking for help and the help was not being granted to them. And again, as I said in the last video, it took until Serena Williams' white husband actually got a doctor and said, something's wrong with my wife, help me, that anything was done for Serena. So it's very unfortunate, you know, that that is the reality of America today, that the money doesn't matter, the education doesn't matter, the way you're able to speak doesn't matter. They judge you on the base of your skin color. And that's so unfortunate. That's so unfortunate. And that's why today we wanted to talk about just, you know, respecting other people for their differences, for their cultural differences, just for being a person in general. I think in today's society, we've kind of become removed and detached from our fellow humans. And I would love to take time in this podcast to just sort of encourage the audience to remember that we're all people. America hasn't ever been a monolith, not for a hundred years. And as much as we are a melting pot, it's important to remember that there are distinct cultures within America that should be celebrated, that should be recognized, and given patience to understand to bridge that gap, lending a hand, especially in the role of public servants. Yeah. Yeah. And it's really hard to, you know, give one solution to this issue, because there is not one solution. As we discussed, this is systemic. Oftentimes, the issues are very difficult to find, but that's why it's so important that we have dialogues like this one. Just to bring awareness to the problem. Right. Like, we should be educating all health care providers, all medical students, I think all students in general, starting from a very early age, I'm not talking college-age students, I'm talking about young students, to kind of look out for these biases, so that they can identify them and bring awareness to them. Because realistically, I mean, if everyone's just ignoring a problem, nothing's going to get done. It just takes one person to use their voice, and we hope that these videos have empowered you all to start using your voices to find these discrepancies that you might be able to either bring awareness to, maybe you can, you know, if you're in a position to, lobby your local politicians. Go out and volunteer, but also, it's just about taking a look at yourself, your own inner biases. Everyone has their biases. Yes. It's human nature. It's not, it doesn't mean that you're an awful person. Everyone has it, but it's up to you to recognize them and to resolve them, because it's unfair, it might be unfair the way you might be treating another person, whether you mean to or not, whether it's intentional or not, because it is a systemic issue. Yeah, and I like to bring up my own bias that I realized that I had, because I think it's important for us to also, you know, explain that we are not perfect people. No one is a perfect person, so, you know, in the previous videos, I did discuss that I had gotten the American Heart Association HSI scholarship, and in that time, I met my literal mentor, my role model, Francesca Martinez, who is the current National Director for Health Equity for the American Heart Association, and while she was training us in, you know, recognizing these health inequities and sort of motivating us to make a change, she took time to recognize the Native land she was on. That is something that I never really thought of. When I thought about women, when I'm thinking about, you know, women's experiences, maybe because I'm just, you know, I'm surrounded by a lot of Hispanic women, I'm surrounded by a lot of Black women, but I'm not surrounded by a lot of Native American or Native Alaskan women. So I wasn't thinking about them when I was thinking about the disparities that women face, but because Francesca pointed them out to me and reminded me of their plight, of their struggle, now I think it's so important to recognize that we are currently recording this video on Lena'i Lena'i pain land. Yeah, and this one, it's again, it's important to recognize, it's like, the issues we're talking about here, we can, we feel comfortable in thinking on, but we're not acknowledging like the Arab communities, like the difference in like religious differences, or like gender differences, sexuality, it's like, we're not really comfortable speaking on those, but those are issues that can be addressed and acknowledged in day-to-day life. So I actually want to ask you, what is cultural competence? How would you define that? So cultural competence is one of the methods used to address these disparities in health care. In general, it's just, it implies a certain level of cultural understanding, understanding the roles and traditions, the history of a culture, providing empathy and the ability to apply that knowledge, that understanding, that appreciation for that culture to communicate with a variety of cultures in spite of pre-existing cultural differences and barriers that may exist, such as language barriers, such as social barriers, class barriers, like class barriers. Reaching a hand across the bridge and helping them up anyway. It's very important, especially in the roles of, like I said earlier, public servants, especially doctors, people who are interacting with a wide variety of people who are serving them and promising to treat them. And you don't get to choose who you're treating, not really. No. But you need to apply the same level of standards that you do someone who looks like you, who's someone who is the exact opposite of you. 100%. And it's not just important in the healthcare setting, as we're pivoting to this global network of companies working together, if you're in business, if you're in marketing, if you're in hospitality, you're going to have experiences where you're going to be collaborating with people from a lot of different countries. So in order for you to secure that business