1
00:00:10,880 --> 00:00:13,445
Welcome to the Swallow Your Pride podcast. I'm

2
00:00:13,445 --> 00:00:15,764
your host, Teresa Richard. I'm a board certified

3
00:00:15,764 --> 00:00:17,864
specialist in swallowing and swallowing disorders

4
00:00:18,164 --> 00:00:20,904
and founder of the MediSLP Collective and MediSLP

5
00:00:21,204 --> 00:00:21,704
Education.

6
00:00:22,324 --> 00:00:24,884
This podcast is dedicated to delivering the latest

7
00:00:24,884 --> 00:00:28,130
evidence based practice to medical SLPs everywhere while

8
00:00:28,130 --> 00:00:31,170
also recognizing that medical SLPs everywhere are doing

9
00:00:31,170 --> 00:00:33,170
the best with what they've got. Whether you

10
00:00:33,170 --> 00:00:35,649
are a new clinician seeking tangible tools for

11
00:00:35,649 --> 00:00:37,649
therapy or a seasoned vet stuck in a

12
00:00:37,649 --> 00:00:39,810
rut, my goal is simple, to help you

13
00:00:39,810 --> 00:00:42,835
advance your practice without feeling overwhelmed or underappreciated.

14
00:00:43,695 --> 00:00:46,174
This means that together, we'll build confidence, broaden

15
00:00:46,174 --> 00:00:48,734
your knowledge, and reignite your passion for our

16
00:00:48,734 --> 00:00:51,215
fields. So if you're listening, I encourage you

17
00:00:51,215 --> 00:00:52,975
to swallow your pride and be open to

18
00:00:52,975 --> 00:00:54,895
new ideas because at the end of the

19
00:00:54,895 --> 00:00:57,079
day, you and your patients deserve that kind

20
00:00:57,079 --> 00:00:59,559
of support. Just a quick disclaimer that all

21
00:00:59,559 --> 00:01:01,960
statements and opinions expressed in this episode do

22
00:01:01,960 --> 00:01:04,519
not reflect on the organizations associated with the

23
00:01:04,519 --> 00:01:07,319
speakers and are their own opinions solely. With

24
00:01:07,319 --> 00:01:08,859
that, let's dive in.

25
00:01:09,734 --> 00:01:12,694
Welcome to the Swallow Your Pride podcast. I

26
00:01:12,694 --> 00:01:15,414
am really excited to do this episode today.

27
00:01:15,414 --> 00:01:17,894
We have an awesome, awesome, awesome guest. We

28
00:01:17,894 --> 00:01:20,614
have miss Jackie Rodriguez with us, and she's

29
00:01:20,614 --> 00:01:23,189
a bilingual SLP based in Atlanta, Georgia. She

30
00:01:23,189 --> 00:01:26,009
graduated from Georgia State University and has extensive

31
00:01:26,069 --> 00:01:28,549
experience working across the lifespan and continuum of

32
00:01:28,549 --> 00:01:31,769
care. She's passionate about bilingualism and multi multiculturalism

33
00:01:32,469 --> 00:01:35,530
across the lifespan, health literacy, and dementia care.

34
00:01:35,590 --> 00:01:37,750
She's a recipient of the ASHA Early Career

35
00:01:37,750 --> 00:01:40,405
Professional Award. Jackie serves as the director of

36
00:01:40,405 --> 00:01:42,504
communications for the Bilingual Empowerment

37
00:01:42,885 --> 00:01:45,864
through Allied Mentorship Program, BEAM SLP,

38
00:01:46,245 --> 00:01:49,444
an organization that provides mentorship for bilingual CSD

39
00:01:49,444 --> 00:01:50,984
students and clinical fellows.

40
00:01:51,460 --> 00:01:54,420
Jackie enjoys educating others about race, ethnicity, and

41
00:01:54,420 --> 00:01:56,340
the field of speech language pathology on her

42
00:01:56,340 --> 00:01:59,319
Instagram account at unlearn with me dot theslp.

43
00:02:00,020 --> 00:02:01,960
So, Jackie, welcome to the show.

44
00:02:02,420 --> 00:02:04,500
Thank you for having me. Yes. Thank you

45
00:02:04,500 --> 00:02:06,085
so much for joining us. So tell tell

46
00:02:06,085 --> 00:02:07,444
the people a little bit more about what

47
00:02:07,444 --> 00:02:09,365
you do. I know you're super passionate. I

48
00:02:09,365 --> 00:02:11,385
always learn so much from you whenever I

49
00:02:11,525 --> 00:02:13,525
read your post. I've I've always learned so

50
00:02:13,525 --> 00:02:15,604
much from you, and you've always been outspoken

51
00:02:15,604 --> 00:02:17,944
about things, but always in just a very

52
00:02:18,349 --> 00:02:21,090
respectful way. And I I I genuinely appreciate

53
00:02:21,310 --> 00:02:23,150
that so much about you. So thank you

54
00:02:23,150 --> 00:02:24,050
for being you.

55
00:02:24,509 --> 00:02:26,449
Thank you. Thanks for having me.

56
00:02:26,750 --> 00:02:29,229
So, a little bit more about me. So

57
00:02:29,229 --> 00:02:30,449
I actually started,

58
00:02:31,185 --> 00:02:33,665
in pediatrics. I started in the schools as

59
00:02:33,665 --> 00:02:35,044
a bilingual diagnostician,

60
00:02:36,705 --> 00:02:40,004
and I evaluated children who were learning English

61
00:02:40,064 --> 00:02:40,564
and,

62
00:02:40,944 --> 00:02:43,284
as their second language. And I think

63
00:02:43,700 --> 00:02:44,360
that first,

64
00:02:45,700 --> 00:02:48,020
job that I had really exposed me to

65
00:02:48,020 --> 00:02:49,159
health disparities

66
00:02:49,460 --> 00:02:49,960
and,

67
00:02:50,900 --> 00:02:52,740
issues with health literacy that we're gonna get

68
00:02:52,740 --> 00:02:56,235
into later. And then I chose the perfect

69
00:02:56,235 --> 00:02:59,694
time to transition to medical SLP. I transitioned

70
00:02:59,754 --> 00:03:00,895
to medical SLP

71
00:03:01,194 --> 00:03:04,555
in 2020 in Sniffs as a traveler, so

72
00:03:04,555 --> 00:03:05,935
it was just lovely.

73
00:03:07,275 --> 00:03:08,014
And then,

74
00:03:09,010 --> 00:03:10,849
happened during that time as well. You know,

75
00:03:10,849 --> 00:03:12,550
I was working in a lot of facilities

76
00:03:12,689 --> 00:03:13,189
where,

77
00:03:13,730 --> 00:03:15,730
they couldn't get coverage. It was in a

78
00:03:15,730 --> 00:03:18,450
rural area. So lots of health disparities as

79
00:03:18,450 --> 00:03:18,950
well.

80
00:03:19,490 --> 00:03:21,969
And I really started to become passionate about

81
00:03:21,969 --> 00:03:24,735
dementia care during that time of my career.

82
00:03:25,194 --> 00:03:27,455
And then now I moved back to Atlanta,

83
00:03:27,675 --> 00:03:30,094
and I really enjoyed that flexible,

84
00:03:31,034 --> 00:03:33,995
traveler lifestyle. So now instead of having one

85
00:03:33,995 --> 00:03:36,254
full time job, I work full time PRN,

86
00:03:37,090 --> 00:03:40,210
primarily in inpatient rehab and outpatient, but I

87
00:03:40,210 --> 00:03:42,210
still, do a little bit of sniff work

88
00:03:42,210 --> 00:03:43,889
here and there and acute care. So I

89
00:03:43,889 --> 00:03:46,210
have experience in a lot of different areas

90
00:03:46,210 --> 00:03:47,669
in our field. And then,

91
00:03:48,449 --> 00:03:52,334
my mom had, rheumatoid arthritis. So growing up,

92
00:03:52,334 --> 00:03:55,134
I kinda grew up going to therapy. So

93
00:03:55,134 --> 00:03:55,794
I have

94
00:03:56,254 --> 00:03:58,974
almost, you know, I would say, truly more

95
00:03:58,974 --> 00:03:59,474
experience

96
00:03:59,775 --> 00:04:02,754
being on the other side of health care

97
00:04:02,894 --> 00:04:05,009
than I do as a speech language pathologist

98
00:04:05,409 --> 00:04:07,969
just because my mom had rheumatoid arthritis for

99
00:04:07,969 --> 00:04:09,969
thirty one years of my life. So that

100
00:04:09,969 --> 00:04:11,969
informs a lot of what I'm passionate about

101
00:04:11,969 --> 00:04:13,810
as well. Yeah. Yeah. And I was sharing

102
00:04:13,810 --> 00:04:15,329
with you, you know, before we hit record

103
00:04:15,329 --> 00:04:17,504
here, I've just been going through some insane

104
00:04:17,504 --> 00:04:19,264
things with my son lately. So we did

105
00:04:19,345 --> 00:04:21,024
we chose to get him a feeding tube

106
00:04:21,024 --> 00:04:22,704
a few weeks ago. Tomorrow is actually one

107
00:04:22,704 --> 00:04:24,144
month. We have his one month post op

108
00:04:24,144 --> 00:04:24,644
tomorrow.

109
00:04:25,024 --> 00:04:25,764
Oh, wow.

110
00:04:26,064 --> 00:04:28,404
And the and the experience

111
00:04:28,785 --> 00:04:30,625
of going through that, like, this is stuff

112
00:04:30,625 --> 00:04:32,884
that I actually work in, but, like,

113
00:04:33,240 --> 00:04:35,740
we still don't have full supplies for everything.

114
00:04:35,879 --> 00:04:37,879
Like, the amount of times I sit on

115
00:04:37,879 --> 00:04:40,439
these one eight hundred hotlines, talk to nine

116
00:04:40,439 --> 00:04:42,600
people that have no idea what's going on,

117
00:04:42,600 --> 00:04:43,100
like,

118
00:04:43,639 --> 00:04:46,199
it's just an act of tenacity. Like and

119
00:04:46,199 --> 00:04:48,074
and it's so sad that this is just

120
00:04:48,395 --> 00:04:51,055
really where we are as a society. And,

121
00:04:51,115 --> 00:04:52,395
you know, I was I was actually thinking

122
00:04:52,395 --> 00:04:54,715
of you last night when and I was

123
00:04:54,715 --> 00:04:56,715
like, I don't know how I actually understand

124
00:04:56,715 --> 00:04:58,555
the system, and I'm having so much trouble.

125
00:04:58,555 --> 00:05:00,574
Like, if I didn't understand the system,

126
00:05:01,039 --> 00:05:03,039
there's no way I would do this. You

127
00:05:03,039 --> 00:05:04,560
know? And no matter how much you love

128
00:05:04,560 --> 00:05:06,879
your child or a family member, some things

129
00:05:06,879 --> 00:05:08,180
are just not worth

130
00:05:08,560 --> 00:05:10,560
the stress and frustration. Like, I think I've

131
00:05:10,560 --> 00:05:12,479
I've literally gained, like, 10 pounds in the

132
00:05:12,479 --> 00:05:15,264
last month just because I'm so stressed out

133
00:05:15,264 --> 00:05:16,644
and frustrated with

134
00:05:17,105 --> 00:05:19,105
the system for my you know? And it's,

135
00:05:19,105 --> 00:05:21,504
like, actually getting it for him has been

136
00:05:21,504 --> 00:05:23,584
so helpful. Like, it's been game changing for

137
00:05:23,584 --> 00:05:25,345
us and for him, but the hoops I've

138
00:05:25,345 --> 00:05:26,404
had to jump through

139
00:05:26,944 --> 00:05:28,884
is just so stressful. So

140
00:05:29,230 --> 00:05:29,970
that being

141
00:05:30,270 --> 00:05:31,790
said, Jackie, tell the people why you're on

142
00:05:31,790 --> 00:05:33,230
the episode today and what we're gonna talk

143
00:05:33,230 --> 00:05:33,730
about.

144
00:05:34,430 --> 00:05:36,509
Sure. So today, we are going to talk

145
00:05:36,509 --> 00:05:37,490
about health literacy.

146
00:05:38,350 --> 00:05:40,430
So if you're not familiar with what health

147
00:05:40,430 --> 00:05:42,850
literacy is, health literacy is essentially,

148
00:05:44,074 --> 00:05:45,055
our understanding

149
00:05:45,995 --> 00:05:48,574
of our body in order to make

150
00:05:48,954 --> 00:05:51,535
decisions about our health. And so,

151
00:05:52,154 --> 00:05:55,134
there are two types of health literacy. There's,

152
00:05:55,675 --> 00:05:59,210
personal health literacy. So, like, for example, let's

153
00:05:59,210 --> 00:06:01,310
say that you are diagnosed with dysphagia.

