Meals on Wheels

This month marks the 45th anniversary of the Older Americans Act Nutrition Program has been the primary piece of federal legislation supporting social and nutrition services to Americans age 60 and older since 1965. We have to  protect the critical funding for the Meals on Wheels programs that are working tirelessly day in and day out to provide nearly 218 million meals, either at home or in group settings, to more than 2.4 million seniors each year.  OAA programs are vital for seniors who are at significant risk of hunger, isolation and losing their ability to live independently. Services provided include:

  • Home-delivered meals and meals served in group settings such as senior centers
  • Transportation
  • Personal care and homemaker support
  •  Caregiver assistance
  • Preventative health

Did you know 1 in 6 seniors struggles with hunger. Meals on Wheels can provide a senior meals for 1 year for about the same cost as 1 day in the hospital.

Nationally, Meals on Wheels serves more than 500,000 veterans each year. The OAA covers 35% of the total cost to provide nutritious meals, safety checks and friendly visits to more than 54,000 Seniors. Programs rely on contributions from state, local, private donations and other resources to cover the rest.

I have worked with seniors in three different states.  This program kept them in their home and out of the nursing home.  It also prevented hospitalization and malnutrition.  I remember admitting several seniors to the hospital for dehydration which was due to lack of food and support services. Instead of going to nursing homes they went home.  Medicaid is the major funding source for covering the cost of nursing home care. Meals on Wheels  decreases the rate of falls, which cost our nation $34 billion each year. When a senior falls, they have serious injury that leads to hospitalization, admission to a Rehabilitation Center and then too often to a nursing home.

Sign the petition by 3/31/2017

Yes, Health Care is Complicated!!

“We must come to see that the end we seek is a society at peace with itself, a society that can live with its conscience.”  Dr. Martin Luther King, Jr.

When I launched my private practice, it was on the eastern shore of Maryland in a small town. I joined a physician who had been in practice for several years.  I managed to keep my schedule light for a few weeks so I could study for my Board Examination.  I had just finished my residency training but I was no stranger to outpatient practice.  After my return from the test which I opted to take in Orlando, I never saw fewer than 20 patients a session.  The busiest days saw us seeing 30 or more patients.  I admit that many walked in but most were scheduled.  This was in 1990 which was the beginning of the rise of HMO’s.  My practice was hospital sponsored.  In less than 1 year, I had repaid the hospital the loan and started to make a profit.  Many of my patients were uninsured but a significant number were Medicaid, Medicare and HMO. I welcomed the Clinton Health Plan and even was interviewed by local newspapers.  Sadly, for my community, it never happened.

While I was on the Eastern Shore in the 90’s, it was apparent that many of the residents had no way out of the cycle of poverty and the health problems neglected from being uninsured.  The reality played out in the Emergency Room of the local hospital day and night.  Being uninsured affected every family. Our community had business owners who were farmers, fisherman, mechanics, contractors and shop owners.  Many made too much money for Medicaid but they could not afford the cost of private insurance.  Many of them landed in the ER with serious medical conditions they had ignored.  Some even called my office and were seen as emergency visits.  One particular case was a bit scary.  One of my staff called and brought her brother in.  He was complaining of chest pain and would not go to the ER. They came to the office and I did an EKG.  To my surprise the brother was having an acute myocardial infarction.  He was uninsured and was still refusing to go to the ER even as the ambulance arrived.  We did get him there.  He and I had a tense ambulance ride together to the tertiary care hospital and I handed him off to the cardiologist who greeted us both and whisked him off to the Cardiac Intensive Care Unit.  Weeks later, the community came together for a fund-raiser.  I attended and was to my surprise honored by everyone for my excellent care.  Unfortunately, I had to leave to go to the ER to care for a patient that was not so fortunate.

