Public Square; 405; Cancer: Connecting to Cultures

FUNDING FOR THE PRODUCTION OF PUBLIC SQUARE PROVIDED BY THE W.K. KELLOGG FOUNDATION. WORKING TO IMPROVE THE LIVES OF VULNERABLE CHILDREN. THIS PROGRAM IS PART OF AMERICAN GRADUATE, "LET'S MAKE IT HAPPEN," A PUBLIC MEDIA INITIATIVE MADE POSSIBLE BY THE CORPORATION FOR PUBLIC BROADCASTING. AND, KEN BURNS PRESENTS "CANCER: THE EMPEROR OF ALL MALADIES" A FILM BY BARAK GOODMAN IS MADE POSSIBLE BY PROJECT SUPPORTERS GENETECH, CANCER TREATMENT CENTERS OF AMERICA, SIEMENS, DAVID H. KOCH, BRISTOL-MYERS, SQUIBB, THE ALFRED P. SLOAN FOUNDATION, KOVLER FUND, THE ARTHUR VINING DAVIS FOUNDATIONS, THE AMERICAN ASSOCIATION FOR CANCER RESEARCH, THE AMERICAN CANCER SOCIETY, THE LEUKEMIA AND LYMPHOMA SOCIETY, THE ENTERTAINMENT INDUSTRY FOUNDATION, STAND UP TO CANCER (SU2C), THE CORPORATION FOR PUBLIC BROADCASTING,

AND PBS. >> THIS PROGRAM IS PART OF AMERICAN GRADUATE - LET'S MAKE IT HAPPEN. A PUBLIC MEDIA INITIATIVE MADE POSSIBLE BY THE CORPORATION FOR PUBLIC BROADCASTING. >> WE THINK, OKAY, IT SHOULDN'T HAPPEN TO US PUEBLO INDIANS. YOU KNOW, IT'S NOT GOING TO COME INTO OUR COMMUNITIES. BUT IT'S ALL OVER. CANCER DOESN'T PICK A PERSON. >> OF COURSE YOU WANT TO HAVE GREAT COMMUNICATIONS WITH YOUR DOCTOR AND TRUST WITH YOUR DOCTOR, NO MATTER WHERE YOU'RE AT, AND PART OF THAT TRUST IS THAT THE DOCTOR LOOKS LIKE YOU. >> IT'S NOT JUST SCREENING WE'RE TALKING ABOUT, IT'S PROVISION OF CARE QUICKLY, AND APPROPRIATE CARE, CULTURALLY COMPETENT CARE. >> SO, A PAP TEST, SOMETHING THAT YOU CAN GO INTO A FACILITY AND THEY CAN DO VERY SIMPLY, THAT YOU CAN GET. BUT IF YOU NEED A COLONOSCOPY, YOU BETTER GET IN LINE. >> THEY CAN'T AFFORD THE MEDICINES YOU PRESCRIBE. YOU SENT THEM TO A PLACE THAT HAS NO INTERPRETERS. COULD YOU CHANGE THIS? >> I TURN AROUND TO OPEN THE DOOR, WALK TO THE DOOR AND OPEN IT AND SAID, BYE, CANCER, OUT. AND I TURN AROUND AND SAYS, WOW, THE HEALING IS STARTING

RIGHT NOW. >> I HOPE EVERYBODY CAN OPEN THEIR HEART AND SAY, THESE PEOPLE REALLY NEED HELP. >> WELCOME TO PUBLIC SQUARE WHERE CIVIC TAGALOG TAKES CENTER STAGE. >> TO HAVE WOMEN THAT LOOK LIKE THEM, TALK LIKE THEM, COME FROM THAT SAME CULTURE, IN OUR CASE WE FIND THAT IT OPENS UP THAT DISCUSSION SO THAT WE'RE ABLE TO UNDERSTAND WHAT REALLY ARE THOSE THINGS THAT KEEP US FROM, YOU KNOW, GETTING SCREENED, OR EVEN GOING TO SEE A DOCTOR. >> CANCER. IT USED TO BE A DEATH SENTENCE, AND MANY FEARED EVEN TALKING ABOUT IT. THAT HAS CHANGE DRASTICALLY IN THE LAST FEW DECADES, AT LEAST IN MAINSTREAM AMERICA. BUT WHAT ABOUT IN OUR DIVERSE COMMUNITIES IN NEW MEXICO? THE NUMBER OF CASES FOR MANY HIGHER AMONG THE ANGLO POPULATION THAN THE HISPANIC OR NATIVE COMMUNITIES, AND YET SCREENING RATES IN THESE COMMUNITIES TEND TO BE LOWER. THUS, IT'S COMMON FOR CANCER TO BE DETECTED AT LATER STAGES.

THAT, ALONG WITH OTHER FACTORS, LEADS TO LOWER SURVIVAL RATES. ALSO, CERTAIN TYPES OF CANCER ARE ACTUALLY HIGHER AMONG THESE GROUPS, SUCH AS COLON CANCER IN HISPANICS, AND CANCER OF THE GALLBLADDER AND KIDNEY IN NATIVE AMERICANS. WHAT ARE THE CHALLENGES TO TALKING ABOUT CANCER IN HISPANIC AND NATIVE COMMUNITIES? WHY AREN'T PEOPLE GETTING EARLIER SCREENINGS? WHAT ROLE DOES ACCESS TO CARE PLAY? AND HOW CAN WE CHANGE THESE OUTCOMES IN NEW MEXICO? WE'LL ANSWER THOSE IMPORTANT QUESTIONS AND MORE WITH A VERY CANDID AND OFTEN HEARTFELT DISCUSSION WITH HISPANIC AND NATIVE SURVIVORS, ADVOCATES AND HEALTH WORKERS, AS WELL AS DATA EXPERTS. AND WE'LL TALK ABOUT SOLUTIONS WITH JOAQUIN BACA AND DR. ART KAUFMAN OF THE UNIVERSITY OF NEW MEXICO. BEFORE WE START, HERE'S A LITTLE MORE INFORMATION ON OUR TOPIC. >> CARMENGLORIA HAS AN APPOINTMENT WITH A NUTRITIONIST, BECAUSE SHE WAS IN A CLINICAL TRIAL. >> IT LOOKS LIKE YOU'VE GOT A HISTORY OF BREAST CANCER; IS THAT CORRECT? >> YES. >> ALL RIGHT. WHEN WAS THE INITIAL

DIAGNOSIS MADE? >> SHE HAS BEEN DIAGNOSED WITH A FATTY LIVER, SO THEY ARE TAKING HER OFF THE CLINICAL TRIALS. SHE JUST NEEDS TO VISIT WITH A NUTRITIONIST TO KIND OF HELP HER, HOW SHE CAN HELP HERSELF. >> THE RECOMMENDATIONS FOR BREAST CANCER ARE A MORE PLANT-BASED DIET. SO WE'LL BE TALKING ABOUT >> DALILA, TALK ABOUT WHAT YOU DO AS A PATIENT NAVIGATOR. >> WHEN I FIRST MEET THEM HERE, WE KIND OF SIT AND VISIT, AND I TELL THEM ABOUT MY JOURNEY AND THE THINGS THAT I'VE HAD TO DO. YOU KNOW, THE SURGERY, THE CHEMO, THE RADIATION, TAKING TAMOXIFEN FOR FIVE YEARS. SO BY ME SHARING MY STORY WITH THEM, YOU KNOW, IT KIND OF GIVES THEM AN IDEA MORE OR LESS WHAT THEY'RE GOING TO BE GOING THROUGH. JUST THEM KNOWING THAT THERE'S SOMEONE HERE THAT HAS BEEN THERE, THAT KIND OF RELIEVES A LITTLE BIT OF THE STRESS. >> AND CARMENGLORIA, WHY IS IT IMPORTANT FOR YOU TO HAVE DALILA HERE WITH YOU? >> IT IS REALLY IMPORTANT

BECAUSE DALILA HAS BEEN IN MY JOURNEY SINCE I START WITH THE BREAST CANCER. SOMETIME WHEN WE ARE WITH WORRY, SO WE -- SOMETIME WE DON'T THINK, OR WE DON'T UNDERSTAND WHAT THEY ARE SAYING TO US. SO DALILA IS HERE TO SUPPORT ME AND HELP ME. >> NOW I'VE BEEN SWITCHED TO ANOTHER HORMONE. IT'S -- WHAT IS IT? ARIMIDEX. >> YEAH, SHE'LL BE STARTING ARIMIDEX. SHE'S ALSO DOING THE INJECTION EVERY 28 DAYS. IT'S THE NEW REGIMEN THAT THE DOCTOR PRESCRIBED TO HER. >> ONE OF THE THINGS THAT WE'LL BE TALKING ABOUT IN THE SHOW IS HOW PATIENT NAVIGATORS CAN HELP BRIDGE THE DIVIDE BETWEEN BIG INSTITUTIONS LIKE THIS AND COMMUNITIES OF NATIVE PUEBLOS OR LATINO HISPANIC COMMUNITIES. CAN YOU TALK ABOUT THAT? >> THERE IS THAT LANGUAGE THAT DOWN, AND WE GET INTERPRETERS IN HERE TO INTERPRET IT BECAUSE YOU SAY ONE THING WRONG IN MEDICAL TERMINOLOGY IN SPANISH, IT CAN MEAN SOMETHING TOTALLY

DIFFERENT. SO PEOPLE START GETTING WORRIED YOU KNOW, IF YOU'RE NOT SAYING IT RIGHT, SO THAT'S WHY WE GET INTERPRETERS INVOLVED, MEDICAL INTERPRETERS. THAT WAY THEY'RE SAYING THE RIGHT THINGS AS IT'S COMING OUT OF THE DOCTOR'S MOUTH. >> AND WHAT HAS BEEN THE REACTION OF THE DOCTORS? DO THEY WELCOME NAVIGATORS? >> VERY MUCH SO, YES. AT LEAST HERE IN OUR FACILITY, YES. ACTUALLY, A LOT OF OUR DOCTORS THAT HAVE COME FROM DIFFERENT FACILITIES, THEY'RE USED TO HAVING NAVIGATORS ON BOARD. ONCE THEY ORDER AN X-RAY OR CT SCAN, WE MAKE SURE THAT'S SCHEDULED AND IT'S DONE IN A TIMELY MANNER BEFORE THEIR NEXT PENDING APPOINTMENT WITH THAT DOCTOR. SO, YES, IT'S VERY, VERY WELCOME TO THE DOCTORS. >> WHY IS IT IMPORTANT THAT SHE'S LATINO, THAT SHE COMES FROM YOUR COMMUNITY? >> IT'S EVERYTHING, BECAUSE IT'S SOMEBODY FOR MY CULTURE. SO SHE WILL UNDERSTAND THE WAY THAT I WILL FEEL SOMETIME, SHE WILL KNOW WHY I FEEL THAT WAY. THE CANDOR, ALSO, BECAUSE SHE SPEAK MY LANGUAGE, SHE

