Elaine Herscher

Dr. Michael LeNoir: Healthcare Doesn’t See African Americans the Same Way

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Recently Julie Rovner of Kaiser Family Foundation Health News interviewed LifeLong’s Dr. Michael Lenoir about racial disparities in medicine. Aside from practicing as an allergist-immunologist in his Oakland clinic, Dr. LeNoir is founder of the African American Wellness Project, formed in response to inequities in healthcare delivery.

The interview ranged from what to do about the increasing incidence of maternal mortality among Black women, to unconscious bias in medicine, to how to educate and train more Black physicians.

Here are some excerpts from Dr. LeNoir’s remarks:

About starting the African American Wellness Project: “It goes back to 2002, when as a doctor in a community that had people of color, physicians of color, I recognized that there was a difference in how African Americans were treated both professionally and personally….I (saw) the differences in how Black people were treated as opposed to whites. And I see the respect that was given to white physicians that was not given to Black physicians….And so that’s when we started the African American Wellness Project to educate African Americans how to deal with some of the aspects of early detection, disease prevention, exercise, and things like that.”

Combatting unconscious bias against patients of color: “A black person should call it out when they see it. That’s the big thing. I think we’re much too docile in the healthcare system…If we get as mad about healthcare that is disrespectful and unequal as we do when someone cuts in front of us in the Safeway line, we wouldn’t have that problem.”

Bringing more Black doctors into the Healthcare system: “The parameters to choose people for medical school need to start earlier, and they need to encourage Blacks, especially Black males of talent, so they can go on and do some things that are necessary to get into medical school.”

Impact of the Supreme Court’s decision banning affirmative action in colleges: “I believe diversity in California is probably 50 percent less than it was in the days when we had more liberal affirmative action guidelines. And so in those days, we were reporting 24, 25 Black students in these classes. That’s not happening anymore. So … I do worry.” 

If he could change one thing to make healthcare more equal: “I think it would be making certain that the system has the tools to detect two types of unconscious bias: this personal unconscious bias on the part of providers, but (also) this institutional unconscious bias. And I think we have to attack that first. Institutions don’t look at African Americans the same way.” 

Click here for the complete interview

Happy International Cat Day!

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Rejoice! Just for today we take a break from the dog days of summer to bring you International Cat Day, celebrating the 600 million felines on the planet.

The day was created on August 8, 2002, by the International Fund for Animal Welfare to raise awareness about the world’s cats and support ways to protect them. Historically, the domestic cat has been both worshipped and maligned.

In ancient Egypt, Mafdet was the first known cat deity, thought to be a protector against snakes and scorpions. The Greeks and Romans used them for pest control and only the wealthy owned cats. But things went downhill for felines from there. During the Middle Ages, cats were thought to carry the Black Death, and through the centuries we all know about their association with evil sorcery and bad luck.

We are well aware, Cleopatra’s time notwithstanding, that not everyone is a fan. Cats are not dogs (although, as you’ll read below, some of ours think they’re dogs.) Cats don’t greet you at door with a big smile and wag of the tail. They are more likely to whine at you accusingly when there’s no food in their dish and sniff off ungratefully after you comply with all their requests.

However, a soft fluffy cat purring gently in one’s lap is a thing of beauty. They are a great source of calm, and when they’re kittens, a great source of amusement as they zoom around and get into all your precious stuff.

Chase
Sylvia Hacaj’s cat Chase, who kinda thinks he’s a dog.
Snap, Elaine Herscher’s cat, proving our cuddliness point

In a recent, perhaps very unscientific, survey, two thirds of cat owners said they would rather spend an evening alone with their cat than with their significant other. (This may say more about the state of our relationships than about our love of cats.)

There are many much-loved, if not suspiciously eyed, cats among us at LifeLong. CEO David B. Vliet has a cat named Romeo (pictured with David on the Intranet page) who is perpetually underfoot. David suspects that Romeo weaves around his feet to get him off balance because he’s secretly plotting his owner’s demise.