I had hoped that the HMO’s would make healthcare affordable but that did not happen. The reality for patients then and now is that if you lack insurance, you end up in the ER.  I worked with the local health department.  My office was ground-zero for many programs.  We saw patients enrolled in the Breast and Cervical Cancer Screening Program, Vaccines for Children and participated in every pharmaceutical company sponsored free medication program. We saw patients from the Mental Health programs, Drug treatment programs, and Adult Daycare.  My office was such a high utilizer of one Pharmaceutical Company Patient Assistance Programs; one company invited me to give a presentation to a group of providers.

I was part of the steering committee and a board member of the new Federally Qualified Community Health Center (FQHC). It was our answer to tacking the rate of uninsured patients.  It was hard work to get the grant written, not by me thankfully but I did read it and had to give input on the clinical operation.  I also had to pledge my service which meant clinical sessions, on call coverage and hospital admissions.  I was also involved in recruiting the first full-time provider.  We were fortunate to be designated a National Health Service Corp (NHSC) site.  This allowed us to recruit a NHSC scholar who could use our site and a 3-year commitment to repay medical school loans. The good news is that built into the Affordable Care Act is increased funding for the NHSC.  The program is now expanded and will allow an increase in primary care providers in areas where they are needed.  We were fortunate to get a brilliant young Family Physician in our community. The CHC is still there but it is now part of a bigger network. Across the US, FQCHC are providing care to uninsured and underinsured patients.

Medicine for me has always been about helping my patients. The Affordable Care Act has changed the delivery of medical care in the US. There is no restriction for preexisting conditions. The Affordable Care Act (ACA) decreased the number of uninsured patients in the US.   The dilemma was increasing the number of providers to care for all of the patients.  Across the country this has happened. The defeat of the Republican’s health care plan was a victory.  I knew it would fail. It was written without the input of anyone with experience in the present health care climate.  After 34 years in medicine, I know how complicated health care is.  I live the reality everyday as I see patients and teach residents and medical students.  The problem is that the history behind all those social programs is not passed on.  Medicaid, Medicare and the Children’s Health Insurance Plan have saved lives and provided care to so many Americans of all ages.

I work with my residents in a Health Start Clinic that provides maternity care to uninsured women. They can get emergency Medicaid for prenatal care.  The Republican plan would have cut this program. We already have poor perinatal health outcomes for an industrialized nation.

Let’s continue to be vigilant and keep up the fight. We must never fail to uphold our democratic process and institutions and remember  what happened when the Germans ignored Adolf Hitler.

 “When a man assumes a public trust, he should consider himself as public property.” Thomas Jefferson

“There comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must take it because conscience tells him it is right.” Dr. Martin Luther King, Jr

Medicaid Expansion under the ACA


Under the Affordable Care Act, health insurance coverage increased. Between 2010 and 2015, the uninsured rate among women ages 18 to 64 decreased from 19.3 percent to 10.8 percent, a relative reduction of 44 percent.

As of 2016, national enrollment in Medicaid has grown to 75.2 million from 57.7 million in 2013, or total growth of 17.6 million (31%). Nine states have posted over 50% growth, with Nevada just shy of doubling at 97%, Colorado 89%, Montana 82%, Kentucky 73%, and California up 71%.

Medicaid is the nation’s largest insurer. It is the centerpiece of the U.S. health care safety net, providing benefits to adults and children who would otherwise have difficulty getting and paying for care. Yet the program is not well understood by the public

  • Nearly 16 million people have gained Medicaid coverage under the Affordable Care Act’s expansions; most had previously been uninsured
  • Most people are satisfied with their Medicaid coverage. A recent Commonwealth Fund survey found that 88 percent of adults are satisfied with their new Medicaid coverage: 77 percent rate it as either good, very good, or excellent (Exhibit 2). These ratings have remained consistent since 2014, when states began expanding their programs
  • Medicaid helps people get care and improve their health.
  • Medicaid provides access to timely care.
  • Medicaid provides comprehensive benefits and financial protection from large medical bills.

Did you know?

A “block grant” is a fixed amount of money that the federal government gives to a state for a specific purpose.