154
00:06:02,170 --> 00:06:04,270
So personal health literacy is,

155
00:06:04,810 --> 00:06:07,150
maybe you'll go home and you might Google

156
00:06:07,370 --> 00:06:09,290
dysphagia, and maybe you find,

157
00:06:09,850 --> 00:06:11,310
an article on WebMD

158
00:06:11,689 --> 00:06:12,430
or Healthline.

159
00:06:12,995 --> 00:06:15,955
You might join a Facebook group for, a

160
00:06:15,955 --> 00:06:17,814
support group for people with dysphagia,

161
00:06:18,675 --> 00:06:20,855
and it's the things that you do outside

162
00:06:21,235 --> 00:06:23,555
of the doctor's office or outside of the

163
00:06:23,555 --> 00:06:27,395
SLP's office to learn about your disability or

164
00:06:27,395 --> 00:06:28,535
your medical condition.

165
00:06:29,169 --> 00:06:29,669
Then,

166
00:06:30,529 --> 00:06:31,430
speech pathologist,

167
00:06:31,810 --> 00:06:34,229
we play an important role in organizational

168
00:06:34,689 --> 00:06:36,229
or sometimes you'll hear institutional

169
00:06:36,529 --> 00:06:39,490
health literacy. And so that is what we

170
00:06:39,490 --> 00:06:40,709
as health care professionals

171
00:06:41,089 --> 00:06:43,269
do to make sure that our patients

172
00:06:43,925 --> 00:06:47,464
understand their bodies and understand the medical condition

173
00:06:47,524 --> 00:06:49,464
or disability that they have.

174
00:06:50,084 --> 00:06:52,664
And so, health literacy is informed

175
00:06:52,964 --> 00:06:55,384
by, these things that we call social determinants

176
00:06:55,524 --> 00:06:58,004
of health. So you'll see them abbreviated as

177
00:06:58,004 --> 00:06:58,504
SDOH.

178
00:06:59,419 --> 00:06:59,819
And,

179
00:07:00,379 --> 00:07:04,079
there are various social determinants of health. So,

180
00:07:05,180 --> 00:07:05,680
your

181
00:07:06,220 --> 00:07:09,279
reading literacy, like how well you can read,

182
00:07:10,300 --> 00:07:12,540
and if you have access to read in

183
00:07:12,540 --> 00:07:13,919
English is one,

184
00:07:14,654 --> 00:07:16,415
social determinant of health.

185
00:07:16,894 --> 00:07:20,334
Your race, your ethnicity, and how that either

186
00:07:20,334 --> 00:07:22,495
matches or does not match the health care

187
00:07:22,495 --> 00:07:24,735
professionals that you work with and the bias

188
00:07:24,735 --> 00:07:27,160
and how bias can play a role in

189
00:07:27,160 --> 00:07:29,180
your interactions with health care professionals,

190
00:07:29,720 --> 00:07:30,379
is another

191
00:07:30,759 --> 00:07:34,120
area. You all also have built community. So

192
00:07:34,120 --> 00:07:35,660
when you look at historically,

193
00:07:37,319 --> 00:07:37,819
segregation,

194
00:07:38,439 --> 00:07:38,939
redlining,

195
00:07:39,319 --> 00:07:40,939
displacement of Native Americans,

196
00:07:41,720 --> 00:07:42,615
the way that

197
00:07:42,935 --> 00:07:44,314
politics have informed,

198
00:07:44,694 --> 00:07:47,754
the way that our country is structured,

199
00:07:48,375 --> 00:07:50,854
that also plays a big role in your

200
00:07:50,854 --> 00:07:52,074
access to resources.

201
00:07:52,935 --> 00:07:54,954
So if you live in a rural area,

202
00:07:55,339 --> 00:07:57,660
you might let you know, in your rural

203
00:07:57,660 --> 00:08:00,060
area, there might be one SLP, and she

204
00:08:00,060 --> 00:08:00,800
might be

205
00:08:01,259 --> 00:08:04,319
the SLP that sees everyone across the lifespan.

206
00:08:05,259 --> 00:08:06,699
As opposed to if you live in a

207
00:08:06,699 --> 00:08:07,439
big city,

208
00:08:08,175 --> 00:08:10,035
you might have access to,

209
00:08:10,574 --> 00:08:12,435
not only, you know, specifically

210
00:08:13,455 --> 00:08:17,615
adult specialized SLPs versus pediatric specialized SLPs, but

211
00:08:17,615 --> 00:08:20,014
you might have access to a specialty clinic.

212
00:08:20,014 --> 00:08:21,955
So if you have ALS, you might have

213
00:08:22,199 --> 00:08:24,839
access to an ALS clinic, whereas people who

214
00:08:24,839 --> 00:08:25,979
live in rural areas,

215
00:08:26,279 --> 00:08:28,519
because of the structure, their community might not

216
00:08:28,519 --> 00:08:29,740
have access to that.

217
00:08:30,759 --> 00:08:33,959
So all of these social determinants of health

218
00:08:33,959 --> 00:08:34,860
work together

219
00:08:35,414 --> 00:08:37,995
to help us to better understand

220
00:08:38,375 --> 00:08:38,875
our,

221
00:08:39,735 --> 00:08:41,975
body and our own health. Yeah. Jackie, you

222
00:08:41,975 --> 00:08:44,934
mentioned something that admittedly I don't know much

223
00:08:44,934 --> 00:08:46,695
about, and and I would love for you

224
00:08:46,695 --> 00:08:47,754
to tell the people,

225
00:08:48,110 --> 00:08:49,790
explain it in your beautiful words a little

226
00:08:49,790 --> 00:08:51,470
bit more, but the the topic, the term

227
00:08:51,470 --> 00:08:52,129
of redlining.

228
00:08:52,830 --> 00:08:54,450
Sure. So redlining

229
00:08:55,070 --> 00:08:58,029
was this policy that started in the nineteen

230
00:08:58,029 --> 00:08:58,529
thirties.

231
00:08:59,070 --> 00:08:59,570
So,

232
00:09:00,029 --> 00:09:03,410
there was this government program that created redlining.

233
00:09:04,245 --> 00:09:07,365
And essentially, it was a racist policy that

234
00:09:07,365 --> 00:09:08,424
zoned neighborhoods

235
00:09:08,965 --> 00:09:09,865
based on,

236
00:09:10,485 --> 00:09:13,524
just simply based on race. So there were

237
00:09:13,524 --> 00:09:16,504
four different zones. There were red, yellow,

238
00:09:17,845 --> 00:09:19,384
green, and blue. So green

239
00:09:19,750 --> 00:09:21,430
was the highest level. And so if you

240
00:09:21,430 --> 00:09:23,910
lived in a green lined neighborhood, typically, that

241
00:09:23,910 --> 00:09:26,309
was a predominantly white neighborhood and, like, a

242
00:09:26,309 --> 00:09:27,690
wealthy white neighborhood.

243
00:09:28,149 --> 00:09:31,269
Then a blue zoned neighborhood would be maybe,

244
00:09:31,269 --> 00:09:32,490
like, a more,

245
00:09:34,565 --> 00:09:36,804
like, middle class to working class, but still

246
00:09:36,804 --> 00:09:38,184
predominantly white neighborhood.

247
00:09:38,725 --> 00:09:41,865
Then your yellow lined neighborhood would be,

248
00:09:42,565 --> 00:09:44,024
immigrant to, like,

249
00:09:44,725 --> 00:09:47,304
are from European countries. So people like,

250
00:09:48,299 --> 00:09:48,799
Italians,

251
00:09:49,980 --> 00:09:50,879
Irish people,

252
00:09:52,700 --> 00:09:55,740
Jewish people. Remember, this is in nineteen thirties,

253
00:09:55,740 --> 00:09:58,620
so this is before, you know, our racial

254
00:09:58,620 --> 00:10:01,259
and ethnic categories of people looked very different

255
00:10:01,259 --> 00:10:02,559
than what it looks like today.

256
00:10:03,134 --> 00:10:05,295
And so they were categorized into,

257
00:10:05,615 --> 00:10:08,435
yellow zoned neighborhoods, and then red zoned neighborhoods

258
00:10:08,654 --> 00:10:10,195
were your black neighborhoods,

259
00:10:10,975 --> 00:10:14,415
and sometimes Asian neighborhoods and Latino neighborhoods and

260
00:10:14,415 --> 00:10:16,514
Native American neighborhoods. And so,

261
00:10:17,759 --> 00:10:19,220
basically, this this

262
00:10:19,519 --> 00:10:21,460
organization and this policy of Redlining,

263
00:10:22,320 --> 00:10:24,559
zoned these neighborhoods by race, and then they

264
00:10:24,559 --> 00:10:25,059
said,

265
00:10:25,519 --> 00:10:28,559
depending on what kind of zone your neighborhood

266
00:10:28,559 --> 00:10:31,045
was in, you could get a mortgage. And

267
00:10:31,045 --> 00:10:33,625
so this is the reason why today,

268
00:10:34,725 --> 00:10:36,024
men the, like,

269
00:10:36,565 --> 00:10:39,945
public housing is often associated with African Americans

270
00:10:40,085 --> 00:10:43,365
because African Americans couldn't get mortgages, so they

271
00:10:43,365 --> 00:10:45,524
couldn't get homes. So they had to rely

272
00:10:45,524 --> 00:10:46,504
on public housing.

273
00:10:47,019 --> 00:10:47,519
Oftentimes,

274
00:10:47,899 --> 00:10:49,820
you know, if you were one of the

275
00:10:49,820 --> 00:10:51,980
few black people who could afford to build

276
00:10:51,980 --> 00:10:52,559
a home,

277
00:10:53,419 --> 00:10:55,820
you often could not get a loan to

278
00:10:55,820 --> 00:10:58,059
repair your home. So homes often fell into

279
00:10:58,059 --> 00:11:00,644
disrepair or cheap materials that have, like,

280
00:11:01,205 --> 00:11:04,085
asbestos or other cancer causing materials were used

281
00:11:04,085 --> 00:11:05,225
to build these houses.

282
00:11:05,764 --> 00:11:08,745
And, redlining neighborhoods also dictated

283
00:11:09,045 --> 00:11:12,985
how grocery stores moved into neighborhoods and hospitals

284
00:11:13,045 --> 00:11:15,304
moved into neighborhoods because these redlined

285
00:11:15,605 --> 00:11:16,105
neighborhoods

286
00:11:16,700 --> 00:11:18,159
were seen as undesirable

287
00:11:18,620 --> 00:11:20,000
or poor neighborhoods.

288
00:11:20,460 --> 00:11:22,620
And so grocery stores and hospitals would not

289
00:11:22,620 --> 00:11:24,379
build in those areas because they felt like

290
00:11:24,379 --> 00:11:26,220
they couldn't make money like they could in

291
00:11:26,220 --> 00:11:28,399
a green zoned a green lined neighborhood.

292
00:11:28,940 --> 00:11:31,019
And all of this has led even though,

293
00:11:31,019 --> 00:11:33,674
you know, red lining is now no longer

294
00:11:33,674 --> 00:11:34,174
legal,

295
00:11:34,634 --> 00:11:35,535
it was outlawed,

296
00:11:35,995 --> 00:11:37,995
it is the reason why one of the

297
00:11:37,995 --> 00:11:40,715
reason why is today in this country, we

298
00:11:40,715 --> 00:11:44,250
still continue to live segregated by race. And

299
00:11:44,250 --> 00:11:46,350
it's the reason why we stereotypically

300
00:11:46,730 --> 00:11:49,929
see black neighborhoods as being bad neighborhoods because

301
00:11:49,929 --> 00:11:50,429
redlining

302
00:11:51,050 --> 00:11:52,590
set the standard for that.

303
00:11:53,610 --> 00:11:55,250
One last thing that,

304
00:11:55,690 --> 00:11:58,009
also happened as a result of redlining is

305
00:11:58,009 --> 00:11:59,445
so these redlined neighborhoods

306
00:12:06,404 --> 00:12:09,225
farms would be built on the borders

307
00:12:09,605 --> 00:12:10,184
of these,

308
00:12:10,804 --> 00:12:12,504
redlined neighborhoods. So

309
00:12:13,205 --> 00:12:15,500
what ends up happening, and this continues to

310
00:12:15,500 --> 00:12:16,860
happen in 2025,

311
00:12:16,860 --> 00:12:20,079
is in these redlined neighborhoods or formerly redlined

312
00:12:20,139 --> 00:12:20,639
neighborhoods,

313
00:12:21,419 --> 00:12:23,120
they are not grocery stores.