deal, to do what you need to do for your company, you have to respect their culture. So let's just make it more part of our everyday lives. I mean, in America, we're surrounded – it's a melting pot here, especially in New Jersey. I mean, we're surrounded by so many different groups, so just making cultural competence the norm is so important as we pivot into this global connectivity. And in order to have cultural competence, you have to have knowledge, and it starts right in college. Ideally, it would start earlier on, like elementary, where you're bringing – you're addressing these differences appropriate for their age level, of course. But curriculums – it's important why the gen eds matter, because you're addressing the ethics. Medical humanities classes are very popular now in medical school because it's addressing the different ethno-medical concepts, the treatment approaches, the fact that there is medical racism ingrained in the Western approach. And I think – I'm not too sure about the Eastern approach to medicine, but I know in the Western approach, it's ingrained. Racism is ingrained, and it's important to acknowledge that and correct it when you're training the future doctors, the future nurses, the future health care providers. Yeah, I mean, last time we talked about the Apgar test, right, where – I'm not saying that every doctor is racist, but when you have a system in place like the Apgar test that defines the baby's ability to breathe based on their skin color being pink – you know, if a baby is pink, it means they're healthy. Black babies are not pink. You know, you need to update that test in order to ensure increased survival for members of the black community or just people who are darker-skinned in general. So – no, I think at this point, you know, we're – you know, we should pivot into your personal favorite example of cultural – of comprehensive cultural awareness, because I wasn't so well-versed on the issue before Ashlyn came to me and spoke to me about the book The Spirit Catches You and You Fall Down. So I'm very involved in public health. I – medical anthropology, medical humanities – I think it's fascinating, and I think it's an important topic, especially for people going into STEM fields. So The Spirit Catches You and You Fall Down by Anne Fadiman is an important look of why we need cultural competency. It is a tragedy. It is the death of a child that could have been prevented or could have been alleviated before it got so bad. It's miscommunication across the board. It was a girl – a Hmong girl. So the Hmong people, if you may not know, they are refugees from Vietnam. They were trained by the CIA to fight the Laos communist forces, and they fled from Vietnam once the Laos took over to America. And these Hmong in particular settled in California. And the older – some, you know, assimilated into America, but others were more distrustful, more – not really wanting to integrate their own cultures. And so they kind of held off. They were kind of – they had to guard up. And so when Leah – so the girl has been Leah Lee. When she suddenly had a seizure at three years old, her parents took her to the hospital, which was a great start. But she didn't – because they did not speak English, they could – they did not have the means to effectively communicate their needs. And the doctors at that hospital did not have a translator. They did not have an interpreter in Hmong culture to effectively mediate that difference between the doctors and the patient. And so they went undiagnosed for over – for almost six months, and her condition got worse and worse. Now, an important thing to note, in Hmong culture, seizures are viewed as a positive thing. It is viewed – it is a spiritual thing. It is – your spirit is being captured. It's being pulled out. And people who have epilepsy are viewed as – they have great potential to become a shamanistic healer. So that is a great thing. It is not a disease in their culture. And that is an important thing to note, because disease, illness, is a cultural perception. So to them, not an illness. But to the Western doctors, your child is sick. They need medicine. But again, you had that inherent distrust, that inherent miscommunication, the inability to communicate between the two, that it kind of escalated. And the parents not actually properly giving their daughter the right medication because they were fearing it was making her sick because they didn't know that side effects were typical. And that it resulted in her eventually being taken away at the doctor's orders. Yeah, CPS actually had to step in because, you know, at first – you know, I will – I want to say, you know, some things about the doctors that I learned. The Hmong culture, there was a large amount of that community in – surrounding this hospital in California, right? And it was even noted that a lot of the doctors did not like to assist the Hmong culture. It is a very difficult, very, very – It is hard. But it's strange to me because, you know, you have this large group of people. I'm sure you could put a translator on staff. But I'm sure that, you know, if this is your demographic that you're going to be serving, you know, you should have a translator. So that was really, I think, the first issue there, right? But also, the doctors did kind of give the family a little bit of leeway with the medication. You know, they believed that because the parents could not read in their own language, nor could understand English very well, that the daughter's extreme amount – she was on multiple medications. She was on a cocktail that had to be given, you know, multiple times a day. That's confusing. That's difficult. So they actually sent nurses to their home to attempt to help the daughter. But again, you know, these nurses aren't translating. They aren't trying to help the parents understand. So, of course, you're going to have some sort of backlash