The Republicans propose that the Federal Government would fund Medicaid as a block grant. Counter to what proponents claim, block grants don’t give states more flexibility with their Medicaid programs.

What does this mean for state Medicaid expansion?

The federal government would set each state’s Medicaid spending amount in advance. That amount would be based on some estimate of state Medicaid spending.  This would mean a significant cut in federal Medicaid support and an increase in state funding.  Most states would meet this need by limiting eligibility.

Overall, hospitals in Medicaid expansion states saw increased Medicaid discharges, increased Medicaid revenue, and decreased cost of care for the poor, while hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue, and growth in cost of care to the poor

What a year it was

Looking back 2016 was a year of celebrating but also a year of disappointment. The year started with spending time with my best friend from medical school and her husband in Oakland, CA. I took this trip to regroup after leaving my position as a medical director at a major university to resume teaching in a family medicine residency program. My friend is always so open and honest. She keeps me grounded because she always tells me the truth. That is important because I can be hard on me. I spent three months reacquainting myself with hospital inpatient medicine. It was a really exciting period which I enjoyed. Getting back into prenatal care in my new position as the Women’s Health Coordinator for the residency program was the most enjoyable.

In May, I attended the annual Society of Teachers of Family Medicine Meeting in Minneapolis Minnesota. I accepted a position as a trustee on the STFM Foundation Board. My husband got the chance to explore Minneapolis. The meeting was highlighted by the keynote speakers. The first was Camara Phyllis Jones, MD, MPH, PhD from the Satcher Health Leadership Institute and the Cardiovascular Research Institute the topic was “Achieving Health Equity: Tools for a National Campaign Against Racism.” She presented several tools for dealing with racism:

June was a spectacular month. We attended our family reunion in Savannah Georgia. It was attended by members of my grandmother’s family.   We had an opportunity to tour Savannah and learn about the impact of slavery in the shaping of the history Savannah and the south. During this time we were in the midst of the most divisive presidential campaign in history.Family_Reunion_Poster_new

In September we went to DC for the opening of the National Museum of African-American History and Culture. The weather in DC was beautiful and we walked all over the place. We did not have tickets to tour the museum but we went to all the festivities. We sat out on the National Mall with the crowds watching the ceremony on one of the many jumbo Trons. We all shed tears after each speaker. Patti Labelle sang “A Change is Gonna Come” and there was not a dry eye. Former President George Bush and his wife Laura Bush were instrumental in getting the bill signed and serving on the board for the museum. The Obamas continued their work. In the words of Lonnie G. Bunch III, founding director of the Museum, “there are few things as powerful and as important as a people, as a nation that is steeped in its history.”aviary-photo_131196457148080220


We spent election at a friend’s. The party was not the celebration we had hoped for. The last time she had an election night party was when Bill Clinton won. I was in Maryland and that was the last time I attended one. It was a heart breaking night. We all were in shock. The next day, I spent the day consoling my residents. I am still coming to terms with my disappointment over Hillary Clinton’s loss. She would have been the first female president of the US and could have joined Angela Merkel and Teresa May.

In December, we spent a week in Ocean City Maryland. The weather was beautiful. I needed the change.


I completed my a 200 hour yoga teacher certification program at The American Yoga Academy .  I am certified as a Health and Wellness Educator. wp_20161211_019

We spent Christmas Day in Baltimore with family. We spent the day visiting family. With Christmas falling on the Sunday, we both had Monday off. We have celebrated 33 New Year’s Eves together.  We spent a quiet evening at home and watched “Casablanca”

Here’s to 2017.   I am going to work very hard the first few months because of projects I need to complete but I do plan to spend time catching up with old friends. I do not make resolutions but if I chose a theme or a word, it would be “Gratitude.”  I am thankful for who I am and what I have which includes friends, family and work that I enjoy. As we celebrate MLK Day and anxiously await the peaceful passage of power from the first black President of the US, Barack Obama, to Donald Trump, I am thankful that the Constitution of the United States has checks and balances. I am hopeful for our future. As a physician, I am confident that the Affordable Care Act will not be repealed because it will have disastrous consequences.