KNOW MY CULTURE. BOTH ARE LATINA. SHE WILL KNOW EXACTLY HOW I WOULD FEEL. >> I WANT PEOPLE IN THE COMMUNITY, ESPECIALLY NATIVE AMERICAN PEOPLE IN THE COMMUNITY, TO SEE THAT WE HAVE SURVIVORS OF CANCER OUT THERE. IT'S SOMETHING THAT WE DON'T TALK ABOUT A LOT IN OUR NATIVE COMMUNITIES, AND SO KNOWING THAT WE HAVE SURVIVES, KNOWING THAT CANCER IS A SURVIVABLE DISEASE, IS REALLY IMPORTANT. >> WE DON'T MAKE WILLS, BECAUSE WE SAY, DON'T TALK ABOUT IT, DON'T DO YOUR WILL, YOU'RE ONLY HURRYING DEATH. AND IT'S THE SAME THING WITH CANCER. DON'T TALK ABOUT CANCER, YOU MIGHT GET IT, YOU KNOW. JUST LEAVE WELL ENOUGH ALONE, DON'T BRING IT ON. THOSE ARE THE MYTHS, AND WE NEED TO STEER IT IN THE OTHER DIRECTION. >> IT'S REAL IMPORTANT TO PUT SOME PERSPECTIVE ON SOME OF THE BARRIERS THAT IN OUR COMMUNITY EXIST.

NOT JUST CULTURAL ISSUES, BUT ALSO LOOKING AT HEALTH CARE SYSTEM BARRIERS AND HOW WE CAN IMPROVE THE CARE FOR OUR COMMUNITY. >> IF WE DON'T ADDRESS THE OPPORTUNITIES AND TAKE ADVANTAGE OF THE OPPORTUNITIES FOR PREVENTION, WE MAY SEE THE CANCER BURDEN IN NATIVE POPULATIONS IN NEW MEXICO FAIL TO IMPROVE, OR EVEN PERHAPS WORSEN. >> THANK YOU ALL FOR COMING TO TALK ON PUBLIC SQUARE TODAY ABOUT CANCER AND CONNECTING CULTURES. CARMENGLORIA, I'D LIKE TO START WITH YOU. TALK ABOUT WHY YOU WERE RELUCTANT TO GET SCREENED, AND HOW THAT FINALLY HAPPENED. >> WELL, I KNEW THAT BEING OVER 40 YEARS OLD, I HAVE TO GET SCREENED, BUT BECAUSE OF A LACK OF INSURANCE, I DIDN'T ACTUALLY WANT TO DO IT, BECAUSE I DIDN'T HAVE ANY MONEY TO PAY. BUT ALSO, IT WAS THAT I THOUGHT THAT WHEN THEY WERE TALKING ABOUT BREAST CANCER, IT WASN'T FOR ME.

IT'S LIKE, THEY WERE TALKING FOR ANOTHER PEOPLE, NOT TO ME. I RECEIVE AN E-MAIL AND I HEARD THAT CASA DE SALUD, IT'S A CLINIC HERE THAT WAS HELPING YOU WITH MAMMOGRAM FOR FREE, SO I WENT TO THE MAMMOGRAM, AND THEY FOUND THERE THAT I HAVE A LITTLE LUMP, AND THEY DID A BIOPSY. SO THEY ACTUALLY TOOK LIKE A WEEK TO CALL ME. I DECIDED TO GO ON VACATION TO NEW YORK, SO I WAS DRIVING THERE WITH MY HUSBAND ON A FREEWAY FULL OF CARS EVERYWHERE, AND I RECEIVED THE CALL FROM THE IMAGE CENTER, AND SHE SAID, I HAVE TO LET YOU KNOW THAT YOU HAVE BREAST CANCER. JUST LIKE THAT. SOMETHING LIKE A CURTAIN GOES COVER, ALL OVER. ANYTHING. THANK GOD I WASN'T DRIVING. SO I SAID, I'M SORRY, COULD

YOU REPEAT WHAT YOU JUST SAY? AND SHE SAID, YES, YOU HAVE BREAST CANCER. I SAID, BUT, CAN YOU TRANSFER ME TO SOMEBODY THAT SPEAK MY LANGUAGE? SO SHE SAID, NO, WE DON'T HAVE ANYBODY HERE THAT SPEAKS SPANISH, I'M JUST A RECEPTIONIST. AND I SAID, BUT COULD YOU TELL ME HOW LONG I'M GOING TO LIVE? BECAUSE ALL THESE QUESTIONS COME AND SAY, WHEN I GOING TO DIE? BECAUSE CANCER IS LIKE DEATH FOR US, IT'S LIKE DEATH. SO SHE SAYS, NO, NO, I'M SORRY, WE DON'T KNOW YET. PROBABLY SOMEBODY WILL CALL YOU TO SET UP A DOCTOR APPOINTMENT, AND I SAID, BUT, OKAY, AND I HAVE TO HANG UP BECAUSE I WASN'T ABLE TO SPEAK ANYMORE IN ENGLISH. IT WAS THE WORST NEWS THAT I EVER RECEIVE IN MY LIFE. SO I SAID, I NEED TO COME BACK TO ALBUQUERQUE, I NEED TO SAVE MY LIFE, I NEED TO DO WHATEVER I HAVE TO DO TO BE ABLE TO SURVIVE. AND SO I CALLED MY BEST FRIEND.

IT WAS ACTUALLY VERY SAD, CRYING WITH ME. AND SHE SAID, LET ME SEE IF I CAN HELP, IF I CAN FIND SOME HELP. AND SHE FOUND THE COMADRE A COMADRE PROGRAM. SO I DID CALL ELBA, AND SHE WAS TALKING TO ME FOR THREE HOURS. SHE WAS GIVING ME ALL THIS SUPPORT. SHE WAS TELLING ME, YOU ARE NOT GOING TO DIE, THAT IT'S ALL RIGHT. I SAID, BUT ELBA, I DON'T HAVE INSURANCE, HOW I GOING TO GET TREATMENT? I MEAN, I'M GOING FASTER THAN ANYONE, BECAUSE I DON'T HAVE ANY -- I DON'T KNOW HOW TO PAY. AND SHE SAY, DON'T WORRY, WE WILL FIGURE IT OUT. IT WAS A VERY ACTUALLY IMPORTANT SUPPORT. IT WAS AMAZING. SOMEBODY WAS TALKING TO ME IN MY OWN LANGUAGE ABOUT MY ISSUE, AND SOMEBODY WAS TELLING ME THAT, NO, EVERYTHING WAS DONE. I MEAN, THAT I WAS ABLE TO LIVE MORE. >> DALILA, YOU ARE ONE OF THE CO-FOUNDERS OF COMADRE WITH ELBA. YOU'RE ALSO A SURVIVOR. >> I'M A SURVIVOR.

IT'LL BE 20 YEARS THIS JUNE. I HAD JUST GONE IN FOR MY USUAL YEARLY STUFF, AND I ENDED UP WITH HAVING TO GO AND SEE A SPECIALIST. I HAD TO ACTUALLY GO IN AND HAVE THE LUMP REMOVED, AND THEN IT CAME BACK POSITIVE. ALL THE NEWS, ALL THE RESULTS, WERE GIVEN TO ME IN HER OFFICE, IT WAS NEVER DONE BY PHONE. THAT'S WHEN I STARTED MY JOURNEY WITH MY CHEMO AND MY RADIATION. >> WHERE DID YOU FIND SUPPORT? >> I FOUND A LOT OF SUPPORT WITH MY CO-WORKERS. I HAD A SON HERE AND A SISTER HERE IN ALBUQUERQUE, WHICH UNFORTUNATELY DIDN'T HAVE ANY SUPPORT. >> YOUR FAMILY DID NOT? >> NO. >> WHY? >> I THINK THEY WERE JUST -- FEAR OF MAYBE DEATH FOR ME, WHICH THIS IS WHAT I THOUGHT, TOO, BECAUSE I HAD JUST LOST MY MOTHER THREE YEARS PRIOR TO MY DIAGNOSIS, FROM PANCREATIC CANCER. AND MY SISTER, OF COURSE, PROBABLY MAYBE SHE FIGURES, WELL, IF MY SISTER HAS IT, I'LL PROBABLY GET CANCER MYSELF, TOO.

