Kind: captions
Language: en
[Intro]: Welcome to Migrant Clinician’s
Networks’ ‘On the Move’ podcast,
a podcast dedicated to providers and health
advocates who work with vulnerable populations,
including migrants and immigrants.
Garcia: Welcome and thank you for joining
us for today's episode "Folks 65+ can risk
less and do more by getting respiratory
vaccines this fall". I'm Deliana Garcia,
I'm the Chief Program Officer for international
and emerging issues at the Migrant Clinicians
Network, and I get to be today's host. In my
role with MCN I have developed programs like
Health Network which is our international bridge
case management and patient navigation system. We
want to make sure that patients have their medical
records available to them as they cross any line,
state, international, whatever. And so,
in that role I also get to work with
folks who are looking at emerging issues like
vaccine preventable diseases. And so, today,
I want to welcome to our podcast Renai Edwards and
Dr Laszlo Madaras, because they're going to talk
to you about the Health and Human Services'
'Risk Less, Do More' campaign and the risks
of illness and the benefits of vaccination for
underserved groups, including patients who are
over 65 and those who are pregnant. So, welcome
to Renai. And Dr Madaras can I call you Laz?
Madaras: You sure can!
Garcia: Great! Well, Renai Edwards is MCN's
Director of Training and Technical Assistance,
and she holds a masters of Public Health from
the University of New Mexico. She began her
career in public health as a volunteer with the
Peace Corps in Honduras, a theme that's going
to continue with Dr Madaras as well, and has
worked for many years at all levels, from city
to international government agencies, with real
attention to infectious disease prevention control
surveillance programs, focusing a lot on community
education and training for clinicians and staff.
Her specialties include HIV, STI, sexual health,
tuberculosis, refugee and immigrant health,
maternal child health, and strategic planning.
And through her work she focuses on health equity,
cultural humility, and language access.
And Dr Madaras, Laz, is MCN's Chief Medical
Officer. And he's responsible for the oversight of
all of MCN's clinical activities. Laz received his
MD and Masters of Public Health from Tuffs
University School of Medicine. He's worked
all over the world. He too was a Peace Corps
volunteer and then in the 1990s and 1994 he
worked on the Congo-Rwandan border during the
Rwandan Genocide. And so he's brought so many
of those lessons with him. And since '96 he's
worked as a Board Certified Family Physician
in both inpatient and outpatient medicine, in
pediatrics, adult medicine, and obstetrics.
He is a frontline clinician and was at
Keystone Health Center, a community health
center in Pennsylvania, where he cared for
farm workers and their families serving as
Assistant Medical Director from 2001 to 2005. He
became a hospitalist in 2005 in Chambersburg and
Waynesboro Hospitals in south central Pennsylvania
where he continues to work part-time to this day.
So, I want to really focus both of you all, and
thank you so much for being here with us today,
on really the questions around the importance
of vaccines for individuals who are 65 years
old plus as well as those who are pregnant. So,
I think if you don't mind I will go ahead and
start with you Laz and say, you know, tell
me a little bit about the importance of,
you know, vaccines and the role that they play
especially for patients who are 65 and older.
Madaras: Okay, great. Thank you so much Dell, and
welcome Renai. And it's great to be here. Yeah,
so over so many years in medicine I've
seen the results of vaccinations improving
people's health all over the world. And
this goes back to even before I was born,
and I'm getting to be in the 60 and over category
- not quite 65, but, where swimming pools were
closed during polio in the late 1950s. So I
came into the world a little bit after that,
a couple years after that. And I was really
grateful that all my childhood vaccinations
were accomplished in the 1960s and early 70s.
Polio, MMR, etc, it was always an important
thing that was never questioned that we
should be vaccinated against everything
that would be life-threatening - life ending
- even in the first half of the 20th century.
Garcia: But Laz, talk to me about
older people, because you're right.
Madaras: Yes.
Garcia: Vaccines for children, really,
I think that there's a lot of support.