Happy New Year: It is finally 2017

I made Gumbo New Year’s Eve. The first time I made it was while we were living on the Eastern Shore.  I had what I thought was a great recipe in a cookbook titled “One of a Kind: Recipes from the Junior League of Mobile.”  It was a wedding gift.  I was making the Gumbo for our Mardi Gras Party at a colleague’s house. A group of us decided to bring Mardi Gras to us. Being the only true southerner, I volunteered to make the Gumbo.

I took my cookbook to my husband’s aunt, Tommie.  She was a New Orleans native and true Cajun (her father was from Paris and her mother, African American). She was known for her Gumbo recipe which she guarded like a state secret.  She took the book and crossed out (with great emotion) some of listed the ingredients and added no new ones.  I did not know that really good gumbo is simple.  She did not use crab meat, chicken or the gumbo file. It’s just good Andouille sausage and lots of shrimp.  The secret is the roux and the cooking time.  The best okra is frozen and do not cook it long.  Add the shrimp and do not overcook.  It only takes a few minutes if the gumbo is hot.

We always purchased the shrimp in Baltimore at Lexington Market for years.  That meant, we always had an ice chest in the trunk and we have transported shrimp as far as Chattanooga, Tennessee.  I always tried to get the sausage there too.  One year, we almost did not find the sausage.   Well the Gumbo was the hit of that party and many more.  Over the years I have made it so many times and it never fails to impress. I have had to toss out a couple of bad batches of roux.

What is unfortunate is that our beloved aunt has Alzheimer’s.  I always made sure we talked for hours when we visited her in Baltimore. So I know a great deal of family secrets.  She lived two row houses down from my mother-in law.  The two of them were more like sisters than sister-in-laws. My mother-in-law passed first.  Tommie was heart-broken. We cleared the house together. When she started showing signs of memory loss and became more difficult to manage: Roy and I would visit, take her to lunch at her favorite place, the “Cheese Cake Factory, and then to church.  We also would take her to the mall and to visit friends and relatives.  Roy had a calming effect on her.  He would drive and talk to her.  She had taken care of him when his mother was working. He always made her laugh.

I made the Gumbo a few years before we lost Tommie’s husband. It was the year Christmas Eve was on a Friday. When I told them I was making it, they all reminisced about Tommie’s Gumbo and told such sweet stories. Well, when I told them I was using her recipe they were in disbelief. They asked how I had been so lucky and I told them. That was a special pot of Gumbo and I was so proud to make it. It was downed with love. We had leftovers for Christmas dinner. They all said it was indeed her recipe. It was also the year after we lost our great hostess, Sylvia. She was the wife of Tommie’s son Jack. Jack is like my husband’s baby brother. Sylvia was the one who put together all the holiday dinners. So that pot of Gumbo was in honor of two great ladies.

I can’t help but speak of Tommie in the past tense.  That is what Alzheimer’s does.  It robs you of the person and leaves just the body. The woman I knew is not here but I did take her to lunch right before she had a turn for the worse. We had a great time.  We may have even gone to church.  She would have been wearing a mink stole or her Persian lamb jacket and I would have been wearing Josephine’s coat (also Persian lamb). Both of the coats are over 50 years old.

New Year’s is a time of reflection.  My New Year’s commitment is to catchup with old friends and colleagues. I want to put the past year behind me. I do plan to stay vigilant but that is for the next post.

Happy New Year!


December 1

December 1 is my husband’s birthday. It marks 33 birthdays that we have celebrated together. December 1 is also World Aids Day. The first World Aids Day was Dec 1, 1988 which was 28 years ago.  I witnessed the first documented case of AIDS and Pneumocystis Carinii Pneumonia in our hospital in 1983 when I was a resident.  4 years later during my Family Medicine residency, we would diagnose many cases in men, women and children.  My residency and pediatrics rotation provided an opportunity to unfortunately hospitalize several children who had AIDS.  I provided care to many patients and watched too many of them die over a period of 12 years.

