The Doctor Who’s Fighting to Get Service Industry Workers Access to Breast Healthcare

Dorothy: [00:00:00] Female restaurant workers are the last to go to the doctor or to have annual mammograms. For them, it isn’t just about not having health insurance, but it’s also because they don’t control their schedule. They can’t just take off and go have an appointment. These are the people that take the best care of you, but they are least likely to take care of themselves.

Here’s what one woman did to change that.

Let’s Talk About Your Breast. A different kind of podcast presented to you by The Rose, the Breast Center of Excellence and a Texas treasure. You’re going to hear a frank discussion about tough topics, and you’re gonna learn why knowing about your breast could save your life. Join us as we hear another story and we answer those tough questions that you may have.

Hi, I am Dorothy Gibbons, and I’m the CEO and Co-founder of The [00:01:00] Rose Breast Imaging Center. And today with us is Dr. Lori Choi. And she is, uh, one of these women that you, you really are so surprised at all the things that she’s been able to accomplish. You were, you are first a vascular surgeon, and that’s a pretty hard field to be in.

Uh, you, you were a Duke grad, you did some of your training here in Houston at Baylor. You won the, uh, Young Investigators Award while you were working in Dr. Oz’s laboratory. I mean, wow.

Lori: That was a lifetime ago, Dorothy.

Dorothy: No, no, but it all, it all fits into the different things that you’ve done, and that passion you’ve had, I think the most, one of the most interesting things to me in the time that I’ve known you is, you know, you do medicine very different.

You, you don’t, and you’re not affiliated with any one institution. [00:02:00] You actually, what we used to call locum tenens or part time.

Lori: Yes, that’s right. Yes.

Dorothy: And that’s incredible. But the most important part of your story that I want to, I want to hear about is your background, your upbringing.

Lori: Okay, well, I’m, as, as you know, I got to know you through the nonprofit I’ll Have What She’s Having, which I co- founded in 2017.

And so the path to that, I think very much stems from where I grew up, which was in Appalachia in Western North Carolina. My dad was the town surgeon. And, uh, he was the doctor who did everything. He did the high school physicals, he did, he delivered babies, he did breast surgery, he did gallbladders, he set broken bones.

And the impact of one person on a community, uh, was very much, uh, imprinted on my mind. One person can make a huge difference, [00:03:00] uh, for one community. And I think that’s what led to my, the way I practice medicine now, because I studied at great institutions and trained here at Baylor, which is a, a huge contributor to cardiovascular medicine for the entire world, trauma surgery as well.

And I got that training here. And then began working in great academic institutions. I was at UTMB in Galveston, which then felt a little bit small, so I moved to Cleveland so I could work at the Cleveland Clinic. And that is, at the time, was certainly considered the, the greatest vascular surgery division in the country.

And while there, something just still wasn’t satisfying to me. And I think it was that I felt that there were so many barriers between a person in that community and the care, the, the state of the art care, the cutting edge care that was present at the Cleveland Clinic. [00:04:00] And, and somehow it just wasn’t satisfying to me.

I wanted to be able to be more easily in contact with people who needed that care. Um, and also, you know, my husband was still here in Houston and we talked about different ways that I could practice vascular surgery and find a job that would check all those boxes and still allow me to see him. And, at that time, It seemed impossible, but the truth is that there’s a growing need for specialists and physicians all over the country in all these rural areas.

There’s a huge division of resources between urban and rural, or wealthy and non wealthy communities, and it’s amazing to me the, the wealth of resources that we have here. And cities like Houston, Cleveland, New York City, or even our secondary cities like Pittsburgh and Cleveland. So. Uh, now I am contacted by agencies that need physicians and I’ll [00:05:00] pick and choose the assignments and I choose to stick to rural areas that are, that have a shortage of physicians and do long term, part time assignments.

So I’m currently working in West Virginia. I’ve worked there for almost a year now and it’s my second time I’ve worked for this particular hospital and with this particular surgeon. So it’s, uh. It’s not easy to make all those things happen. It’s not easy to find a part time position with a practice and a group of physicians that you really respect, but I’m just in that position now so I can do that full time.

Giving 110 percent for a limited amount of time and then I leave and get rejuvenated by doing the non profit work and then go back. The truth is, in my experience, vascular surgery is a 28 day a month job and usually long, 12 to 16 hour days. And I [00:06:00] have mentors who are able to sustain that kind of schedule.

