Dorothy: [00:00:00] She has the most mispronounced first name of anyone I have ever known. Today we’re talking to Brahana, the H is silent, Brahana Marksberry, and she is the second longest living employee we have here at The Rose. I’m the first. Brahana has been with us through thick and thin, she runs many different departments, but I think the most important thing about Brahana is she’s really the heart of The Rose.
If you have a patient that needs to get in, she’ll find a way. If you have a patient that needs to be navigated and is not sure what she needs to do, Brahana finds a way. Brahana is that way shower, make it happen, behind the scenes person who’s been at my side for the last 25 years.
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Brahana, thank you so much for being with us today. You know, you have such a reputation around here at The Rose, and you are our Center’s Director. It’s so much more than the Centers, because you’re also our HIPAA Compliance Officer, and you’re over the Patient Navigation Department.
Brahana: Correct.
Dorothy: But I think your claim to fame is that you’ve lived here for [00:02:00] 25 years.
Brahana: I’ve grown up here.
Dorothy: Yes, you’ve grown up here. So. One of the things, as I was thinking about, for your time with us, uh, and there’s only one other employee currently that’s any longer than you, and that’s me. Um, did you know about The Rose when you first applied?
Brahana: I had heard of The Rose, but I didn’t really know the story. Um, I came from three OBGYNs in Clearlake, and so of course we did referrals for women who were uninsured at that time.
Dorothy: So, and your background was always with physicians, healthcare, practice manager, yeah. What was your first job here?
Brahana: Office manager.
Dorothy: Okay. So you started there.
Brahana: Started office manager here at the Featherwood location only, and then grew from there.
Dorothy: What do you remember about those early days?
Brahana: It was easier, a lot less coordination, I guess, you know, we, we didn’t have as many, um, it seems like departments. You [00:03:00] know, there was one person who did one job and one person who did another job until we grew out to, you know, individual departments, but.
Dorothy: Right, and I, I was, uh, as I looked back at our history, you know, we, we were serving like 12,000, 15,000 women then, which sounded like a lot.
Brahana: Yeah.
Dorothy: At that time, but now we’ve doubled that, so, and added so many more services. Makes a difference.
Brahana: Yeah. That, that makes a huge difference.
Dorothy: Yeah. So what are some of your favorite memories about being here?
Brahana: Um, just watching the growth of The Roses and where you and Dr. Melillo have taken us and, and just the number of women that we’ve been able to help. You know, that’s just, it’s amazing.
Dorothy: So, in your role, especially as being the director over the patient navigation program. Explain to us what that is exactly.
Brahana: For patient navigation, for The Rose, we’re different. [00:04:00] Everything we do is different. Um, there’s navigators in the hospital systems like Memorial, and um, you know, Clear Lake, and the HCA’s.
But those, navigators are navigating within their own hospital system. We navigate from the outside in to the hospital system. So our navigators have to develop relationships with their navigators in the hospital systems so that we can get our patients referred in instead of within the system. So it’s a little bit different in, in.
Dorothy: And who are they referring in?
Brahana: Our uninsured patients.
Dorothy: Who are diagnosed?
Brahana: Who are diagnosed with breast cancer. Yes, ma’am.
Dorothy: Right. And that’s about how many a year now?
Brahana: It’s averaging to 250. Um, you know, we, we were seeing where it was half and half. Our total numbers were around, always around 400 the last two or three years. And we’re just seeing a slight shift where there’s more insured than our uninsured women right now.
Dorothy: And [00:05:00] it’s such a slight shift that we’re not even sure it’s going to hold.
Brahana: Right. Yeah. We saw it last year and then a little bit more this year. So, um.
Dorothy: So what does it mean to be uninsured and diagnosed with breast cancer?
Brahana: It means you’re not sure if you’re going to get help. You’re not sure if you’re going to get treatment. There’s, there’s only, there are only three ways to be helped. And now there’s, you know, the help is being limited based on what’s currently happening with, um.
Dorothy: Some of the systems.
Brahana: Some of the systems and, you know, politically, those kinds of things. So, you know, If they’re eligible, they can apply for the special Medicaid through Breast and Cervical, which is a program for the state. And or if they live in Harris County, they can apply for the Gold Card through Harris County.