Caring for patients with HIV/AIDS influenced the direction of my entire medical career. I learned case management while working with the lone nurse and social worker from the local health department who had the arduous roles of following all the active patients from two counties.  We met monthly to discuss our patients.  The hospital Pharmacist helped us manage pain and treat complicated infections.  He calculated medication doses and consulted with other experts.

I had to study and improve my Women’s Health skills. Now I am the Women’s Health Coordinator for the Family Medicine Residency. Many patients wanted and demanded integrative medicine therapies.   I was forced to read about new herbs and vitamins to augment AZT and help ease its side effects. New drugs were being developed and it meant attending conferences to stay updated.

Now, I am training to be a health and wellness educator which includes being a yoga instructor. My goal is to teach physicians techniques to prevent burnout and maintain resilience in a demanding profession.

I always thought I had the ability to talk with patients but AIDS taught me how to deliver bad news and be loving and supportive. It led me into Hospice Care and for 6 years, I learned to be with a diverse group of patients at the end of their remarkable lives. I learned to ease the difficult transition for their families. It was for me lightening.

The number of new HIV diagnoses fell 19% from 2005 to 2014. It is hard to believe that with all the new information that there are a rising number of new HIV infections in young African American and Hispanic males.  This can also lead to an increase in infections in women.  The irony is that we relaxed push to get information out there to this group.  According to the Centers for Disease Control (CDC), African Americans represent approximately 13% of the U.S. population, but accounted for an estimated 45% of new HIV infections in 2015. Also, Hispanics/Latinos represented 18% of the population but accounted for 24 % of new HIV infections in 2015.

According to the United Nations November 2016 Factsheet:

  • Worldwide, 2.1 million [1.8 million–2.4 million] people became newly infected with HIV in 2015.
  • New HIV infections among children have declined by 50% since 2010.
    • Worldwide, 150 000 [110 000–190 000] children became newly infected with HIV in 2015, down from 290 000 [250 000–350 000] in 2010.
  • Since 2010 there have been no declines in new HIV infections among adults.
    • Every year since 2010, around 1.9 million [1.9 million–2.2 million] adults have become newly infected with HIV.
  • In 2015, 1.1 million [940 000–1.3 million] people died from AIDS-related causes worldwide, compared to 2 million [1.7 million–2.3 million] in 2005.
  • As of the end of 2015, 35 million people have died from AIDS-related illnesses since the start of the epidemic

I am no longer working with patients who have AIDS but I do know that I will be diagnosing and referring new patients for treatment. This disease is still making an impact worldwide. I still remember all the sons, daughters, husbands, mothers, artists, and friends that have died.

Today, I celebrate my husband’s birthday. Meeting him 33 years ago changed my life.  I recognize the significant impact HIV/AIDS has had on the world and my medical career.  I recognize the tireless work being done to care for patients.  Also, we have a lot more work to do and recent updated UNAIDS information estimates that 26.2 billion US $ will be required for the AIDS response in 2020 and 23.9 billion required in 2030. We can impact these numbers through supporting education and prevention efforts both in the US and worldwide.

9/11 & Grandparents Day: Choices to Make

As we remember 9/11, we do have to make sure our future is bright. A great post from Lisa Winkler.


It’s National Grandparents Day.

It’s also the 15th anniversary of 9/11.

And both these days resonate for me.

On Sept. 11, 2001, I was teaching 8th grade Language Arts  in South Orange, NJ when the principal made a vague announcement over the PA system. Rumors started and I tried calling my husband, who worked in New York City, using the classroom telephone. He told me what happened based on what he knew.