But the truth is that I’m, I’m, I’m just going to be honest, I can’t. I’m really prone to burnout when I work that kind of schedule.

Dorothy: Oh, yeah, it sounds like anyone would be.

Lori: It sounds like it, but there are, there are some really great people I’ve worked with in my life who are not. And I think for me, part of it is when I’m doing the same thing over and over, I’ll feel like I’m just on a hamster wheel.

And in some ways it’s good for me to be In the operating room, in a clinic, and then in the public health world trying to fix the infrastructure of medicine as well as help that one individual who’s right in front of me. And I think you’re in a similar situation, right? You help individuals with their breast care.

But you are also an important part of trying to improve access to breast health care and trying, you would do anything to get people better access to care. I think that working on those two sides. I think it’s the right balance for me.

Dorothy: And you’re so right that rural communities, they just [00:07:00] don’t have the resources.

We, so many things we take for granted, you’re just not going to find them in, in those rural communities. We, we see that as we take our mobile, uh, coaches out and to Southeast Texas and to East Texas. It’s just very different. I don’t think I ever appreciated how Easy it is to, uh, think we know everything there is about poverty, or about, uh, medically underserved folks, or Because we were here in Houston, you can walk through a neighborhood and you can kind of tell, that’s, that’s a low income neighborhood. But in the rural communities, that poverty is behind the gate. And you may not always know just how tough it is for the people that are living there. I just, I’ve just learned so much since we’ve been going to this, to the rural communities. So you founded I’ll Have What She’s [00:08:00] Having in 2017?

Lori: Yes.

Dorothy: And first, I want to know, how did you get that title? I mean, who came up with this?

Lori: That was definitely me, and the, and the, it’s a bit, it’s a bit of a long roundabout story, but at this time, um, you know, I’m married to a chef, and, and, and people, you might think you know what that’s like in your wildest dreams, like maybe she eats, Great food all the time and I mean the truth is I mean that is true That’s exactly the way my life is married to a chef and I would eat something at home and I think oh my gosh This is so good.

You have to put this on a menu somewhere and It just occurred to me like, you know, what you should have as a menu item that’s called I’ll Have What She’s Having and it’ll be the things that you’ve Tried out on us at home and I’m like, “yes That’s a hundred percent has to be had by everyone in the world because it’s so good” and he promptly nixed that idea but in the meantime, you know, I was thinking about how [00:09:00] You know health care and the way we treat our women and the way we treat our children Well how we treat the most vulnerable people in our society a great society will hold those vulnerable individuals up and treat them incredibly well.

And, um, at that time, what we were seeing in women’s health, um, was pretty shocking, although not quite on other people’s radars. Uh, so when we started the non profit, we said what we really want to do is create a world in which what the women are experiencing and what the women have is the envy of every citizen in the world.

So let’s name it in, uh, for what we want to see. That what we have is the best and not something second rate or, um, or truly, uh, devastation to human rights or something like that. So that’s how we got started. And of course, it references a really fun moment in cinema history.

Dorothy: Yes, yes. And it is, it’s really very profound.

[00:10:00] I’ll Have What She’s Having. You know, when I look at our insured and our uninsured populations, there is a big difference.

Lori: Yes.

Dorothy: And the uninsured population never expects to have. The same kind of care or the same kind of treatment. It’s, uh, like you said, it’s sad. It’s more than sad. It’s criminal sometimes.

Lori: Yes, and then we also, when you look at an uninsured population, a younger one, let’s say, young men, young women, adolescent age, the truth is that a man can skip healthcare for many, many years. And there, there really won’t be any untoward effects. But you and I both know a woman cannot do that, right? Um, she has to see a physician or a healthcare provider to get reproductive healthcare.

She needs to have regular screenings to evaluate for GYN cancers, most of which would be asymptomatic. And you and I have talked about this. You’re seeing breast cancer in younger and younger people. And one of the ways that that will be detected will be by a healthcare professional. So if we don’t have our young women in [00:11:00] front of healthcare professionals, they’re gonna, they’re gonna die of things that they shouldn’t die from.

Dorothy: That’s so true. Very true. So now, tell me about the organization. How, how does it work? It’s, it’s really geared for that restaurant worker?