I HAD A DAUGHTER WHO LIVED IN SANTA FE, BUT UNFORTUNATELY I JUST COULDN'T SEE HER COMING TO EVERY APPOINTMENT TO SUPPORT ME, TO BE THERE WITH ME. SHE WOULD CALL ME AND SEE HOW I WAS DOING, BUT I ALWAYS TOLD HER, I'M FINE, I'M FINE. >> ARE YOU TRYING TO BE STRONG FOR YOUR FAMILY? >> I WAS. I'M THE OLDEST IN THE FAMILY, SO GROWING UP I HAD A LOT OF RESPONSIBILITY BECAUSE I WAS THE OLDEST. I DID WORK, ALSO, THROUGHOUT MY JOURNEY. BUT I WAS TRYING TO PROTECT MY FAMILY, LIKE, IT'S OKAY. I JUST HAD TO FIND IT WITHIN MYSELF THAT I COULD DO THIS. >> DID YOU GO TO SUPPORT GROUPS? >> I DID START GOING TO A SUPPORT GROUP. THE MAJORITY OF LADIES WERE ANGLO, THERE WAS ONLY ONE HISPANIC WOMAN. BUT I JUST COULDN'T CONNECT. THERE WAS JUST NOTHING THERE THAT I COULD RELATE MYSELF TO, OTHER THAN THE CANCER. >> HELEN, YOU ALSO HAD A DIAGNOSIS, AND YOU ARE A SURVIVOR. >> YES. >> CONGRATULATIONS. >> THANK YOU. >> DO EITHER OF THESE

EXPERIENCES SOUND SIMILAR TO ANYTHING YOU EXPERIENCED AS A NATIVE WOMAN WHEN YOU GOT YOUR DIAGNOSIS? >> IN BOTH CASES, IN BOTH THEIR EXPERIENCES, IT'S BECAUSE OF THE INSURANCE. CONTRACT HEALTH COULDN'T DECIDE WHETHER I QUALIFIED OR WHAT WITH THE PUBLIC HEALTH SERVICE IN SANTA FE. BUT HOW I CAME ABOUT DISCOVERING IS, I WAS TAKING A SHOWER, LATHERY HANDS, AND I DISCOVERED A LITTLE, LITTLE LUMP IN MY BREAST. I WAITED TWO WEEKS. LIKE SHE SAID, IT'S NOT SUPPOSED TO HAPPEN TO YOU. IT HAPPENS TO OTHER PEOPLE. BUT THEN I -- IT TOOK A WHILE FOR ME TO DECIDE TO GO, AND IT WAS LIKE ABOUT TWO WEEKS, AND THEN I WENT TO A DOCTOR IN SANTA FE AT THE PUBLIC HEALTH SERVICE, AND SHE SENT ME FOR A MAMMOGRAM. BUT NOTHING CAME BACK

POSITIVE. THERE WAS JUST GRAY MATTER, AND THAT I SHOULDN'T WORRY ABOUT IT. BUT MY DAD USED TO SAY, YOU KNOW YOUR BODY THE BEST, MORE THAN ANY DOCTOR WILL, SO THAT'S WHAT TOOK ME BACK TO THE DOCTOR, AND SHE SENT ME TO SANTA FE IMAGING, AND PUT ME THROUGH MRI. THEY DID A BIOPSY, AND WHEN THEY TOLD ME IT WAS POSITIVE, NUMB. NOTHING. YOU DON'T HAVE -- I DIDN'T HAVE NO FEELINGS. I WASN'T SAD, I WASN'T THINKING OF DEATH, I WAS JUST LIKE, NUMB. SO I WENT HOME AND WENT STRAIGHT TO MY -- I WALKED INTO THE HOUSE, BECAUSE I LIVED ALONE, I WENT STRAIGHT TO MY PRAYER CORNER AND TOOK MY CORNMEAL AND I STARTED TALKING, BECAUSE MY DAD SAID, DON'T EVER PRAY IN SILENCE, TALK OUT. AND MY DAD, HE PASSED ON. I REMEMBERED WHAT HE HAD SAID, SO I SAID, WELL,

FATHER GOD, I'M HOME, YOU KNOW THE DIAGNOSIS. SO I SAID, YOU'RE THE GREAT PHYSICIAN, AND I'M NOT GOING TO ACCEPT THIS CANCER. I CAN'T DENY THE DIAGNOSIS, BUT I'M NOT GOING TO ACCEPT THE CANCER IN MY BODY. SO I SAID, TAKE MY HAND, PREPARE ME FOR THIS BATTLE JUST LIKE YOU PREPARE OUR BOYS FOR WAR. I HAVE A WAR IN MY HANDS, I SAYS, I CAN GO THROUGH IT WITH YOU. SO THAT'S HOW I TOOK IT, AND I SAID, THANK YOU. I BREATHED THE HEALING IN, AND I SAID, START HEALING RIGHT NOW. AND I TURNED AROUND AND I WENT, WHOA, YOU KNOW. BOOM, I CLAIMED THE HEALING. I TURNED AROUND, OPENED THE DOOR, WALKED TO THE DOOR AND OPENED IT, AND SAID, BYE, CANCER, OUT. AND I TURNED AROUND AND SAID, WOW, THE HEALING HAS

STARTED RIGHT NOW. SO I WENT ABOUT MY DAILY BUSINESS AND GETTING SCHEDULED. THAT'S WHAT I CONCENTRATED ON, GETTING TO THE DOCTOR FOR SURGERY OR WHATEVER, AND TO LEARN MORE ABOUT IT. >> WHAT ARE SOME OF THE CHALLENGES YOU GUYS TRY TO ADDRESS GETTING PEOPLE TO TALK ABOUT CANCER? >> WHAT WE TRY TO VALIDATE IS, YOU KNOW WHAT, IT'S IN ORDER FOR US TO BE THERE FOR AND OUR COMMUNITY. WE NEED TO BE THERE FOR OURSELVES. WE NEED TO BE ABLE TO MAKE THAT TIME TO GET THAT SCREENING AND TO REACH OUT. AND SO HERE'S WHAT WE'RE GOING TO TALK ABOUT TODAY, HOW DO WE DO THAT. >> THAT'S AN EFFECTIVE WAY TO MESSAGE THAT FOR LATINO HISPANIC WOMEN WHO ARE USED TO PERHAPS PUTTING EVERYONE ELSE FIRST. >> EXACTLY. THE OTHER PART OF THAT IS, THE WOMEN IN THE COMMUNITY WHO ARE ABLE TO FEEL COMFORTABLE WITH THE WOMEN WHO HAVE CANCER, OR WHO ARE SURVIVORS, THEY HEAR THEIR STORY AND SO THEY'RE ROLE-MODELING. THERE IS A WOMAN THAT THEY CAN ASSOCIATE WITH, BREAST CANCER AND EARLY DETECTION.

AND THE WOMEN, THEMSELVES, SHARE THESE STORIES, AND SO NOW THE WOMEN LEAVE THERE BELIEVING AND FEELING, OKAY, NOW I HAVE THE KNOWLEDGE. THEY WATCH A VIDEO, THEY PARTAKE IN -- WE ALSO TAKE PART IN DEBUNKING THOSE MYTHS. SO THERE ARE SOME MYTHS, FOR EXAMPLE, ABOUT RADIATION, GETTING RADIATION FROM THE MAMMOGRAM, OR WHAT'S SAFE, WHAT'S NOT SAFE, OR, YOU KNOW, CAN I EVEN GET ONE, I HAVE NO MEDICAL INSURANCE. SO A LOT OF DISCUSSION HAPPENS IN THOSE CLASSES. SO THAT'S ONE OF THE CHALLENGES THAT WE ADDRESS. AND THEN THE OTHER THING IS THE EMOTIONAL SUPPORT THAT DALILA SAID. WOMEN NEED TO BE ABLE TO TALK ABOUT THEIR EXPERIENCE WITH OTHER WOMEN REGARDLESS OF WHO YOU ARE, WHATEVER EXPERIENCE YOU'VE HAD, WHETHER IT'S EVEN A CHRONIC DISEASE, THAT YOU FEEL, RIGHT, THAT YOU'RE WITH PEOPLE THAT UNDERSTAND YOU, THAT YOU'RE WITH PEOPLE THAT YOU CAN TRUST. SO TODAY WE HAVE SPANISH-SPEAKING SUPPORT GROUPS IN ENGLISH. THEY SHARE AND THEY TALK ABOUT SPIRITUAL PRAYER, THEY

TALK ABOUT THEIR FAMILIES, THEY TALK ABOUT THEIR CANCER, THEY SUPPORT ONE ANOTHER. SO THAT'S ONE OF THE OTHER COMPONENTS. >> YOU TALKED ABOUT MYTHS. WE HAVE SOME COMMUNITY HEALTH WORKERS FROM OUR PUEBLO COMMUNITIES, AND I WANT TO ASK IRIS AND SIMON, AS COMMUNITY HEALTH WORKERS, DO YOU ENCOUNTER THAT? ARE THERE MYTHS ABOUT CANCER THAT PREVENT PEOPLE FROM TALKING ABOUT IT? >> A LOT OF THE NATIVE AMERICANS OR PUEBLO PEOPLE ARE AFRAID TO GO SEE DOCTORS BECAUSE WE DON'T WANT TO LEARN ANYTHING BAD THAT IS HAPPENING TO OUR HEALTH. AND ONE IS, EVERYBODY HAS HIT THE NOTE ON TRANSLATION. YOU KNOW, WHEN WE GO AND VISIT THE DOCTORS, WE'RE HERE NODDING OUR HEADS. DO WE REALLY UNDERSTAND WHAT OUR DIAGNOSIS IS? US NATIVES, WE HAVE PRAYERS THAT WE DO EVERY DAY, AND WE ASK FOR PRAYERS, AND WE THINK IT SHOULDN'T HAPPEN TO US PUEBLO INDIANS.

IT'S NOT GOING TO COME INTO OUR COMMUNITIES. BUT IT'S ALL OVER. CANCER DOESN'T PICK A PERSON. JUST IT'S SOMETIMES GENETIC, OR SOMETIMES JUST HOW YOU TAKE CARE OF YOUR HEALTH. SO WHEN MS. BIRD, WHEN I WAS STILL WORKING IN SANTO DOMINGO, HAD COME FOR ASSISTANCE, I HAD NO CLUE ABOUT WHAT CANCER WAS. WE NEED TO GET OUR COMMUNITY HEALTH REPRESENTATIVES EDUCATED SO WE CAN BE OUT THERE TO BE IN SUPPORT. WE NEED THE RESOURCES TO HELP OUR COMMUNITY MEMBERS. >> AND JUST TO ADD ON TO WHAT IRIS HAS SAID, AS PUEBLO INDIANS, YOU KNOW, I THINK WE'RE KIND OF IN DENIAL OF OUR CANCER STUFF. WHAT I REALIZED IN THE LAST 10-15 YEARS IS THAT THERE IS AN INCREASE OF PEOPLE GETTING CANCER, AND AS