Eventually we found out more, and were asked to gather information from our students about where their parents worked and who might be home to collect them. The school emptied and staff who lived locally, including me, stayed with the students who couldn’t leave on their own. I focused on the tasks and the ambiguity of the news—we didn’t have televisions in the classrooms. I knew something terrible had occurred and worried about my husband getting home that…

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I really am speechless but I have to say something


The events of the past few months have been mind-numbing. For me, this is what happens when I get overloaded with so much negativity.  I go numb and then I have to process all my feelings.  This helps me be logical and rational when all those around me seem to be falling apart.  I used this process all through college, medical school, residency training and now as a residency faculty.

I am starting Yoga Teacher Training.  I am going to use it to teach anyone who will let me all the techniques I have learned to have balance mentally, physically and emotionally. More about that journey in another post.

I went to HS in 1971 and graduated in 1975. A great deal had happened and was happening in Birmingham, Alabama.  We (Black students)  were integrating predominantly White schools and we  all had to adjust. I learned how volatile and fragile this coexistence would be when I lost the race for Student Body President in 1974.  I had an energized campaign with posters, a member of the football team as my campaign manager and a great staff of friends.  We blanketed the school with posters with snappy campaign slogans. I spent hours writing my speech for the assembly. I wore my beautiful green pantsuit (school colors) on Election Day. I would be the first “Black” student body president if I won. So tensions were running high and we were scared of being robbed of our victory.  I lost to the White quarterback and captain of the football team.  The end of my junior year had many achievements.  The band was led by a Black Drum Major; we had one black majorette, two black cheerleaders, a star Black running back for out  football team , a great basketball team and even a Black president of the national Honor Society.

The coexistence we had achieved could have unraveled. We could have degenerated into rage. I really think our parents would have come up to the school and made us regret that move.   We (Black students) congregated in the football stadium.  My campaign manager was upset and so was I. That moment, I  had to decide whether to let that anger take me and us over or propose a different solution. I presented it and they were more upset.  I had to hold back tears and manage my anger. So, I chose to take the role as Parliamentarian .  That was the position always offered to the losing candidate for president.  It gave me a place on the Student Council and made me an officer.   I also had to teach parliamentary law to all the student council members. I became an expert and taught the best course ever done.   It got me into Tri-Hi-Y and paved the way for the person who would later be the first Black Student Body President. We all had a choice to make that day and the wrong one would have changed the course of our lives.

I watched John Lewis as he skillfully tried to respond to the House protest over the failure to pass gun legislation and I could feel his attempt to display calm amid the storm. He is a shining example of the art. They were our examples. .  So, as I looked back on that time in HS, I realized that we all used “excellence” and restraint  to overcome prejudice and stereotypes.  We had an award winning marching band, cheerleading squad, majorettes and football team.  The school choirs – male and female glee clubs- were award winning and we had the best end of year musical competitions ever.   We sent a large number of Black students off to college on academic and athletic scholarships.  They all went on to excel.  We reluctantly became a family and in 1975, we had the first integrated Prom.  Our theme was ” Like A Bridge Over Troubled Waters.” Many of our parents came and it went off without incident.

So what am I trying to say? Learning to respect what a person contributes can make us all successful. We spend too much time being afraid to allow every person the opportunity to succeed not realizing that there is enough for all of us. When every student had the opportunity to be in the school choir, the result was a beautiful melody that brought tears to your eyes.  My sister sang in the Glee Club and my best friend went on from Glee Club to major in music and have an award winning school music program.

Maya Angelou expressed it best in “Human Family”

I note the obvious differences
in the human family.
Some of us are serious,
some thrive on comedy.

Some declare their lives are lived
as true profundity,
and others claim they really live
the real reality.

The variety of our skin tones
can confuse, bemuse, delight,
brown and pink and beige and purple,
tan and blue and white.

I’ve sailed upon the seven seas
and stopped in every land,
I’ve seen the wonders of the world
not yet one common man.

I know ten thousand women
called Jane and Mary Jane,
but I’ve not seen any two
who really were the same.

Mirror twins are different
although their features jibe,
and lovers think quite different thoughts
while lying side by side.

We love and lose in China,
we weep on England’s moors,
and laugh and moan in Guinea,
and thrive on Spanish shores.