314
00:12:23,500 --> 00:12:24,320
There are,

315
00:12:24,860 --> 00:12:26,174
you have a lot of, like,

316
00:12:26,975 --> 00:12:27,475
environmental,

317
00:12:28,894 --> 00:12:31,235
you have high a higher risk of developing

318
00:12:31,855 --> 00:12:32,355
environmental,

319
00:12:33,214 --> 00:12:35,955
diseases. So think of things like COPD, emphysema,

320
00:12:36,174 --> 00:12:37,855
if you're living right next to a factory

321
00:12:37,855 --> 00:12:40,195
and you're exposed to smoke all the time.

322
00:12:41,049 --> 00:12:43,370
And then because there are not grocery stores,

323
00:12:43,370 --> 00:12:45,389
you're at a higher risk of

324
00:12:45,690 --> 00:12:46,909
things like diabetes,

325
00:12:47,289 --> 00:12:50,409
high blood pressure, high cholesterol because your these

326
00:12:50,409 --> 00:12:52,424
communities often rely on,

327
00:12:53,065 --> 00:12:56,024
corner stores that we know don't have healthy

328
00:12:56,024 --> 00:12:56,524
foods.

329
00:12:57,304 --> 00:13:00,024
So one experiment that I've done in some

330
00:13:00,024 --> 00:13:00,845
of my presentations

331
00:13:01,384 --> 00:13:03,565
is I will have my participants,

332
00:13:05,419 --> 00:13:08,320
Google grocery stores in a white,

333
00:13:08,940 --> 00:13:11,740
and wherever they live, in the white area

334
00:13:11,740 --> 00:13:14,620
where they live. And then Google grocery stores

335
00:13:14,620 --> 00:13:16,860
in the black area of wherever you live.

336
00:13:16,860 --> 00:13:19,259
And you'll see that this still continues to

337
00:13:19,259 --> 00:13:21,795
happen. You'll see that in mostly white areas.

338
00:13:21,795 --> 00:13:24,195
That's where you'll see things like whole foods

339
00:13:24,195 --> 00:13:26,754
and fresh markets and places that sell fresh

340
00:13:26,754 --> 00:13:30,215
organic produce. And then in majority black neighborhoods,

341
00:13:30,355 --> 00:13:33,095
you'll see things like corner stores that sell

342
00:13:33,154 --> 00:13:35,175
a lot of highly processed foods,

343
00:13:35,570 --> 00:13:36,450
not a lot of,

344
00:13:37,009 --> 00:13:40,070
fresh fruits and vegetables. And that leads to

345
00:13:40,370 --> 00:13:43,269
a lot of these disparities that we're seeing,

346
00:13:44,210 --> 00:13:47,090
with our patients who come in and have,

347
00:13:47,090 --> 00:13:49,250
you know, these who end up having strokes

348
00:13:49,250 --> 00:13:52,274
because of hypertension, high blood pressure, cholesterol,

349
00:13:52,735 --> 00:13:54,595
things like that. So fascinating, Jackie.

350
00:13:55,134 --> 00:13:57,455
What led you down this, for lack of

351
00:13:57,455 --> 00:13:59,934
a better term, rabbit hole of of exploring

352
00:13:59,934 --> 00:14:02,335
all? I mean, that it makes perfect sense

353
00:14:02,335 --> 00:14:03,774
the way you just explained it. But, yeah,

354
00:14:03,774 --> 00:14:05,875
it's really fascinating to me.

355
00:14:06,789 --> 00:14:08,789
I think it's just because of my, like,

356
00:14:08,789 --> 00:14:11,110
own personal interest, just from coming from, like,

357
00:14:11,110 --> 00:14:13,669
a multicultural background. So my dad's Puerto Rican.

358
00:14:13,669 --> 00:14:15,289
My mom was African American.

359
00:14:15,829 --> 00:14:17,990
And I've always been really interested in, like,

360
00:14:17,990 --> 00:14:20,264
race and culture and also black history. And

361
00:14:20,264 --> 00:14:22,504
so sometimes I'll just see things, and I'm

362
00:14:22,504 --> 00:14:23,004
like,

363
00:14:23,464 --> 00:14:25,784
some there's, like, something that just seems very

364
00:14:25,784 --> 00:14:27,784
racist about this situation, and then I'll look

365
00:14:27,784 --> 00:14:30,845
it up. And, historically, there's my answer. So

366
00:14:30,904 --> 00:14:33,329
that's that's a honest answer.

367
00:14:34,429 --> 00:14:35,709
Talk to me a little bit more about

368
00:14:35,709 --> 00:14:38,589
how low health literacy what what exactly should

369
00:14:38,589 --> 00:14:40,509
SLPs know about that? How how is that

370
00:14:40,509 --> 00:14:42,370
manifest in swallowing disorders?

371
00:14:43,309 --> 00:14:45,329
Okay. That's a great question. So,

372
00:14:46,029 --> 00:14:47,329
let's imagine that

373
00:14:47,904 --> 00:14:50,225
you are a patient that has had a

374
00:14:50,225 --> 00:14:52,245
stroke and now you have dysphasia.

375
00:14:53,024 --> 00:14:53,524
So,

376
00:14:54,465 --> 00:14:56,705
and let's say that you have a third

377
00:14:56,705 --> 00:14:59,605
grade education. So you don't read very well.

378
00:14:59,745 --> 00:15:01,205
Maybe you've taken, like,

379
00:15:01,850 --> 00:15:04,570
a couple of science classes, but you don't

380
00:15:04,570 --> 00:15:07,070
have a very strong background. Right?

381
00:15:07,449 --> 00:15:09,850
So now, you know, we there have been

382
00:15:09,850 --> 00:15:13,049
so many conversations about informed consent and how

383
00:15:13,049 --> 00:15:14,250
we want patients to,

384
00:15:15,754 --> 00:15:19,274
we're kinda moving away even from modified diets

385
00:15:19,274 --> 00:15:20,334
and moving towards,

386
00:15:20,875 --> 00:15:23,534
like, what do the patients want and just

387
00:15:23,914 --> 00:15:25,695
following in their direction. But

388
00:15:26,554 --> 00:15:27,754
we if you don't

389
00:15:28,440 --> 00:15:31,340
it it's there's so many factors here. So

390
00:15:32,039 --> 00:15:33,899
let's start with a stroke. So,

391
00:15:34,759 --> 00:15:37,080
for example, I have a patient right now

392
00:15:37,080 --> 00:15:37,580
who,

393
00:15:38,679 --> 00:15:41,419
this particular patient had an aneurysm,

394
00:15:42,695 --> 00:15:44,794
which led to his stroke, and

395
00:15:45,095 --> 00:15:48,215
it manifested in a seizure and a fall.

396
00:15:48,215 --> 00:15:50,134
And so he was brought in after having

397
00:15:50,134 --> 00:15:51,434
a seizure, and then they,

398
00:15:51,894 --> 00:15:53,894
did his imaging, and they realized that he

399
00:15:53,894 --> 00:15:56,215
had one stable aneurysm, and then he had

400
00:15:56,215 --> 00:15:58,049
had a stroke on the other side of

401
00:15:58,049 --> 00:16:00,309
his brain. And so I was

402
00:16:01,009 --> 00:16:03,089
one for one, this is was a Spanish

403
00:16:03,089 --> 00:16:03,909
speaking patient.

404
00:16:05,169 --> 00:16:06,529
By the time he got to me, he

405
00:16:06,529 --> 00:16:08,210
had been in the hospital for over a

406
00:16:08,210 --> 00:16:10,365
month, and no one had explained to him

407
00:16:10,524 --> 00:16:12,784
what happened to him. All he knew was

408
00:16:12,845 --> 00:16:15,485
the word stroke. And so for many people,

409
00:16:15,485 --> 00:16:17,245
if you have a low level of health

410
00:16:17,245 --> 00:16:17,745
literacy,

411
00:16:18,764 --> 00:16:20,605
like, when you think about a stroke, that's

412
00:16:20,605 --> 00:16:23,584
a very complex medical event that happens.

413
00:16:24,200 --> 00:16:26,940
And to many people with low health literacy,

414
00:16:28,039 --> 00:16:30,519
a stroke might just mean, well, it's something

415
00:16:30,519 --> 00:16:32,759
that my grandma had, and, like, she needed

416
00:16:32,759 --> 00:16:34,600
a lot of help afterwards. But they don't

417
00:16:34,600 --> 00:16:37,340
actually know, like, what does a stroke mean.

418
00:16:37,634 --> 00:16:39,894
So then, like, with this particular patient,

419
00:16:40,754 --> 00:16:43,174
we're having I was, like, trying to explain

420
00:16:43,235 --> 00:16:46,274
to him what his blood vessels are and

421
00:16:46,274 --> 00:16:48,535
how blood vessels bring oxygen

422
00:16:49,315 --> 00:16:51,540
up and blood up from the heart to

423
00:16:51,540 --> 00:16:53,700
the brain, and that's like food for the

424
00:16:53,700 --> 00:16:55,139
brain. And then,

425
00:16:55,620 --> 00:16:58,259
with an aneurysm, an aneurysm is kind of

426
00:16:58,259 --> 00:17:00,980
like a bubble in your blood vessel, and

427
00:17:00,980 --> 00:17:01,960
it exploded.

428
00:17:02,754 --> 00:17:05,714
And now the blood is not flowing up

429
00:17:05,714 --> 00:17:07,875
to the brain and the brain tissue dies

430
00:17:07,875 --> 00:17:09,634
because the brain is not getting that food

431
00:17:09,634 --> 00:17:11,015
from the blood and oxygen.

432
00:17:11,634 --> 00:17:12,375
And so

433
00:17:13,234 --> 00:17:16,134
to him, he like, after having this conversation,

434
00:17:16,275 --> 00:17:18,740
this you could tell things were starting to

435
00:17:18,740 --> 00:17:20,839
click. So he wanted to know, like,

436
00:17:21,299 --> 00:17:22,440
what could cause,

437
00:17:23,460 --> 00:17:25,539
a lack of flow of blood up to

438
00:17:25,539 --> 00:17:27,619
the brain. And so we talked about, like,

439
00:17:27,619 --> 00:17:30,119
other factors too, how, like, things like cholesterol,

440
00:17:30,179 --> 00:17:31,859
high blood pressure, those are other things that

441
00:17:31,859 --> 00:17:33,000
can lead to a stroke.

442
00:17:34,095 --> 00:17:35,554
And then he was like, well,

443
00:17:35,855 --> 00:17:36,674
what causes

444
00:17:37,295 --> 00:17:39,454
high cholesterol and what causes, like, high blood

445
00:17:39,454 --> 00:17:39,954
pressure?

446
00:17:40,494 --> 00:17:40,894
And,

447
00:17:41,375 --> 00:17:43,615
we talked about foods that you eat and

448
00:17:43,615 --> 00:17:44,515
how that could,

449
00:17:45,375 --> 00:17:48,309
cause changes to your blood pressure. And he

450
00:17:48,309 --> 00:17:50,150
was like, okay, I understand. Well, you know,

451
00:17:50,150 --> 00:17:51,990
like, I eat like this food, like pork

452
00:17:51,990 --> 00:17:53,349
has a lot of, like, fat in it,

453
00:17:53,349 --> 00:17:54,869
and that could cause high blood pressure. And

454
00:17:54,869 --> 00:17:56,009
I was like, yes. Yes.