Arcelia Valadez, Patient Accounts Lead, has a kitten called Baby, who was abandoned by her mother. Proving that cats and dogs get along better than their reputations, Arcelia says that Baby tries to breastfeed from one of her dogs, whom she has decided is her mom.

Again with the dog-like behavior, Development & Communications Director Sylvia Hacaj’s cat Chase likes to accompany the family for walks around the neighborhood. “He follows along like a puppy,” Sylvia says. Chase was a neighbor’s cat originally, but he spent so much time around Sylvia’s house, the neighbor decided he’d rather live with them.

To celebrate today, International Cat Care, the custodians of this holiday, suggests some extra play and attention for our furry felines. If that doesn’t do the trick, maybe just a nice nap.

National Health Center Week: Safe Housing

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The sign is familiar to anyone traveling I-580: “California Hotel” lit up in giant letters above a distinctive Mission-style red brick building. You can’t exactly book a reservation in this imposing landmark building, but you can roam the lobby appreciating artwork commemorating performances by the likes of Billie Holiday, James Browne, Aretha Franklin, and Big Mama Thornton.

The California Hotel has seen its share of ups — the first hotel in the area where African American entertainers and guests could stay — and downs, a fall into disrepair in the ‘70s. But the hotel, built in 1929, has survived decades of transformation to become home today to LifeLong’s clients in supportive housing.

The former hotel is just one site in LifeLong’s Supportive Housing Program – or SHP – in Berkeley, El Cerrito, and Oakland. National Health Center week begins on Monday August 6 with Public Health in Housing Day. So it’s a good time to look into what our housing program has to offer.

LifeLong SHP brings health and social services to more than 770 people in subsidized housing at sites in Berkeley, El Cerrito, and Oakland so that tenants with histories of homelessness can achieve housing stability and improve their quality of life.

The program offers primary medical care, behavioral healthcare, outreach, housing stabilization, case management, social services benefit advocacy, and employment/vocational support. SHP is administered by LifeLong’s Homeless Services and its Director, Ryan Wythe.

The California Hotel has the distinction of being an historic landmark registered on the National Register of Historic Places, and the interior is filled with original Mission and Spanish Colonial Revival architecture. LifeLong SHP has eight other locations in Oakland, five in Berkeley, and one in El Cerrito.

Interview with Dr. Meggie Woods

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Recently, the Alameda Health Consortium interviewed Dr. Meggie Woods, Lead Clinician at LifeLong’s Trust Health Center, to learn more about their patient-centered care, especially as it relates to our LGBTQIA+ and Trans community members. A reprint of Dr. Woods’ interview appears here.

Name: Dr. Meghan (Meggie) Woods, (they/them)
Title: Lead Clinician, LifeLong Medical Care, TRUST Health Center
Guiding Quote: Try your hardest, and do your best. – Dan Woods, my dad

Alameda Health Consortium: Tell us a little bit about yourself. 

Dr. Meggie Woods: I grew up in Southern California. My dad was the first in his family to go to college and my mum immigrated from Australia when they got married. My parents raised me with a strong sense of responsibility to serve others in need. I graduated from Brown University with concentrations in International Relations and Latin American Studies. In my early career, I was an HIV case manager. This work inspired me to pursue medicine. I attended medical school and Family and Community Medicine residency at University of California, San Francisco (UCSF) and I completed the HIV medicine track during residency where I earned my HIV Specialist certificate.

Four years ago, I became a primary care provider at TRUST clinic at LifeLong Medical Care where we offer integrated primary care to people experiencing homelessness in Oakland, CA. I am the Lead Clinician and run the HIV, substance use and gender affirming care programs. I am board certified in Addiction Medicine. I am a site Principal Investigator for a National Institutes of Health (NIH) grant studying the effects of mobile and drop-in care models for people living with HIV and experiencing homelessness. I am also a volunteer clinical professor in the UCSF Family and Community Medicine department.