Lori: It is. That’s right. But when we got started and we were trying to talk about all the inequities in women’s, when women’s health care, we wanted, uh, and that really came to me from the restaurant women themselves.

I mean, part of what we try to do is advocate for women in the food and beverage industry. They’re generally working in a male dominated field, or in the front of the house as waiters and bartenders. They’re in a tipped economy, which puts them at something of a disadvantage as well. Uh, so, when we asked those, we were trying to, uh, Generate a buzz and me attention towards the talented women and by doing pop up events and it was their decision to start to raise money with those events and when I asked them what they wanted to raise money for it really was to [00:12:00] direct attention about the inequities in women’s health care and then later as we got started one of our founding members who was a very talented baker named Karen Mann she said to me “Lori how does it make sense that we are having women who work full time or time and a half volunteer to put on these events to raise money for women and their health care when we ourselves are not healthy?”

And that was truly a light bulb moment for me and I started looking at our volunteers themselves, our participants, our members, in saying, who’s insured? Who’s actually healthy? What are the things that we’re doing that aren’t healthy? And, and that’s really how it’s directed, because they are just a snapshot of many working women.

They’re balancing a lot of different responsibilities. They don’t have access to, uh, healthcare because they’re not insured. Um, they face all the same barriers, social barriers, time barriers that, um, many, many women face in terms of trying to get their health care. So we’re using, [00:13:00] they’re, they’re willing to step forward and say, I am that face of the uninsured working woman, and these are my concerns.

These are the, the, my priorities. And so it’s just sort of grown hand in hand while we’ve been able to do the pop ups to do that media buzz and generate media attention for these talented individuals We’ve also been able to raise some funds and direct attention towards these incredible inequities in the health care system.

Dorothy: And that those funds have meant so much.

I mean you’re over a million dollars now, aren’t you and—

Lori: We’re close. Yeah, we’re close.

Dorothy: Yeah. And I know that you’ve Uh, made it possible for many of the women who are uninsured to have well woman exams and mammograms and of course that’s, that is the two basics of any woman’s real health care, you know, we’ve got to have those.

I am so, um, concerned about our state’s approach to women and especially [00:14:00] about the uninsured woman. You know, there is nothing out there. We have, we have one program in the state that will assist with breast and cervical cancer. But don’t even think about getting help if you have ovarian or lung cancer or any of the other kinds of cancers.

Lori: Yes, that’s right.

Dorothy: That’s just horrible.

Lori: It’s very piecemeal. The state has some programs which will assist lower income women to getting health care. For example, the Healthy Texas Women Plan covers your well woman exam, will cover contraception. But one of the physician volunteers that we have, we call them the physician advisory crew, we talked about this program.

She, Dr. Codi Wiener, works at Texas Children’s Hospital. In their women’s health division, she described to me that women would come in to her, and if they had another problem, for example, a urinary tract infection, there was no money for the antibiotics for that person. [00:15:00] If the person was really pale and was describing like, constant or frequent bleeding, uh, and obviously might need a blood transfusion.

There was no money to actually check what her red blood cell level was. Um, there was no money to do an ultrasound to see if there was a problem. So we would, it’s very piecemeal for the healthy Texas women. It’s, it’s only for family planning, nothing outside of that. And for a physician like Dr. Wiener. What we saw was she, as a trained physician, knew exactly what needed to be done. She had all the tools that needed to be done. But there were no funds to allow her to do the work. Uh, and, and in some cases your institution won’t, can’t support that, that level of care. Because they’re not built for it. So she would be trying to refer the person to a Ben Taub, the Harris County System, um, one of the community health clinics or Um, or a Planned Parenthood, and as you know, a busy woman is not going to want to go to [00:16:00] another doctor just to, to because of her monetary status.

She’s just going to not go, most likely.

Dorothy: That’s true.

Lori: So, um, and people don’t understand that, how busy these people are. They’re working. They have family responsibilities. They don’t have time to go shopping around at, you know, five different places to get their health care. So, what we, we did for Dr. Wiener was, we raised and created a small fund for her to use in that exact situation.

Just when she knew exactly what needed to be done, she would be able to provide that care. So it’s not a lot of money, but it’s just enough to help several women who were in that uninsured situation.

Dorothy: My goodness, if you can’t buy antibiotics, or if you’re, that, that’s just It’s awful.