455
00:17:56,470 --> 00:17:58,470
And then towards the end, he was like,

456
00:17:58,470 --> 00:17:58,970
but

457
00:17:59,269 --> 00:18:01,109
this whole thing that happened to my brain,

458
00:18:01,109 --> 00:18:03,335
like, it's all because I fell. Right? Like,

459
00:18:03,335 --> 00:18:04,774
I had the seizure and I hit my

460
00:18:04,774 --> 00:18:07,095
head, and, like, that injury to my head

461
00:18:07,095 --> 00:18:08,694
is what caused the fall. And so to

462
00:18:08,694 --> 00:18:09,194
him,

463
00:18:09,575 --> 00:18:11,815
like, to me, that made a lot of

464
00:18:11,815 --> 00:18:13,589
sense. Because to him, like,

465
00:18:14,069 --> 00:18:14,569
the

466
00:18:14,950 --> 00:18:16,569
the physical action

467
00:18:17,029 --> 00:18:19,609
of a fall is, like, causing a stroke

468
00:18:19,750 --> 00:18:21,990
makes a lot more sense to someone who

469
00:18:21,990 --> 00:18:23,909
might not have a very high level of

470
00:18:23,909 --> 00:18:24,650
health literacy

471
00:18:25,190 --> 00:18:27,095
as opposed to, like, oh, you have all

472
00:18:27,095 --> 00:18:29,255
these blood vessels moving through your body, and

473
00:18:29,255 --> 00:18:31,894
that's what's leading, you know, an interruption of

474
00:18:31,894 --> 00:18:34,295
blood flow has caused this stroke. That's much

475
00:18:34,295 --> 00:18:36,394
more of of, like, a higher level,

476
00:18:38,455 --> 00:18:41,115
concept to understand. And so then,

477
00:18:41,900 --> 00:18:43,819
you know, I was talking to some other

478
00:18:43,819 --> 00:18:44,319
coworkers,

479
00:18:44,779 --> 00:18:47,099
and they said, well, I don't know why

480
00:18:47,099 --> 00:18:48,539
you had to explain to him that he

481
00:18:48,539 --> 00:18:49,980
had a stroke because I already told him

482
00:18:49,980 --> 00:18:52,240
that. And I was like, okay. But

483
00:18:52,859 --> 00:18:53,919
did you actually

484
00:18:54,375 --> 00:18:56,315
explain, like, in detail

485
00:18:56,695 --> 00:18:59,414
all these different facts and all about all

486
00:18:59,414 --> 00:19:01,015
these different parts of the body and how

487
00:19:01,015 --> 00:19:03,414
they work together collectively to lead to a

488
00:19:03,414 --> 00:19:05,575
stroke? Or did you just say, like, hey.

489
00:19:05,575 --> 00:19:07,015
You had a stroke, and, like, this is

490
00:19:07,015 --> 00:19:08,154
why you can't

491
00:19:08,700 --> 00:19:10,299
move this side of your body, or this

492
00:19:10,299 --> 00:19:12,380
is why your attention is not like it

493
00:19:12,380 --> 00:19:14,000
used to be. So,

494
00:19:14,700 --> 00:19:16,960
what we really need to think about,

495
00:19:17,900 --> 00:19:20,079
our patient's level of education,

496
00:19:20,940 --> 00:19:24,065
their access to, you know, maybe they're not

497
00:19:24,065 --> 00:19:27,025
understanding the purpose of our therapy because they've

498
00:19:27,025 --> 00:19:29,424
never they're not familiar with our health care

499
00:19:29,424 --> 00:19:32,144
system. They've never been to therapy before. They

500
00:19:32,144 --> 00:19:32,644
don't,

501
00:19:33,184 --> 00:19:35,339
maybe they live in an area where they

502
00:19:35,339 --> 00:19:36,779
have to take the bus and it takes

503
00:19:36,779 --> 00:19:38,779
two hours to get to the doctors. They

504
00:19:38,779 --> 00:19:40,940
don't go to the doctor frequently. And it's

505
00:19:40,940 --> 00:19:43,259
not necessarily that they don't want to, but

506
00:19:43,259 --> 00:19:45,419
that all these social determinants of health are

507
00:19:45,419 --> 00:19:45,919
barriers.

508
00:19:46,940 --> 00:19:47,440
So

509
00:19:47,744 --> 00:19:50,065
let's go back to, like, our theoretical stroke

510
00:19:50,065 --> 00:19:52,325
patient that now has dysphagia. Right?

511
00:19:52,625 --> 00:19:55,204
So we had to spend all that time

512
00:19:55,424 --> 00:19:57,825
just for the patient to understand what a

513
00:19:57,825 --> 00:20:00,224
stroke is. Right? And now we get to

514
00:20:00,224 --> 00:20:00,724
dysphagia,

515
00:20:01,105 --> 00:20:02,805
and this person is aspirating.

516
00:20:03,769 --> 00:20:06,889
How do you explain what aspiration is to

517
00:20:06,889 --> 00:20:09,069
a patient that does does not understand

518
00:20:09,369 --> 00:20:12,409
what their lungs do or doesn't understand what

519
00:20:12,409 --> 00:20:15,369
the esophagus is or the larynx or all

520
00:20:15,369 --> 00:20:16,589
these other, like,

521
00:20:17,005 --> 00:20:17,744
very complicated

522
00:20:18,525 --> 00:20:21,424
body parts that even maybe your average person

523
00:20:21,484 --> 00:20:23,404
might not be familiar with, but let alone

524
00:20:23,404 --> 00:20:25,904
someone that has very, very limited education.

525
00:20:26,525 --> 00:20:29,085
So sometimes we have to take a step

526
00:20:29,085 --> 00:20:31,430
back and we need to do some education

527
00:20:31,890 --> 00:20:32,950
about the anatomy

528
00:20:33,250 --> 00:20:35,910
before we can even get to the conversation

529
00:20:36,130 --> 00:20:38,789
about, well, you're aspirating. This is what aspiration

530
00:20:38,849 --> 00:20:41,190
means. What do you want to do?

531
00:20:41,505 --> 00:20:43,424
What medical decision do you want to make?

532
00:20:43,424 --> 00:20:46,305
So that's how low health literacy is gonna

533
00:20:46,305 --> 00:20:48,785
show up in our therapy sessions. Yeah. Thank

534
00:20:48,785 --> 00:20:51,265
you. I one thing that that struck me

535
00:20:51,265 --> 00:20:53,759
while you were explaining that is I remember

536
00:20:53,759 --> 00:20:54,740
we had a course,

537
00:20:55,119 --> 00:20:56,099
in my PhD

538
00:20:56,720 --> 00:20:59,279
work last semester, and it's it was a

539
00:20:59,279 --> 00:21:01,119
course all about health care education. And there

540
00:21:01,119 --> 00:21:03,220
was one thing that they constantly

541
00:21:03,599 --> 00:21:06,740
stressed was these brief checks for understanding.

542
00:21:07,815 --> 00:21:10,134
And that just made me think of that.

543
00:21:10,134 --> 00:21:11,815
How often do we do that with our

544
00:21:11,815 --> 00:21:14,315
patient? Stop blabbing or stop assuming

545
00:21:14,774 --> 00:21:17,815
or stop going on our rants and literally

546
00:21:17,815 --> 00:21:20,154
just stop and check for their understanding

547
00:21:20,454 --> 00:21:21,815
and not, oh, do you know what a

548
00:21:21,815 --> 00:21:24,430
stroke is? But, like, do you actually understand

549
00:21:24,809 --> 00:21:26,589
what happened, why you're here?

550
00:21:26,890 --> 00:21:29,369
So, yeah, thank you. That that's just made

551
00:21:29,369 --> 00:21:31,210
that made that correlation for me. So thank

552
00:21:31,210 --> 00:21:31,710
you.

553
00:21:32,089 --> 00:21:34,994
Yeah. Totally. And I one question that I

554
00:21:35,075 --> 00:21:36,835
often get is people will say, well, how

555
00:21:36,835 --> 00:21:38,615
do you assess health literacy?

556
00:21:39,555 --> 00:21:43,015
And there are some formal health literacy assessments.

557
00:21:43,714 --> 00:21:45,095
But to be honest,

558
00:21:45,394 --> 00:21:47,069
I prefer to just use

559
00:21:47,630 --> 00:21:48,849
informal conversational

560
00:21:49,230 --> 00:21:49,730
interviewing

561
00:21:50,269 --> 00:21:50,769
to,

562
00:21:51,230 --> 00:21:53,389
to your point about, like, asking people what

563
00:21:53,389 --> 00:21:56,049
they understand because then you get,

564
00:21:57,309 --> 00:22:01,089
more information that is directly related to our,

565
00:22:02,585 --> 00:22:04,525
our role as speech language pathologist.

566
00:22:04,825 --> 00:22:06,825
So, like, usually, when I get a patient,

567
00:22:06,825 --> 00:22:08,585
like, the first thing I'll say is, you

568
00:22:08,585 --> 00:22:10,424
know, what tell me, like, a little bit

569
00:22:10,424 --> 00:22:12,505
about what happened to you, why are you

570
00:22:12,505 --> 00:22:13,005
here.

571
00:22:13,704 --> 00:22:14,184
And I'm,

572
00:22:15,119 --> 00:22:17,200
you know, most of the time in inpatient

573
00:22:17,200 --> 00:22:19,599
rehab, but often in outpatient. So I'm seeing

574
00:22:19,599 --> 00:22:20,420
a lot of,

575
00:22:21,039 --> 00:22:22,960
stroke patients. So that's kind of my frame

576
00:22:22,960 --> 00:22:25,700
of reference, stroke traumatic brain injury. And and

577
00:22:25,839 --> 00:22:28,240
every once in a while, I'll see other

578
00:22:28,240 --> 00:22:30,579
populations. But I would say that's my

579
00:22:30,934 --> 00:22:31,434
main,

580
00:22:31,894 --> 00:22:33,674
typical demographic of patients.

581
00:22:34,214 --> 00:22:36,375
And then I'll say I'll ask them to,

582
00:22:36,375 --> 00:22:38,694
you know, well, what led to this stroke?

583
00:22:38,694 --> 00:22:40,454
Do you did the doctors tell you, like,

584
00:22:40,454 --> 00:22:41,194
what happened?

585
00:22:41,734 --> 00:22:42,474
And so,

586
00:22:43,779 --> 00:22:46,420
then I can kinda get an idea of,

587
00:22:46,420 --> 00:22:48,980
okay, what's that's about how much of,

588
00:22:49,539 --> 00:22:51,859
you know, their body they understand. I I

589
00:22:51,859 --> 00:22:53,320
also like to talk about,

590
00:22:53,940 --> 00:22:56,339
the blood vessels and also the nerves. And

591
00:22:56,339 --> 00:22:58,365
so I'll ask my patients, like, do you

592
00:22:58,365 --> 00:23:01,164
understand what your nerves do? And, like, 90%

593
00:23:01,164 --> 00:23:02,605
of the time, my patients will tell me

594
00:23:02,605 --> 00:23:03,105
no.

595
00:23:04,204 --> 00:23:06,285
And then I'll ask them too. I'll say,

596
00:23:06,285 --> 00:23:08,204
well, you know, tell me a little bit

597
00:23:08,204 --> 00:23:08,684
about,

598
00:23:09,484 --> 00:23:11,819
why are you hearing speech? Like, what's what's

599
00:23:11,819 --> 00:23:13,419
happening? And so they might say, well, I'm

600
00:23:13,419 --> 00:23:16,220
having trouble swallowing. And I'll say, has anyone

601
00:23:16,220 --> 00:23:18,380
told you, like, what the name of this

602
00:23:18,380 --> 00:23:20,859
disorder is? Because I wanna make sure that

603
00:23:20,859 --> 00:23:22,079
they know the words,

604
00:23:22,940 --> 00:23:23,440
dysphagia,

605
00:23:24,224 --> 00:23:24,724
aphasia,

606
00:23:25,105 --> 00:23:25,605
apraxia,

607
00:23:25,904 --> 00:23:29,984
dysarthria, cognitive communication disorder because they might leave

608
00:23:29,984 --> 00:23:30,484
me

609
00:23:31,105 --> 00:23:32,704
and they might go to the next level

610
00:23:32,704 --> 00:23:34,384
of care, or they might just see another

611
00:23:34,384 --> 00:23:36,785
health professional. And that other health professional might

612
00:23:36,785 --> 00:23:37,525
say, well,

613
00:23:38,279 --> 00:23:40,519
your, you know, your aphasia is really improving.

614
00:23:40,519 --> 00:23:42,039
And they're like, well, what are you talking

615
00:23:42,039 --> 00:23:44,860
about? Because no one has ever actually used

616
00:23:45,160 --> 00:23:47,400
the medical term. So you wanna make sure

617
00:23:47,400 --> 00:23:50,120
that, like, when you're educating people, you know,

618
00:23:50,120 --> 00:23:52,299
you're asking these questions, you're listening,

619
00:23:52,694 --> 00:23:55,034
and then you're not excluding information.

620
00:23:55,335 --> 00:23:57,274
You're just breaking information

621
00:23:57,654 --> 00:24:00,134
all the way down and but still at

622
00:24:00,134 --> 00:24:00,954
the same time

623
00:24:01,335 --> 00:24:04,294
using those medical terms because they that is

624
00:24:04,294 --> 00:24:04,794
how

625
00:24:05,250 --> 00:24:06,470
people with disabilities

626
00:24:06,769 --> 00:24:09,250
can self advocate if they have that language.

