Dr. Beena Nagappala (00:00):
I think that we have to take care of each other in terms of being healthy so we can serve our community.
From Spaugh Dameron Tenny, it's the Prosperous Doc podcast. Real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Tenny.
Shane Tenny (00:24):
There is nothing like a global pandemic to open our eyes to aspects of life that previously were underappreciated. And as I've thought about some of the lessons that I've learned from COVID, there's definitely a new understanding of what supply chain means. There's a greater appreciation for the teachers and the schools that care for our kids all day, and there is definitely a greater awareness of the disparity of healthcare and health information in our country. And that's what I want to talk about today... community health.
Shane Tenny (01:02):
My guest, Dr. Beena Nagappala, began her medical education in India, completed her residency in the US, in board-certified in family medicine, has a master's degree in public health, health management, health policy and currently she's also the medical director of Community Health in Detroit, Michigan, where there's over 22 school-based community health sites around the Detroit metro area, all of which serve the community and are part of Dr. Nagappala's vision for helping the folks around her.
Shane Tenny (01:37):
Dr. Nagappala, welcome. Thanks so much for being with us today.
Dr. Beena Nagappala (01:40):
Thank you. It's great to be here.
Shane Tenny (01:42):
Well, let's start the conversation maybe just with defining some terms a little bit. Can you level set for us? What is community health? What type of work does it encompass?
Dr. Beena Nagappala (01:56):
I work for a not-for-profit organization and community health is what they also provide for our local community, which includes our parish nursing and we have school-based clinics. We run health fairs for the community. So we check blood pressure, blood sugar, and provide free immunizations for the community. So we try to serve the community that we have our hospitals at and around.
Shane Tenny (02:25):
And when we talk about community healthcare and the whole public policy around that, we're really identifying the fact that there are segments of our country and our communities that receive unequal medical care or medical attention or medical information either by virtue of their geography or their socioeconomic situation or things like that. Is that a fair understanding?
Dr. Beena Nagappala (02:52):
Yes, I agree. Some of these clinics, the school-based clinics, are where the people we serve belong to some of these communities where there is lack of care, lack of access to care, I would say, in terms of transportation, doctors in the communities. They have to travel around outside of where they live to access these types of services. So yes, there is a distinct level of care that they lack.
Shane Tenny (03:21):
Now, you're board certified and practice in family medicine. I guess maybe I'll call that your day job is seeing patients and families and things like that. Where in your professional development, did you begin to sense in yourself an interest or an appetite in public healthcare and that sort of thing?
Dr. Beena Nagappala (03:44):
I think that during my [MPH 00:03:45], I realized the racial disparity in healthcare that's out there, and especially coming from Detroit area, I see that during my rotations and such. I've seen that during my rotations. I always feel the need to provide care for the indigent. So when this opportunity opened up where I could be the medical director for Community Health and to serve the local community, I took upon it myself to apply for it and I eventually got the job, yes.
Shane Tenny (04:19):
So you juggle this role in addition to your day job patients?
Dr. Beena Nagappala (04:24):
Yes. [crosstalk 00:04:26]. I'm a part-time family medicine doctor. I work in a group practice, so there are seven of us. There are six physicians, one nurse practitioner. I have great colleagues. They are wonderful. In terms of group practice, when I'm not there, there's someone always there to take care of my patients if needed. So in that way, they were very supportive of my other roles that I'm involved in. My group is extremely supportive for what I do. So I don't feel the need that I have to be in one place. So this allows me to do what I want to do for the community too.
Shane Tenny (05:04):
Your role as medical director of Community Health, what does that look like day to day? Are you part-
Dr. Beena Nagappala (05:09):
So I [crosstalk 00:05:10]-
Shane Tenny (05:10):
Are you dealing with the schools? What's the scope of things?
Dr. Beena Nagappala (05:13):
So we have a lead of Community Health, Ken Coleman. He's great. All our mission and vision is to serve the kids of Detroit area or Michigan, I would say, because we do have clinics out in Kalamazoo and in Flint area. So it's not just the Detroit area. We do have a couple other clinics. Actually, we have 27 clinics now. We've expanded.