Lori: And, and our community health clinics, for example, Legacy, Hope Clinic, um, they’re all excellent as well, but there’s all, they’re all at capacity.

Dorothy: All. Every one of them.

Lori: And so, we [00:17:00] need to be able to expand the primary care capabilities of, uh, and access for these, for our women as much as we can.

Dorothy: So what a dilemma for the doctor trying to give care.

Lori: Yes, that’s right. And that is only gotten worse since Roe reversal to be honest with you I was became a member of the Houston Women’s Commission Which was created by the mayor in the City Council in 2021 to advise them on issues of gender equality and after Roe reversal Well, actually since SB8 (Senate Bill 8) I’ve been talking to Physicians in our major medical centers and in our community health clinics around the around the county About the effects of these laws and it’s truly impacting their ability to act in the patient’s best interest To be able to perform the standard of care and that is a new a new thing since September 1st of last year, really.

It was always difficult It’s always been incredibly difficult, I believe, for those who work in the women’s health realm. But it’s [00:18:00] now, I believe that they are at times in a moral quandary because they know exactly what needs to be done. And the, the law is preventing them from doing it. Because it would put their own practice or even the hospital at risk, they believe, um, for, for legal action.

Dorothy: And with good, good reason to believe that my goodness.

Lori: Yeah, it’s very very confusing out there right now And I think that my heart goes out to every physician who’s working in that realm because I know it’s not easy I know that to be To know what you want to provide state of the art science based medical care and to be prevented from doing that by A thoughtless law, I think, and some people who probably have some very good intentions in terms of what they think is right and wrong, they’re having some really devastating impact not only on individuals and their families, um, but also [00:19:00] on our, on medicine, on, on, uh, how we prioritize science, um, how we, how we.

Practice in the one of the greatest medical centers in the world and that impact is Not going to be easily erased. It can’t be easily reversed I think that a lot of people would hesitate to move to Texas to do whatever job they have simply because their spouse their teenage children could all be impacted by by these things

Dorothy: Absolutely.

I would be very discouraging for anyone even considering going into medicine if they really saw what was going to happen.

Lori: Yes.

Dorothy: Through their practice. There was a time when we used to say the insurance companies control medicine. And now it’s, it’s a whole different ball game with a lot of consequences that just don’t make any sense at all.

Lori: No, I, I think that you and I would [00:20:00] agree that you’ve never had to consider consulting a lawyer before. having someone get a test or a procedure here. And that’s certainly never been the case for me as well. It’s always, I’ve always been able to step back, think, now what is the best thing for this person?

What’s the best thing for this patient? And even if, uh, in the back of your mind, you’re thinking some medical legal circumstance, you always know what the right thing is to do, and I’ve never been prevented from doing it. And I think that to, I’m not sure that I have the, the, what is it, the moral, the strength to continue to practice if I was constantly being asked to compromise the standard of care.

Dorothy: Wow, what a great example. Have to consult. Attorney before you can practice.

Lori: Yes, that is just I know that I mean I’ve spoken to some people who are in charge of training the next generation of maternal fetal medical [00:21:00] Physicians specialists and these are people who deal with high risk pregnancies. They have a real calling To want to do that kind of work Then they’re having trouble recruiting for those training positions now because of this law.

Dorothy: And we already have a problem with primary care, period.

Lori: Yes.

Dorothy: Having enough of those doctors in Texas. So, let’s go back for just a minute to that Texas Healthy Women. It does have some benefits, but it stops at age 44. It is like Our health stops at age 44. What about all the, you know, primarily that we care for are in their 50s. And again, they are not, they won’t qualify for family planning.

They, you know, even if we had another bucket of funds to draw from, there’s just nothing out there. The only way you can get on Medicaid in Texas is if you’re pregnant, just had the child; make less than $4,000 a year; are [00:22:00] disabled. I mean, this is it. They do have the children’s Medicaid, but it does not, there’s nothing for adults even, especially for women, who are the caregivers, most of the time, in their families.

You know, you mentioned that, what you see with the role of women in that caregiver spot. So, share that with us a little bit.

Lori: Well, I’ve always thought of women, um, as parents, moms, but I’m also realizing now, uh, because I primarily deal with an elderly patient population. And if I walk in the room and there’s no one there sitting there but this little old man or this little old lady, then my heart will sink a little bit.