627
00:24:09,250 --> 00:24:11,890
That language is so powerful. So Yeah. Yeah.

628
00:24:11,890 --> 00:24:13,570
Thank you for sharing that. It it's an

629
00:24:13,570 --> 00:24:14,070
interesting

630
00:24:15,170 --> 00:24:17,650
dynamic because it's, like, sometimes are we, you

631
00:24:17,650 --> 00:24:19,650
know, talking down to our patients or are

632
00:24:19,650 --> 00:24:23,345
we being too elementary? But I've looked at

633
00:24:23,345 --> 00:24:25,684
it as it's actually being much more respectful

634
00:24:25,904 --> 00:24:26,404
to

635
00:24:27,025 --> 00:24:29,585
helping them get the care that they actually

636
00:24:29,585 --> 00:24:31,505
need. You know? And I I just was

637
00:24:31,505 --> 00:24:33,025
thinking of it. And since I had with

638
00:24:33,025 --> 00:24:34,830
my son of trying

639
00:24:35,529 --> 00:24:37,369
to get connected with this one nurse that

640
00:24:37,369 --> 00:24:38,990
was doing some stuff for us, and,

641
00:24:39,289 --> 00:24:40,570
you know, I said, how how can I

642
00:24:40,570 --> 00:24:42,090
can I call you? Like, can I you

643
00:24:42,090 --> 00:24:43,369
know, what's the best way for me to

644
00:24:43,369 --> 00:24:45,049
call you? And she's just don't, like, don't

645
00:24:45,049 --> 00:24:47,535
even deal with the hospital system phones. Like,

646
00:24:47,535 --> 00:24:48,974
she's like, just go through the app and

647
00:24:48,974 --> 00:24:50,335
send me a message, and it literally comes

648
00:24:50,335 --> 00:24:52,015
right to my phone. And I said, okay.

649
00:24:52,015 --> 00:24:53,134
But, like, can you show me how to

650
00:24:53,134 --> 00:24:54,414
set up the app? And she's like, you

651
00:24:54,414 --> 00:24:55,695
want me to show you how to set

652
00:24:55,695 --> 00:24:56,894
up the app? And I was like, yeah,

653
00:24:56,894 --> 00:25:00,059
I do. Like, I'm smart, but also, like,

654
00:25:00,140 --> 00:25:02,059
I know that a million things can go

655
00:25:02,059 --> 00:25:04,059
wrong when I leave here and I can't

656
00:25:04,059 --> 00:25:05,680
get in the app. So I, like, downloaded

657
00:25:05,820 --> 00:25:07,420
the app and I was like, Okay, what

658
00:25:07,420 --> 00:25:08,539
do I do now? And she's like, Oh,

659
00:25:08,539 --> 00:25:10,220
you have to type this code in. And

660
00:25:10,220 --> 00:25:11,420
I was like, How would I have known

661
00:25:11,420 --> 00:25:14,140
that? Right. She's like, Yeah, I guess you

662
00:25:14,140 --> 00:25:15,519
probably wouldn't have

663
00:25:16,085 --> 00:25:18,164
Like so I sat there for ten minutes,

664
00:25:18,164 --> 00:25:19,684
like, got it set up, and there was

665
00:25:19,684 --> 00:25:21,684
other little tricks too that she's like, oh,

666
00:25:21,684 --> 00:25:22,825
yeah. Just click here

667
00:25:23,125 --> 00:25:24,724
and, like, just text right there. And I

668
00:25:24,724 --> 00:25:26,825
was like, I never would have. Like,

669
00:25:27,285 --> 00:25:29,045
that's not how I would have done this.

670
00:25:29,045 --> 00:25:31,109
And to me, it was a lesson in,

671
00:25:31,109 --> 00:25:32,809
like, we owe this to our patients

672
00:25:33,670 --> 00:25:34,970
to have these conversations,

673
00:25:35,350 --> 00:25:38,070
walk them through this stuff. Like, it's not

674
00:25:38,070 --> 00:25:39,990
that I'm stupid, but they some of this

675
00:25:39,990 --> 00:25:42,170
stuff is just so complicated. Complicated.

676
00:25:42,950 --> 00:25:44,009
Like Right.

677
00:25:44,474 --> 00:25:47,855
Yep. And then too, like, imagine if, you

678
00:25:48,234 --> 00:25:48,815
know, you didn't

679
00:25:49,115 --> 00:25:50,335
you weren't very literate

680
00:25:50,714 --> 00:25:52,095
in using a smartphone

681
00:25:53,434 --> 00:25:55,595
or if you didn't read very well or

682
00:25:55,595 --> 00:25:57,755
even if you don't speak English and that

683
00:25:57,755 --> 00:26:00,174
application was completely in English.

684
00:26:00,609 --> 00:26:03,109
And what ends up happening so often is

685
00:26:03,250 --> 00:26:05,809
because we are not doing our job with

686
00:26:05,809 --> 00:26:06,309
organizational

687
00:26:06,690 --> 00:26:07,429
health literacy,

688
00:26:07,970 --> 00:26:10,390
we end up blaming it on the patient

689
00:26:10,450 --> 00:26:12,869
and saying, like, oh, the patient was noncompliant.

690
00:26:13,569 --> 00:26:15,764
And it's like, yeah. And it's like, were

691
00:26:15,764 --> 00:26:16,904
were they noncompliant,

692
00:26:17,284 --> 00:26:18,585
or were we, like,

693
00:26:19,125 --> 00:26:21,284
not meeting them where they're at and giving

694
00:26:21,284 --> 00:26:23,524
them the support that they really need? There's

695
00:26:23,524 --> 00:26:26,244
just a million barriers that we're not helping

696
00:26:26,244 --> 00:26:27,924
with. And, look, it was something else too.

697
00:26:27,924 --> 00:26:28,424
Like,

698
00:26:28,930 --> 00:26:30,369
she went by I'm just making up a

699
00:26:30,369 --> 00:26:32,210
name. Like, she went by Judy or something,

700
00:26:32,210 --> 00:26:34,289
but her name was, like, Lauren inside the

701
00:26:34,289 --> 00:26:36,049
app. So I'm like, I never would have

702
00:26:36,049 --> 00:26:37,250
texted you like that. And she's like, oh,

703
00:26:37,250 --> 00:26:38,609
I didn't realize that's how it came up.

704
00:26:38,609 --> 00:26:40,369
Like, she didn't even realize that was how

705
00:26:40,369 --> 00:26:42,605
it came up on the user side. You

706
00:26:42,605 --> 00:26:44,365
know? So there's so many it was just

707
00:26:44,365 --> 00:26:46,224
such a big lesson to me and, like,

708
00:26:46,444 --> 00:26:48,605
hey. Let's exactly what you're saying. Let's not

709
00:26:48,605 --> 00:26:50,224
blame these people for being,

710
00:26:50,845 --> 00:26:51,504
you know,

711
00:26:52,204 --> 00:26:54,444
noncompliant. Let's actually see if they can figure

712
00:26:54,444 --> 00:26:56,784
out this super complex system that

713
00:26:57,440 --> 00:27:00,319
that we live in. Okay. So we've we've

714
00:27:00,319 --> 00:27:02,640
talked about, you you know, with without doing

715
00:27:02,640 --> 00:27:04,660
this justice, we've talked about just

716
00:27:05,039 --> 00:27:07,920
mainstream English speakers. Okay. I know there's a

717
00:27:07,920 --> 00:27:09,680
lot of other dialects. I know there's a

718
00:27:09,680 --> 00:27:10,819
lot of other languages.

719
00:27:11,279 --> 00:27:12,660
Let's dive into that.

720
00:27:13,005 --> 00:27:13,505
Yeah.

721
00:27:14,045 --> 00:27:16,125
So, this is something that I see at

722
00:27:16,125 --> 00:27:18,704
work a lot as well. And even when,

723
00:27:19,565 --> 00:27:22,605
I'm interacting with people at different conferences or

724
00:27:22,605 --> 00:27:23,424
on Instagram,

725
00:27:23,805 --> 00:27:26,045
that's a question that comes up a lot.

726
00:27:26,285 --> 00:27:28,880
So people will say, I I just feel

727
00:27:28,880 --> 00:27:29,700
really uncomfortable

728
00:27:30,000 --> 00:27:30,819
working with

729
00:27:31,119 --> 00:27:33,839
people who speak another language or people who

730
00:27:33,839 --> 00:27:37,619
speak another dialect. And I honestly feel like

731
00:27:37,839 --> 00:27:39,299
it's our dialect

732
00:27:39,615 --> 00:27:43,214
speakers whose needs are often not being met,

733
00:27:43,214 --> 00:27:45,375
whereas our and that's not to say that

734
00:27:45,375 --> 00:27:47,615
there are not health care disparities that are

735
00:27:47,615 --> 00:27:48,755
impacting our

736
00:27:49,055 --> 00:27:51,694
people who speak other languages, just that there

737
00:27:51,694 --> 00:27:52,914
are more formal

738
00:27:53,250 --> 00:27:55,670
structured measures in place to support,

739
00:27:57,009 --> 00:27:58,630
speakers of other languages

740
00:27:59,009 --> 00:28:01,809
that there are not necessarily in place for

741
00:28:01,809 --> 00:28:03,670
dialect speakers of English.

742
00:28:04,289 --> 00:28:06,230
And so what I mean by that is

743
00:28:06,414 --> 00:28:06,914
oftentimes

744
00:28:07,454 --> 00:28:08,914
you know, I'm based in Atlanta,

745
00:28:09,775 --> 00:28:12,654
and Atlanta is really a unique area in

746
00:28:12,654 --> 00:28:13,154
that,

747
00:28:14,015 --> 00:28:16,734
we're a pretty large metro area. And when

748
00:28:16,734 --> 00:28:19,055
you think about the Deep South, we're probably

749
00:28:19,055 --> 00:28:21,214
one of the biggest cities in the Deep

750
00:28:21,214 --> 00:28:21,714
South.

751
00:28:22,710 --> 00:28:25,190
So you get a lot of people who

752
00:28:25,190 --> 00:28:26,009
come from,

753
00:28:27,430 --> 00:28:29,430
like, some of the bigger cities in the

754
00:28:29,430 --> 00:28:31,990
Northeast and have moved down to Atlanta because

755
00:28:31,990 --> 00:28:33,990
it's more affordable, but you still get the

756
00:28:33,990 --> 00:28:35,049
big city vibes.

757
00:28:35,795 --> 00:28:38,054
You also get a lot of people from

758
00:28:38,994 --> 00:28:39,494
rural,

759
00:28:40,194 --> 00:28:42,994
South Georgia and other smaller towns in the

760
00:28:42,994 --> 00:28:45,255
South that have now moved into the city.

761
00:28:45,554 --> 00:28:48,035
And then you have your native Atlanans, which

762
00:28:48,035 --> 00:28:50,269
are a dying breed. And so you have

763
00:28:50,269 --> 00:28:52,049
all these different dialects

764
00:28:52,509 --> 00:28:53,329
going on.

765
00:28:54,190 --> 00:28:54,690
And

766
00:28:55,150 --> 00:28:58,429
with our black patients in particular, with our

767
00:28:58,429 --> 00:29:00,769
black patients who are African American English

768
00:29:01,150 --> 00:29:01,650
speakers,

769
00:29:01,974 --> 00:29:04,375
one thing that I often see is a

770
00:29:04,375 --> 00:29:06,315
dialectal mismatch between,

771
00:29:07,254 --> 00:29:09,674
the speech language pathologist and the patient themselves.

772
00:29:10,134 --> 00:29:12,054
And that puts our patients in a very

773
00:29:12,054 --> 00:29:14,474
vulnerable position to where they could be overdiagnosed

774
00:29:15,014 --> 00:29:16,589
with things like dysarthria,

775
00:29:17,289 --> 00:29:17,789
apraxia,

776
00:29:18,569 --> 00:29:19,549
or even

777
00:29:20,329 --> 00:29:22,190
I've had patients who have,

778
00:29:23,049 --> 00:29:24,029
pretty significant,

779
00:29:24,970 --> 00:29:25,929
not just, like,

780
00:29:26,490 --> 00:29:29,869
verbal apraxia, but also oral and physical apraxia.

