Let's Talk

Cultural Understanding Emanating Outward

About Episode 12

Let’s Navigate...

On this week’s episode, we examine an angle on the concept of well beyond medicine: cultural understanding. In this case, how it begins within the walls of Nemours Children’s Health from our associates and emanates out to others — patients, families, and, ultimately, into the community through our Associate Resource Groups (ARGS).

Representatives from two Nemours Children’s ARGS, DESian (South Asia) and the Health Care Alliance of Asian and Pacific Islanders (HAAPI), join us as we honor Asian American Native Hawaiian and Pacific Islander month.

Carol Vassar, producer

Rituparna Deb, MBBS, MD, FAAP
Sheeja K. Abraham, MD
Benjamin Duong, PharmD
Laura Kam

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Episode Transcript

[00:00:00] Carol Vassar, podcast host/producer: (MUSIC) Welcome to Well Beyond Medicine, the Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go. (MUSIC) Let’s go, oh, oh…well beyond medicine! (MUSIC ENDS). 

[00:00:21] Benjamin Duong, PharmD, Nemours Children’s Health: When you learn something from people or from a culture, you accept it as a gift, and it is your lifelong commitment to preserve it and build on. 

[00:00:33] Carol Vassar, podcast host/producer: The voice of Nemore’s associate Dr. Benjamin Duong, and the words and music of the great cellist Yo-Yo Ma, as we examine today, one angle of the concept of well beyond medicine: cultural understanding, in this case, beginning from within the walls of Nemours with our associates and emanating outward to each other, to patients and families, and ultimately into the community. And our Associate [00:01:00] Resource Groups, ARGs, provide the conduits for that. The ARGs, briefly, are associate-led groups of like-minded individuals who meet to provide support, affiliation, and drive change in their respective areas.

[00:01:15] DESian, for example, brings together associates who identify their ethnicity as from India, Pakistan, Nepal, Bhutan, Sri Lanka, Maldives, and other countries in South Asia. The Healthcare Alliance of Asian Pacific Islanders, HAAPI, provides support and an inclusive environment for Asian and Pacific Islander associates from the Asian continent and the Pacific Islands, including Hawaii and American Samoa.

[00:01:43] Both ARGs are represented on the podcast today as we celebrate Asian-American Native Hawaiian and Pacific Islander Month. From DESian, we have Dr. Rituparna Deb, and Dr. Sheeja Abraham, and from HAAPI, Dr. Benjamin Duong and Laura Kam. We [00:02:00] begin our conversation by checking in with our guests on their passion, both professionally and personally for the work of their respective ARGs. Dr. Seeja Abraham gets us started. 

[00:02:11] (MUSIC STING) 

[00:02:13] Sheeja Abraham, MD, Nemours Children’s Health: For me personally, you know, I’ve lived in the United States for over 50 years. I came when I was a child. I grew up in Brooklyn and part of my identity is being a New Yorker. You know, I’ve lived in Pennsylvania for almost 30 years, but I still consider myself a displaced New Yorker.

[00:02:31] But being South Asian is also a part of who I am. And you know, there are certain immigrant populations who can blend in very easily. I think as Asians, we could be here 10 generations. We’re still gonna look different. So it’s how patients and colleagues see me before I’ve even said hello to them. So, you know, I embrace that I embrace my culture and I really like the comradery of others like me, you know, who have had similar [00:03:00] experiences.

[00:03:00] Professionally, I feel that many patients of any minority population feel kind of lost in the American healthcare system. They don’t really understand how to navigate that, and I think that is especially true of South Asian populations cuz they tend to be a little bit more reticent. They’re not out there and loud, you know; they tend to be more reserved, especially in the face of authority. So I hope that we can be a voice for them and help them to navigate this system that is so complex. 

[00:03:36] Carol Vassar, podcast host/producer: Rituparna, how about you? 