We seek success in Finland,
are born and die in Maine.
In minor ways we differ,
in major we’re the same.

I note the obvious differences
between each sort and type,
but we are more alike, my friends,
than we are unalike.

We are more alike, my friends,
than we are unalike.

We are more alike, my friends,
than we are unalike.

Acupunture at the Norman Bethune Hospital

Here is a great article on acupuncture in China


In January, 1975, the National Guardian newspaper, a radical, independent weekly and the Chinese government sponsored a three week tour for American farmers. My husband Marty and I were excited to be invited.

We travelled through six major cities and their surrounding areas, tasting every aspect of Chinese life, as guests of the Chinese government. There were twenty-two in our party, including our coordinator from the United States. Two or three translator/guides accompanied us throughout our travels in China. In each of the regions we visited, local officials joined us to enlighten us about their work, and the history and culture of each site.

One of the most memorable events of the tour was the visit to the Norman Bethune Hospital in Shih Chia Chuang. Dr. Norman Bethune, a thoracic surgeon from Montreal, relinquished his privileges at state of the art hospitals in Canada in 1939 to establish the hospital in Shih…

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Let’s call it what it is

What a few months we have had!!! For me, it has been busy and a little stressful at times.  Fortunately, I  had the opportunity to hear Dr. Camara Jones who is the president American Public Health Association.  If you have never heard her, please view this TEDxEmory Talk Allegories on Racism. Dr. Jones addresses the three levels of racism: institutionalized, personally mediated, and internalized.  I had to reflect on my personal experience and how I could stop and confront racism.  Dr. Jones talks about being on a conveyor belt and just moving forward without ever addressing these issues. She urges us to turn around and look.  Then we must stop and confront racism. Throughout my professional career, racism has been evident and has decreased access to health care for my patients and opportunities for my own professional advancement.

Academic Medicine has less than 2 % representation by Underrepresented Minorities(URM).  The overall number of URM students in medical school is less than 10%.  URM is defined as  Blacks, Mexican-Americans, Native Americans (that is, American Indians, Alaska Natives, and Native Hawaiians), and mainland Puerto Ricans.  Bernie Sanders was calling for “Health Care for All” but he failed to discuss the obvious. Unless we address the root cause of health disparities we will exacerbate the problem.  We need to increase the physician workforce and increase the number of URM’s in all areas.  Medical education is expensive  and we need to find ways to reduce cost. We need to develop pipeline programs that support URM students starting in elementary school.  This is one of the main reasons I supported a group of talented people who wrote a grant proposal that was funded by the Foundation of the Society of Teachers of Family Medicine to develop the curriculum and expand The Ladder.  It is based on: ” Cascading mentorship provides a framework where not only do knowledge and experience flow from the most senior to the most junior Ladder members, but younger members are individually empowered to share their own voices and experience with their peers and those scholars who in turn look up to them.” Those of us who have succeeded know that it was with the help of our families, teachers, churches and community programs.  Mentoring programs are vital to develop a diverse workforce.

In this election year, you see the effects of racism.  President Obama has been exemplary as a president despite the obvious disrespect shown to him.  We must stand together and confront all the barriers placed in front of us.  Voting is a right that must be protected and exercised. We must be willing to turn around on that conveyor belt and confront racism. The Affordable Care Act, Women’s Reproductive Rights and the Supreme Court hang in the balance.  President Obama is taking the opportunity to make us aware of these threats.  He is challenging us all to stand up and confront it. We are a diverse nation with a global responsibility to ensure  health, equal rights  and safety for all.  We are faced with new emerging diseases, threats to our safety from terrorist and poverty.

So, the election of the wrong candidate to the to the US presidency has world-wide implications. So I stand with Hillary Clinton because she is the most qualified.  There is no other choice.  I have not missed an election since my first one at age 18. I felt my vote alone was the reason Jimmy Carter won. So as the President said “we” have the power to make a difference and change our country.