MRS. BIRD HAS MENTIONED ABOUT INDIAN HEALTH SERVICE, YOU KNOW, THE CONTRACTS, THERE'S NO FUNDS, PEOPLE ARE AFRAID, PEOPLE DON'T UNDERSTAND WHAT CANCER IS ABOUT. THERE'S A LOT OF PEOPLE THAT DO HAVE CANCER IN THEIR PUEBLO. >> AND YOU'RE SAYING WITH IHS, THE INDIAN HEALTH SERVICE, THE CONTRACT, YOU'RE NOT SURE WHAT SERVICES YOU'RE ELIGIBLE FOR, OR THERE'S NOT ENOUGH SERVICES? >> THERE'S NOT ENOUGH SERVICES. >> THERE'S NOT ENOUGH MONEY. >> THERE'S NOT ENOUGH MONEY TO GO AROUND. IN THE LAST, WHAT, 12 YEARS, THEY DID AWAY WITH A LOT OF SERVICES IN THE INDIAN HEALTH SERVICE. MEDICAL, DENTAL, WHATEVER. AND THEN WHEN YOU GO TO CONTRACT FOR A MAMMOGRAM, A COLONOSCOPY, WHATEVER, YOU HAVE TO APPLY, AND WE DON'T HAVE A CHOICE. A LOT OF PEOPLE DON'T HAVE

INSURANCE. >> ARE THESE SIMILAR TO WHAT YOU'RE SEEING, JEAN, AT ZIA PUEBLO? >> YES. WE USED TO HAVE THE MOBILES COME UP AND HAVE THAT SERVICE PROVIDED FOR WOMEN, BUT NOW THEY'RE ON WAITING LISTS. INDIVIDUALS THAT HAVE INSURANCES, THOSE ONES WILL GET IN FOR A MAMMOGRAM FASTER. OUR CHR PROGRAM HAS BEEN INVOLVED WITH NATIVE AMERICAN CANCER EDUCATION, LEADERSHIP INSTITUTE, WHICH CAME OUT OF UNM. >> THAT'S COMMUNITY HEALTH WORKER? >> YES, COMMUNITY HEALTH REPRESENTATIVES. AND WE WENT AND WE CAME UP WITH CANCER 101 CURRICULUM. WHEN SOMEBODY GETS DIAGNOSED WE'RE USUALLY INVOLVED TO GO IN AND DO A ONE-TO-ONE EDUCATION. BUT THAT'S WHERE -- THAT'S THE PATIENT'S PREROGATIVE.

SOME OF OUR COMMUNITY MEMBERS DON'T WANT THEIR COMMUNITY MEMBERS, THEIR FAMILIES, TO EVEN KNOW THAT WITH THIS. THEY WANT TO TACKLE IT THEMSELVES. WE'RE LETTING THEM KNOW, IT'S ALL RIGHT. IT'S ALL RIGHT TO GO THROUGH THE CRYING, YOU KNOW, THE ACCEPTANCE. >> LET ME ASK DR. CHACON, THERE ARE A LOT OF CHALLENGES YOU'RE FACING. >> IN NATIVE COMMUNITIES, WE WHAT WE CALL CONTRACT HEALTH SERVICES OR PREFERRED CARE. WHOSE GOING TO PAY FOR THIS? HOW IS IT GOING TO GET PAID? SO THERE ARE MANY CHALLENGES WHEN IT COMES TO CANCER, AND MANY OTHER CHRONIC DISEASE. I THINK REAL BASIC IS EDUCATION. AS A FOUNDER OF CENTER FOR NATIVE AMERICAN HEALTH AT THE UNIVERSITY OF NEW

MEXICO, WE BEGAN THAT CANCER 101 TRAINING, WHICH WAS TAKING MODULES THAT HAD BEEN CREATED IN THE NORTHWEST TRIBES AND MODIFYING THAT TO SOUTHWEST CULTURES, SOUTHWEST TRIBES, WHAT WE HAVE TO DEAL WITH HERE IN NEW MEXICO AROUND CANCER, PROVIDING THAT AT THE COMMUNITY LEVEL, NOT AT THE COMMUNITY WITH TRAINERS BEING CHRs. >> WHY IS IT IMPORTANT TO BE AT THE COMMUNITY LEVEL VERSUS WHEN YOU HAVE TO COME TO ALBUQUERQUE TO THE CANCER CENTER, OR TO SANTA FE? >> YOU'RE SAFE. YOU'RE HOME. YOU'RE WITH FAMILY. YOU GET TO SPEAK WHAT YOU WANT TO SAY. YOU HOPE THAT THINGS ARE HONEST AND YOU'RE AT A LEVEL PLAYING FIELD. WHEN YOU'RE AT THE INSTITUTION, YOU EXPECT TO GO THERE FOR TREATMENT. MAYBE SOMETIMES EVEN, I THINK WE FEEL LIKE YOU GO

THERE SOMETIMES TO GET BAD NEWS, TO DIE, WHICH IS NOT GOOD. SO BRINGING THIS TO THE COMMUNITY AND HAVING PEOPLE IN THE COMMUNITY TALK ABOUT THEIR PERSPECTIVE, THEIR HOME, THEY'RE SAFE. WHAT'S THE SUPPORT? HOW CAN WE GARNER WHAT'S HERE, CULTIVATE WHAT'S HERE IN OUR COMMUNITY TO RESPOND TO THE NEEDS? >> WHAT I THINK IS SO SIGNIFICANT ABOUT WHAT DR. CHACON IS SAYING IS THAT WE FIND THE VERY SIMILAR THING. WE BRING THE CLASSES TO WHERE THE WOMEN ARE. IT'S NOT JUST, RIGHT, THE MAMMOGRAM, BUT EVERYTHING ELSE THAT PRESENTS A CHALLENGE TO GETTING THAT. LOOK LIKE THEM, TALK LIKE THEM, COME FROM THAT SAME CULTURE, IN OUR CASE WE FIND THAT IT OPENS UP THAT DISCUSSION SO THAT WE'RE ABLE TO UNDERSTAND WHAT REALLY ARE THOSE THINGS THAT KEEP US FROM, YOU KNOW,

GETTING SCREENED, OR EVEN GOING TO SEE A DOCTOR AND UNDERSTANDING THAT BETTER. >> EMILY, I WANT TO ASK YOU, THIS BRINGS ME TO SOME OF THE WORK YOU'RE DOING RIGHT NOW AT UNM. WE'VE RECORDED STORIES OF SURVIVORS. WHY ARE YOU DOING THIS? >> WE'RE GOING THROUGH OUR LIVES AND WE RECEIVE OUR CARE AT INDIAN HEALTH SERVICE FACILITIES FOR OUR WHOLE LIVES. THAT'S WHERE WE GO. AND I KNOW THIS FOR MY OWN IHS, AND WE WOULD TALK ABOUT, YOU ONLY GO TO LIKE ST. VINCENT'S TO DIE OR TO GET REALLY BAD NEWS, LIKE DR. CHACON WAS SAYING. SO WHEN YOU'RE GOING FOR CANCER, THAT'S COMPLETELY OUTSIDE YOUR COMFORT ZONE. THERE IS A HISTORY OF UNETHICAL PRACTICE IN NATIVE AMERICAN COMMUNITIES IN THE WORLD OF MEDICINE, AND THIS HAS KIND OF TRICKLED DOWN INTO THE COMMUNITY SO THAT THERE'S A LOT OF MISTRUST, AND IT EFFECTS THE WAY PEOPLE FEEL ABOUT HEALTH

CARE. SO I NOTICED THIS IN MY RESEARCH THAT THERE WAS A LOT OF MISTRUST, SO I DEVELOPED A PROGRAM TO MAKE THESE THINGS CALLED DIGITAL STORIES. THEY'RE SHORT THREE TO FIVE MINUTE VIDEOS WHERE PEOPLE TALK ABOUT THEIR OWN EXPERIENCES OF GOING THROUGH CANCER AND CANCER TREATMENT, OR FAMILY MEMBERS WHO HAD GONE THROUGH CANCER TREATMENT. AND THEN I TOOK THEM AND PLAYED THEM IN A NATIVE-SERVING CLINIC TO SEE IF THEY CHANGED THE WAY PEOPLE FEEL ABOUT HEALTH CARE, IN GENERAL, TO SEE IF THEY EFFECTED THAT MISTRUST. >> DO YOU HAVE ANY INSIGHTS YET, OR ARE YOU STILL CRUNCHING THE DATA? >> I'M STILL CRUNCHING MY DATA. I'M REALLY HOPING THAT THEY ACTUALLY CHANGE THE WAY PEOPLE FEEL ABOUT THEIR HEALTH CARE IN GENERAL. BUT I DID FIND THAT JUST GOING THROUGH THE DIGITAL STORY PROCESS, ABOUT MAKING THE DIGITAL STORIES, WAS A REALLY TRANSFORMATIVE EXPERIENCE, THAT WHEN PEOPLE TALKED ABOUT THEIR CANCER, WHEN PEOPLE MADE THEIR STORIES, IT REALLY MADE THEM FEEL BETTER ABOUT THE EXPERIENCE IN GENERAL. TELLING YOUR STORY IS

IMPORTANT. >> THERE ARE STILL GREATER INCIDENCES OF CANCER IN THE ANGLO COMMUNITY IN NEW MEXICO, BUT THE OUTCOMES ARE WORSE FOR THE COMMUNITIES OF COLOR. >> HISTORICALLY, THE RATES OR THE RISKS OF DEVELOPING THE ANGLO POPULATION, IN THE NONHISPANIC WHITE POPULATION, AND SOMEWHAT LOWER IN HISPANICS, AND THE LOWEST ACTUALLY IN THE NATIVE COMMUNITIES. THAT'S CHANGED. SOMETHING HAS CHANGED IN THE LAST 100 YEARS. NOW THERE IS CANCER HERE. AND ALTHOUGH THE RISKS OF CANCER OVERALL ARE SLIGHTLY LOWER IN THE NATIVE COMMUNITIES, THOSE RISKS ARE CHANGING. THE GOOD NEWS FOR NATIVE COMMUNITIES AND HISPANIC COMMUNITIES IS THAT IN GENERAL, YOUR RISK OF DEVELOPING CANCER IS LESS, BUT THE BAD NEWS IS THAT AMONG PEOPLE WHO DO DEVELOP CANCER, THEY TEND TO BE DIAGNOSED AT LATER STAGES, SUGGESTING THAT WE'RE NOT BEING AS EFFECTIVE WITH SCREENING AS WE COULD BE. AND AS A RESULT, PROBABLY YOUR CHANCES OF DYING FROM