when you suddenly see these doctors showing up to your house. Because to me, it really seemed like there was an extreme lack of understanding. An extreme lack of understanding. And this understanding wouldn't be kind of mediated until later on they had – her name was – what is it? Janine? Janine, yes. Janine. And she eventually became a friend of the Hmong people and was able to help mediate, give instructions, teach the parents on how to, like, properly administrate it. And so eventually, Leah was returned from her foster. And it's important to note that her foster mom had also noted that the medications that the parents were worried about, about making Leah sicker, had also seemed to be adversely affecting Leah as well. So it was a known issue that the medications were harmful to Leah, but it was for the greater good. Yeah, I will say, you know, it is difficult. It is difficult. When you're working with a cocktail of medications, and some are being given, some aren't being given, that's really difficult to communicate and talk about that. Because they were taking blood from Leah to confirm her, whether she was taking the medication or not. And mind you, this is a child. She was six years old when things took a really tragic turn for the worse. She was gone and better for a while. Yeah, she was better. You know, she did respond to treatment eventually. She was doing well. She was no longer having these extreme epileptic symptoms, but… When, unfortunately, she had fallen off the swing, hit her head, and then went into another episode that lasted for two hours. Two hours, a two-hour-long seizure. Which is incredibly dangerous. More than 20 minutes is considered a risk for brain damage. But doctors were able to stabilize her. However, it wasn't known how badly she'd be affected until later on. And, unfortunately, repeated and re-hospitalizations after that resulted in hospital infections, because some of the drugs that were given lowered her immune system, made her more susceptible to hospital-acquired bacterial infections, but still popular. Especially at this time. Yes. And then you also have to note that the disease she had was the Lennox-Gastra. Very rare. Very, very rare disease that also leads to an increase in infections. So something that you couldn't really help. Yeah, I mean, it kind of seems like, you know, this child was having 100 seizures a year. That's really not good for mental development. It was really unfortunate that after, you know, they were able to stabilize her after her two-hour-long seizure, they intubated her with a nose tube. And that's actually where the infection started. And one of the issues is that Leo, at this point, was known for her seizures. That the doctors, to her, it's part of it. One of the difficulties between Western medicine versus Eastern medicine is that Western medicine, disease is viewed as a war. Something to treat. You are your disease. You are not a person. And so they weren't taking a look at everything about Leo. And so they kind of missed the infection. They weren't focusing on the infection until it came too late. Yeah, and then they actually sent her to a different hospital. And they felt that, you know, it had just gone too far. But by the time she arrived, you know, she was declared medically brain dead. And it's just an unfortunate case of the damages, the death that can happen because of discommunication. In this case, it was a six-year-old girl who didn't die until years later. But she had a life ahead of her. If more measures early on were taken to kind of bridge that gap, to get it a proper translated, to help teach the doctors how to be a bit more empathetic towards their own culture. Right. So you didn't have that immediate barrier, like, oh, these are difficult. They had preconceptions of these are difficult people. They're ignorant. They don't understand what we're saying. I'm right. But they didn't have the same, like, in their culture, doctors, especially Western doctors, were not to be trusted. They had their own shaman. Everything was spiritual. So they did not understand the physical, the mental, the psychological diseases. And the same way we, like you and I might do. Yeah, yeah. And even when I was, you know, reading the story, I was just so upset. It's kind of tragic. Jeanine, the social worker who kind of changed everything, got the child on the appropriate medication. You know, she was doing better. Jeanine spent a lot of time researching Humong culture. She spent a lot of time talking with the shamans, gaining trust of the shamans. But Jeanine stepped in later on in the case, once this child was already having hundreds of seizures a year. So not that I'm saying that, you know, Jeanine should have gotten involved sooner. But I just wish there was somebody like Jeanine working at the hospital, who could have helped the large amount of Humong people in that area. And since this book came out, the author, later on, near the end of the book, had actually brought up an important point. There is a psychiatrist and medical anthropologist known as Arthur Kleinman, who developed this kind of program of eight questions that helps bridge the gap between cross-cultural medicine, looking at how that person in that culture might view the disease. Like, what is wrong? What's the problem? What do you think caused the problem? What do you think started it? How do you want to treat it? Like, what is wrong and how do you want to fix it? And when the author had applied that survey to the parents, it showed that they did have an understanding that something was wrong, but it wasn't able to be properly articulated. And so going forward, the survey could be used to help, earlier on, intervene in those cross-cultural disputes and see how the patients are actually understanding the condition they're suffering from. Yeah, right. So you're just talking at these people. And actually, as in the