781
00:29:30,169 --> 00:29:31,389
And I will see,

782
00:29:32,384 --> 00:29:35,125
bias with our, African American,

783
00:29:35,664 --> 00:29:36,164
patients

784
00:29:36,545 --> 00:29:39,184
with them, like, having an attitude or not

785
00:29:39,184 --> 00:29:41,105
wanting to cooperate when I'm like, okay. Let's

786
00:29:41,105 --> 00:29:42,625
let's take a step back and let's think

787
00:29:42,625 --> 00:29:44,565
about have you, like, fully assessed

788
00:29:45,380 --> 00:29:48,099
all areas of motor planning. Are do they

789
00:29:48,099 --> 00:29:50,500
have an attitude or are they physically not

790
00:29:50,500 --> 00:29:52,659
able to engage in this activity at the

791
00:29:52,659 --> 00:29:55,240
level that you're wanting them to engage in?

792
00:29:56,339 --> 00:29:57,000
And so

793
00:29:57,755 --> 00:29:59,054
this there's this concept

794
00:29:59,595 --> 00:30:01,054
of dialect density.

795
00:30:01,595 --> 00:30:02,095
And,

796
00:30:02,794 --> 00:30:03,694
dialect density

797
00:30:04,154 --> 00:30:06,075
when I went to Georgia State, I worked

798
00:30:06,075 --> 00:30:09,034
under doctor Julie Washington, and she's very well

799
00:30:09,034 --> 00:30:10,875
known in the speech world for her work

800
00:30:10,875 --> 00:30:11,855
that she's done

801
00:30:12,240 --> 00:30:15,039
on African American English in children and how

802
00:30:15,039 --> 00:30:17,539
that impacts African American children's

803
00:30:18,319 --> 00:30:18,819
ability

804
00:30:19,119 --> 00:30:19,700
to learn

805
00:30:20,160 --> 00:30:21,779
to read in mainstream

806
00:30:22,240 --> 00:30:24,019
American English. And so

807
00:30:24,414 --> 00:30:26,674
she has this concept of,

808
00:30:27,134 --> 00:30:30,194
dialogue density, which is how many features

809
00:30:30,654 --> 00:30:34,755
of African American English your speech has. So

810
00:30:35,134 --> 00:30:36,269
many of us,

811
00:30:36,910 --> 00:30:39,549
African Americans and other ethnic groups of black

812
00:30:39,549 --> 00:30:40,930
people in The United States

813
00:30:41,470 --> 00:30:44,910
use elements of African American English, but not

814
00:30:44,910 --> 00:30:47,309
all of us use the syntactic and the

815
00:30:47,309 --> 00:30:49,950
phonemic features of African American English. Some of

816
00:30:49,950 --> 00:30:51,875
us might use just expressions,

817
00:30:53,615 --> 00:30:56,575
or sayings, but might not actually use the

818
00:30:56,654 --> 00:30:58,355
some of the grammatical features.

819
00:30:59,055 --> 00:31:00,994
But then you have others, or

820
00:31:01,375 --> 00:31:03,390
you might be a person who does use

821
00:31:03,390 --> 00:31:05,390
a lot of grammatical features, but you code

822
00:31:05,390 --> 00:31:08,109
switch depending on what areas you're in. Then

823
00:31:08,109 --> 00:31:10,269
you have people who don't code switch, who

824
00:31:10,269 --> 00:31:12,210
always just use, like, highly,

825
00:31:14,109 --> 00:31:15,250
syntactic or grammatical,

826
00:31:16,029 --> 00:31:18,049
features of African American English.

827
00:31:18,505 --> 00:31:20,845
And if you're not familiar with that dialect

828
00:31:20,904 --> 00:31:22,744
and you get someone that comes in with

829
00:31:22,744 --> 00:31:25,644
a stroke and you're struggling to understand them,

830
00:31:26,025 --> 00:31:27,404
is it truly dysarthria,

831
00:31:27,784 --> 00:31:30,044
or is it that they're a dialect speaker?

832
00:31:31,519 --> 00:31:32,899
So that's one example.

833
00:31:33,839 --> 00:31:35,679
And then another thing that I'll see too

834
00:31:35,679 --> 00:31:37,859
with these patients is sometimes,

835
00:31:39,119 --> 00:31:40,899
because they are

836
00:31:41,200 --> 00:31:43,380
they have such high dialect density,

837
00:31:44,894 --> 00:31:47,695
there's a lot of bias there. And so

838
00:31:47,695 --> 00:31:49,855
instead of looking at all these fat these

839
00:31:49,855 --> 00:31:51,475
social determinants of health

840
00:31:51,855 --> 00:31:52,355
so,

841
00:31:52,815 --> 00:31:54,894
you know, you might have a an AAE

842
00:31:54,894 --> 00:31:57,134
speaker who has high dialect density, who comes

843
00:31:57,134 --> 00:31:58,755
from a redlined area,

844
00:31:59,299 --> 00:32:00,440
who maybe

845
00:32:00,740 --> 00:32:03,299
does not have good access to health care

846
00:32:03,299 --> 00:32:05,940
or who shops in those corner stores like

847
00:32:05,940 --> 00:32:08,019
what I mentioned earlier. And they come in

848
00:32:08,019 --> 00:32:10,759
and they have diabetes that's very poorly controlled,

849
00:32:10,900 --> 00:32:11,400
hypertension

850
00:32:11,779 --> 00:32:14,474
that's uncontrolled or poorly controlled, maybe they didn't

851
00:32:14,474 --> 00:32:16,234
know they have it, and now they've had

852
00:32:16,234 --> 00:32:16,894
a stroke.

853
00:32:17,194 --> 00:32:17,694
And

854
00:32:18,634 --> 00:32:20,095
these patients, because

855
00:32:20,875 --> 00:32:24,075
they're they speak with such high dialect density

856
00:32:24,075 --> 00:32:25,375
and are so different

857
00:32:25,740 --> 00:32:27,819
from the person who is evaluating them and

858
00:32:27,819 --> 00:32:29,920
have much different life experiences.

859
00:32:30,779 --> 00:32:33,039
These patients are at risk of being,

860
00:32:34,299 --> 00:32:37,180
die or not diagnosed, but labeled as quote

861
00:32:37,180 --> 00:32:38,079
unquote noncompliant

862
00:32:38,460 --> 00:32:38,954
or,

863
00:32:39,595 --> 00:32:40,095
that

864
00:32:40,634 --> 00:32:42,234
you know, there's I just don't see the

865
00:32:42,234 --> 00:32:43,534
same type of,

866
00:32:45,115 --> 00:32:48,075
effort being put into their care as I

867
00:32:48,075 --> 00:32:48,875
do speaker

868
00:32:49,434 --> 00:32:50,255
people who,

869
00:32:50,634 --> 00:32:52,839
one, are not black, our patients who are

870
00:32:52,839 --> 00:32:55,399
black, our patients who are not African American

871
00:32:55,399 --> 00:32:57,640
English speakers, and our patients who come from,

872
00:32:57,640 --> 00:33:00,200
you know, more wealth or better access or

873
00:33:00,200 --> 00:33:02,619
who have better high higher health literacy.

874
00:33:03,960 --> 00:33:05,659
Another issue that I see

875
00:33:06,295 --> 00:33:08,375
in Atlanta, and I'm so curious to know

876
00:33:08,375 --> 00:33:10,934
too with some of your listeners based on

877
00:33:10,934 --> 00:33:12,855
where they're at in The United States, what

878
00:33:12,855 --> 00:33:13,595
they see.

879
00:33:14,214 --> 00:33:15,494
We get a lot of,

880
00:33:15,974 --> 00:33:18,375
patients from The Caribbean. So I see a

881
00:33:18,375 --> 00:33:21,275
lot of, Jamaican patients, Haitian patients.

882
00:33:22,900 --> 00:33:25,720
We also get there's a large West African

883
00:33:25,859 --> 00:33:26,359
population

884
00:33:26,740 --> 00:33:29,299
in Atlanta, so we'll get a lot I'll

885
00:33:29,299 --> 00:33:31,000
have a lot of patient to,

886
00:33:31,700 --> 00:33:34,279
they speak English, but they speak a different

887
00:33:34,420 --> 00:33:34,920
dialect

888
00:33:35,299 --> 00:33:38,075
of English. And so whereas when I get

889
00:33:38,075 --> 00:33:41,674
a Spanish speaker, there's always the assumption that,

890
00:33:41,674 --> 00:33:43,695
okay. Like, we need to get an interpreter.

891
00:33:43,835 --> 00:33:45,595
We need to be you know, do we

892
00:33:45,595 --> 00:33:47,355
have a Spanish version of this test, or

893
00:33:47,355 --> 00:33:49,355
are we gonna do informal measures? We're gonna

894
00:33:49,355 --> 00:33:52,259
consider Spanish. I don't always see that same

895
00:33:52,320 --> 00:33:53,700
effort being put into,

896
00:33:54,400 --> 00:33:54,880
these,

897
00:33:55,920 --> 00:33:58,559
speakers of English who speak dialects from other

898
00:33:58,559 --> 00:33:59,779
countries. And so,

899
00:34:01,200 --> 00:34:03,519
again, you see the same risk factors. So

900
00:34:03,519 --> 00:34:05,619
they're very high risk of being,

901
00:34:06,674 --> 00:34:10,054
you know, incorrectly diagnosed with a neurogenic communication

902
00:34:10,275 --> 00:34:13,335
disorder, whether it's cognitive impairment or a dysarthria

903
00:34:13,635 --> 00:34:14,214
or anaphasia,

904
00:34:15,234 --> 00:34:16,534
due to cultural differences.

905
00:34:17,315 --> 00:34:19,769
And there's always that assumption too that just

906
00:34:19,769 --> 00:34:22,329
because we speak the same language that we

907
00:34:22,329 --> 00:34:25,210
have the same life experiences, and we tend

908
00:34:25,210 --> 00:34:27,610
to not look at culture in our dialect

909
00:34:27,610 --> 00:34:30,989
speakers. So I think that's also really important

910
00:34:32,755 --> 00:34:34,855
when we bring it back to that,

911
00:34:37,074 --> 00:34:38,994
when we are doing our assessments or when

912
00:34:38,994 --> 00:34:40,514
we're trying to get a gauge of what

913
00:34:40,514 --> 00:34:43,074
our patient's level of health literacy is, making

914
00:34:43,074 --> 00:34:45,269
sure that we're asking a lot of questions

915
00:34:45,489 --> 00:34:48,450
before we make assumptions. And so asking, you

916
00:34:48,450 --> 00:34:50,630
know, is this patient who

917
00:34:51,410 --> 00:34:53,730
you know, I'm doing this activity with this

918
00:34:53,730 --> 00:34:55,670
patient. They really don't seem to understand.

919
00:34:56,210 --> 00:34:58,784
Is it because of cognitive problems and because

920
00:34:58,784 --> 00:35:01,585
of reasoning issues, or is it because this

921
00:35:01,585 --> 00:35:04,224
activity that I'm doing with this patient is

922
00:35:04,224 --> 00:35:05,764
not culturally appropriate?

923
00:35:07,344 --> 00:35:09,844
And then, obviously, the same things are gonna

924
00:35:09,905 --> 00:35:12,570
apply to our Spanish speakers and to and

925
00:35:12,570 --> 00:35:14,809
let let me not say Spanish speakers because

926
00:35:14,809 --> 00:35:17,130
there's so many other languages spoken, but to

927
00:35:17,130 --> 00:35:18,910
our non English speakers.

928
00:35:19,530 --> 00:35:20,030
So

929
00:35:21,050 --> 00:35:23,390
and just and and I think too that

930
00:35:23,610 --> 00:35:25,470
the gaps in health literacy

931
00:35:26,285 --> 00:35:29,485
are often much wider with our patients who

932
00:35:29,485 --> 00:35:31,265
are from other countries because

933
00:35:31,724 --> 00:35:32,465
you have,

934
00:35:33,164 --> 00:35:35,724
depending on what country they're from, you could

935
00:35:35,724 --> 00:35:38,545
have a health care system that is completely

936
00:35:38,605 --> 00:35:38,909
different

937
00:35:52,445 --> 00:35:55,244
socioeconomic level. So, like, working class in The

938
00:35:55,244 --> 00:35:58,605
United States versus working class in whatever country

939
00:35:58,605 --> 00:35:59,824
they're from looks

940
00:36:00,125 --> 00:36:01,264
very, very different.