At TRUST Clinic, we meet people when they are often at the lowest point in their life.

AHC: What was it about community health centers (CHCs) that drew you to their work?

MW: The appeal of a career in family medicine to me is using science to serve others. I sought out global health opportunities in Kenya, El Salvador, and Haiti during my medical training. As a newly minted Family Medicine physician, I volunteered in the largest refugee camp in the world, in Bangladesh. In 2017, the Rohingya people fled genocide in Burma to this mountainous forest region on the Bangladesh-Burma border. While I enjoyed my global health work, I felt limited in my role as a foreign physician because of the linguistic and cultural barriers. I wanted to work in my community and use my skills in HIV medicine and gender affirming care. I was incredibly lucky to learn about TRUST Clinic from a close friend who already worked at Lifelong. I met with Dr. Jason Reinking, Associate Medical Director, who recruited me for my precise background and interests. I did not realize back then how vital Community Health Centers are to their communities. By providing comprehensive primary care in a single location, low-income patients can access the care they need without stigma or logistical barriers. I find this model appealing because I want to take care of the most vulnerable and difficult to engage in care.

I feel incredibly honored and humbled to walk with my patients on their journeys.

Dr. Woods

Dr. Woods

AHC: In your role as a primary care provider at LifeLong Medical Care’s TRUST Health Center, what are often some of the barriers you experience in providing care for people experiencing homelessness?

MW: People experiencing homelessness face myriad barriers to staying healthy. For example, without a safe place to sleep at night, many rely on stimulants to stay awake. Without bathroom access, many will forgo diuretics to avoid urinating in public places. My patients lack consistent access to healthy food, which makes treating conditions like insulin-dependent diabetes challenging. These kinds of barriers all compound each other, and the result is that people experiencing homelessness die on average 20 years younger than people who have secure housing.

At TRUST, we meet people when they are often at the lowest point in their life. We have hot food and hygiene kits to meet immediate needs. New patients have many items on their “to do” list, after spending years without healthcare or being discharged from the hospital after a critical illness. We can see patients as often as needed and chip away at that list. We try to provide as much as possible in-house. Our entire team of providers, MAs, RNs, health and wellness coaches, case managers, recovery support counselors, therapists, psychiatrists, and triage staff are trained in trauma-informed care in order to approach our patients with greater understanding and empathy for what they have experienced in life. Our philosophy of care is deeply rooted in harm reduction. Our patients come to us for help, but that help must make sense for their lives.

I work with patients in depth to understand what their daily life is like to craft customized medication regimens that are reasonable for a patient, given their constraints. I avoid diuretic blood pressure medicine, for example, if I know someone is rough sleeping – that is, sleeping outside without adequate shelter. I reach for a weekly injectable diabetic medicine that can be given in the clinic before starting a diabetic patient on insulin. TRUST has a robust behavioral health department that patients seeking psychiatry and therapy can easily access. We receive patient medications when they have no address and get robbed frequently. Our nurses give injectable medications such as long-acting buprenorphine, long-acting antipsychotics, hormones, and HIV medicines. This helps patients who struggle to take pills regularly adhere to their treatment plans. We stock a wide range of harm reduction supplies such as naloxone, safe injections kits, fentanyl test strips and talk openly and nonjudgmentally about substance use. Our goal is to prevent overdose deaths and not impose a moral judgment. Our support staff of health and wellness coaches, intensive case managers, HIV case managers, and recovery support counselors are incredible at helping patients navigate the healthcare system – from switching county health plans to scheduling a specialist appointment and arranging transportation.

AHC: Barriers to accessing appropriate and culturally competent care can contribute to health disparities in transgender persons. Can you share more about what these disparities look like and why they exist in this community?