Dr. Beena Nagappala (05:38):
Ken Coleman is our lead, and we also have someone who is in charge of operations, but I am the medical director. I supervise the nurse practitioners. I help with policymaking for these clinics. If there's any clinical need that they need to run things by me in terms of a case, or if there is a tough case, or if they want to run anything by me, they call me, then we talk. So it's not set times as such. They can call me anytime, but I do make policies or at least develop some policies for the clinics.
Shane Tenny (06:13):
So a lot of the way that Community Health manifests in your area, it sounds like you've got clinics that are held throughout the community and throughout the year, but a large part of the mission is really being fulfilled through the school system.
Dr. Beena Nagappala (06:26):
Shane Tenny (06:26):
Is that right?
Dr. Beena Nagappala (06:27):
Shane Tenny (06:28):
And has that been in place for a long time or is that a program that-
Dr. Beena Nagappala (06:31):
No, it's been there for, yeah, more than 20 years.
Shane Tenny (06:34):
Mm-hmm (affirmative), mm-hmm (affirmative).
Dr. Beena Nagappala (06:35):
But slowly we've expanded in terms of grants provided by the state, the state funding, things like that. So we've expanded more. Our behavioral health, we've expanded that tremendously in the last few years. But also, of course, clinical care has expanded.
Shane Tenny (06:55):
Are the clinics in high schools or elementary or is there-
Dr. Beena Nagappala (07:00):
Mostly high schools, but we do have a few middle schools and elementary schools. The clinics are run by a nurse practitioner or a nurse, and then we have a behavioral health specialist and a medical assistant to have. So that's a model that we've developed, and most clinics run it through that model. Some clinics only have behavioral health. It depends on the funding provided. Or some clinics only have a nurse there. So again, it depends on the funding provided to that school or the need of the school, too, is also taken into consideration.
Shane Tenny (07:31):
So there's not only just a nurse or even a mid-level nurse practitioner. It sounds like you also have behavioral health specialists, which, of course, has really come into light over the last couple years with the pandemic and the different emotional issues that many of us have felt, I think, being sequestered and social distancing and the stress of COVID and things like that. It sounds like there's really a pretty good spectrum of care that's available to these children.
Dr. Beena Nagappala (07:56):
Yes. Yes, certainly behavioral health has been in the forefront right now to provide for these kids. Mental health is so important to all of us. So I feel like we provide good care for these children.
Shane Tenny (08:09):
This program, you said it's been around almost two decades, I guess, or about that long, which it sounds like it's pretty tremendous and successful. Is there a lot of appetite to have clinics set up in schools or do you face [inaudible 00:08:25] rolling them out or just a budgetary one?
Dr. Beena Nagappala (08:28):
I think the schools have to qualify to be eligible for these clinics. So they have to have a certain percentage of lower socioeconomic students and things like that in the school to be eligible for funding. And again, they are very popular in terms of providing care. So we have increased our numbers and we've expanded. Because I belong to the Ascension Health System, we've expanded to Kalamazoo, Flint area. So yes, we have and there is a possibility that we might be expanding to other places in Michigan.
Shane Tenny (09:02):
In terms of the care that's provided to the children, can you talk a little bit about just the logistics? I mean, since we have medical providers that listen to this podcast, what's the logistics of the approval since the parents aren't there? Do you have an EMR system? How are records related to either primary care or hospital, that sort of thing?
Dr. Beena Nagappala (09:22):
Yes, of course. So at the beginning of the school year, a packet is sent to all parents, to all the kids, with consents for our clinics. So the parents who want to use our clinics as a primary care source, I would say during the school year at least, sign the consent and send it with the child. The child is then seen in our clinic depending on the care they need. Nurse practitioners pull up immunization records. If there's a need for the child to get immunization record, they send for the child to come in and get it. So the child doesn't have to go elsewhere to get the immunizations or any other care. If they have a sore throat, they come down, be evaluated, a strep is run. If it's just a viral infection that doesn't need much care, they're sent back to the class. Or if there is something that needs the parents to be called, parents are called.
