Title
Chapter 03: Heath Disparities and MD Anderson
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Description
Elizabeth Garcia spends this chapter discussing how MD Anderson Cancer Center addressed the COVID-19 pandemic and racial justice related issues. Specifically, she notes the institution’s partnership with Lyndon B. Johnson Hopsital to assist with their COVID patients. Moreover, Garcia describes how she and her collegues addressed the murder of George Floyd. She details how this opened up difficult discussions at MD Anderson, which exposed racism faced by many staff members. In drawing this segment to a close, Garcia notes the effects of remote work and how the institution impressively had no layoffs amid a global health crisis.
Transcript
Nina Nevill
Now in terms of something that we’ve kind of seen broadly over the last year, this is talked about, I think, in a lot of fields and in a lot of career paths as sort of the disparities in health that existed, obviously, before the pandemic, and then with the pandemic, and the ice storm, and other things have kind of been just expanded upon. And I’m thinking here specifically about racial disparities and gendered and socioeconomic disparities. And I was wondering if you could talk a little bit about any of those during this past year, what arose, what could you see, if any, and how were they treated or how were they addressed?
Elizabeth Garcia, BSN,MPA,RN
So I was really proud of our organization that we actually had an agreement with LBJ to take their COVID patients when they didn’t have beds. And we’ve had a census of LBJ patients and gave them excellent care, including excellent follow-up care during the pandemic, so I’m really proud of our organization that we tried to balance some equity there, hospitals that wouldn’t have beds when we would have beds, so that was good. I think that we heard a lot from our staff that we wouldn’t have otherwise heard if things weren’t going on in society the way they would. So, for example—well, I’ll tell you that after the George Floyd murder, it was a Monday and we were coming into work. And we had a conference call every morning at eight o’clock, Monday, Wednesday, and Friday, I think, at eight o’clock to update on the pandemic, and what was going on and everything. And Dr. Tereffe ran those calls. So I texted her—and she’s been a great mentor, by the way, too, and a great partner. So I texted her at like 7:15 and it started at 8:00. And I texted her and I said, we have to say something about the George Floyd murder. No one had been at work since it came out on the news. And I said, we just have to. Everyone’s thinking about it. Everyone’s talking about it. We have to. He grew up a couple miles from here. And, well, Welela called me at 7:40 and said, I just got your text. She said, I’ve been thinking about this and thinking about this. You really think we should say something because I think we should too? And I said, yes, Welela, we have to say something. And she said to me, I just can’t Beth. I just can’t. And I said, okay, I’ll say something. Just put up a slide and I’ll come up with something to say. And she said, okay. And so she put up a slide of Martin Luther King, and I swear, I’m a spiritual person, and forgive me if you’re not, but I feel like God was with me, writing my words because I came up with them in five minutes. And I just felt so proud that we acknowledged—together, we decided we would do this, and we acknowledged. And, basically, I just said that no matter who you are, no matter what walk of life you come from, what race, what ethnicity, you are a valued member of the MD Anderson community. And this unjust death is just atrocious. And we all have to stand together for justice and for reconciliation, and we have more to talk about. And I got so many emails and texts from people to say, I’m so glad you said something. I’m so glad we said something. And I’m proud that I think that—I think that Dr. Pisters would have said something no matter what because he’s that kind of person, but I’m proud that Welela and I started the conversation together. So I’m very, very proud of that.
Nina Nevill
It sounds like overwhelmingly those folks that I’ve talked to so far in these interviews have had the same response and have said the same thing that they feel proud of the way that MD Anderson kind of sprung into action and didn’t let it kind of just slide by or some sort of—
Elizabeth Garcia, BSN,MPA,RN
Never silent.
Nina Nevill
On a superficial level discussed—yeah, not silence and not—but really opening conversations and dialogues and saying, hey, we should and can talk about this and whoever needs to, there’s a space for that here, which I don’t think all workplaces are—or welcomed at all. So that’s wonderful.