But when you walk in and you see A sister, a daughter, an aunt, any, any woman. It really is just um, it’s this moment where I just know everything is probably going to be fine. Because there’s a caring family member there and it’s a woman who’s going to, this is a huge [00:23:00] stereotype, but they’re, they’re there to take notes.

They’re there to ask these questions and then they’re going to disseminate that information to this clan of other people who are there to support that patient. But um, I realize more and more that, when, when the conversations with those patients kids that the women are, are taking care of their children and they’re taking care of their work families and they’re taking care of their parents or their elderly aunts and they are, that, that “sandwich generation” is just applying, just, it’s, it’s going to apply to all of us.

So um, I think that we don’t appreciate how challenging it is to, to juggle all of those things. And the women consistently will put their own health on the back burner. Um, and, and you’ve seen this as well in the pandemic, women put their health on the back burner in part because we were told we really need to put that off for now because of the pandemic.

But you don’t, women [00:24:00] don’t need an excuse to put their health on the back burner, you know, and so I know I’ve spoken to a lot of my friends who are breast surgeons and they’re seeing far more advanced disease.

Dorothy: Yes.

Lori: You know, everyone who’s in medicine told me that in every specialty, vascular, heart, Cancer care.

Everyone that they’re meeting and seeing, the diseases are way more advanced. As if we were living in a community that doesn’t have health resources. And I think it’s partly because people put off that care, but it’s also just the stress of our times is, is making the diseases worse.

Dorothy: And draw in access to care, and for sure they’re not going to be able to keep up with the regular things.

Lori: Yes.

Dorothy: The, the, um, how does someone access I’ll Have What She’s Having? How, how do they find help with you?

Lori: So we, our website is IllHaveWhatShesHaving.org and any restaurant worker in the [00:25:00] area can access care through us. The, they’ll click on, um, healthcare sign up and they can sign up for preventive medical care at one of the community clinics.

Uh, mental health care, which we do in partnership with a group called Ethos Wellness. And for a mammogram with you, state of the art, 3D at The Rose, um, which is something that we’re really, really proud to be able to offer. I know that there are other breast imaging centers that we could partner with in the area, but the reason why we choose to work with The Rose is because they hands down have the best patient navigators uh, of any system I’ve ever seen in my life. And it’s, we’ve already talked about how many hoops and hurdles a person has to overcome in order to get care. It’s, it’s even crazier in, in breast care. And your navigators do such a great job. I just think that, I’ve thought this since I [00:26:00] was a kid, when you’re ill is no time to have to, to figure all that stuff out.

You know, when you get, when your car breaks down, you have to figure out what you’re going to do. If you’re, if you get in a car accident, you have to figure out all these things. And it’s stressful, but if it’s your own body and, and the stress of worrying about what’s going to happen, having to navigate that system would really be overwhelming for some, for so many people.

And to know that if we refer someone for a mammogram with The Rose, if they find that they need further testing, if they find that they have a diagnosis of breast cancer, to know that your team would help navigate them through all of that is, is just, it’s everything.

Dorothy: So, you’re so, so right about that need for a navigator.

I’ve said for many years, it doesn’t matter what disease. It doesn’t matter what health question. We need somewhere to go. And that’s the other part about access to care. [00:27:00] Many times that uninsured woman has no idea where to go. And to ask for help is just hard. You know, if you’ve, if you’ve worked all your life and Always carried it on then to have to go somewhere and ask for help, it’s just really difficult. I can’t tell you how many women come to us and pay cash in the beginning not gonna ask, you know No matter what. And then when we get to the biopsy, they can’t afford that. And suddenly we’re asking them, alright, let’s hear more about where are you in your financial uh, status and lo and behold, she qualifies and could have qualified from the beginning.

I, I think that’s just inherent in a lot of women. You know, we’re used to just getting through, making it happen. I will never forget what you said during COVID, how women were really taking it on the chin. I just thought, Oh, that’s so true. The home care for the kids, the [00:28:00] parents care, and all the things that I heard my friends talking about.

And, you know, not being able to be with your loved ones when they’re that ill. It was just, it was terrible.