Dorothy: So, it’s only public health or the state program.
Brahana: Correct.
Dorothy: But once they get in the state program, and that’s what your navigators do.
Brahana: Correct.
Dorothy: They [00:06:00] know. Which program to put them in, probably at the time of diagnosis?
Brahana: Uh, usually yes, because we’ve already, um, received the documents that we need and to get them in, in our internal programs. So they, they know what the qualifications are. So it’s, it’s an either an application for Harris Health or an application for, for the state.
So, um, and both usually take about two weeks for them to get approved. And then there, for the Medicaid, it’s HMO plans, Medicaid HMO plans. So not everyone takes them, not everyone’s on them. So it’s fairly limited to where our patients can go once they get approved for the Medicaid plan.
Dorothy: And of course we diagnose about a third of our uninsured diagnosed are coming from outside.
Brahana: Yes.
Dorothy: Harris County.
Brahana: Absolutely.
Dorothy: So that means that we have to rely on the state program.
Brahana: Yep.
Dorothy: And we have to be able to navigate them in whatever county they live in.
Brahana: Yes. Which is challenging because.
Dorothy: Yes. [00:07:00]
Brahana: Not every county has a countywide system. So, you know. They may either have to move, you know, or, or go back to their country of origin, you know, those type of things, which is, is really challenging for the families.
Dorothy: Right. And I always wanna emphasize that the country of, uh, origin might not be Mexico.
Brahana: Exactly.
Dorothy: It could be Nigeria, it could be China, it could be.
Brahana: Absolutely. And we’ve had some, you know, times had to come, come back to Africa. Yeah.
Dorothy: Where their family is.
Brahana: Absolutely.
Dorothy: Because they’re here by themselves and it’s a very hard time to be by yourself when you’re, when you’ve been diagnosed. Alright, so that’s one of the serious things you do, even though I think you get a lot of pleasure out of helping people.
Brahana: Oh, absolutely. Yeah. This job. allows me to help someone every single day. I can go home every day and say, I approved a payment plan or I approved a [00:08:00] sponsorship or, you know, I helped someone get in somewhere that they needed. And, and that’s why I, I’m still here.
Dorothy: But you know, it’s not just the uninsured that you make happen.
Brahana: True.
Dorothy: Because we have a lot of insured, but how many calls do you think you get a day that say, We’ve got this lady that is very concerned about this area in her breast and I know you’re booked.
Brahana: Yeah, two or three a day, probably. Um, sometimes not as often, but yeah, they’re, you know, because we’re not affiliated with the hospital system, our process is different and, you know, our, our qualifications are different.
So it’s easier sometimes to, to get into The Rose and, and navigate through your insurance than it is going through a hospital system. So, those are the kind of calls we get.
Dorothy: And the services that we provide include
Brahana: Screening all the way up to diagnosis. So screening mammogram, [00:09:00] abnormal mammogram, diagnostic mammogram, ultrasound, breast biopsies, which include ultrasound guided or stereotactic, and then access to MRI, genetic testing.
Dorothy: And that’s available to everyone.
Brahana: To all.
Dorothy: Yes. We don’t make a difference if you’re insured or uninsured.
Brahana: Absolutely. Our doctors, our radiologists, no one, no one knows. Yeah.
Dorothy: Uh, you’ve created a lot of programs since you’ve been here. And, and you’ve, you know, think about even the Shrimp Boil. You were always our number one prize getter.
Brahana: Yeah. Yeah, that was fun. I mean, I was, that was early on and that was one of my goals is to, you know, help raise as much money as we can. And, uh, one of the other programs is I was at a meeting with some of the community partners and one of them talked about, um, they just asked their patients for [00:10:00] donations.
And I thought, well, why not? I mean, we see them all, insured, uninsured, let’s ask. So our first year that we did that, we raised $50,000 between the front desk and mobile, just asking patients if they would like to help a woman who was uninsured and couldn’t afford to pay.
Dorothy: That’s a lot of money for us. And it’s continued all this time.
Brahana: Yeah, it has.
Dorothy: So, how are you instrumental in Bikers Against Breast Cancer?
Brahana: You know, first.
Dorothy: Are you a biker?
Brahana: No, I’ve not, not a biker, never been a biker. I’ve ridden.