MW: The biggest disparities for transgender people are safety, access to medical care, and respect for their autonomy (the right to identify with their lived name and pronouns and have that identity be respected). Transgender people have always existed, but transphobia has kept us in the shadows until recently. However, increased visibility has not translated into increased safety. In 2022, 32 transgender people were murdered, the majority of whom were BIPOC (Black, Indigenous, People of Color). According to Trans Legislation Tracker, 561 anti-trans bills have been introduced in 49 states this year. These sobering statistics demonstrate the real dangers that transgender and gender diverse people face today.

Finding a trans-competent provider still largely depends on word of mouth. Most medical providers have received little to no exposure to gender affirming care. The logistical hurdles to changing your name are onerous and time-consuming. This can result in medical staff and providers using the wrong name and/or pronouns, despite their best intentions.

AHC: In what ways are Community Health Centers uniquely positioned to provide care for members of the LGBTQIA+ and Trans communities?

MW: Community Health Centers can offer a full spectrum of services for our queer and transgender communities. Sexual health services like PrEP and STI testing can be integrated into primary care clinics or separate spaces. Hiring queer and transgender staff at all levels who reflect the identities of our patients helps create safe spaces. Medical providers prescribing hormones are just one part of that. Therapists who are familiar with writing gender affirming surgery letters of support and support staff skilled at navigating the legal name change process help transgender and non-binary patients’ transition.

At TRUST, I conduct regular training with our staff on gender-affirming care and queer health issues. We help our transgender and gender diverse patients access gender affirming surgeries, hormones and assist with legal transition. Many patients previously thought they were not eligible for these life-saving treatments because they were experiencing homelessness. We have partnered with local surgeons who accept Medi-Cal and LifeLong’s Adeline Street Recuperative Care to provide a safe place to recover post-operatively. These relationships have allowed our patients to realize their gender affirming goals.

In addition to hiring staff, the physical space of a clinic must reflect the values held. In response to feedback about confusion regarding why we were asking about pronouns, we put up signs in the exam rooms explaining what pronouns are and why they’re important.

AHC: Is there anything else you wish to share about your journey and your work with historically marginalized community members?

MW: I came out as queer in college. Gay marriage was still illegal, and most people had a very narrow understanding of gender. While I always considered myself to be genderqueer and non-binary, I didn’t start using they/them pronouns until a few years ago. Providing gender affirming care has been one of the most rewarding parts of my medical career. The relief on a patient’s face when we meet for the first time and I ask their name, pronouns, and gender-affirming goals is profound. They can be themselves with me, because I trust them to know what the right path for them is. Sometimes, my exam room is the only place in their lives where they can be their authentic selves. It’s not safe elsewhere. We work together to find the right therapist, identify social supports, and over time I start to see positive shifts in gender expression, confidence, and circumstances. I feel incredibly honored and humbled to walk with my patients on their journeys.

Interview with Dr. Meggie Woods

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Recently, the Alameda Health Consortium interviewed Dr. Meggie Woods, Lead Clinician at LifeLong’s Trust Health Center, to learn more about their patient-centered care, especially as it relates to our LGBTQIA+ and Trans community members. A reprint of Dr. Woods’ interview appears here.

Name: Dr. Meghan (Meggie) Woods, (they/them)
Title: Lead Clinician, LifeLong Medical Care, TRUST Health Center
Guiding Quote: Try your hardest, and do your best. – Dan Woods, my dad

Alameda Health Consortium: Tell us a little bit about yourself. 

Dr. Meggie Woods: I grew up in Southern California. My dad was the first in his family to go to college and my mum immigrated from Australia when they got married. My parents raised me with a strong sense of responsibility to serve others in need. I graduated from Brown University with concentrations in International Relations and Latin American Studies. In my early career, I was an HIV case manager. This work inspired me to pursue medicine. I attended medical school and Family and Community Medicine residency at University of California, San Francisco (UCSF) and I completed the HIV medicine track during residency where I earned my HIV Specialist certificate.