book, when she was declared brain dead, the parents did not understand that they were asking, should we take your child off life support? And she was taken off, right? Even though the parents didn't know they were consenting. Maybe they said, yes. I don't really know exactly how that was communicated, but she was taken off life support when the parents did not actually want her to be taken off life support. Like, really just understanding, making sure the other person understands what you're saying. Informed consent. And I mean, it's a principle that I even practice when I tutor my students. I know I'm always, I explain to my students the information they need to know. And then I ask them to explain it back to me. Just make sure that they're actually understanding what I'm saying, that my words are entering their brain. I just wish that there was more of that in this case. Like this example, this is a very extreme, very severe example. But you can see it day to day. If any of you have a parent or know someone who is non-English speaking, right? Trying to, especially if you're bilingual, going to the doctor's appointments, trying to translate. Because there's that difference, like you can't speak English. If you can't speak English, you can't speak to your likely English speaking doctor. And so you're not receiving the proper care and attention. You can't communicate your worries, your fears. And that just might lead to not wanting to go to the doctor in the first place. That might lead to not wanting to get vaccinated because you have this preconceived notion, I'm not saying this isn't true, but you have this notion that if you walk into the doctor's office, there's going to be no one who's able to help you. Or you're going to be made to feel not intelligent. Or you're going to be made to feel like, you know, you're just going to shake your head and nod because you don't know what's happening and you weren't offered a translator. Because it's easier at times. And you know, we're both very privileged to speak English. But a lot of members of my family don't speak English. They only speak Spanish. So it's just really hard trying to talk to them about things like the COVID-19 vaccine. Because even for me, somebody who is fluent in Spanish, somebody who's willing to learn the different terms in Spanish of what everything means, the other person might just not have that education or that background of what mRNA is. Even if I say mRNA in Spanish, if they don't know what it is, and they don't understand how it works, that's really difficult to communicate. You know, we have to think of ways to bridge the gap between the doctor or the researcher and your average person. Exactly. It's a big part of my personal mission going forward. Because it's what happened during the COVID-19 pandemic with all the vaccine disparities should not have happened. Should not have happened. But it's unfortunate because that's the reality of the situation. A lot of people passed away because they did not get vaccinated. Because they just didn't understand the vaccine and did not trust the government. Because when you hear stories, not stories, actually not stories, when you hear about the Ted Sikhi experiment, or you hear about the case of Leah, what are you supposed to think? How are you supposed to feel? Then on average, so a study looking into how satisfied racial and ethnic minorities with their healthcare providers, with the healthcare they've received in general, only 1% of white people are dissatisfied. Whereas for African-Americans, Asian-Americans, and Latinos, they are over 10%. So like 15%, 13%, 11% think that they would receive better care if it came from someone of their race, who looks like them. Talks like them, knows how to explain things to them. And this doesn't even account for the fact that like, so my brother, he is a transgender man. And so it's a regular uphill battle when he's going to doctors just to get his gender identity confirmed, to not be misgendered, to be taken seriously. And that is disgusting. And how does that make them feel? How does that make you feel when you're put in that situation where you're not being respected for who you are? Why would I want a return for treatment? Exactly. And this doesn't even, you know, come into question, all the other barriers. That minority stays trying to go to the doctor. First, I'd just like to say that on average, African-Americans and Latinos are more likely to have chronic conditions when compared to white or Asian-Americans. So already, you see that they probably need more medical attention than the average white person past the age of 50. Now, this could probably be because, you know, well, multiple reasons, but just early access to doctors, right? Preventative care is something that I've always been taught to do. Go to the doctor every single year you have to. But not everybody has the option to do that. I know my dad's African-American, and he would regularly get upset. My mom, who's white, going to the doctors, like, why are you taking me for everything? Because you don't go to the doctors unless you're basically dying. It's something, if it can be treated at home, it can be treated at home. And when you look at just uninsured, right? Because you have that mentality, right? The cultural mentality. But then you also just have the fact that American medical care is extremely expensive. So if you don't have insurance, I found people just ignoring their symptoms because they don't want to pay. Now, on average, 35% of Latinos are uninsured. 