Madaras: Right, right. So starting off
from that time to the older population,
which is where I'm at now also, what I want to
say here is that, you know, as we get older we
tend to accumulate disease processes. Sometimes
these are things we can't help, they're part of
our genetic inheritance from our parents, some
people get diabetes, some people get Hepatitis,
some people get lung disease. As we get older,
these accumulations make it more likely that,
if we're suffering from an additional insult
from one of the vaccine preventable diseases,
we're going to get sicker, suffer, more
and possibly die. Other issues including,
when we get older we use tobacco and alcohol, and
so many of the adults that I see in my practice,
you know, have requirements for supplemental
oxygen. Their lungs aren't as strong as
they used to be. So for the 65 and older a
combination of the accumulation of comorbidities
and some of the health preventable processes that
we use, you know, will result in a higher risk for
diseases such as COVID, such as influenza, such as
RSV - which fortunately are vaccine preventable.
Garcia: So you're talking about the 65
plus group and the processes that can
come over time. In that same vein though we
frequently kind of bring in the whole issue
of pregnant people as well,
and what's the issue for them?
Madaras: So with pregnant people, we can
vaccinate the pregnant person. In addition,
we get some passive immunity that passes through
to the infant, so when that infant is born they
already have the advantage of having some of the
antibodies that their parent has given them. And
that lasts for about the first six months of
life most often, and then it's time for their
childhood vaccinations to kick in. Now as we
know, the immune system is always poised to get
any type of infection that comes to your system,
but the disadvantage is then you have to be sick
and you have to recover and pregnant people and
the elderly have a harder time recovering. So
we've given them the advantage of vaccination.
The vaccinations that we're talking about are
very helpful to avoid the unnecessary falling
sick from the illness itself and rather get the
advantages of having an immune system that is
poised and ready to be induced to protect the
pregnant person and the adult over 65 from getting
the illness itself, which often is lifesaving. And
I can say that, you know, having worked in the
hospital for over 30 years in the United States
and other places, that it's the people who don't
take advantage of vaccinations that end up sicker,
that end up in a hospital having to be seen by
a doctor like me in the hospital, often ending
up in the Intensive Care Unit on a ventilator,
Etc. And I really want to avoid that, and that's
why I always encourage people to be vaccinated,
especially the 65 and older and pregnant people.
Garcia: You know, Renai, we're going to turn
to you because the other thing that I think
comes up in all of this, and Laz you may
want to weigh in as well in a second, is,
you know, beyond 65 plus and pregnant people, we
speak frequently of the importance of including
immigrants and migrants, the Spanish speaking
populations, or non-English speaking populations,
and I think some of this - both the age
and condition populations, as well as then
special circumstances - are the folks that
you're really trying to work with in this
partnership with the Health and Human Services
'Risk Less, Do More' campaign. What brought
about the partnership and what is the
goal for MCN's work in the partnership?
Edwards: Sure, and you know, first I just want
to make a little disclaimer that, you know,
as an employee of Migrant Clinicians Network
I can't speak for the Department of Health and
Human Services or for the 'Risk Less, Do More'
campaign but I can talk about our partnership
with them with the purpose of promoting this kind
of vaccination for seasonal migrant agricultural
workers, for immigrant communities, and for folks
that don't speak English very well. Because of
Migrant Clinician Network's reach among clinicians
that serve migrant and seasonal farmworkers,
immigrants, people with limited English
proficiency, and our reach directly to
those communities, they partnered with MCN
to spread the word about respiratory vaccines
beyond general English language advertising.
So, you know, our goal is to really try to
reach clinicians whose purpose is really working
with a migrant and seasonal farm worker community
and with immigrants. So we really want to reach
them and make sure that this message is getting
beyond the general English-speaking audience
that most of the promotion is going to go to.
Garcia: And so we want to hear a little bit
more about the campaign. So set it up for us.
Edwards: You know, 'Risk Less, Do More' is
really trying to use uplifting, colorful,
family oriented in particular messages for diverse
communities to provide resources and help increase
awareness and access to respiratory vaccines.
So there's a whole wide variety of videos that
are available, there are materials that
clinicians can use with their patients,
and there's stuff that's really just trying to
reach these communities directly. And it's, again,
it's very family oriented, really trying to help
people think about the bigger picture of who
they're living with, who they're interacting
with, what they're doing to enjoy life.