941
00:36:01,804 --> 00:36:02,304
So,

942
00:36:04,010 --> 00:36:06,889
and just, you know, familiarity with our health

943
00:36:06,889 --> 00:36:07,710
care system,

944
00:36:09,929 --> 00:36:12,969
understanding of the body, educational level. So it's

945
00:36:12,969 --> 00:36:15,449
really important that we're thinking about all these

946
00:36:15,449 --> 00:36:15,949
things,

947
00:36:16,385 --> 00:36:18,625
especially when we're gonna about to give a

948
00:36:18,625 --> 00:36:20,005
person a diagnosis,

949
00:36:21,025 --> 00:36:23,824
of a neurogenic communication disorder. We wanna make

950
00:36:23,824 --> 00:36:24,885
sure that we're not

951
00:36:25,264 --> 00:36:25,764
accidentally

952
00:36:26,224 --> 00:36:26,724
diagnosing

953
00:36:27,264 --> 00:36:28,244
low health literacy

954
00:36:28,545 --> 00:36:29,444
as a disorder.

955
00:36:30,500 --> 00:36:32,739
Yeah. Talk to me, Jackie. I I know

956
00:36:32,739 --> 00:36:35,539
you're you're always very well spoken in responses

957
00:36:35,539 --> 00:36:37,219
to questions like this, so I would love

958
00:36:37,219 --> 00:36:38,679
to have this on the air.

959
00:36:39,139 --> 00:36:41,460
What do we do in those situations? Like,

960
00:36:41,460 --> 00:36:43,859
what what you know, me, Theresa Richard, I'm

961
00:36:43,859 --> 00:36:44,599
going in

962
00:36:45,224 --> 00:36:47,385
working with somebody that has one of these

963
00:36:47,385 --> 00:36:48,765
West African dialects.

964
00:36:49,305 --> 00:36:50,365
Mhmm. What suggestions

965
00:36:50,905 --> 00:36:52,365
do you do in those situations?

966
00:36:53,465 --> 00:36:53,965
So,

967
00:36:55,144 --> 00:36:57,724
what I always start out with is,

968
00:36:59,619 --> 00:37:02,099
so I'll ask my patients, you know, tell

969
00:37:02,099 --> 00:37:04,440
me a little bit about where you're from,

970
00:37:05,780 --> 00:37:08,579
where you know, starting with figuring out do

971
00:37:08,579 --> 00:37:10,980
they live in The United States or were

972
00:37:10,980 --> 00:37:13,484
they visiting The United States? I've had patients

973
00:37:13,484 --> 00:37:15,804
who I had a lady one time who

974
00:37:15,804 --> 00:37:17,964
had a layover in Atlanta and had a

975
00:37:17,964 --> 00:37:21,085
massive stroke during her layover from a country

976
00:37:21,085 --> 00:37:23,105
in Africa. She was on her way to,

977
00:37:23,644 --> 00:37:26,364
another state to visit her daughter and had

978
00:37:26,364 --> 00:37:27,025
a massive

979
00:37:27,630 --> 00:37:30,109
stroke. And so just making sure was and

980
00:37:30,109 --> 00:37:32,510
and also see patients who are visiting family

981
00:37:32,510 --> 00:37:34,670
ended up having a stroke. So that's a

982
00:37:34,670 --> 00:37:35,889
lot different than

983
00:37:36,190 --> 00:37:39,150
someone who has lived in this country for

984
00:37:39,150 --> 00:37:39,650
years

985
00:37:40,029 --> 00:37:43,105
and speaks a different dialect of English. Right?

986
00:37:43,105 --> 00:37:45,025
So starting there, I know that sounds very

987
00:37:45,025 --> 00:37:46,864
basic, but it it can make a big

988
00:37:46,864 --> 00:37:47,364
difference.

989
00:37:48,545 --> 00:37:49,045
Or,

990
00:37:50,864 --> 00:37:53,424
also, you know, how how long have you

991
00:37:53,424 --> 00:37:54,989
lived in The United States?

992
00:37:55,389 --> 00:37:57,650
Tell me a little bit about how familiar

993
00:37:57,789 --> 00:38:00,110
are you with our health care system. Have

994
00:38:00,110 --> 00:38:01,969
you ever done rehab before?

995
00:38:03,710 --> 00:38:05,489
Tell me a little bit about,

996
00:38:06,590 --> 00:38:08,909
what is your what languages do you speak

997
00:38:08,909 --> 00:38:11,234
at home? Because often what I will see

998
00:38:11,234 --> 00:38:11,734
is,

999
00:38:13,315 --> 00:38:15,494
especially, like, with some of my West African

1000
00:38:15,554 --> 00:38:16,054
patients,

1001
00:38:17,795 --> 00:38:19,494
so there are, like,

1002
00:38:20,675 --> 00:38:23,094
Pidgin languages. So it's like a

1003
00:38:23,449 --> 00:38:24,349
mix of

1004
00:38:24,969 --> 00:38:26,989
native West African languages

1005
00:38:27,369 --> 00:38:28,269
and English.

1006
00:38:28,969 --> 00:38:31,230
So kind of similar to, like,

1007
00:38:32,009 --> 00:38:34,190
creoles, like, what are spoken in Jamaica.

1008
00:38:35,049 --> 00:38:37,505
But it's not it would not be intelligible

1009
00:38:37,804 --> 00:38:40,385
with a native English American

1010
00:38:40,844 --> 00:38:42,304
American English speaker.

1011
00:38:43,244 --> 00:38:45,804
So asking, you know, when you're with your

1012
00:38:45,804 --> 00:38:46,304
family,

1013
00:38:46,605 --> 00:38:48,525
what language do you use? Are there any

1014
00:38:48,525 --> 00:38:51,025
other languages that are spoken in the home?

1015
00:38:52,199 --> 00:38:54,940
And then also just when you're doing activities.

1016
00:38:55,400 --> 00:38:55,900
So

1017
00:38:56,360 --> 00:38:58,460
I'll ask my patients as well.

1018
00:38:58,760 --> 00:39:00,619
Let's say that we're doing

1019
00:39:01,000 --> 00:39:03,719
we've got a cog patient, and we are

1020
00:39:03,719 --> 00:39:05,494
working on calculations,

1021
00:39:07,474 --> 00:39:09,095
math, things like that.

1022
00:39:09,715 --> 00:39:11,875
So and I know this is not exactly

1023
00:39:11,875 --> 00:39:14,195
a direct answer to your question about dialect

1024
00:39:14,195 --> 00:39:16,755
speakers, but if you've got someone who might

1025
00:39:16,755 --> 00:39:18,914
speak more than one language. So I will

1026
00:39:18,914 --> 00:39:20,454
ask my patients. I'll say,

1027
00:39:21,210 --> 00:39:22,989
like, if you're in an area where

1028
00:39:23,289 --> 00:39:24,030
you know,

1029
00:39:24,489 --> 00:39:26,110
there's a large population

1030
00:39:26,730 --> 00:39:27,710
of whatever

1031
00:39:28,090 --> 00:39:30,650
cultural background your patient is from, I might

1032
00:39:30,650 --> 00:39:32,329
ask, like, tell me a little bit about,

1033
00:39:32,329 --> 00:39:34,030
like, when you go to the doctor,

1034
00:39:35,255 --> 00:39:36,235
does your doctor

1035
00:39:36,614 --> 00:39:38,855
speak your language, or do you have to

1036
00:39:38,855 --> 00:39:40,695
have an interpreter that comes with you, or

1037
00:39:40,695 --> 00:39:42,695
do you bring a family member that comes

1038
00:39:42,695 --> 00:39:44,295
with you? And when you go to the

1039
00:39:44,295 --> 00:39:46,375
doctor, are you just sitting there and your

1040
00:39:46,375 --> 00:39:48,454
family member is doing all the talking for

1041
00:39:48,454 --> 00:39:51,250
you because you don't feel comfortable speaking in,

1042
00:39:51,949 --> 00:39:54,989
in English? Or are you advocating for yourself?

1043
00:39:54,989 --> 00:39:57,230
Like, what, you know, what's the change there?

1044
00:39:57,230 --> 00:40:00,050
Or even with, grocery shopping. So,

1045
00:40:00,909 --> 00:40:03,150
I had a patient who was from an

1046
00:40:03,150 --> 00:40:06,210
Asian country that spoke multiple languages, and

1047
00:40:06,965 --> 00:40:08,744
he mostly shopped in

1048
00:40:09,125 --> 00:40:11,765
a grocery store that was from his that

1049
00:40:11,765 --> 00:40:13,864
was run by people from his community.

1050
00:40:14,244 --> 00:40:16,644
So when he would go grocery shopping, he

1051
00:40:16,644 --> 00:40:19,204
was only speaking in his language from his

1052
00:40:19,204 --> 00:40:19,704
country.

1053
00:40:20,099 --> 00:40:23,000
So we might want to target the skills

1054
00:40:23,059 --> 00:40:25,300
that we work on for grocery shopping in

1055
00:40:25,300 --> 00:40:27,700
his language if that's gonna be what's culturally

1056
00:40:27,700 --> 00:40:28,920
appropriate for him.

1057
00:40:29,700 --> 00:40:32,260
And then again, you know, when you have

1058
00:40:32,260 --> 00:40:33,079
that breakdown,

1059
00:40:33,764 --> 00:40:35,844
asking lots of questions. Tell tell me a

1060
00:40:35,844 --> 00:40:36,904
little bit more about

1061
00:40:37,364 --> 00:40:39,844
why you're thinking this or expand on what

1062
00:40:39,844 --> 00:40:41,304
you mean by this. Or,

1063
00:40:41,764 --> 00:40:44,025
tell me a little bit more about why

1064
00:40:44,085 --> 00:40:45,844
why do you why do you not understand

1065
00:40:45,844 --> 00:40:47,525
this? Like, I don't like to say it

1066
00:40:47,525 --> 00:40:48,090
that way.

1067
00:40:48,809 --> 00:40:50,829
I'm trying to think of a specific example.

1068
00:40:50,890 --> 00:40:51,630
So okay.

1069
00:40:52,250 --> 00:40:55,130
I had a patient from another country, and

1070
00:40:55,130 --> 00:40:57,769
you'll probably notice right now that I'm trying

1071
00:40:57,769 --> 00:41:00,570
not to say what country my patients are

1072
00:41:00,570 --> 00:41:02,875
from. Because one thing that I've noticed is

1073
00:41:02,875 --> 00:41:04,655
that when I'm educating people

1074
00:41:05,355 --> 00:41:06,174
about multiculturalism,

1075
00:41:07,194 --> 00:41:09,114
it's so easy to be like, okay. Well,

1076
00:41:09,114 --> 00:41:10,875
every time I get a patient from Mexico,

1077
00:41:10,875 --> 00:41:12,074
I need to do x, y, and z.

1078
00:41:12,074 --> 00:41:13,775
Every time I get a patient from Haiti,

1079
00:41:13,800 --> 00:41:15,160
I need to do x, y, and z.

1080
00:41:15,160 --> 00:41:17,160
But we're not actually using, like, the same

1081
00:41:17,160 --> 00:41:19,559
critical thinking skills that we use for when

1082
00:41:19,559 --> 00:41:23,179
we suspect that a patient has hypokinetic dysarthria

1083
00:41:23,320 --> 00:41:26,780
or suspect that a patient has pharyngeal anesthesia.

1084
00:41:26,840 --> 00:41:29,114
Like, we shouldn't just say, you know, with

1085
00:41:29,114 --> 00:41:30,875
this culture, we need to do this. With

1086
00:41:30,875 --> 00:41:32,414
this culture, we need to do that.

1087
00:41:32,795 --> 00:41:34,735
So, anyway, back to my story.

1088
00:41:35,434 --> 00:41:38,015
So I had a patient from another country,

1089
00:41:38,555 --> 00:41:41,515
and, we were doing a task where some

1090
00:41:41,515 --> 00:41:43,519
of those, like, cards so this is a

1091
00:41:43,519 --> 00:41:45,679
lower level cog patient, and I'm showing her

1092
00:41:45,679 --> 00:41:47,860
cards that have something odd.

1093
00:41:48,239 --> 00:41:49,840
And she has to tell me, like, what's

1094
00:41:49,840 --> 00:41:51,860
the problem in the picture. And,

1095
00:41:52,320 --> 00:41:54,400
it was a picture of a bathroom with

1096
00:41:54,400 --> 00:41:55,059
a tree

1097
00:41:55,844 --> 00:41:57,684
in the middle of the bathroom. And she

1098
00:41:57,684 --> 00:41:59,864
was like, there's nothing wrong with this picture.