THE SAME CANCERS ARE GREATER. >> DO WE KNOW WHAT THE -- WE'VE TALKED ABOUT SOME OF THE BARRIERS. BUT WHAT ARE SOME OF THE BARRIERS TO GETTING THE SCREENINGS OR THE EARLY INTERVENTIONS? >> LIKE MS. PINO ALREADY SAID, WE'RE NOT GETTING THE MAMMOGRAM VAN COMING OUT TO THE COMMUNITIES. THERE'S TREMENDOUS DISTANCE, AND THIS IS TRUE FOR ALL RURAL COMMUNITIES. JUST GETTING YOURSELF TO A FACILITY THAT HAS A SCREENING AVAILABLE TO THEM IS A MAJOR BARRIER. IHS, INDIAN HEALTH SERVICE, CAN'T PAY FOR A LOT OF SCREENING, SO IF YOU NEED SOMETHING THAT IS OUTSIDE OF WHAT THEY CAN PAY FOR IN ONE OF THEIR FACILITIES, YOU NEED TO GET CONTRACT HEALTH TO PAY FOR IT. CONTRACT HEALTH IS VERY COMPLICATED, AND SO WHAT WE'VE BEEN TALKING ABOUT IS SIGNING UP, GETTING ON A WAITING LIST, ALL THESE THINGS, AND THAT'S A HUGE BARRIER TO SCREENING. SO A PAP TEST, SOMETHING THAT YOU CAN GO INTO A FACILITY AND THEY CAN DO VERY SIMPLY, THAT YOU CAN GET, BUT IF YOU NEED A COLONOSCOPY, YOU BETTER GET IN LINE. >> AND COLON CANCER IS ONE OF THE CANCERS THAT'S RISING. >> AND ANOTHER, JUST TO ADD

ONTO THAT, WE'RE TALKING ABOUT SCREENING, AND WE CERTAINLY WANT TO PROMOTE SCREENING, BUT THAT'S NOT THE END OF THE STORY. IT'S PROVISION OF CARE QUICKLY, AND APPROPRIATE CARE, CULTURALLY COMPETENT CARE. >> I THINK THIS TOPIC BRIDGES VERY NICELY WITH THE ROLE OF CHRs AND PROMOTORS AND COMMUNITY HEALTH WORKERS IN GENERAL, IN THAT AS CRITICAL AS THEY ARE IN THE COMMUNITY, AND I THINK CHRs AND COMMUNITY HEALTH WORKERS IN GENERAL PLAY A PRIMORDIAL ROLE IN THE COMMUNITY, THEY ALSO PLAY AN IMPORTANT ROLE IN BRIDGING THE GAP BETWEEN SOME OF THE FEARS THAT COMMUNITY MEMBERS HAVE AND ACCESSING HEALTH CARE THAT AT SOME POINT INVARIABLY WILL BE NEEDED IN ALBUQUERQUE OR SANTA FE OR OUTSIDE OF THE COMMUNITY SETTING. AND THE COMMUNITY HEALTH WORKERS, CHRs, CAN PLAY A NAVIGATOR ROLE IN HELPING COMMUNITY MEMBERS UNDERSTAND WHAT AWAITS THEM WHEN THEY

DO STEP OUTSIDE THE COMMUNITY. >> THE CHRs, THE NAVIGATORS, THE PROMOTORS, ARE ALL CRITICAL IN NOT ONLY UNDERSTANDING THESE BARRIERS AND CHALLENGES, NOW YOU'RE GOING TO TURN TO THIS HEALTH CARE SYSTEM AND SAY, HELLO, CAN YOU MAKE THESE CHANGES, PLEASE. >> THAT'S A GREAT SEGUE INTO OUR NEXT SEGMENT WHERE WE'LL START TALKING ABOUT SOLUTIONS. SO HOLD TIGHT, WE'RE GOING TO ADD IN A FEW PEOPLE AND BE RIGHT BACK. >> THANK YOU ALL FOR COMING BACK FOR THE SECOND PART OF PUBLIC SQUARE. I'D LIKE TO START WITH DR. KAUFMAN. WE ENDED OUR LAST DISCUSSION TALKING ABOUT THE IMPORTANCE OF COMMUNITY HEALTH WORKERS AND THE ROLES THEY CAN PLAY IN ADDRESSING SOME OF THESE DISPARITIES. CAN YOU TALK A LITTLE BIT MORE ABOUT THAT? >> THE HEALTH SYSTEM ONLY EFFECTS ABOUT 10% OF WHAT MAKES COMMUNITIES HEALTHY. IT'S REALLY THE SOCIAL DETERMINANTS; EDUCATION,

DIET, TRANSPORTATION, SOCIAL MARGINALIZATION, ALL OF THOSE OTHER FACTORS THAT ARE HEALTH. COMMUNITY HEALTH WORKERS SPEND MUCH MORE TIME WITH THE SOCIAL DETERMINANTS THAN WE DO SITTING IN A CLINIC OR IN A HOSPITAL, SO IT'S CRITICAL THAT WE WORK IN PARTNERSHIP WITH COMMUNITY HEALTH WORKERS. ONE OF THE PROBLEMS IS THAT WE'VE NEVER BEEN TRAINED TO WORK WITH COMMUNITY HEALTH WORKERS, AND MANY TELL US THEY'LL BRING PATIENTS TO US, BUT WE DON'T KNOW HOW TO WORK WITH THEM. SURPRISINGLY ENOUGH, WE JUST FINISHED A STUDY OF 2000 PATIENTS WHO JUST WALKED UNIVERSITY AND FIRST CHOICE, AND LO AND BEHOLD, HALF OF THEM HAD A MAJOR ISSUE IN SOCIAL DETERMINANTS. NUMBER ONE WAS ACTUALLY ACCESS TO UTILITIES. PEOPLE WANTED MORE EDUCATION. THEY DIDN'T HAVE ADEQUATE JOBS. TRANSPORTATION WAS A PROBLEM. FOOD ACCESS. IT WAS TOTALLY UNKNOWN BY THE HEALTH CARE SYSTEM, UNLESS THESE QUESTIONS WERE ASKED. BUT WHEN WE GOT THIS ANSWER, WHAT DO WE DO? SO NOW THE UNIVERSITY HAS

ACTUALLY HIRED COMMUNITY HEALTH WORKERS TO MATCH WHAT WE'VE HEARD AROUND THE TABLE HERE TO ADDRESS THESE MAJOR PROBLEMS. >> JOAQUIN, I WANT TO ASK YOU, WITH THAT IN MIND, HOW IS THE UNIVERSITY SHIFTING HOW IT TRAINS DOCTORS TO ENCOMPASS THE REALITIES WE'VE HEARD IN THIS ROOM TODAY? >> THERE IS A GOOD AMOUNT IN CULTURAL COMPETENCY WITHIN THE CURRICULUM OF THE MEDICAL SCHOOL FROM A STANDALONE PRODUCT TO INTEGRATED WITHIN THE WHOLE SPHERE OF IT, AND I THINK THAT'S GOING TO MAKE A BIG DIFFERENCE. IT TAKES A LOT OF TIME. AND THE REASON THAT WE SAW THAT IS THE ACCREDITATION AGENCY, LCME FOR MEDICAL SCHOOLS, HAS ACTUALLY PRESCRIBED THAT, AND I THINK THAT IS A HUGE POLICY ISSUE THAT CAN CHANGE THE WAY THAT MEDICAL SCHOOLS APPROACH THIS. SO FURTHER CHANGES LIKE THAT I THINK WOULD HELP IN TERMS OF MEDICAL EDUCATION. I THINK IN TERMS OF THE OTHER DISCIPLINES, THEY'RE IN SOME WAYS A LITTLE BIT FURTHER AHEAD, NURSING AND

PUBLIC HEALTH AND OTHER DISCIPLINES. >> ONE THING I WONDER IS, WOULD IT HELP IF WE HAVE A MILLION DR. CHACONS. I MEAN, RECRUITING MORE NATIVE AND LATINO HISPANIC DOCTORS TO MEDICAL SCHOOL. >> ONE THING I WAS JUST TALKING TO DR. VALLEJOS, WHO IS THE DIRECTOR OF ADMISSIONS AT THE MEDICAL SCHOOL, AND SHE WAS MENTIONING A BIG EFFECT THAT THE BA-MD PROGRAM HAS HAD IN TERMS OF CHANGING THE DEMOGRAPHICS, AND ALSO DR. KAUFMAN HAS NOTICED THIS SINCE THEY FOCUS TWO-THIRDS ON RURAL COMMUNITIES AND ONE-THIRD ON THE URBAN, THAT WE'VE SEEN A HUGE SHIFT IN THE APPLICANT POOL, AND I THINK THAT'S MADE A BIG DIFFERENCE. THEY APPLY OUT OF HIGH SCHOOL AND THEY ACTUALLY HAVE A SPOT KIND OF RESERVED FOR THEM IN MEDICAL SCHOOL ONCE THEY GRADUATE. >> I'M CURIOUS, I'M GOING TO ASK SOME OF OUR FOLKS WHO HAVE BEEN HERE WHAT YOU THINK ABOUT THESE KIND OF POSSIBLE SOLUTIONS THAT WE'RE TALKING ABOUT, IF THAT WOULD ADDRESS SOME OF THE ISSUES THAT YOU'RE FACING RIGHT NOW. DR. CHACON? >> WHEN YOU SPEAK TO OUR

COMMUNITIES, IF THEY HAD A CHOICE, OF COURSE YOU WANT TO HAVE GREAT COMMUNICATIONS WITH YOUR DOCTOR AND TRUST WITH YOUR DOCTOR, NO MATTER WHERE YOU'RE AT, AND PART OF THAT TRUST IS THAT THE DOCTOR LOOKS LIKE YOU. YOU KNOW, I AM FORTUNATE THAT I'M A NATIVE PHYSICIAN WORKING IN A NATIVE COMMUNITY, AND I DON'T HAVE TO BE A NAVAJO PERSON WORKING IN A NAVAJO COMMUNITY FOR NATIVE PATIENTS TO TELL ME THINGS THAT THEY OTHERWISE MIGHT NOT TELL, YOU KNOW, DR. KAUFMAN, BECAUSE HE'S NOT FROM THE COMMUNITY. HE DOESN'T UNDERSTAND THAT NATIVE CULTURE WAY OF LIFE THAT IS JUST INGRAINED IN WHO WE ARE. AND THAT'S NOT TO SAY DR. KAUFMAN CANNOT -- YOU KNOW, THAT THERE WON'T BE A TRUST RELATIONSHIP THERE. THERE CERTAINLY WOULD BE. WE NEED MORE NATIVE PHYSICIANS, HISPANIC PHYSICIANS, NURSES, AT ALL LEVELS OF THE FIELD OF PRIMARY CARE AND MEDICINE.