Garcia: You know, I'm going to go back
to Laz for just a second because Laz it
seemed like during COVID there was a lot
of 'how is it that we get this message out
to groups so that they can understand the
risks and the environment in which they're
living'? And I think that was one of the
things that you spoke to a great deal.
Madaras: Yes, yeah, during the years of the
pandemic we were trying to work with community
health workers and trusted leaders to get the
message out - the correct message out - on COVID,
the vaccination possibilities, and how they could
get the care that they needed from clinics that
were open. And Migrant Clinicians Network really
helped connect some of the people that were
working in very, very high-risk jobs. High-risk
jobs not only because they're working in things
like assembly lines and places that was fast
moving action, but also because they could not
use personal protective equipment as other places
could use. So they're close together at work,
they're close together in the commute home. And in
their homes which often were trailers, you know,
people would be together in larger groups, and it
was very easy then to have viruses transmit one
person to another even if the people themselves
knew how to prevent this from happening.
Sometimes they could not adhere to some of the
guidelines that were recommended by the CDC. And
I think our migrant population is especially
vulnerable for those reasons I mentioned.
Garcia: Right.
Madaras: That has to do with,
you know, how they lived.
Garcia: Right.
Madaras: Fortunately we did get the message
across and in my area in Pennsylvania, also,
most of them did get vaccinated. And that's
a great tribute to an organization like MCN.
That we're able to get that message out and
get as many people vaccinated as possible.
Garcia: Yeah. I think that, you know, we did
demonstrate some considerable work and strength.
And Renai, I think you're carrying it on. And I
think the program that you have in place to do
here with this partnership in the 'Risk Less, Do
More' campaign is in the, I think, in the spirit
of what we've always tried to do. But, please
tell us a little bit more about the messages,
about the design, about what you're trying to
look at - anything that you'd really like to note.
Edwards: I think, you know, some of the critical
things are just really thinking about how the
people around you also can influence you. So,
if I'm thinking about my mother, if I'm thinking
about my aunt, if I want to make sure that they're
going to be okay for the holidays coming up and
we're all together and who knows who's coming with
what. Right? So really trying to think about, you
know, how to help your family members get vaccines
if they need them, or other people that you might
be looking after, especially if they have any kind
of chronic conditions. If you've got relatives
who live in a nursing home or are in, you know,
for extra care. Those are folks to be thinking
about too. And as well as pregnant people that
might be in your life and coming to your events,
or just that you're going to spend time. Right/
The whole idea is that, really, literally, they
want people to have less risk so that they can do
more of the things that they like. And it may be
with your friends, it may be with your family, but
really having things safer. And who wants to be
in bed sick or potentially in a hospital when you
could be having a great time with your loved ones?
Garcia: And I think that that's really great to
hear because I think so much of what happened in
the early days of COVID was there was a discussion
of risk and then there was a willingness of people
to throw caution to the wind and go ahead and be
not well or, you know, potentially ill and then
mixing and being at parties. So tell us some of
what are the resources that are available Renai.
Edwards: Sure, so there are, like I said,
there's resources for clinicians. So if
clinicians have things that they want to
give to individuals that are 65 or older,
or that are pregnant. If they have something
that they want to give to someone who's there
with their family to help their family member get
the care that they need. There's a lot of things
like that. There's a lot of social media going on
right now that's trying to get people all, in all
the circumstances, to help increase this awareness
and interest in getting vaccinated. But really,
a lot of it is just really trying to promote the
idea and motivate folks that this is a helpful
thing for you. This is a thing that's going to
help keep you going and having a great time.
Garcia: And Laz, tell me, you know, please. I went
and had all three vaccines. I had my COVID, I had
a flu, and then I had RSV, and I was fine. But I
had others who, you know, struggled, or were just
reluctant. Talk to us about taking them one at a
time or in combination, any advice you might have.
Madaras: Sure, sure. So yes, you can take them all
at once that is totally fine medically speaking.