Dr. Beena Nagappala (10:15):
So things like that. Immunizations such as tetanus and measles, mumps, rubella and flu vaccines, especially during the season that we are in right now for, we run flu clinics for the kids to come and get their vaccines.
Shane Tenny (10:30):
Is the program affiliated with Ascension Health or another medical organization or you maintain your own records and protocols internally and-
Dr. Beena Nagappala (10:39):
So we do. We have an EMR. We are part of the health system. We are all employed by the health system. So we have the health system's EMR records, which we can easily access. So if the nurse practitioner... It goes from one clinic to another clinic for the need. If there's need, she goes to another clinic. She can access that through the internet.
Shane Tenny (11:02):
Through COVID, we've seen all kinds of misinformation spread across the country, not just in school systems and not just in communities. It's difficult. Have you been able to successful provide information to parents or to students about the pandemic or how to treat it or how to diagnose or be tested or those sorts of things?
Dr. Beena Nagappala (11:28):
Yes. So when the shutdown happened, the schools closed and for the most of last year, the schools went into virtual care, but our nurse practice were available by Telehealth to help these parents if they had any questions about COVID or anything for that matter, if they had questions about symptoms of COVID. And when the vaccinations came across, we were there to help the parents navigate through all the information that was out there about the vaccines or the side effects about the vaccines.
Dr. Beena Nagappala (12:00):
Our nurse practitioners are very well educated in terms of information regarding COVID and what to provide for these parents. And even the vaccine clinics we have, the parents are more than welcome to come and ask questions. We've had parents ask us a lot of questions, especially about the vaccines and, of course, symptoms of COVID. We have information where to go get tested, and we are trying to provide testing in the clinic itself. So we actually have bought some machines so that we can run the testing in the clinics.
Shane Tenny (12:31):
Are you or will you be able to provide COVID vaccinations for students-
Dr. Beena Nagappala (12:36):
Shane Tenny (12:36):
... that consent?
Dr. Beena Nagappala (12:37):
Yeah. So far, we've had COVID vaccine clinics where the first and the second shot are given out, but we plan on providing the vaccines in the clinic and hopefully in the next couple weeks.
Shane Tenny (12:49):
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Shane Tenny (13:54):
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Shane Tenny (14:11):
You've been in this role for, I think, almost a decade you said?
Dr. Beena Nagappala (14:16):
Yes. Almost 10 years, yes.
Shane Tenny (14:17):
How do you measure the effectiveness of a program like this on the community at large?
Dr. Beena Nagappala (14:24):
So again, the state has its own mandates that we need to follow in terms of how many patients to see. They have certain criteria that we need to meet to qualify for funding. They want us to, of course, increase the outreach out there in terms of how many patients we touch and how many patients are seen, how many physicals. We run [SDI 00:14:45] clinics at these high schools. So there are certain metrics that we have to meet to be eligible as a school-based clinic.
Dr. Beena Nagappala (14:54):
In terms of us, we also have certain metrics that we have to meet. We have chart audits and our own quality metrics that we try to implement that we can succeed in.
Shane Tenny (15:08):
Is there a story that's stands out to you or a patient that stands out in your mind that just left you with the impression, this is why we're doing this?
Dr. Beena Nagappala (15:17):
Every day. Every day I feel like we serve the community at large, whether it be a sore throat we take care of, or if there is a sexually transmitted disease that we take care of, or if there's a child who's pregnant that we are take care or we're providing care for them. At sports physicals, we find things that have been missed, a murmur or here or there. So, yes, of course. And more than anything that we've realized in the last one year is that these children have had no immunizations, no vaccines because of lack of care or because they couldn't access care. Not lack of care, access to care because the pandemic. So I think that providing immunizations to keep them healthy and they don't get sick is a big part of our culture.