THE OTHER THING ABOUT HAVING MORE DIVERSITY, MORE STUDENTS COMING INTO THE PROGRAMS AT THE UNIVERSITY, IS THAT THE FACULTY AND THE STAFF HAVE TO REFLECT THOSE POPULATIONS, AS WELL. AND THE LEADERSHIP LEVELS. >> WE ARE CONSTANTLY SITTING WITH FAMILIES THAT THEIR KIDS ARE INTERESTED IN MEDICAL SCHOOL, THEY'RE COMING FROM THE RURAL AREAS, THEY'RE NOT AWARE OF RESOURCES, THEY'RE NOT EVEN AWARE OF THE SCHOLARSHIPS. THEIR WANT IS THERE. AND THEN THEY BRING IN OTHER ISSUES, ESPECIALLY IN OUR MORE IMMIGRANT COMMUNITIES WHERE THEY'RE CARRYING THE FAMILY. SO IN SOME PROGRAMS, THEY HAVE ACTUALLY PUT IN FINANCIAL PACKAGES, LIKE FINANCIAL AID. NOT FINANCIAL AID IN THE TRADITIONAL OF HELPING THE STUDENT, BUT HELPING THE FAMILY SO THAT THESE STUDENTS CAN GET THROUGH COLLEGE AND GO FORWARD. >> I THINK THIS IS CRITICALLY IMPORTANT, BECAUSE IF YOU LOOK AT THE SOCIAL DETERMINANT THAT

PROBABLY HAS THE BIGGEST IMPACT ON HEALTH, THIS IS GRADUATING FROM SCHOOL. GET INTO A HEALTH CAREER, BECAUSE IT'S A VERY BIG EMPLOYER, THAT'S TERRIFIC. BUT JUST GRADUATING FROM SCHOOL MEANS EVERYTHING. SO I THINK OUR INVESTMENT IN EDUCATIONAL ATTAINMENT IS A HUGE BENEFIT TO HEALTH. AND IF WE LOOK AT THE POPULATIONS IN NEW MEXICO WHO HAVE THE LOWEST RATE OF GRADUATION FROM HIGH SCHOOL, IT TENDS TO BE THE ETHIC MINORITIES, IT TENDS TO BE IN RURAL AREAS. WE DON'T INVEST ENOUGH IN THOSE, AND WE HAVE TO IF WE'RE REALLY SERIOUS ABOUT HEALTH. >> ABSOLUTELY. WE'RE WORKING AND MOVING YOU CAN'T SACRIFICE THE CURRENT GENERATION OF PATIENTS WHO NEED CARE NOW. I THINK THAT'S ANOTHER THING THAT HAS TO BE DONE. THE EXISTING PHYSICIANS, THE EXISTING MEDICAL STUDENTS, REGARDLESS OF WHAT THEIR BACKGROUND IS, HAVE TO BE INSTRUCTED IN CULTURAL COMPETENCE, HOW TO BE SENSITIVE TO DIFFERENT CULTURES, BECAUSE THEY'RE GOING TO BE PROVIDING CARE TO DIFFERENT PEOPLE, AS WELL. SO IT'S ABSOLUTELY CRUCIAL THAT WE BRING IN THE UNDERREPRESENTED GROUPS TO FILL THE HEALTH CARE POSITIONS.

BUT THEY'RE NOT GOING TO FILL ALL OF THEM. EVERYBODY WHO'S PROVIDING HEALTH CARE HAS TO BE CULTURALLY COMPETENT. >> WE HAVE, THROUGH THE CENTER FOR NATIVE AMERICAN HEALTH, INCORPORATED SOMETHING CALLED A STUDENT NAVIGATOR WHERE WE HAVE SOMEBODY FROM THE INSTITUTION KIND OF HELP NAVIGATE HOW TO GET THROUGH. BUT IT'S FROM THE COMMUNITY, IN THE COMMUNITY, AND CAN KIND OF HELP ON BOTH ENDS OF IT. SO HAVING SOMEBODY IN THE INSTITUTION TO HELP GUIDE THOSE KINDS OF HURDLES AND THINGS THAT ARE THERE. BUT ALSO, LEARNING WHAT THE RESOURCES AND THE OBSTACLES MIGHT BE IN THE COMMUNITY, AND HOW TO NAVIGATE THROUGH SOME OF THAT. SO I THINK THAT WAS A GREAT MODEL, AND I THINK IF WE HAD MORE OF THOSE -- BUT I THINK WE SEE FREQUENTLY THAT THAT KIND OF INVESTMENT IS DIFFICULT TO ENCOURAGE WITHIN THE INSTITUTION BECAUSE YOU SEE IT AS -- IT DOESN'T GENERATE CLINICAL REVENUE, IT DOESN'T GENERATE RESEARCH MONEY, NECESSARILY, AND IT DOESN'T QUITE FIT INTO WHAT THE NORMAL MODEL OF THE INSTITUTIONAL MISSION IS. >> GO AHEAD, DR. CHACON.

>> WHEN I WENT THROUGH MEDICAL SCHOOL, I WAS ONE OF THE ONLY FEW -- OUT OF 300 ONLY TWO OF US WHO WERE NATIVE. GOING THROUGH A CADAVER LAB, WHEN IT'S TABOO FOR ME TO BE IN A ROOM AROUND DEAD BODIES, BASICALLY, TO BE IN THAT ENVIRONMENT WAS JUST TOTALLY TABOO FOR ME COMING FROM THE NAVAJO CULTURE. TO HAVE TO DEAL WITH THAT, THERE'S NOBODY AROUND AT THE MEDICAL SCHOOL FOR ME TO BE SAFE, TO BE IN AN ENVIRONMENT, TO TALK TO A FACULTY MEMBER, FOR THEM TO UNDERSTAND WHAT I WAS GOING THROUGH. THAT CHALLENGE, I MEAN, IT STILL EFFECTS ME TODAY WHEN I THINK ABOUT IT. THAT DIVERSITY OF TEACHING OUR STUDENTS THAT COME IN, WHEREVER THEY'RE FROM. THEY'RE FROM NEW YORK -- >> THERE YOU GO AGAIN. >> HAVING THAT DIVERSE STUDENT POPULATION IS THAT WE TEACH EACH OTHER, THAT WE'RE IN THE SAME CLASSROOM,

WE'RE SITTING SIDE BY SIDE, WE'RE AT THE SAME TABLE, AND THAT MY PERSPECTIVE IS HEARD AND RESPECTED AS MUCH AS I'M LISTENING TO HIS PERSPECTIVE. >> WELL, I WANTED TO ASK OUR HEALTH WORKERS, BECAUSE YOU SEEM TO BE KEY BRIDGES, AND I KNOW COMADRE DOES THIS, AS WELL, RIGHT? SOMETIMES YOU'RE GOING INTO THE INSTITUTIONS WITH THE PATIENTS AND BEING BRIDGES. HOW DOES THAT -- IS THAT EFFECTIVE, OR ARE YOU RESPECTED IN YOUR ROLE? INTO INSTITUTIONS, WE WILL ALSO INVITE A FAMILY MEMBER, BECAUSE THE FAMILY MEMBER LIVES WITH THE PATIENT. BUT SOME PEOPLE THAT DO LIVE ALONE, YES, THAT'S WHEN WE ARE THERE, AND THAT'S WHEN WE DO THE TRANSLATION FOR A BETTER UNDERSTANDING OF THEIR MEDICAL CONDITION. >> I'VE BEEN THERE AS A PATIENT, ALSO, AND I'VE BEEN THERE AS A PEER NAVIGATOR FOR COMADRE A COMADRE, AND THE BARRIERS ARE A LOT. A LOT.

THE LANGUAGE, SOMETIMES ME AS A PATIENT, I HAVE TO WAIT HOURS FOR SOMEBODY TO GO INTO THE ROOM AND TRANSLATE FOR ME, BECAUSE EVEN WHEN I SPEAK ENGLISH, JUST THE FACT OWN LANGUAGE, THAT IS WHAT I WANT. I WANT THE TRUST THERE. IT DOESN'T MEAN THAT I DON'T TRUST THE OTHER PEOPLE, BUT I FEEL MORE COMFORTABLE LISTENING TO A DOCTOR THAT IS TELLING ME SOMETHING AND I'M GOING TO UNDERSTAND 100%. >> I'VE HAD THE OPPORTUNITY JUST RECENTLY WHERE I WAS WITH A PATIENT, AND SHE WENT TO GO SEE HER ONCOLOGIST, AND THE ONCOLOGIST HAPPENED TO HAVE A SPANISH-SPEAKING PHYSICIAN WITH HER. I MEAN, BEAUTIFUL SPANISH. AND I SAW THE DIFFERENCE AFTER THE APPOINTMENT WITH THE PATIENT, HOW SHE FELT MORE COMFORTABLE, UNDERSTOOD EVERYTHING THAT WAS BEING SAID TO HER, AND YOU COULD TELL IN THE FACE THAT SHE WALKED OUT WITH A LOT MORE