Dorothy: But you were always in the middle of it.
Brahana: I rode twice. Um, it was my community of friends that, that were bikers that, that I had some. And so, um, and just being friends with, with the leader at the time was DeEtta.
So, just It was something fun and different. We went from golf tournament to, you know, bike rides. So that was trying to grow that and [00:11:00] with the bus, with Loco Bob and those kinds of things. So it was, that was a fun time.
Dorothy: And it was a decade of,
Brahana: yeah, 10 years.
Dorothy: Yes. And I think the last year was over a hundred thousand dollars.
Brahana: Yeah.
Dorothy: Yeah. Yeah. That was a very different kind of fundraiser. You know, that was probably the one I was the most uncomfortable with, because all that testosterone, and all those men, and they’re in all those weird costumes.
Brahana: And well, and to see Dr. Melillo on one, that’s when she started, so that was, that was kind of fun.
Dorothy: And what was the other one that you were involved in? It wasn’t something you started, but weren’t you there when Palmer?
Brahana: Oh, yes.
Dorothy: Tell us that.
Brahana: Pink Goat Society. I had never felt so proud to be in an audience to where The Rose was highlighted. So this young man, his stepmother was diagnosed with breast cancer. And so we helped her, diagnosed [00:12:00] her. And so he was in FFA, Future Farmers of America, in school, and he was raising a goat. And so at that time, there was no ceilings on how much money the students could raise. So he said he wanted to to donate, you know, his winnings to The Rose. And just in the, the audience, someone stood up and said, I’ll give $5,000.
And another one stood up and said, I’ll give $5,000. And just to, it went up to $50,000. And just to see that in the community was, was very special.
Dorothy: Yes, it even went higher than that. That because once someone matched one of the big, big bits. Yes. And that’s was, his college fund.
Brahana: Yeah.
Dorothy: You know, that’s what always amazed me. This was not a wealthy, no, family or anything. And for him to give all of that to us was just amazing.
Brahana: It was, it was.
Dorothy: I always say you were there when the men were [00:13:00] crying and holding on to each other and they couldn’t believe it raised so much money.
Brahana: Yep. It was, it was, it was, it was amazing. I mean, like I said, just to see the community come together and, and, um, At the rodeo. Support him at the rodeo, yeah.
Dorothy: At the Pasadena Road Livestock Show and rodeo, yeah.
Brahana: And I was a volunteer. I had been a volunteer at the rodeo. So, I knew a lot of people in the room. And a lot of the companies, you know, the owners in, in that, in Pasadena area. So, I knew a lot of the people, so it was, it was, just great to see.
Dorothy: Were you born in this area?
Brahana: No. Born in Bay City. Ah. And then we moved to Houston.
Dorothy: Yeah. So you certainly knew the area.
Brahana: Yes.
Dorothy: You were always a community volunteer.
Brahana: Yes.
Dorothy: So, what through all this time has frustrated you most about our healthcare system for women?
Brahana: Um, that it’s not equal.
Dorothy: How is that?
Brahana: If you’ve got insurance, [00:14:00] you know, you have more access. If you don’t have it. It doesn’t matter what nationality you are. If you can’t afford to have insurance, then you may or may not receive care. And if you do receive it, it may not be at the same level as if you had insurance. So, but that’s not the, that’s not how it is at The Rose. Regardless, you, you get our top notch care.
Dorothy: But that’s an important distinction because many, many women would not take advantage of things like breast reconstruction. They could not take off work.
Brahana: Exactly.
Dorothy: Even though it was something that was offered through the state program, not always, but once it was, I was just amazed that, and I, and if you remember in those early years, so many women chose to have a mastectomy when they could have had a lumpectomy because 12 weeks of radiation was just out of reach. They, they couldn’t be off. Yeah. That’s what always bothered me so [00:15:00] much. You know, even though we had plans and ways of getting them into that same care, do you remember the times when they could not get the nausea medicine?
Brahana: Yes. Well, and they couldn’t have more than three prescriptions.
Dorothy: Right. I know your navigators found a way around that one.
Brahana: Yeah, we had to go.
Dorothy: I don’t even know if I want to know how.