Shane Tenny (16:04):
Yeah. I'm struck by just the structure, I guess, around it and your comment that for folks that have haven't lived through the struggle of access to healthcare, the beauty of a program like yours is you're not just providing capable care, but because it's integrated with the school system, the students have the access to it by virtue of the busing system or transportation or things like that. They can get there-
Dr. Beena Nagappala (16:31):
Shane Tenny (16:31):
... and be there and then see and get help for what [crosstalk 00:16:35].
Dr. Beena Nagappala (16:35):
Right. And some of our clinics, especially our high school clinics, have an outside door. There are some nurse practitioners who can see up to 26 years of age, whether if they are some kids from another school who need to come in can come in through those doors and be seen in the clinics.
Shane Tenny (16:52):
Speaking of parents, what is the response or the communication protocol back to a child's parents?
Dr. Beena Nagappala (17:00):
There is an encounter that's printed out and given to the child. If the parent wants more information, well, there's always the nurse practitioners who are available to answer their questions through the school day. So again, the communication, it depends on how much they want, what they want. There's always communication with the parent.
Shane Tenny (17:20):
You serve on the Academy of Family Practice Physicians there in Michigan. What do you see as the future of community health? Where are the winds blowing in this area now as we [crosstalk 00:17:37]?
Dr. Beena Nagappala (17:38):
I think more public health. I think that I in the last one year has realized how important public health is to our communities. I think that we have to take care of each other in terms of being healthy so we can serve our community or taking care of us so that my neighbor can be healthy. You know?
Dr. Beena Nagappala (17:58):
So I think that's the biggest role that I've seen in the last one year is that it is caring for your next door neighbor or your friend, your relative, whoever it is. Public health, it encompasses all of that. You know? I think that is going to be a big change in how we see things in the near future, especially regarding infectious diseases. And also all the policies that are going to be made will focus on public health in the near future. I think that's what we realize.
Shane Tenny (18:30):
Say a little bit more about that. When you talk about policies that are going to be mindful of or focused on public health, what comes to mind? What do you see?
Dr. Beena Nagappala (18:38):
It can be anything. It can be your e-cigarettes, the vaping that's happening. There are bills in the house or the senate that go by regarding that. They can be in terms of vaccines, in terms of scope of practice. There are so many things that come about that our academy is involved with.
Shane Tenny (19:01):
There are folks that listen to our podcast that have chosen or committed to the field of medicine and are still in training, maybe in medical school, maybe in rotations of residency and thinking about what specialty they want to choose, what field of medicine. You have chosen or are passionate about family medicine. Say a little bit about this field to somebody who might be listening and thinking, hmm, I wonder if I should do family medicine or cardiology or whatever?
Dr. Beena Nagappala (19:33):
I say go where your passion is. But I love what I do. I've been a family medicine doctor for over almost 20 years now, and I truly love what I do. I see kids. I see their parents. I see their grandparents. I love the variety. I do a lot of procedures in the office. I feel that this gives me satisfaction in knowing the whole family. And I know the family history, so I can focus on that. When a child comes in, okay, I know the parent's history. I know that family dynamic that happens in that household, which plays a role in the child or the adult's mental health well-being. So I feel that I can make a difference in their lives, however small I can make. But I truly enjoy what I do.
Dr. Beena Nagappala (20:20):
I know there's a lot of administrative burdens that we have as doctors with all our paperwork, our charting, which is never ending. But I think it's the small day-to-day interactions which I have with my patients, and these minor chains can make a big difference in their lives, whatever it might be. So it could be just listening to them talk about their anxiety regarding whatever may be going on in their lives, or it could be taking care of their diabetes, hypertension, removing a lesion that has been bothering with them. You know? So it can be anything that's going on that makes a big impact.
Shane Tenny (21:00):
Excellent. Well, Dr. Nagappala, thanks for what you are doing not only for your patients, but for the community all around you and the difference you're making in their lives.
Dr. Beena Nagappala (21:08):
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