[00:03:38] Rituparna Deb, MD, Nemours Children’s Health: I’m a pediatric healthcare provider, you know, so unless you address a whole person with their background, you don’t know their culture, their religious and socioeconomic, or social norms of a patient that cannot be treated as whole, and being a pediatric provider, you are dealing with the whole family. You cannot just advise something and that will be [00:04:00] followed if you don’t know what their religious beliefs and practices are and social differences and families perceive healthcare workers completely differently, and they may not disagree with their provider or express themselves because they do not want to offend someone they respect. Or sometimes, they will not bring up or they will not talk about things which the thing the other person is not going to understand. And uh, that’s why I think we need to be together as this, uh, group, which specifically has a lot of things with the health which they cannot advocate for themselves well, we can become their advocate. And again, uh, If we think ourselves as Nemours associates, we can probably help each other in like professional development and like provide mentoring to future generations coming for either, you think, medical students, nursing students, or now the business analytics part of it in any of them [00:05:00] in the field of medicine.

[00:05:02] And we cannot talk about culture and just talk about work. And sometimes lot of things are not getting recognized and people are just talking work that. Is not, uh, making 

[00:05:13] a healthy environment. 

[00:05:14] Carol Vassar, podcast host/producer: Laura, I wanna ask you the same question. Why is it important to you personally, professionally, to be part of the ARG that you are part of?

[00:05:23] Laura Kam, Nemours Children’s Health: I think along the same veins as everybody’s mentioned, you know, the belongingness is important. I think, you know, exclusion, if that’s even a word, is it’s so systemic and ingrained inside of us that we don’t even realize we do it in just minor acts of, you know, not realizing that it’s a cultural holiday that’s important that, you know, somebody’s fasting and we book a lunch meeting, you know, and, I think having these ARGs and being a part of a group that we can have these open and honest conversations, you know, with each other and share our experiences, really does foster that sense of belonging. One of the things that I love in our [00:06:00] HAAPI ARG is that we do what called Tea Time, and it’s kind of an open forum where we usually bring a topic and we can talk about. You know, one of the, the ones I love most is like, how do we react to the question of “Where are you from?” You know, and I think anybody who doesn’t look Caucasian gets that question at some point. You know? And, and then how we all react to that is different or similar. And to be able to find that common ground with somebody else within Nemours really nice. I’m not a practitioner, I’m not, I don’t work in the health, the clinical side of things. So to be able to talk about just some of the things that we all experience that maybe someone else didn’t think about that is on the clinician side can say, “Oh, I should take that back to the practice and be able to understand that if somebody walks in with this, this is how this person that’s in our ARG reacted to it. Maybe I should be mindful of it as well, when dealing with patients or the family.”

[00:06:51] Carol Vassar, podcast host/producer: Speaking of patients and families, these ARGs are not only important to the people who are members of them, they’re really important [00:07:00] and have some benefit for our patients and families. Let’s talk a little bit about that, especially with the clinicians on the line. So Seeja, I’m gonna go to you first. For that. How does the work that you’re doing, the community you’re building in your ARG, impact the patients and families you serve? 

[00:07:18] Sheeja Abraham, MD, Nemours Children’s Health: So one of the main focus of our ARG is to really reach out to the community in general in terms of educating them about some important healthcare issues that are often in our culture, sort of, shoved under the rug. You know, there’s a definite stigma to discussing. Issues or airing things like mental health, developmental issues, sexual and women’s health issues. These are all things that are sort of taboo topics. You just don’t talk about it. You don’t let everyone in your community know that your child may be experiencing a mental health issue.

[00:07:59] So [00:08:00] a big focus that we have is to really do more community outreach perhaps in some of the, you know, we’re looking at some of the religious institutions like mosques and temples. It’s a good place to, uh, kind of be at the grassroots. And then also looking at like community centers and festivals to be more of an educational piece. We just did an autism walk with a South Asia group, both in Philly and in Delaware. And we have just gotten funding for a community project to, uh, improve the awareness of autism within the South Asia community. So, you know, we have, uh, a lot of these interests because what we wanna do is we wanna bring these kinds of conditions out of the woodwork and really put them front and center so that if not the first generation, then the second generation, the, the kids whom we’re taking care of would feel [00:09:00] like it’s something they can talk about, not just in their families, but at their visits or to their healthcare provider, or even to a teacher or someone else that they respect. 