But you can also spread them out a little bit. So
the caution there is don't wait so long to spread
out the last one that 'oh boy, now I just caught
that particular one because I waited a little too
long to get vaccinated'. And we do have now, we
do have influenza A in the hospital. We do have
some of the other, you know. COVID is still
there, you know, it hasn't gone away. We want
everybody know that COVID hasn't gone away. RSV
is there and influenza is here now. We are now,
as we're talking in the last week of October
2024, and the season is upon us. Especially
in the Mid-Atlantic and New England States.
We're starting to feel all these viruses that
are coming and are vaccine preventable. So we
want to get that message out now. And I want
to talk to the clinicians who listen to this to
please, you know, work with your fellow clinicians
and your family members - as Renai said - to get
the word out that the vaccines are here, they're
available. And I recommend that you take them all
at once or one at a time, but please get them all.
Garcia: Get them all! And Renee, I mean, you know,
Laz is talking about educating people around the
risk. I think risk discussions and understanding
risks versus benefits is always such a difficult
thing in any public health arena. When we talk
about sort of the risk and benefits, we get
stuck in that place of trying to describe risk
realistically but not so that we're just stuck
in negative or frightening messages. And I think
that the risk less piece to do more that you have
been describing is helpful in setting that kind of
a tone. So what's the goal really in this project?
Edwards: Well the goal is largely to
help people feel positive about getting
vaccinated. To see that there's a benefit
to it. To see beyond the risk and maybe,
you know, taking it lightly or thinking
this isn't going to happen to me, or 'I
had it once and it was okay'. To really, again,
thinking beyond yourself and with your family,
with your friends, but also what do you want to
be doing in the next couple months? Do you want
to be in in bed sick or do you want to be out
doing the things that you enjoy doing? And so,
that's sort of the idea here. Is to really
go from, you know, not doing the, you know,
doing things to avoid becoming sick so
that you can do the things you really love.
Garcia: And I think Laz, you talked about
the hospital, but now, talking about the
health center, when you've been working with
patients what has been the most convincing
for them? What are the stories that you
tell or the or the angle that you use?
Madaras: Yeah, so I try to tell the patients who
have undergone some of these illnesses themselves
and had come back, I say 'do you really want
your loved one to experience this? I think
not. I think if you know your grandma, you know,
can she really sustain what you just sustained
as a 40-year-old? Okay?' I said, you know, as you
get to be older, and you get to be 65 and older,
you may not be able to withstand the illness
as it stands, as it is right now. And sometimes
I use them as an advocate then to spread to
the rest of the family. 'Yes, grandma please,
do get your vaccines because this is going to
be really important'. And one other thing, Dell,
I want to touch on, and this is partly because it
was discussed last month at the United Nations,
is antibiotic resistance. And this is a bigger
picture of how you can prevent diseases,
viral illnesses such as RSV, such as covid, and
such as influenza A, from then adding onto a
bacterial pneumonitis which requires antibiotics.
So the process there of what I would suggest
is get the vaccine, don't get sick, don't get
pneumonia on top of the viral illness. A bacterial
infection on top of a viral illness is very bad.
Especially if you're 65 and older. Especially if
you're pregnant. And if you can prevent the use of
unnecessary antibiotics you've saved something for
your children, your grandchildren, Etc that we can
use these antibiotics for more years. And again,
antibiotic resistance is something that the
United Nations globally, WHO, I mean we we're
all concerned about that as clinicians. So
I would, clinician to clinician, and health
worker to health worker, this is another aspect
of vaccinations that I would like to emphasize.
Garcia: So talking about clinicians then,
Renai, you tell me, you're talking to
clinicians. What's your message to them and
for the work that they need to be doing?
Edwards: You know, we are here as trusted
messengers. Right? People count on us to
bring them the accurate information. So,
for clinicians.., so whether, you know,
you're the doctor, you're the PA, you're the
assistant that's in the office helping someone,
having that information and sharing it with them
really helps them have it from a source that they
can trust. And so, for clinicians or anyone else
who wants to get some more materials from 'Risk
Less, Do More', you can go to the website. And I
think the easiest thing is just search 'Risk Less,
Do More'. HHS has a specific website that's
www.risklessdomore.hhs.gov. You can also go
to the Centers for Disease Control and theirs
is a similar long www.cdc.gov/risklessdomore,
all one word. But again, I think if
you just search the campaign itself,
that's probably the easiest
way to get what you need.