Elizabeth Garcia, BSN,MPA,RN
Right. And I’m lucky enough to have Dr. Gale Kennebrew, who’s the Director of Chaplaincy of Spiritual Care and Education in my division and only since last year, actually. But she’s a leader in this space in being able to discuss these things. And so when all this started, we had open discussions with our teams about what experiences they’ve had. And we discovered that people at the front door, people in the kitchen, people in these service roles were being bullied by patients and caregivers. It wasn’t other staff. It was patients and caregivers. And they told some heartbreaking stories. And a lot of them told me that that they felt that they just had to let it go because they were in a service role. And they didn’t want to jeopardize their job. And they just had to take it. And we were all like—all our leaders in our division were like you do not have to take this. You immediately tell that person; you need to wait right here. I’m calling my supervisor. You do not have to—there was a—and so in a couple of our division meetings, I actually had people get on and tell their story about what happened to them and what their experience was. And we called it out as what it was if it was racist, or if it was sexist, or if it was prejudiced, or whatever it was. We actually called it out what it was, and we went through the steps of what you should do if that happened to you. So I’m proud that we got their stories out. And we gave them a forum to talk about them and to really talk about what do we do when—and now we’re having a terrible problem in trying to put a standard operating procedure in place of patients and caregivers bullying and harassing and really threatening our staff on social media. It’s not as much racist or it hasn’t been racist thus far. I’m sure it will get there. But it’s been violent. It’s been scary. And these are people who are trying to take care of patients. And it’s been terrible. It’s just been terrible. And we’ve had to remove staff from situations and move it up the chain because you can’t let them be abused.
And there’s nothing we can do sometimes because we have to—I had a chair call me yesterday and say, I cannot allow our providers to be treated like this, I can’t. And I said, we have to go through the legal process of separating them from care. And in the meantime, we have to treat their cancer. We can’t say we’re not going to give their chemotherapy because they bullied us. It’s not the right thing to do, but I know it’s very difficult. And he said, I have no other provider to give this person to. They’re horrible. And I said, I understand, but we’re going to have to just administer the chemotherapy until—we’re going through the steps, but we have to go through all the steps.
Nina Nevill
Wow. Did it seem like these conversations—like some of the folks in service roles felt more comfortable stepping forward with this after some of the events of racial violence last year or does this seem kind of like an ongoing—
Elizabeth Garcia, BSN,MPA,RN
Oh, yes, definitely. No. They definitely felt more comfortable and felt like because the organization gave the message, you can talk about these things. And I’m proud to say in our division, we gave that message very clearly. And Gale Kennebrew helped us do that. They were more comfortable telling us stories. And I would have people call me in my office and say, hey, I work in inpatient services and I wanted to tell you what happened to me. So it was heartbreaking listening to these stories. I had one woman tell me a patient told her that she couldn’t have gotten her clothes legally because they’re too nice and she’s black.
Nina Nevill
Oh my goodness,
Elizabeth Garcia, BSN,MPA,RN
I know. A patient.
Nina Nevill
That’s horrible.
Elizabeth Garcia, BSN,MPA,RN
It’s horrible. I’ve never seen a black person dress like you.
Nina Nevill
Oh my goodness.
Elizabeth Garcia, BSN,MPA,RN
It breaks your heart. We have patient stories that will break your heart, but we have staff stories that will break your heart.
Nina Nevill
Sure. Because those who are suffering, especially patients at MD Anderson who are going through something, of course, that is horrible, but it’s also absolutely no justification to treat others that way or to violate others or harass. And it’s horrible to hear stories like that, but it’s good that people feel comfortable coming forward now and talking about them. Otherwise, I can imagine a lot of this—it would be very easy for an institution so big to kind of allow this to be swept under the rug, and the fact that these conversations are happening, and they’re coming to your desk and to your door, it’s, hopefully, a step in the right direction in having some sort of accountability.
Elizabeth Garcia, BSN,MPA,RN
Yes, yes. And we don’t want to stop those discussions. I’ve also found there’s a lot of sensitivity around when someone does make a misstep in what they say at work or—I had a leader tell a racist joke in a meeting, unfortunately. But there was someone else in the meeting who I explained too that I was going to talk to her and I would take action, but this other person wants to have her fired. And so I think that there’s also a lot of lack of forgiveness or lack of compassion for people who make mistakes. We all make mistakes. My two adult children are constantly saying to me, that’s a microaggression. I’m like, oh my gosh, I can’t say anything. But we all have to be cautious, but we also have to educate and forgive each other and know that that—especially if you know a person well, you know that’s not what’s in their heart, you know that people make mistakes.