[00:09:10] Rituparna Deb, MD, Nemours Children’s Health: And we have to start with baby steps, you know? So then only we can think about bigger steps in the future. All of us have had experience while being in training here and all multiple times when another provider or other healthcare providers of the group are well cognizant about the need of a family in one room. Either that family is Caucasian family, or we are making a Jewish family. We have need of that. But the second. The second moment when I brought up that, okay, this is an Asian family in here, they have this requirement, I was completely brushed off. Okay? So this experience has, when went through everyone, I think all, uh, all Asian population has felt it at some point of time during their trainings and all.

[00:09:57] So, I mean, [00:10:00] sometimes it’s just that, okay, we don’t know what their need is, so we don’t want to exclude their need is okay. And, uh, sometimes it’s maybe different, but our goal is that like, you know, it comes, everything comes advocations you know, so we are now, the whole medical community is aware of the kosher food needs and everything, but like if we don’t advocate for ourselves, nobody is gonna give us anything and nobody is gonna know for anything, you know?

[00:10:23] So for patient purposes, this is very important. When they go to a doctor, they should be able to talk what they mean. When we are referring to a nutritional specialist, nutrutional specialists should not be giving them advice which is not a cultural inappropriate food for them totally. Or not even able to count in their calories what they have eaten because they don’t know what the food is.

[00:10:44] I have seen those in practical scenarios for patients and uh, that that is one thing and that’s why we want to reach out to our community. Also, the community has a huge mental health and uh, I will say sexual reproductive health stigma. That’s mental health [00:11:00] stigma is all over the Asian community. Autism awareness is another of major step, which we are trying to, we got some funds we are trying to activate and relocate throughout the summer.

[00:11:09] Carol Vassar, podcast host/producer: In terms of the HAAPI ARG, Ben, Laura, are you doing similar outreach within your community? 

[00:11:16] Benjamin Duong, PharmD, Nemours Children’s Health: For our HAAPI ARG, we’re pretty much one year and a half old, so we are still trying to find ways to engage our community. I think there’s one thing we’re trying to plan in both Delaware Valley and uh, Florida is some kind of volunteering, uh, like a local food drive.

[00:11:31] But for our, how we kind of impact our community is, you know, by educating our providers. We’re doing a talk about pediatric mental health in Asian Americans to, you know, bring that awareness, you know, how do we minimize that stigma? How do we have providers understand how to approach that with our Asian and Asian-American Pacific Islander and Native American population?

[00:11:54] Carol Vassar, podcast host/producer: Laura, anything to add with regard to what HAAPI is doing in terms of community outreach? I know you’re a [00:12:00] young ARG. What are you looking to do in the future? 

[00:12:03] Laura Kam, Nemours Children’s Health: Some of the conversations that we’ve had, with Asian, hate being so prevalent right now, and trying to figure out ways to arm our associates even, you know, with resources on how to deal with Asian hate. There’s a resource out there called Right To Be, it’s a nonprofit organization, and they’d provide some webinar trainings on like how to be a bystander when you witness something, or how to, if you’re a victim of you know, some sort of hate or confrontation, how to navigate through that as well. So that’s some of the areas that we’ve discussed working through, and then potentially bringing maybe that training to Nemours as well and for the associates. 

[00:12:42] Rituparna Deb, MD, Nemours Children’s Health: Can I let’s something to it? 

[00:12:44] Carol Vassar, podcast host/producer: Please do. 

[00:12:45] Rituparna Deb, MD, Nemours Children’s Health: There is another good thing which Nemours is doing. Our, which our leaders do is like recognition of world events sometimes. So, the Asian hate event, which happened a few months back when Dr. Moss sent a letter for all [00:13:00] associates to be mindful of everyone’s feeling. And, uh, recognizing that. Those small gestures also mean a lot sometimes to everyone. You know, all the associates feel that like, you know, at least somebody is recognizing us or, uh, Like during covid, multiple things, which has came up and uh, recognition came from not just recognition. Or like, I will say, even saying their opinion loud that okay, we don’t support this kind of hate don’t support this kind of things. And clearly and loud in enterprise-wide email, it means a lot. So, I will say the progress is being made, so, but we just need to continue that. 