Four years ago, I became a primary care provider at TRUST at LifeLong Medical Care where we offer integrated primary care to people experiencing homelessness in Oakland, CA. I am the Lead Clinician and run the HIV, substance use and gender affirming care programs. I am board certified in Addiction Medicine. I am a site Principal Investigator for a National Institutes of Health (NIH) grant studying the effects of mobile and drop-in care models for people living with HIV and experiencing homelessness. I am also a volunteer clinical professor in the UCSF Family and Community Medicine department.

At TRUST Health Center, we meet people when they are often at the lowest point in their life.

AHC: What was it about community health centers (CHCs) that drew you to their work?

MW: The appeal of a career in family medicine to me is using science to serve others. I sought out global health opportunities in Kenya, El Salvador, and Haiti during my medical training. As a newly minted Family Medicine physician, I volunteered in the largest refugee camp in the world, in Bangladesh. In 2017, the Rohingya people fled genocide in Burma to this mountainous forest region on the Bangladesh-Burma border. While I enjoyed my global health work, I felt limited in my role as a foreign physician because of the linguistic and cultural barriers. I wanted to work in my community and use my skills in HIV medicine and gender affirming care. I was incredibly lucky to learn about TRUST Clinic from a close friend who already worked at Lifelong. I met with Dr. Jason Reinking, Associate Medical Director, who recruited me for my precise background and interests. I did not realize back then how vital Community Health Centers are to their communities. By providing comprehensive primary care in a single location, low-income patients can access the care they need without stigma or logistical barriers. I find this model appealing because I want to take care of the most vulnerable and difficult to engage in care.

I feel incredibly honored and humbled to walk with my patients on their journeys.

Dr. Woods

Dr. Woods

AHC: In your role as a primary care provider at LifeLong Medical Care’s TRUST Health Center, what are often some of the barriers you experience in providing care for people experiencing homelessness?

MW: People experiencing homelessness face myriad barriers to staying healthy. For example, without a safe place to sleep at night, many rely on stimulants to stay awake. Without bathroom access, many will forgo diuretics to avoid urinating in public places. My patients lack consistent access to healthy food, which makes treating conditions like insulin-dependent diabetes challenging. These kinds of barriers all compound each other, and the result is that people experiencing homelessness die on average 20 years younger than people who have secure housing.

At TRUST, we meet people when they are often at the lowest point in their life. We have hot food and hygiene kits to meet immediate needs. New patients have many items on their “to do” list, after spending years without healthcare or being discharged from the hospital after a critical illness. We can see patients as often as needed and chip away at that list. We try to provide as much as possible in-house. Our entire team of providers, MAs, RNs, health and wellness coaches, case managers, recovery support counselors, therapists, psychiatrists, and triage staff are trained in trauma-informed care in order to approach our patients with greater understanding and empathy for what they have experienced in life. Our philosophy of care is deeply rooted in harm reduction. Our patients come to us for help, but that help must make sense for their lives.

I work with patients in depth to understand what their daily life is like to craft customized medication regimens that are reasonable for a patient, given their constraints. I avoid diuretic blood pressure medicine, for example, if I know someone is rough sleeping – that is, sleeping outside without adequate shelter. I reach for a weekly injectable diabetic medicine that can be given in the clinic before starting a diabetic patient on insulin. TRUST has a robust behavioral health department that patients seeking psychiatry and therapy can easily access. We receive patient medications when they have no address and get robbed frequently. Our nurses give injectable medications such as long-acting buprenorphine, long-acting antipsychotics, hormones, and HIV medicines. This helps patients who struggle to take pills regularly adhere to their treatment plans. We stock a wide range of harm reduction supplies such as naloxone, safe injections kits, fentanyl test strips and talk openly and nonjudgmentally about substance use. Our goal is to prevent overdose deaths and not impose a moral judgment. Our support staff of health and wellness coaches, intensive case managers, HIV case managers, and recovery support counselors are incredible at helping patients navigate the healthcare system – from switching county health plans to scheduling a specialist appointment and arranging transportation.