35%. Now, they're the highest demographic. African-Americans make up 20% in comparison to white Americans who make up 12%. So there are multiple layers to this. Also, just including how when you live in a more affluent area, typically you have access to a wide variety of doctors with a lot of specializations. In other communities, in minority communities. Especially rural communities. In rural communities, of course. If you don't have a car that is reliable, that can take you, and also the time to drive there, you're not going to be able to see that specialist who might be able to help you with your chronic condition or to prevent a chronic condition in the future. Being sick is costly. And it's unfortunate that the time taken earlier in your youth to not go to the doctor, it kind of comes back full force when you're 50. And so you have to take the time at that point. Because this isn't even considering people who are below the poverty line, who cannot afford to take a day off. Who aren't offered the same sick pay, vacation time that people in a more corporate setting would have. They have multiple jobs, and so they might not be eligible. Right. I mean, a while back I participated in a poverty simulator. Where we were basically given, I was a mom of three kids. And I think I made $500 a month, something around there. And I had to go through various situations and scenarios. And at one point, I got sick. And I sat there and I looked at my fake finances. And I thought about my fake children. And I wanted to cry. Because that is something that a decision people make in real life every single day. Going to work, even when you feel terrible. Because if you don't go to work, you won't have money to buy food for your children. Have money to pay rent for you and your children. It's so unfortunate that healthcare gets put on the back burner in America. Because of the high cost and the prejudice of certain doctors. They might just select areas where there is more affluent people. Makes sense, I guess. I mean, I wouldn't do that. But again, this is why we are trying to urge people of color, trying to urge minorities to not feel uncomfortable, feel confident in joining the STEM field. Because if you want to see a change in your community, you have to go and make that change yourself. Who knows the community better than you? That's true. Who knows your community better than you? You have a rapport already. So you're able to, you have that cultural understanding. Yeah, and I think, you know, talking about culture, we have to bring up food. I mean, food is so important in Latin American culture. I mean, food is the way that my mom shows me love. She cooks for me to show her my love. I know that's a sentiment that a lot of Latinos share. But unfortunately, I think that when we look at recommendations that are provided by doctors when you are at risk of developing diabetes, or maybe a heart disease, when they are trying to advise you on modifying your diet so that you can live a happier, healthier life, oftentimes those foods are very Eurocentric. Very Eurocentric. You know, you're not getting ingredients that you're seeing in Black households or Hispanic households. Even Asian households. Right, right. But I mean, I think it is important to note that Asian Americans actually have... Because they have very healthy food. Very healthy food. And they have less chronic illness by percentage compared to white Americans. So we really should be including these tidbits from all these different cultures because I'm sure that if we did that, it would also just help the person receiving that pamphlet feel comfortable modifying their diet. Because if somebody's eating in one way, a very, you know, let's say a Latino diet, I'm eating a lot of rice, beans, I'm eating a lot of, you know, chicken, that's enough maybe. And a doctor gives me a lot of like Eurocentric white food. You don't eat that. I don't eat that. So I would much rather have recommendations based on the foods that are involved in my culture. That isn't asking a lot. It's not. No, and I genuinely feel like if we took the time to maybe create a website, maybe we could have a website that has different food recommendations with inspirations from different cultures, different ethnicities. And I'm not saying that everything in Latin American culture is super healthy, but that's the point. There are some things that are very healthy that can be added to our diets. And maybe if we knew that eating garbanzo beans, I eat a lot of garbanzo beans, eating them is healthier, I would eat them over your regular beans. So it's like, I know a black culture where it's like a lot of it was due to, you know, stemming from slavery. And so you had these high calorie foods. You also have the worst of the worst pick given to you. And so that kind of evolved into today, especially to the higher percentage are under the poverty line, where you're highly to make do with what you have. It tends to be unhealthier. And that's not even acknowledging the environmental factors of what you're being exposed to. It's hard to find food, especially in food deserts, so in the rural countries. But that doesn't mean that there isn't a way to moderate, what is it, remedy your own food where it's like, or it's like instead of like fried food, then you could like air fry, convection air. Or even recommend air frying over just regular fries. I feel like that's something that we're so hesitant to do. But listen, they're going to eat fried food anyways. Let's just give them the healthier recommendation. I love a good crunch. People might not do that. You know, I actually recently made carrot fries in an air fryer. That sounds like an amazing way to add a different vegetable to your diet. You know, if we advertise food in that way, and we're just, we're very respectful to other people's cultures and just gave them a lot of options. Because health doesn't mean bland food. Health does not, you know, you can add seasoning. The garlic is not going to kill you. That's hilarious. Yeah, and I mean, even when you look at a hot and cold theory in Mexican culture, I think that's something. In Chinese culture you see it too. Oh, really? I didn't know. I didn't know. Where it's just the idea that certain foods are correlating to a certain