[00:13:39] Carol Vassar, podcast host/producer: I wanna ask this. We’ve talked a little bit about, we’ve talked a lot about stigma with regard to sexual health and with regard to, um, mental health. Let’s talk about disparity. Let’s look at kind of the other end of this. What health disparities are you seeing, are you aware of in your respective communities? And [00:14:00] I’m gonna go to Seeja for that one. 

[00:14:03] Sheeja Abraham, MD, Nemours Children’s Health: So, you know what, um, South Asian Americans have a higher incidence of cardiovascular disease and type two diabetes. Some of that is genetic. Uh, some of that is environmental factors with diet and screening for these conditions ought to be started at a younger age. Um, and preventative measures should be undertaken in the pediatric population. These are not things that we’re typically screening for in the general pediatric population, but an understanding of that health issue in this particular population, you know, would certainly, I think, improve that so that primary care physicians can be aware of that increased risk and be looking at that. 

[00:14:47] Many of the disparities that are occurring are mostly because most immigrant families don’t tend to seek routine well care, and, you know, in our [00:15:00] population, uh, well childcare because it’s considered that you go to the doctor when you’re sick. And the notion of seeking medical care as a resource, as a preventative medicine, especially in childhood, is not really that well understood. So, I think that that may foster some of this disparity. And I think nutrition is a very big factor as well. You know, on both ends of the spectrum, many of the South Asians, and in fact, the Asian population that we see as a gastroenterologist, I’m evaluating them for failure to thrive because the Asian diet often caloric intake is not so great. So it’s important to look at that. 

[00:15:42] And then we have the second generation of Asian Americans who are eating the American diet and are facing some of the issues that our general population is, which is, you know, going towards obesity and overweight. So I think these are some issues [00:16:00] that we really need to be focused on as healthcare providers.

[00:16:04] Rituparna Deb, MD, Nemours Children’s Health: I wanted to add to it, adolescent girls, okay from South Asian population, are often anemic because they have lower hemoglobin because they’re not meat eaters and they’re from like strict vegetarian families. And, uh, they have started menstruating and menstrual. I mean, menstrual hygiene is a total different question again, you know, but, uh, Then they’re menstruating and then that they need an extra iron. That need is a lot of times not identified. Okay? Uh, not all adolescents generally we give supplements or offer supplements or anything like that, but that is something to be recognized by all pediatric practitioners, that if it’s a vegetarian family, completely, probably we should offer and, uh, to remove these disparities.

[00:16:49] Yes. Like, uh, we are trying. To make our, all our providers also more acknowledging about those facts. Medicine is so big that no one knows [00:17:00] everything, you know, so there’s no one who knows everything. So it’s every day trying to be reminding, increasing awareness in, in amongst all our pediatricians. 

[00:17:10] Carol Vassar, podcast host/producer: I’m wondering, how do your ARGs promote the idea of well beyond medicine? Seeja. 

[00:17:20] Sheeja Abraham, MD, Nemours Children’s Health: So, you know, as pediatric healthcare providers, wellness is a very intrinsic part of what we do. You know, it’s not as common a theme in adult medicine as it is in pediatrics. The majority of patients that we all take care of are well children that we want them to continue to be well. So I think that, you know what we mentioned before, really increasing awareness in the South Asian population of disease states and chronic conditions, mental health, reproductive health issues, these things will, I think, improve the quality of wellness in our patient population in our [00:18:00] community. So I think wellness is at the root of, uh, what pediatrics is about, and we definitely wanna continue that into our own communities.

[00:18:12] Carol Vassar, podcast host/producer: Well said. Ben, I’m gonna go to you. Same question. How do the ARGs feed into the idea of well beyond medicine? 

[00:18:20] Benjamin Duong, PharmD, Nemours Children’s Health: I think kinda, what we kind of discussed throughout the podcast is bringing that awareness and using that awareness of increase that kind of cultural competency that was kind of discussed on previous podcasts for providers and for associates in our community to incorporate that too, you know? Yeah. Beyond medicine. So yes, we treat the patients, but how do we individualize the therapy even further, uh, not just the standard of care of certain medications that may not be representative of that certain population, but going beyond to consider what are some of the factors at home or in their environments or in their communities that may have contributed to this, and how do we improve that? [00:19:00] So that’s really somewhat, you know, our ARGs trying to educate a little bit and plan to do so in the future is more connection to that well beyond medicine and other factors that we shouldn’t consider across our various cultural backgrounds. 