1099
00:42:00,324 --> 00:42:01,925
And so I could have just been like,

1100
00:42:01,925 --> 00:42:04,885
okay. Well, this lady's problem solving skills are

1101
00:42:04,885 --> 00:42:06,244
not there. So I was like, okay. Tell

1102
00:42:06,244 --> 00:42:07,385
me more, like,

1103
00:42:08,405 --> 00:42:11,019
why, you know, with this picture tell me

1104
00:42:11,019 --> 00:42:13,500
more about I I see this tree in

1105
00:42:13,500 --> 00:42:14,160
the middle

1106
00:42:14,539 --> 00:42:17,019
of the bathroom and, like, at my house,

1107
00:42:17,019 --> 00:42:19,579
like, that's that's weird to me that there's

1108
00:42:19,579 --> 00:42:22,140
a tree in the bathroom. Like, would why

1109
00:42:22,140 --> 00:42:23,740
why is it is that not odd to

1110
00:42:23,740 --> 00:42:26,324
you? And then it's like, well, yeah, it's

1111
00:42:26,324 --> 00:42:28,485
not odd to me because in my country

1112
00:42:28,485 --> 00:42:29,704
that I grew up with,

1113
00:42:30,005 --> 00:42:32,344
bathrooms are typically in the backyard.

1114
00:42:32,644 --> 00:42:34,885
It's like an outdoor type of thing. So

1115
00:42:34,885 --> 00:42:35,704
this tree

1116
00:42:36,324 --> 00:42:38,005
is like what it was like in my

1117
00:42:38,005 --> 00:42:38,505
country.

1118
00:42:38,989 --> 00:42:41,630
So asking questions and leaning on the side

1119
00:42:41,630 --> 00:42:43,969
of, like, oh, maybe there is a cultural

1120
00:42:44,030 --> 00:42:47,809
breakdown that's happening here that's leading to why

1121
00:42:48,269 --> 00:42:49,730
this patient is not understanding

1122
00:42:50,030 --> 00:42:52,894
instead of just jumping to, like, oh, this

1123
00:42:52,894 --> 00:42:55,534
lady's cognition is not is not great, or,

1124
00:42:55,534 --> 00:42:58,195
oh, this patient does not want to participate,

1125
00:42:58,255 --> 00:43:00,414
or, oh, this patient has an attitude. Let's

1126
00:43:00,414 --> 00:43:02,655
see if we could figure out where the

1127
00:43:02,655 --> 00:43:03,795
breakdown is.

1128
00:43:04,640 --> 00:43:05,920
Awesome. I love that. Thank you. That's a

1129
00:43:05,920 --> 00:43:06,739
great example.

1130
00:43:07,199 --> 00:43:09,519
Jackie, thank you so much. This has just

1131
00:43:09,519 --> 00:43:11,940
been such a lovely, wonderful,

1132
00:43:12,719 --> 00:43:15,199
insightful conversation. I I like I said, every

1133
00:43:15,199 --> 00:43:16,719
time I talk to you, I learn something

1134
00:43:16,719 --> 00:43:18,239
more. Every time I read your post, I

1135
00:43:18,239 --> 00:43:20,000
learn something more, and and you just have

1136
00:43:20,000 --> 00:43:21,734
a way of breaking down the information in

1137
00:43:21,734 --> 00:43:22,554
such a easy

1138
00:43:23,174 --> 00:43:24,855
easy to understand way, but also a way

1139
00:43:24,855 --> 00:43:26,214
that's sort of like, duh, I should have

1140
00:43:26,214 --> 00:43:27,574
known that or I should have

1141
00:43:28,375 --> 00:43:31,255
like, okay. So, anyways, thank you for being

1142
00:43:31,255 --> 00:43:33,094
you. I I really, really appreciate all the

1143
00:43:33,094 --> 00:43:34,074
work that you do.

1144
00:43:34,460 --> 00:43:36,539
Oh, you're welcome. Thank you for the compliment.

1145
00:43:36,539 --> 00:43:38,299
Any any final thoughts? I realized I just

1146
00:43:38,299 --> 00:43:40,139
closed this down. Any any final thoughts on

1147
00:43:40,139 --> 00:43:40,880
your end?

1148
00:43:41,179 --> 00:43:43,339
No. It's okay. So one other thing that

1149
00:43:43,339 --> 00:43:45,199
I wanted to mention earlier,

1150
00:43:45,900 --> 00:43:48,139
and it's something that I've been trying to

1151
00:43:48,139 --> 00:43:51,425
bring awareness to in my presentations is,

1152
00:43:52,365 --> 00:43:54,385
so there is a research study.

1153
00:43:54,845 --> 00:43:56,204
I'll make sure that you have it so

1154
00:43:56,204 --> 00:43:57,744
we could put it in the show notes.

1155
00:43:58,204 --> 00:43:58,704
And,

1156
00:43:59,405 --> 00:44:01,505
it looks at the athena

1157
00:44:01,885 --> 00:44:03,170
health care documentation

1158
00:44:03,869 --> 00:44:05,409
system, so, like, their EMR.

1159
00:44:06,429 --> 00:44:08,449
And it assessed how long

1160
00:44:09,069 --> 00:44:09,569
doctors

1161
00:44:10,109 --> 00:44:13,650
are spending time with their patients. And so,

1162
00:44:14,510 --> 00:44:17,114
this health care this EMR, the way that

1163
00:44:17,114 --> 00:44:19,114
it works is it was looking at primary

1164
00:44:19,114 --> 00:44:21,515
care visits too. So the the doctor walks

1165
00:44:21,515 --> 00:44:22,015
in.

1166
00:44:22,474 --> 00:44:23,135
The doctor

1167
00:44:23,434 --> 00:44:26,175
starts his time. The doctor does his assessment,

1168
00:44:27,130 --> 00:44:29,769
counsels the patient, and then from there, the

1169
00:44:29,769 --> 00:44:30,269
doctor,

1170
00:44:32,570 --> 00:44:35,230
orders prescriptions and then closes out the time.

1171
00:44:35,369 --> 00:44:37,550
And so they have found that the average

1172
00:44:37,609 --> 00:44:39,369
time for all of this to happen for

1173
00:44:39,369 --> 00:44:41,869
doctors was eighteen point nine minutes.

1174
00:44:42,755 --> 00:44:46,055
So when we think about our patients, especially

1175
00:44:46,195 --> 00:44:49,315
our neuro patients, that it's so rare that

1176
00:44:49,315 --> 00:44:50,914
you get a patient who's had a stroke

1177
00:44:50,914 --> 00:44:53,574
that doesn't have, like, a million underlying diagnoses.

1178
00:44:55,409 --> 00:44:57,489
And we're thinking about if you've got a

1179
00:44:57,489 --> 00:44:59,670
patient who's got kidney disease,

1180
00:45:00,049 --> 00:45:01,750
high blood pressure, diabetes,

1181
00:45:02,210 --> 00:45:05,269
eighteen point nine minutes is not enough time

1182
00:45:05,730 --> 00:45:06,230
to

1183
00:45:07,250 --> 00:45:07,750
incorporate

1184
00:45:08,784 --> 00:45:11,585
education for all of these different factors. And

1185
00:45:11,585 --> 00:45:12,085
so

1186
00:45:12,385 --> 00:45:14,304
one thing that I have really started doing

1187
00:45:14,304 --> 00:45:16,324
with my therapy is shifting,

1188
00:45:17,344 --> 00:45:19,525
the things that I work on and incorporating,

1189
00:45:20,704 --> 00:45:21,445
health literacy.

1190
00:45:21,744 --> 00:45:22,864
And so I

1191
00:45:23,530 --> 00:45:26,010
the American Health Association I mean, I'm sorry.

1192
00:45:26,010 --> 00:45:27,309
The American Heart Association

1193
00:45:27,610 --> 00:45:29,789
has some amazing resources.

1194
00:45:30,250 --> 00:45:30,970
They have a,

1195
00:45:31,530 --> 00:45:33,690
handout called Let's Talk About High Blood Pressure

1196
00:45:33,690 --> 00:45:34,349
and Stroke.

1197
00:45:34,730 --> 00:45:36,890
I always read that with my patients, and

1198
00:45:36,890 --> 00:45:39,309
I teach them how to sequence the steps

1199
00:45:39,744 --> 00:45:41,045
to taking their blood pressure.

1200
00:45:41,505 --> 00:45:42,005
So,

1201
00:45:42,945 --> 00:45:45,664
think I want I hope that listeners think

1202
00:45:45,664 --> 00:45:47,445
about high about health literacy

1203
00:45:47,905 --> 00:45:50,965
and ways that they can incorporate that into

1204
00:45:51,184 --> 00:45:52,565
their therapy. So

1205
00:45:52,864 --> 00:45:54,164
we could either do,

1206
00:45:55,019 --> 00:45:56,880
you know, things like walkbooks

1207
00:45:57,500 --> 00:45:59,360
or things like games,

1208
00:45:59,900 --> 00:46:01,440
or we could actually

1209
00:46:01,739 --> 00:46:02,239
incorporate

1210
00:46:03,019 --> 00:46:05,820
ways to help a person learn more about

1211
00:46:05,820 --> 00:46:08,445
their body. And I think that with

1212
00:46:09,065 --> 00:46:10,905
cognition and of, you know, and,

1213
00:46:12,264 --> 00:46:14,364
communication disorders, aphasia, dysarthria,

1214
00:46:14,824 --> 00:46:17,005
it's so you can literally target

1215
00:46:17,545 --> 00:46:18,045
anything.

1216
00:46:18,344 --> 00:46:19,085
And so,

1217
00:46:19,864 --> 00:46:22,460
think about ways that you can help your

1218
00:46:22,460 --> 00:46:25,980
patients better advocate for their needs in your

1219
00:46:25,980 --> 00:46:28,460
therapy instead of just doing the run of

1220
00:46:28,460 --> 00:46:29,039
the mill

1221
00:46:29,579 --> 00:46:31,659
drilling and things that we work on. So

1222
00:46:31,900 --> 00:46:33,599
It's, like, so meta. Like,

1223
00:46:34,315 --> 00:46:36,974
yeah. Mind blowing. Yeah. Yeah. Awesome.

1224
00:46:37,275 --> 00:46:39,515
Anyways, thank you. Thank you. Thank you again,

1225
00:46:39,515 --> 00:46:42,074
Jackie. Super appreciate this conversation. And, yeah, we'll

1226
00:46:42,074 --> 00:46:43,675
make sure that Thanks for having me. Some

1227
00:46:43,675 --> 00:46:45,195
really great show notes because I think you

1228
00:46:45,195 --> 00:46:46,335
just gave some really

1229
00:46:46,800 --> 00:46:49,760
tactical, practical things that SLPs can do today.

1230
00:46:49,760 --> 00:46:51,680
Because I think when you think about how

1231
00:46:51,680 --> 00:46:54,160
do I explain health literacy, it sounds like

1232
00:46:54,160 --> 00:46:56,000
a mountain that no one even knows where

1233
00:46:56,000 --> 00:46:58,239
to start. So thank you for showing some

1234
00:46:58,239 --> 00:46:59,860
practical tips to that.

1235
00:47:00,525 --> 00:47:01,025
Sure.

1236
00:47:01,484 --> 00:47:03,664
Thanks for having me. Yeah. Of course.

1237
00:47:04,364 --> 00:47:06,924
And that's a wrap for this episode. As

1238
00:47:06,924 --> 00:47:09,405
always, thank you so much for listening. And

1239
00:47:09,405 --> 00:47:10,844
if you'd like to download the show notes

1240
00:47:10,844 --> 00:47:14,784
from this episode, please visit swallowyourpridepodcast.com.

1241
00:47:15,030 --> 00:47:16,550
There, you can also sign up for our

1242
00:47:16,550 --> 00:47:18,469
email list so that you'll never miss another

1243
00:47:18,469 --> 00:47:18,969
episode.

1244
00:47:19,510 --> 00:47:21,190
If you do like what you hear, then

1245
00:47:21,190 --> 00:47:23,849
please subscribe and leave a review on iTunes

1246
00:47:24,390 --> 00:47:26,070
or share it on social media with your

1247
00:47:26,070 --> 00:47:28,309
friends and colleagues, because that is what keeps

1248
00:47:28,309 --> 00:47:29,690
these episodes coming.

1249
00:47:30,174 --> 00:47:32,014
If you'd like to be a guest, share

1250
00:47:32,014 --> 00:47:34,574
feedback or request a topic to be discussed

1251
00:47:34,574 --> 00:47:39,054
on the show, please email podcast@TeresaRichard.com.

1252
00:47:39,054 --> 00:47:41,135
Thank you so much for listening and we'll

1253
00:47:41,135 --> 00:47:42,355
catch you next week.