temperature and that it's based around, so your body has, so when you're infected with a hot disease or a cold disease, so a cold disease would be like a common cold, and that in order to like heal yourself, you need to neutralize it with a hot food. And so instead of being prescribed, you know, hey, drink a lot of fluids, like a lot of cold fluids, broth, like hot things are more likely to help you. That's going to treat you. And so patients who are ascribing to this, who are coming from this culture where this is the predominant belief in how to like, and how to treat yourself. Doctors might conflict with their own belief by offering certain foods that clash, where it's like you don't treat a cold disease with a cold food. You treat it with a hot food or hot on hot. And it's, but doctors often do not have this understanding. They don't understand. And so that's why you have a lot of patients not conforming to the doctor's orders. Yeah, you just, you just smile, you know, you nod your head and then you walk out and you just completely let that go. You don't know what they're talking about. Because in your culture, you've been taught your entire life. Okay, if I have a cold, I'm going to drink my chicken noodle soup. And move on with my life. All right, if the doctor is recommending you drink just fluids and not giving you those specific details, how is that going to build trust between the doctor and the patient? It's not, we have to be respectful of these things and these intricacies. And I know this is asking for a re-education of our United States doctors. But I think that it's so important and it's so valuable because it can improve health outcomes for people across the country. It would save people, like, and that's not even being dramatic, but a lot of people that would be able to receive proper health care, to receive proper treatment, to preventative care. Yeah, yeah. And I think really the reason why all of this is important is, again, is just because we want to make sure that every American is living a happier, healthier life and reaching their full health potential. We want to cut down on premature death. We want to cut down on the rate of chronic disease and chronic illness because a lot of it, we really only see in America. It's just really unfortunate because we're such a beautiful nation full of so many different people, so many beautiful cultures. And I just wish that they were given the time to be respected more. Absolutely. And again, we're having to cover the religious differences and how that affects it. Oh, wow. I mean, yeah, the religious differences have to be a whole other video. But yeah, it's just really being respectful. You know, for me, I'm Columbian, but I'm also Jewish. An interesting mix. A definitely interesting combination. My mother is Columbian. My dad's from Germany. Is your mother Christian? My mother was Catholic. Catholic. My mother was Catholic, yeah. But I remember hearing about a time when a doctor allowed a rabbi to visit. There was a family of Hasidic Jews who were looking for treatment and they wanted the rabbi to actually come in and, you know, talk to the doctors and speak to them. And the doctors agreed. And because the doctors were more willing to, you know, say, yeah, okay, bring the rabbi, have him perform whatever ritual he needs to perform. And, you know, that's fine. We'll respect your culture. They were just more responsive. Do you have trust in your doctors? You have trust. We really, at the end of the day, I think the whole point of really creating this video, it all kind of goes down to, like, increasing trust. Trust, communication, respect. Just respect the other person. Your neighbor. Because, you know, we always say that you should be respectful. I think in school, we're definitely taught to be respectful of the people who are superior to us. But I think we need to shift that and also make sure that the teachers are being respectful of the children. Because that'll teach the kids that, regardless if you've gone to medical school for 10 plus years and you have this huge education, there's always something to learn from different people. And you should be respectful to them. You don't deserve to be disrespected. No, no one does. No one does. And I think that's a great way to, you know, tell you guys, thank you so much for listening to our podcast series. We're very thankful to have gotten this platform in order to talk about our own beliefs and hopefully make more people believe that they can use their voice to spread awareness on whatever issues you deem important. For us, it's health care. For us, it's, you know, you know, reaching the medical system where it's like more awareness for people, where it's more cultural understanding or what is it like the Heart Association for you? Yeah, so like for me, the American Heart Association, really being an HSI scholar changed my life. I went from, you know, I understood that some of these inequities were there, but I didn't realize how deeply ingrained they were in our culture. So for me, ringing the alarm on health care inequities is something that I'll never shut up about. I always, currently a teacher, I taught two laboratory classes this semester. I was also a supplemental instructor and I made sure that I told my students about accurate representation in research trials and inclusivity. I know that not every single one of my students is going to go into research and that's okay because they can take my message and apply it to other areas of life. Because health care isn't the only time that minorities are discriminated against. Absolutely. Every chapter, basically. Pretty much, but we only have time to talk about health care. So I think on that note, we want to say thank you. Thank you so much to CSAM for allowing us to hop on the podcast and we hope maybe to come back to talk to you again. Have a great night, everyone. Have a great night.