Brahana: Well, we had to go straight to the pharmaceutical companies, you know, for, for help with that. But yeah, that was, that was challenging.
Dorothy: So speaking of all the things that you were involved in that I didn’t know about.
Brahana: Yeah.
Dorothy: Do you remember the woman under the bridge?
Brahana: Yes. That one just. Something I just couldn’t let go. She was homeless. And, um, her and her husband were living in a tent behind a strip center in Umble. And it was when it was freezing, freezing [00:16:00] cold when we, you know, we had to shut down and stuff. So we got blankets.
We didn’t even think about it. Now that I think about it, I’m thinking, oh, we probably shouldn’t have done that by ourselves. Probably should have brought someone with us. But we loaded up the Jeep and, you know, just went to find her and, you know, it was, it She was so thankful and it was just, it was, it was just hard to know somebody was out there that, you know, we had to do something. So,
Dorothy: and she needed a phone because we were trying to.
Brahana: We’re trying to help her get into treatment, trying to get her appointment set up. She had a cell phone. The gas station would let her come in and charge. Only one of the attendants. If someone else was working, they wouldn’t allow. So, um, I bought her a, uh, solar charger so she could set it out in the sun, and then she could plug her phone in and charge so we could, we could reach her. So, yeah. You just never know.
Dorothy: You know, I always think, [00:17:00] even like during our holiday party for the sponsored women, and we call her, we call our uninsured women “Sponsored” because someone has to sponsor their services.
Brahana: Right. Someone paid for it.
Dorothy: I don’t think we’ve ever used “charity care” or we’ve never used integen because that doesn’t describe our patients at all. But there are so any needs that they have that we can’t imagine.
Brahana: That’s what so special about our navigators, is they educate themselves, you know, they’re frequent callers, or involved with the 211 to know what services are out there available for our patients that need help. You know, with rent or paying bills or whatever. You know, they don’t know everything, but they’re well versed in whats out there available for our patients that need it.
Dorothy: And speak spanish.
Brahana: Speak Spanish.
Dorothy: Which helps.
Brahana: Absolutely.
Dorothy: You have an awful lot of women who, Spanish is their first [00:18:00] language, so it’s just easier when you understand it. The other thing the navigators do is they’re right there when the lady’s being told she, she does have breast cancer.
Brahana: At the time of diagnosis, which our radiologist will, you know, we don’t make the phone call. We actually have the patient come in and they can bring someone with them or not. But our navigator is there from the beginning when they find out and then they determine at that time, okay, is she ready to move on and try to make, apply for whatever program she’s going to be available, or does she need time?
Does she need to soak this in? Does she need to think about this? Go home, get with her family, get her support system, and then come back. So they’re, they’re able to, to, to, you know, kind of judge what’s the best thing for the patient at that time.
Dorothy: I remember one of our patients saying the, the moment you hear your name and the word breast cancer in the same sentence everything else shuts down.
Brahana: Yeah, they don’t [00:19:00] hear anything else.
Dorothy: You can’t, you can’t think, you can’t. Even, you don’t even know what to ask or, you know, what it is that you’re going to be needing. So I think it’s so important that our navigators understand that and, and are going to be following them up.
Brahana: Yeah.
Dorothy: They know they have a friend there.
Brahana: Absolutely. Yeah.
Dorothy: I’ve often thought we need that same program for insured women.
Brahana: Yeah, I mean, we, we’ve helped a few. There’s especially some on Medicare. They, they may or may not have a PCP because it’s not required. So they will ask, you know, well, where do I go? What do you, who do you recommend? Can you help me get a referral? So we can certainly help them, you know, get the referral if, if need be. But yeah, we’d love to expand it.
Dorothy: So I asked several people, what would they ask you? And they all wanted to know, How did working at The Rose impact you personally? [00:20:00]
Brahana: Again, it’s, it’s helping, you know, it, it, it’s not what I started out. It’s the reason I started out, but once you get here and you get bitten by the bug, you know, of being, of being able to help someone, that’s, that’s why, I mean, that’s why I’m here.
Dorothy: But how did that change you?
Brahana: How did it change me? Oh, um, I came from corporate, so. Everything’s by the book. There’s, you know, if there’s a rule, you got to follow the rule. Sometimes rules, they just don’t fit. And so you have to do whatever you can do to make it happen. So I’ve become much more flexible as far as, um, those kinds of things and just passionate about helping. That, that’s what changed me.