[00:19:14] Carol Vassar, podcast host/producer: Laura

[00:19:15] Laura Kam, Nemours Children’s Health: I think, you know, putting out the information for the providers to know upcoming holidays and stuff, and then referencing them with the patients, I think adds a level of belonging. I think that makes them feel heard, makes them feel like they’re being represented, that there’s, you know, they’re getting support. And I think all of that is very important, especially when we talk about mental health and your sense of self-worth. You know, if you always constantly feel like you marginalized, it wears on you. And by creating this kind of well beyond medicine and reaching out to the cultural factors for patients, I think it helps that sense of belonging and can create a safe place for the patients that feel [00:20:00] like you know that they’re being heard or that they’re the things that they’re feeling aren’t brushed off, you know, that they can trust that this provider, this doctor that they’re seeing, or you know, nutritionist or whoever it may be, they’re going to hear what they have to say because they’ve already brought to the table you know, acknowledge the difference between us and them, or them and us.

[00:20:22] Carol Vassar, podcast host/producer: Dr. Rituparna 

[00:20:23] Rituparna Deb, MD, Nemours Children’s Health: So knowing the culture or having a little bit of knowledge about the culture when you are seeing a patient, it’s, uh, very important. So it’s trying to give those, uh, tidbits when the patient comes in. And if, if any provider can relate, oh, okay, you do this because of that, or, okay, once your diet, oh, okay, got it.

[00:20:43] You got this, this, this. Okay. So. That kind of gives the patient, as Laura said, it’s a, it’s a feeling of that like, okay, we are good. I, I’ll not be called on because I said I feed my kids certain things. Okay, this person understands this, my cultural value and that’s how I [00:21:00] feed like this, or in this mold or feed by hand or not feeding with this spoon, you know, those kind of issues come in. Now, a lot of people are actually very cognizant about those small differences, and that’s why Nemours, as a pediatric group is very well recognized in the community and they, they come for it too. Uh, I understand it’s very hard to relate that like, okay, I now learned about this festival. And then identifying, okay, this patient may be from this cultural group and connecting those two dots needs practice, but we all can practice. The people who came in here, I know when is Passover. I know when is Christmas. I know how we talk about this and what we are doing on this. So if everyone can train their brain this way, but we just need an attitude for that.

[00:21:54] Carol Vassar, podcast host/producer: When allies have questions, are the ARGs a good resource to go to? Maybe they’re handling a [00:22:00] patient, they have a patient and they have a question just culturally, and maybe they just simply don’t know the answer. Are the ARGs a resource that we can use to learn more and educate ourselves as allies? 

[00:22:11] Benjamin Duong, PharmD, Nemours Children’s Health: I would say yes, um, because we are a network of, uh, associates that have a maybe a better understanding for their patient that we can help you to direct them to a, maybe a particular provider that has, uh, be more expert in that topic. Or we can kind of give our partially collective, or even a group discussion at our ARG about a partiuclar topic that maybe this provider’s question, but could be many other providers that they don’t really ask. So I think it is a great resource too, just us as an ally to help our patient care, even our associates in certain situations too is that, is this network that’s available for all.

[00:22:48] Rituparna Deb, MD, Nemours Children’s Health: I agree with Ben. You know, like and your question, yes. Use the ARGs. Please use the ARGs as a resource. If you have a question about their culture. If you have a question about the patient [00:23:00] or parent behavior, you are not understanding. If it is coming from a culturally-backed situation, please ask us. Probably we will be able to, in between, like between these two ARGs we cover, like we, we can cover a big group of population, okay?

[00:23:16] And the world population, we know how, where it is going and how, where it is coming from. This will be more resourceful going ahead featuring together. 