Nina Nevill
Yeah. And I think it’s such an important thing that you said that educating is such a big part of it. And when you have such a big institution, and you have something like racial violence or just racism happening at some level, to be able to have the institution at a higher-level talk about it, and for that burden to not fall on the people who are offended and who feel violated, I think that’s a huge key piece of it is that, sure, we should educate one another and talk about it. But it shouldn’t have to be constantly the people who feel offended having to do that work. And it sounds like MD Anderson tries to have some other initiatives coming from the middle and from the top and opening those conversations and saying we’re going to educate from here rather than kind of placing all of that on the individual. It sounds like they’re more kind of systems and processes in place to do that.
Elizabeth Garcia, BSN,MPA,RN
Yes, yes.
Nina Nevill
Well, in terms of other disparities, I know that there have been quite a few conversations with some of the—for example, like work from home, remote, socioeconomic disparities with access to like care, caregiving, and childcare, and then some gender disparities with that as well. And I just was wondering if the people that you work with, many of whom were remote, if you’ve seen anything like that, or have been part of any conversations that kind of tried to address some of these other inequities?
Elizabeth Garcia, BSN,MPA,RN
Yeah, I think the institution has tried to address the inequities a lot. We have people, particularly in the call center, we have operators working there who are on the lower pay scale of the organization. And then we have advanced practice nurses who are in the upper pay scale of the organization. And they all went to work from home, not 100 percent, but almost 100 percent. And, surprisingly, we got no complaints from anyone about setting things up at home. And they were grateful to be home. They like it a lot. We’re going to stay home. Occasionally, I did get requests for like printers or things that we would never provide, desks, chairs, etcetera. And we talked through that and about how you’ll save in other areas, such as parking and uniform, stuff like that. But we won’t be providing that level of—but we will provide what we will provide. So it wasn’t that much of a concern in our area surprisingly. I was expecting that, but it didn’t happen. I think a lot of it is because of the very clear communication from our upper leaders and the constant communication. So yeah, it was the—sometimes some of the higher paid people that are working at home that wanted like an ergonomically correct chair sent to them or whatever. And I was like, oh, God, grab your dining room chair and call it a day. (Laughs)
Nina Nevill
Yeah, it sounds like different areas, I guess, had more of these disparities come forward than others. And it’s always good to hear that they’re—when there aren’t a lot of complaints, that’s definitely a positive to have. I guess I’m wondering now that I have kind of put together the pieces of this past year a little bit and what it looked like for MD Anderson, is there anything that jumps out at you in terms of what MD Anderson did differently than other big institutions? I know that you mentioned this kind off ability—
Elizabeth Garcia, BSN,MPA,RN
Well, we didn’t do any layoffs.
Nina Nevill
That’s a big one. Yeah, no layoffs.
Elizabeth Garcia, BSN,MPA,RN
That was a huge one and one that we kept emphasizing with our teams, for example. In other organizations, patient education was entirely laid off or furloughed for the length of the pandemic. Food and Nutrition Services, Leisa Bryant, who’s the director there, now the executive director, she brilliantly moved people around as retail locations shut down. And, for example, she started up the inpatient delivery service because people didn’t have their loved ones there, so they could drop off food and personal items and clothes and whatever. And we would deliver it to their room. And she set that up very early on as a way of repurposing the people who were working in retail to be able to provide a very valuable service. And, actually, we’ve gotten accolades from across the country about her setting that up. That was pretty smart. And the patients absolutely loved it. And they did over 150 deliveries a day at the height of the pandemic, yeah, before we had visitors.
Yeah, so no layoffs was huge. Huge. And I know that there were people working at home that were not doing 40 hours of work a week. I know that they were. Now, I tried to get them to come in and do [screaming?]. I wasn’t always successful. In my division, I was. But, yeah, so I think that was a pretty significant commitment. That meant a lot to the organization. The focus on wellness, the focus on access to testing whenever you wanted, other organizations did not have that.
Nina Nevill
Can you talk a little bit more about wellness? Sorry, I didn’t mean to interrupt you.
Identifier
GarciaE_20210731_C03
Publication Date
7-13-2021
Publisher
The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Topics Covered
B: Institutional Processes;B: Obstacles, Challenges;B: Gender, Race, Ethnicity, Religion;C: Diversity at MD Anderson;
Recommended Citation
Garcia, Elizabeth BSN, MPA, RN and Nevill, Nina, "Chapter 03: Heath Disparities and MD Anderson" (2021). MD Anderson 2020 Interview Project. 21.
https://openworks.mdanderson.org/mda2020_interviewsessions/21
Conditions Governing Access
Open
About the Interview
From the interview:
Elizabeth Garcia, BSN,MPA,RN, Oral History Interview, July 13, 2021