AHC: Barriers to accessing appropriate and culturally competent care can contribute to health disparities in transgender persons. Can you share more about what these disparities look like and why they exist in this community?

MW: The biggest disparities for transgender people are safety, access to medical care, and respect for their autonomy (the right to identify with their lived name and pronouns and have that identity be respected). Transgender people have always existed, but transphobia has kept us in the shadows until recently. However, increased visibility has not translated into increased safety. In 2022, 32 transgender people were murdered, the majority of whom were BIPOC (Black, Indigenous, People of Color). According to Trans Legislation Tracker, 561 anti-trans bills have been introduced in 49 states this year. These sobering statistics demonstrate the real dangers that transgender and gender diverse people face today.

Finding a trans-competent provider still largely depends on word of mouth. Most medical providers have received little to no exposure to gender affirming care. The logistical hurdles to changing your name are onerous and time-consuming. This can result in medical staff and providers using the wrong name and/or pronouns, despite their best intentions.

AHC: In what ways are Community Health Centers uniquely positioned to provide care for members of the LGBTQIA+ and Trans communities?

MW: Community Health Centers can offer a full spectrum of services for our queer and transgender communities. Sexual health services like PrEP and STI testing can be integrated into primary care clinics or separate spaces. Hiring queer and transgender staff at all levels who reflect the identities of our patients helps create safe spaces. Medical providers prescribing hormones are just one part of that. Therapists who are familiar with writing gender affirming surgery letters of support and support staff skilled at navigating the legal name change process help transgender and non-binary patients’ transition.

At TRUST, I conduct regular training with our staff on gender-affirming care and queer health issues. We help our transgender and gender diverse patients access gender affirming surgeries, hormones and assist with legal transition. Many patients previously thought they were not eligible for these life-saving treatments because they were experiencing homelessness. We have partnered with local surgeons who accept Medi-Cal and LifeLong’s Adeline Street Recuperative Care to provide a safe place to recover post-operatively. These relationships have allowed our patients to realize their gender affirming goals.

In addition to hiring staff, the physical space of a clinic must reflect the values held. In response to feedback about confusion regarding why we were asking about pronouns, we put up signs in the exam rooms explaining what pronouns are and why they’re important.

AHC: Is there anything else you wish to share about your journey and your work with historically marginalized community members?

MW: I came out as queer in college. Gay marriage was still illegal, and most people had a very narrow understanding of gender. While I always considered myself to be genderqueer and non-binary, I didn’t start using they/them pronouns until a few years ago. Providing gender affirming care has been one of the most rewarding parts of my medical career. The relief on a patient’s face when we meet for the first time and I ask their name, pronouns, and gender-affirming goals is profound. They can be themselves with me, because I trust them to know what the right path for them is. Sometimes, my exam room is the only place in their lives where they can be their authentic selves. It’s not safe elsewhere. We work together to find the right therapist, identify social supports, and over time I start to see positive shifts in gender expression, confidence, and circumstances. I feel incredibly honored and humbled to walk with my patients on their journeys.

Epic Going into HyperDrive

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In advance of the upgrade happening Monday July 24, the Epic (HIT) Team wants all users to have a heads-up on some of the key changes they can expect.

As previously noted back in March with the install of “Book It,” Epic is moving toward a web-based application platform called “HyperDrive.” In an effort to help with the overall transition and adoption to HyperDrive, OCHIN has been taking pieces of the application and implementing them over this past year. Next month will be the remainder of the large changes with the transition to HyperDrive that will be primarily on the clinical side.  

Kindly see below for our upcoming training opportunities and education materials to help you and your staff prepare for these changes:

7/12 Wednesday 12-1pm (join here)

7/17 Monday 8-9am (join here)

7/19 Wednesday 12-1pm (join here)

HyperDrive Wiki Page: (click here)

If you have any additional questions please open a service request titled “HyperDrive.”

Sincerely,

Epic (HIT) Team