[00:23:25] Sheeja Abraham, MD, Nemours Children’s Health: I think Carol, we appreciate our allies for standing up for us. So sometimes it might be a situation where one of us is not there, but something is mentioned, you know, outside of our presence. And I think to have people stand up and say, “Hey, you know, I don’t think that’s necessarily right.” Or as someone says something about a patient or a family. I think having that openness and, and I would say that, I’m very thrilled with our, my Nemours colleagues that I do feel that that [00:24:00] sense of allyship from them. But I, I think allies are so important in all, in the work that we all do, 

[00:24:07] Rituparna Deb, MD, Nemours Children’s Health: and trying to building alies and using that opportunity as a, like an educational opportunity, also, when someone is talking about a patient or a family or a colleague, that that person does something which they didn’t understand why this is like that. So if you know that culturally what is going on there, feeding that, like tell about it. Like, okay, so you know what, that’s why they did this. Okay? Or this is their thinking behind it, or this is the culture behind it. Okay? That increases the opportunity for the allies also to understand the group better.

[00:24:40] (MUSIC SUNG) Well beyond medicine. 

[00:24:42] Carol Vassar, podcast host/producer: Thanks for listening to our exploration of the DESian and HAAPI ARGs at Nemours With me, Carol Vassar and our guests, Dr. Rituarna Deb. Deb, Dr. Seeja Abraham, Dr. Benjamin Duong, and Laura Kam.

[00:24:58] Other [00:25:00] ARGs at Nemours include Adelante, Pride, Caregivers, Women at Work, and African Heritage. Get more information on Nemours’ ARGs in the show notes, where you’ll also find a link to the nonprofit Right to Be, mentioned by Laura Kam as a training resource to respond, to intervene in, and heal from harassment.

[00:25:20] How about you? What are you doing to help foster an inclusive and welcoming culture and community? Continue the conversation with us by leaving your voicemail at nemourswellbeyond.org. That’s nemourswellbeyond.org. Who knows? Maybe you’ll hear your voice on an upcoming episode of the Well Beyond Medicine Podcast. And while you’re there, check out our other episodes, subscribe to the podcast, and please leave a review. 

[00:25:48] Thanks to Che Parker, Cheryl Munn, Susan Masucci, and Jennifer Rearden for this week’s production assistance. Thanks also to Berkshire Community College in Pittsfield, Massachusetts for the audio [00:26:00] of Yo-Yo Ma (MUSIC BEGINS) playing his cello in 2021 while waiting in line to get his COVID-19 vaccine.

[00:26:07] Join us next week as we discuss the importance of a mentally well workforce with Nemours Chief Well-being Officer, Dr. Maureen Leffler. Until then, remember, together we can change children’s health for good… well beyond medicine.

[00:26:24] (SUNG) Well beyond medicine!

Listen on:

Put a face to it.

Meet Today's Guests

Benjamin Duong, PharmD

Benjamin Duong, PharmD, serves as Clinical Pharmacogenomics Service Manager under the Nemours Children’s Precision Medicine Program. His position leads the implementation of a clinical pharmacogenomics service across the enterprise including developing an in-house pharmacogenomic panel in collaboration with the Molecular Diagnostic Laboratory. He also participates in NIH-funded research and is the co-lead for the Nemours HAAPI ARG.

Rituparna Deb, MBBS, MD, FAAP

Rituparna Deb, MBBS, MD, FAAP serves as pediatrician-in-charge at Nemours Children’s Health, Newark. She received her medical degree from Lady Hardinge Medical College, University of Delhi and her residency training from The Unterberg Children’s Hospital, New Jersey. She has a special interest in Adolescent Health and is co-lead of the Nemours Children’s DESian ARG.

Sheeja K. Abraham, MD

Sheeja K. Abraham, MD is pediatric gastroenterologist for Nemours Children’s Health in the Philadelphia region. She emigrated to the U.S. at age 8 from India. She received her medical degree from SUNY-Downstate Medical College, followed by a pediatric residency at Cornell Medical Center and pediatric GI fellowship at Mount Sinai Medical Center. She has been with Nemours for 23 years and serves as the co-lead for the DESian ARG.

Laura Kam

Laura Kam is a project manager for the Florida Administrative Office and co-lead of the Nemours Children’s HAAPI ARG at Nemours Children’s Hospital, Florida.

Subscribe to the Show