Dorothy: But, your mother told us, do you remember that time when she said, Brahana hates doctors? And I was going, oh my gosh, how could she be in this role if she hates doctors? She’s got to work with [00:21:00] referring doctors? She’s got to work with radiologists?
Brahana: When I was younger, uh, I remember vividly getting sick, going to the doctor, and you know, she always had me in cute little dresses, and so he tried to lift the dress up to put the stethoscope Scope on me, and that was it. That, no, no, no, you know, just, and, and. Being older, I had to go to the doctor. Dad came with me, uh, drew blood, passed out at the, you know, just riding the thing. Just deathly afraid of needles, scared of doctors, but yeah. But here I am.
Dorothy: Here you are.
Brahana: Our doctors are the best. So there, you know, there’s, there’s no fear here.
Dorothy: Okay. So another question that they wanted me to ask you was, How have I changed?
Brahana: Oh, are you kidding? We don’t have to wear pantyhose. That’s one of the first things I remember is like, Oh, I don’t even own panties. I’m gonna have to go buy some, you know? So back then [00:22:00] we, we, you know, if your legs were showing, we, we had to wear pantyhose, but you have, I don’t want to use the word softened cause you were always soft, but I would say you’re more flexible as well too.
You’re, I guess not as rigid with with the, I guess, all the causes for women, because you were very, very vocal in the beginning of, of how you felt, you know, that kind of thing. So I don’t know if it’s, if, I just don’t hear it as much from you, but no matter what the topic was about, for women, you were equal rights and, you know, just very, very vocal about it.
Dorothy: Yeah. Sometimes you, you have to know what battles to take.
Brahana: Exactly. Yeah.
Dorothy: Yeah. And, and that’s something, especially trying to deal with women’s health in Texas has been very challenging.
Brahana: Well, and, and trying to let go. You know, you’ve had to let go of not being involved in every single thing every day. And I know that’s a challenge for you because The Rose is your baby, but [00:23:00] you, you still, you still keep connected, but, but not the day to day every day.
Dorothy: That’s true. Cause I have a great team, great people.
Brahana: That’s right.
Dorothy: So what, what would you say was your saddest time here, or the most difficult to get through?
Brahana: For me, personally, it was COVID. You know, The Rose shut down, and then, uh, for about a month, and then when we came back, um, it was myself and Patricia Stapleton, which was our, is our, uh, imaging manager here at Featherwood.
And it was she and I, and there was one other person at the front desk and one tech. And so the halls were empty, you know, it was, it was just a really sad time not to have all of our support team, you know, here to be able to, you know, to, to see them every day and, and do what we were doing. That was probably the saddest for me.
Dorothy: So yesterday when we were, [00:24:00] we were roasting.
Brahana: Roasting. Yes.
Dorothy: Sort of, during one of our meetings, I, the, the thing that kept coming up about you was how much you cared for your team, for your staff.
Brahana: Yeah. It’s real important to connect with them. And you may not always want to get involved, but. I often say, I don’t know how some of our employees get up and come to work every day with the challenges that they’re dealing with personally, but we help them. We’re here, you know, where we understand and we listen and we care. So it makes a big difference.
Dorothy: Inside and out.
Brahana: Yeah. Yeah.
Dorothy: Alright, any last words of advice to those that are listening? Don’t get in a non profit.
Brahana: No, no. Just take care of yourself. Don’t forget you matter. And you need to take care of yourself to be able to be there for others.
Dorothy: Good advice. Thank you, Brahana, so much for [00:25:00] joining us. I know this was a little difficult, but I appreciate you being in that seat.
Brahana: Thank you for asking.
Post-Credits: Thank you for joining us today on Let’s Talk About Your Breasts. This podcast is produced by Speke Podcasting and brought to you by The Rose. Visit therose.org to learn more about our organization. Subscribe to our podcast. Share episodes with friends, and join the conversation on social media using #LetsTalkAboutYourBreasts. We welcome your feedback and suggestions. Consider supporting The Rose. Your gift can make the difference to a person in need. And remember, self care is not selfish. It’s essential.