INFORMATION THAT SHE UNDERSTOOD IN HER LANGUAGE, VERSUS WHEN THERE ISN'T SOMEONE TO INTERPRET FOR HER. THEY CAN HAVE THE INTERPRETER, YES, BUT THE ACTUAL PERSON BEING A PHYSICIAN WAS A MUCH MORE EFFECTIVE VISIT WITH THE DOCTOR AT THAT POINT. >> ANOTHER THING IS, A LOT OF THE NATIVE PEOPLE WON'T TAKE THE TIME TO READ WHAT THE PHYSICIANS GIVE THEM. SO A LOT OF US, WHEN WE WERE DOING THE HEALTH EDUCATION, WE USED A VISUAL, BECAUSE WE INTAKE THAT INFORMATION BETTER IF WE SEE VISUALS. >> EMILY, YOU WANTED TO SAY SOMETHING. >> THERE'S A BIG DRIVE FOR CULTURALLY CONGRUENT OR CULTURALLY COMPETENT CARE THAT'S BEING TAUGHT AT THE ACADEMIC LEVEL, AND WHAT WE SEE IN PRACTICE IS VERY DIFFERENT FROM WHAT THEY'RE SAYING IS BEING TAUGHT. SO WE'VE SEEN SOME GOOD EXAMPLES OF WHAT SHOULD BE

HAPPENING. HAVING AN ACTUAL SPANISH-SPEAKING PHYSICIAN, THAT'S A GREAT EXAMPLE. BUT WHAT WE SEE IN THE TEXTBOOKS IS STUFF LIKE, NATIVE PEOPLE DON'T LIKE TO MAKE EYE CONTACT. THAT'S A CLASSIC EXAMPLE OF WHAT WE SEE IN THE NURSING TEXTS. OR I SEE, WHEN I GO ON A NURSE, THEY'LL SAY, WE'RE PRACTICING CULTURALLY CONGRUENT CARE, WE HAVE VERY LARGE ROOMS SO WHEN OUR NATIVE PATIENTS COME AND THEY HAVE ALL THEIR FAMILY HERE, WE CAN FIT THEM ALL IN THE ROOM. WELL, THAT IS NICE, BUT WHO ARE YOU TALKING TO WHEN YOU HAVE THIS FAMILY? THAT'S JUST THE FIRST STEP. SO THE WAY THAT THE CHRs ARE REALLY HELPING OUT IS THEY'RE HELPING DIRECT THE CARE HERE. THEY'RE HELPING TO SLOW DOWN THE CONVERSATION SO THAT WHEN THE CLINICIAN WALKS INTO THE ROOM, THE CONVERSATION DOESN'T TAKE PLACE IN THREE SECONDS AND THEN THEY'RE OUT OF THERE. THEY'RE SAYING, WHOA, WHOA, WHOA, YOU NEED TO SLOW DOWN AND YOU NEED TO HAVE THIS CONVERSATION AT OUR PACE.

>> DR. KAUFMAN? >> A LOT OF THE INTERVENTIONS WITH COMMUNITY HEALTH WORKERS ARE IN THE COMFORT ZONE OF THE CLINICIAN'S. IT'S OUR TURF. IT'S OUR HIERARCHY. WE MOVE IN AND OUT AT OUR PACE. BUT WE'VE BEGUN TO SEE THAT THERE ARE COMMUNITY HEALTH WORKERS WHO ACTUALLY RUN CLINICS, AND THEY SUPERVISE, WHERE WE'RE OUTSIDE OUR COMFORT ZONE. AND ONE OF THE BEST EXAMPLES THAT WE'VE LEARNED THE MOST FROM IS IN THE INTERNATIONAL DISTRICT, AND IT'S SPECIFICALLY FOR UNDOCUMENTED IMMIGRANTS. THE ONE POPULATION THAT'S NOT GOING TO RECEIVE ANY BENEFIT FROM THE AFFORDABLE CARE ACT, BUT THEY'RE A VITAL PART OF OUR COMMUNITY. NO PATIENT LEAVES THAT CLINIC UNLESS THEY GO THROUGH A EXIT INTERVIEW WITH A COMMUNITY HEALTH WORKER. OVER HALF THE PATIENTS, THE COMMUNITY HEALTH WORKER COMES BACK AND SAYS, THEY DIDN'T UNDERSTAND WHAT YOU SAID, THEY CAN'T AFFORD THE MEDICINES YOU PRESCRIBED, YOU SENT THEM TO A PLACE THAT HAS NO INTERPRETERS, COULD YOU CHANGE THIS. OR WORSE, WHICH IS MORE EMBARRASSING, YOU DIDN'T UNDERSTAND WHAT THE REAL PROBLEM IS. BECAUSE THAT TRUST, AS PART OF AN EXIT INTERVIEW, WAS CRITICAL.

SO WE'RE SCRATCHING OUR HEADS AND THINKING, WAIT A MINUTE, HALF THE PATIENTS IN OUR REGULAR CLINIC AT THE UNIVERSITY PROBABLY DON'T UNDERSTAND WHAT WE'RE SAYING AND THEY'RE JUST NODDING. SO WE DO HAVE TO CHANGE THE LOCATION OF WHERE WE PRACTICE AND LEARN TO REALLY RESPECT WHAT THIS POWERFUL ROLE OF A COMMUNITY HEALTH WORKER IS. >> YOU MEAN THE PHYSICAL LOCATION? >> ABSOLUTELY. >> IT WOULD BE WONDERFUL TO CHANGE THOSE POWER RELATIONSHIPS WHERE THE COMMUNITY HEALTH WORKERS, ARE A CRITICAL PART INCLUDED IN THE TEAM, THEY'RE NOT JUST, YOU KNOW, WELL, LET'S GET THAT CHR OR PROMOTORS TO COME TO THE BIOPSY. BUT HOW ABOUT, NOT THE AFTERTHOUGHT, HOW ABOUT AT THE FRONT AND CENTER. AND I THINK THAT THAT'S WHERE I SEE A CHALLENGE WITH US, IS THAT WE SEE THAT THERE ISN'T THAT DESIRE TO INVEST. >> BUT THEN THE DOCTOR-PATIENT CONNECTION NEEDS TO BE THERE, TOO. THEY COME IN WITH A CLIPBOARD AND SAY, OKAY, MS. BIRD, YOUR HEMOGLOBIN, VITAMINS, YOUR CALCIUM, THEY'RE ALL OKAY.

AND ONE TIME, I JUST SAT THERE LIKE THIS. I PUT MY HAND LIKE THIS, AND SHE DIDN'T EVEN -- LIKE THE DOOR OPENED THIS WAY, AND I WAS SITTING THERE, AND THE COUNTER WAS RIGHT THERE. SHE LAID HER BOOK ON IT AND READ IT, AND THEN -- >> SHE DIDN'T LOOK AT YOU? >> AND THEN SILENCE. SHE TURNED AROUND, AND I SAID, GOOD MORNING, DOCTOR. AND THEN, YOU KNOW, I TOLD THEM THAT I WAS JUST WAITING FOR YOU TO START TALKING TO ME, YOU'RE STANDING THERE TALKING TO THE CLIPBOARD. >> DR. ESPEY, SOME DOCTORS DON'T REACT WELL WHEN PATIENTS SPEAK UP. >> THEY DON'T. >> IS THERE ANYTHING -- WE'RE TALKING ABOUT A LOT OF CULTURAL SHIFTS HERE. >> IT IS CRITICAL TO ELEVATE THE ROLE OF COMMUNITY HEALTH WORKERS AND CHRs IN THE CLINICAL SETTING, BUT I THINK THERE'S AN ENORMOUS OPPORTUNITY, ESPECIALLY IN CANCER PREVENTION. A THIRD OF CANCERS, ROUGHLY, ARE DUE TO INADEQUATE PHYSICAL ACTIVITY, OBESITY AND POOR DIET. AND THERE'S AN OR WHERE THE COMMUNITY HEALTH

WORKER, CHR PROFESSION, CAN REALLY HAVE A HUGE IMPACT. >> YOU KNOW, A LOT OF THESE THINGS NOT ONLY CAN THE CHRs ADDRESS, BUT IF WE SECTORS, LIKE EDUCATION AND HEALTH AND THE POLICYMAKERS, TO TALK ABOUT THE BASICS, YOU KNOW, THE STRESS THAT'S CREATED BECAUSE A PARENT CAN'T HAVE A JOB THAT ALLOWS THEM TO PAY FOR HEALTHY FOOD, OR YOU KNOW, THEY HAVE TO WORK THREE JOBS JUST TO MAKE ENDS MEET, TO MAKE THE RENT PAYMENT AND TO MAKE THE UTILITIES, THOSE THINGS HAVE THE GREATER EFFECT ON THE STRESS LEVELS, WHICH ALSO EFFECT HOW YOUR BODY DEALS WITH ILLNESS. >> DR. CHACON, YOU COULD SEE A PATIENT AND RECOMMEND, LIKE YOU NEED TO EAT FIVE TO SEVEN FRUITS AND VEGETABLES A DAY AND GO OUT AND EXERCISE. WHAT DO YOU DO WHEN THAT'S NOT A REALITY THAT THEY CAN

MEET, NECESSARILY, IF THEY ARE FACING SOME OF THOSE? >> I THINK IT REALLY TAKES A PROVIDER LEVEL, WHAT IS AVAILABLE AND WHAT ISN'T. WHAT'S REALISTIC. I CAN TELL THEM EVERYTHING ABOUT HOW TO LIVE AND EAT CAN ADDRESS SOME OF THESE OTHER ISSUES, THESE SOCIAL DETERMINANTS, THEN, YOU KNOW, I'VE SPENT ALL MY TIME TALKING AND DOING ALL OF THESE THINGS THAT IT'S -- SO THEN I WILL ADDRESS WHAT ELSE IS GOING ON. WHAT ARE THE STRESSORS IN YOUR LIFE. WHAT IS PREVENTING YOU FROM DOING SOME OF THESE THINGS. HOW DO WE HELP, YOU KNOW, AND FACILITATE GETTING SOMEONE HEALTHY. >> WE STARTED A MENS AND WOMENS GROUP. SOME OF THE QUESTIONS, OR SOME OF THE THINGS THAT THE WAS, WE'RE FORGETTING HOW WHEN PEOPLE, WHEN OUR ELDERS GREW UP, THEY WERE HEALTHY. DIABETES WAS NOT AROUND. CANCER WAS NOT AROUND.