Garcia: Well, you know, and I think that that's
wonderful that you're moving forward. And the
other thing that I would want to add to it,
or, you know, reiterate, is that MCN's been
doing this for a while, right? You all had
a campaign before that you were looking at,
I believe it was COVID based. So I think
letting everyone realize that MCN has been
doing this work successfully for a long time is
really critical. So if you're doing 'Risk Less,
Do More' campaign, you gave us the
resources, you talked to us about why
you wanted people to be engaged in it.
Is there anything that's upcoming like
this podcast or another webinar or anything
that you would want to let us know about?
Edwards: Sure! In addition to the webinar we
just did, the podcast right now, there are
a few blogs that will come out. And locally,
in Texas especially, we have some stuff going
on at Ventanilla de Salud offices, the Mexican
consulate. There's a bunch of health fairs where
they're promoting the campaign and the information
for people. They're promoting the vaccines. There
will be some information on radio there and in
newspapers in Spanish. And so, we're hoping to
really kind of just get the word out as we
go through this respiratory illness season.
Garcia: Well, thank you very much. We're at
time so I'm going to go ahead and sign this
off. But I do want to thank you for coming,
for speaking to us about the campaign,
for speaking to us about patient
care and clinician education and
the work of the groups that are engaged
in all of this. Any final comment Laz?
Madaras: Yes, I'd like to add that I'm very
proud of Migrant Clinicians Network and our
partnerships in the past with getting
out information on things like COVID-19
vaccinations to our communities. Again, in
a multilingual format to places where it's
hard to reach sometimes. And so, I'm really
proud of the partnerships we have formed and
the partnerships we have now with 'Risk Less, Do
More', in this campaign. So I'm really excited
about moving forward and using some of the,
some of the platforms, some of the formulas
that we've used in the past and move forward
successfully here. No, thank you very much for
your questions and I appreciate working with Renai
and our whole MCN staff. We are a very motivated
group of people doing wonderful things. And again,
this partnership is going to be very good one.
Garcia: Renai, any last words?
Edwards: So, you know, here with, as Laz
was saying, you know, consistency is really
important too. Right? We've been continuing to
promote vaccines as necessary and, you know,
taking care of your patients and taking
care of your family and doing it in a
wide variety of ways, really just to
go on and have a healthy life. And so,
that's a consistent thing and a consistent
message. And I think that helps also build on
the idea of being trustworthy and, you know,
really wanting to do well for other folks.
Garcia: I agree. I think that that repeated
message and that continuous message of trust
is really critical. So thank you all so much for
being on the podcast today. To the listeners - and
you can reach me at DGarcia@migrantclinician.org.
I'm not sure that I can add a whole lot to your
conversation but I'm always amenable to receiving
messages from folks - so please. And you can
connect with us through social media. MCN has a
Facebook, a LinkedIn, a Twitter, Instagram. And
so you should be able to find all of those links
on our website which is www.migrantclinician.org.
I think you can go there and find more expert
guidance and tools to improve the quality of
care for vulnerable populations. Please, we
ask all of you to follow our podcast 'On the
Move' with MCN. Come back and listen. And Renai,
again, Laz, again, thank you all so very much.
Madaras: Thank you Dell.
Edwards: Happy to be here.
[Outro]: Visit Migrantclinician.org/signup to
subscribe to MCN’s News Blog to get updates
on new MCN podcasts, and blog posts. Migrant
Clinicians Network is a national non-profit
dedicated to providing practical solutions at
the intersection of vulnerability, migration,
and health. Donate to support our work
at www.migrantclinician.org/donate.
[Disclaimer]: The content in this podcast is for
general informational purposes only. The content
of this podcast is not intended to be a substitute
for professional medical advice, diagnosis,
or treatment. Please consult official and/or
federal sources for up-to-date health guidelines.