WHAT DID THEY DO THEN VERSUS WHAT WE HAVE NOW. SO I KNOW IN THE MENS GROUP, I'M JUST GOING TO SHARE A LITTLE BIT OF WHAT THEY WERE TALKING ABOUT, IS THEY'RE GOING TO GO BACK TO TRADITIONAL PLANTING. HUNTING, THEY HUNT FOR THEIR FOOD. THEY WALK TO GO GET THEIR WATER. SO THEY'RE DOING THE EDUCATION FROM THE YOUNG KIDS TO ELDERS, AND IN THEIR GROUP, THEY HAVE A VARIETY OF PEOPLE THAT ARE PARTICIPATING. SO, YOU KNOW, IF WE GO BACK TO HOW WE LIVED BEFORE, I THINK IT SHOULD MAKE A DIFFERENCE, AND ITL A UNDERSTANDING OF WHERE WE ARE AT NOW THAT WE HAVE ALL OF THESE CHEETOS AND SODAS, AND NOT EXERCISING. >> GOING BACK TO THE COMMENT THAT DR. CHACON MADE ABOUT TELLING THESE PEOPLE, EAT HEALTHY FOOD AND STUFF, THAT'S A HUGE BARRIER, BUT IMAGINE THE BARRIER NOW WITH

TO IMPLEMENT, TAKING AWAY THE DRIVER'S LICENSE FROM THE UNDOCUMENTED PEOPLE. WHAT ARE LADIES GOING TO DO? WHAT ARE THEY GOING TO DO WHEN THEY HAVE TO GO FOR CHEMOTHERAPY? HOW ARE THEY GOING TO DRIVE IF THEY DON'T HAVE DRIVER'S LICENSE? WHO'S GOING TO DRIVE THEM? THEIR HUSBANDS? THEIR HUSBAND IS PROBABLY UNDOCUMENTED, TOO, AND HE CAN'T DRIVE EITHER. SO THEY DON'T HAVE DRIVER LICENSE, HOW THEY GOING TO SAVE THEIR LIVES? SO I WAS THINKING THAT BEFORE MAKING ALL THESE HUGE DECISIONS, THEY NEED TO SEE THAT WE ARE HUMAN BEINGS, YOU KNOW. >> WHEN I FIRST GOT DIAGNOSED AND SURGERY, I WAS BOMBARDED WITH INFORMATION. I DIDN'T KNOW I HAD A NAVIGATOR. I DIDN'T KNOW I HAD A CASE MANAGER. SO FAMILY MEMBERS OR CHRs GO WITH YOU, BECAUSE YOU'RE BOMBARDED WITH ALL KINDS OF -- I MADE SO MANY MISTAKES, I MADE WRONG CHOICES. SO THAT'S WHAT I WANT TO DO, YOU KNOW, EDUCATE PEOPLE. YOU HAVE CHOICES. AND ASK, ASK, ASK. >> ASK, ASK THE DOCTOR.

>> WHAT WOULD BE THE MOST EFFECTIVE SOLUTIONS THAT WE COULD IMPLEMENT NOW? >> IF A GROUP OF PEOPLE WOULD BUT TOGETHER A BINDER AND LIST ALL THE RESOURCES. WE TRIED TO LOOK FOR RESOURCES SO WE CAN REFER PEOPLE TO PICK UP A BOX OF GROCERIES, OR WE HELP OUR WOMEN WITH GAS CARDS FOR THEM TO BE ABLE TO GO TO SO I PERSONALLY THINK, HAD I BEEN GIVEN A BINDER TELLING ME THIS, YOU COULD DO THIS IF YOU DO THAT, I THINK IT WOULD HAVE GIVEN ME A BETTER IDEA AS TO WHAT I COULD DO, AND WHAT WAS OUT THERE IN THE COMMUNITY TO HELP ME TO FOCUS ON MY HEALTH. >> IT DOES SEEM LIKE THE COMMUNITY HEALTH WORKERS CAN BE -- THEY'RE ALREADY ACTING IN THAT KIND OF ROLE, THE WAY YOU DESCRIBED IN THE CLINIC HERE, DR. KAUFMAN. SO IS IT A MATTER OF INTEGRATING THEM MORE INTO THE HEALTH SYSTEM? >> I THINK ONE OF THE ADVANTAGES NOW IS THAT THERE IS A PAYMENT SOURCE THAT WE NEVER HAD BEFORE.

FOR THOSE WHO ARE ON MEDICAID, NOW THE WAY MANAGED CARE COMPANIES MAKE PEOPLE HEALTHY. WHAT A CONCEPT. THAT'S WHY THEY'RE INVESTING IN COMMUNITY HEALTH WORKERS, SOCIAL DETERMINANTS. IT'S THE KIND OF CHANGE AND INCENTIVE THAT WE NEVER HAD BEFORE, BECAUSE IF WE DID DIDN'T GET PAID FOR IT. NOW THEY HAVE TO INVEST IN IT. SO I THINK WE HAVE TO LOOK AT DIFFERENT STRATEGIES WHERE YOU HAVE KIND OF THE WIND AT YOUR SAILS. SOME OF THE BIG FUNDERS NOW CAN SUPPORT THIS WHERE THEY NEVER DID BEFORE. >> IS THIS BECAUSE OF THE AFFORDABLE CARE ACT? >> BECAUSE OF THE AFFORDABLE CARE ACT. >> WE BROUGHT THIS UP LIKE 20 YEARS AGO, BUT WE WERE SHOVED TO THE SIDE. WHAT WE WERE TOLD IS, YOU KNOW, THE PROFESSIONAL, THE DOCTORS, THE NURSES, THE LPNs, THE PHARMACISTS, ALL THOSE ARE LICENSURE. THAT WAS A BLOW BELOW THE BELT, YOU KNOW, TO OUR CHWs, CHRs AND

PROMOTORS, BECAUSE THEY SAID THEY'RE NOT LICENSED, WELL, TO HECK WITH YOU, YOU KNOW, WE'RE THE ONES THAT YOU'RE GOING TO COME FULL CIRCLE TO. >> YOU WERE ON THE FOREFRONT LONG BEFORE PUBLIC POLICY CAUGHT UP WITH YOU. I WANT TO THANK YOU ALL. I'M GOING TO GIVE CARMENGLORIA THE FINAL WORD BEFORE WE LEAVE. >> I BELIEVE THAT EVERYBODY, IT DOESN'T MATTER WHERE THEY'RE COMING FROM, THEY NEED TO BE TREATED WITH RESPECT. THEY NEED TO BE TREATED WITH DIGNITY. WE NEED THE RIGHT TO COMMUNICATION WITH OUR DOCTORS AND OUR HEALTH CARE SYSTEM. WE NEED PARTNERSHIP. WE NEED HELP. SO, I BEEN THERE AND IT'S REALLY HARD, SO I HOPE EVERYBODY CAN OPEN THEIR HEART AND SAY, THESE PEOPLE REALLY NEED HELP. NOT ONLY TO GET BETTER

PHYSICALLY, BUT ALSO PSYCHOLOGICALLY, BECAUSE WHEN CANCER COMES, IT DOESN'T COME -- IT'S JUST NOT ONLY THE PERSON THAT GETS THE SICKNESS, IT'S THE ENTIRE FAMILY. AND WE ARE THERE, AND WE NEED YOU GUYS. THANK YOU. >> THANK YOU VERY MUCH. I APPRECIATE YOU ALL COMING TO TALK ABOUT THIS. >> I WOULD LIKE TO SEE SOMETHING IN THE COMMUNITY THAT WOULD COME TOGETHER AND TRAIN MORE WOMEN OR MEN TO DO THE NAVIGATION PORTION OF IT. YOU NEED SOMEONE THAT'S GOING TO BE THERE THAT'S BEEN THERE, THAT CAN UNDERSTAND. >> OUR TASK IS TO TRY TO MAKE SURE THAT COMMUNITY HEALTH WORKERS ARE A VITAL ACADEMIC HEALTH CENTER AND IN HEALTH SYSTEMS. FOR THE COMMUNITY HEALTH WORKERS, THEIR VALUE IS UNDERSTOOD IN THE COMMUNITIES, BUT NOT AS MUCH BY THE PROVIDERS. SO WE'RE GOING TO MAKE THAT WORK. >> THERE'S SO MUCH MORE THAT NEEDS TO BE DONE IN TERMS OF

TRANSFORMING THE SYSTEM, AND DR. HAOZOUS MENTIONED THAT, TOO. YOU'RE GOING TO THE HOSPITAL, AND THE STUDENTS THAT WERE TRAINED IN THE MEDICAL SCHOOL COME BACK TO US AND COMPLAIN THAT WHILE THEY'RE DOING THEIR TRAINING IN THE HOSPITAL, THE LEADERSHIP AND THEIR TRAINERS FOR THE ROTATIONS ARE TELLING THEM, YOU KNOW, YOU REALLY CAN'T DO THOSE THINGS THAT THEY TOLD YOU IN CULTURALLY COMPETENT TRAINING. THOSE ARE NICE IN THEORY, BUT YOU CAN'T REALLY DO THEM IN PRACTICE WHILE YOU'RE HERE, YOU JUST HAVE TO DO WHAT WE TELL YOU. SO THOSE CHANGES THAT WE'RE TRYING TO MAKE KIND OF COME UNDONE. >> WE'RE AT THE BOTTOM INTERNATIONALLY OF ALL WESTERN COUNTRIES IN TERMS OF HEALTH, IN TERMS OF THE QUALITY OF OUR HEALTH CARE. WE HAVE TO CHANGE. ABOUT THESE ISSUES ON A DAILY BASIS AND NOT BE AFRAID, AND NOT BE AFRAID TO PROPOSE GREAT IDEAS, AND TO SIT AT THE TABLE WITH THOSE WHO ARE IN CONTROL. UNFORTUNATELY, IT COMES DOWN TO FUNDING.

IT MIGHT COME DOWN TO LEGISLATION, POLICY-MAKING. BUT THOSE THINGS DON'T HAPPEN WITHOUT HEARING THE VOICE OF THE PEOPLE IN THE COMMUNITY. >> JOIN US FOR PUBLIC SQUARE ON THE LAST THURSDAY OF EACH MONTH, AND VISIT OUR WEBSITE BY GOING TO NewMexicoPBS.org AND CLICKING ON 'LOCAL PRODUCTIONS.' HERE YOU CAN GIVE US FEEDBACK OR SUGGEST TOPICS. ALSO, JOIN THE CONVERSATION BY SEARCHING FOR 'PUBLIC SQUARE.' THANK YOU FOR WATCHING.