Lori: Yes, that’s right. There’s, now that we’re, we seem to be past the worst of it. It’s really, it’s, it’s mind boggling to know that, that what women overcame during that time. Because just the traditional structure of homes, the burden of all of that homeschooling and, and child watching for hours that they didn’t have to before and oftentimes trying to keep another job at the same time.

But really the whole thing just got dumped in their laps, right? You may have a job, if you had a restaurant job and you needed to go to that restaurant job. Um, there was, there was no answer for, for those people. You have to educate your kids, but you have a job and you can’t do both. And what are you going to do?

It was just, there really wasn’t [00:29:00] a solution for people.

Dorothy: And the restaurant and the retail business was most hit with places closing down or, you know, cutting back on, on their hours or whatever that, that was a. That was the other part they were having to carry.

Lori: Yeah, so the restaurant industry and the pandemic in Houston is an interesting thing because they There were many jobs, many restaurants who, that lost occupancy and so there were fewer jobs, but many were very, very busy.

But there was an added stress, even going back to work, because if you can remember back at the beginning, we felt this was an incredibly infectious disease. We weren’t, we thought we could catch it from surfaces and, and people who had never faced, uh, disease in this way, so quickly. We’re now walking into, and we really didn’t know, so we were putting them in a, in sort of an unknown situation by, by, by asking them to go back to [00:30:00] work.

Dorothy: Oh, yes.

Lori: So there were people who couldn’t, couldn’t work, um, Because their jobs were gone, but there were others who would have preferred not to work because of the fear of getting sick Because they had to go home to elderly parents or they had, you know, small Immunocompromised people in the home. So it was it was hard on them completely, but I do think that a lot of them felt That we put them in danger or that they were placed in danger in order to keep working.

And, um, and there’s stress from that. I think it’s part of the worker shortage now is that a lot of people are, are not able to do, to work in the way that they were before, simply because they’re exhausted from the pandemic. And I know that we don’t have a lot of, there are some people out there who don’t have sympathy for that, but it’s the fact of the matter is we’re facing a worker shortage now and Uh, I think that the worker shortage and row reversal presents the industry with a unique opportunity to improve itself.

[00:31:00] To say, we don’t think that we’ve done a really good job before. But let’s look at where we are weak and, and try to do better. And so I think that the fact that I’ll Have What She’s Having talks about lack of healthcare access, lack of healthcare awareness, uh, in the industry is a moment that I think that everyone could take advantage of.

Um, so we want to improve the healthcare awareness of every restaurant worker, some of whom are very young and they don’t think about these things, but the pandemic showed us that none of us are invulnerable. And there’s almost certainly going to be another one at some point.

Dorothy: Yes, and it’s so, it’s so refreshing to hear that something good may have come out of this or could come out of all these last two years.

That’s, that’s really interesting how we could take that and make it different. Uh, so, Lori, if you hadn’t become a physician, what field would you have been gone into?

Lori: When I was an undergraduate, I was in political [00:32:00] science, and so I think I was going to be in public policy.

Dorothy: I think you are in public policy.

I mean, you’re willing to talk about it.

Lori: So I think that this amount of public policy is all that I could handle, though. The truth is that, from what I’ve seen, I don’t think I would be a very good politician. I don’t think I have the patience for that. Um, I don’t, I mean more of a mindset of a surgeon, which is, there’s a problem, let’s fix it now.

Let’s fix it right now. You know, and then let’s move on. Not, let’s talk about it. Let’s compromise, let’s go with a lump.

Dorothy: Debate it, yes.

Lori: You know, it’s even in medicine there’s um, there’s people who are drawn to different specialties and people who are in medical fields are generally willing to try therapy, give it a couple weeks, a month, and then, and then revisit and I think that people who are drawn to surgery are, don’t have that kind of patience.

Dorothy: Right. But there, do you believe there are things we can do with public policy, with our government?

Lori: Oh, I do. [00:33:00] I do. And I mean, it really comes down to we have to have elected officials who prioritize the things which are important to us. And I just believe more and more that the current state of the healthcare system is not serving the people who are paying into it and the people who cannot afford to pay into it. It’s not serving us. So, just like education, the healthcare of the citizenry just has to be a priority. I don’t believe that we. There can be profit made in medicine, but that can’t be the end goal. The end goal needs to be a more healthy citizenry, which will just be people who can continue to work, prosper, and, and the society benefits, just like the society benefits from having a more educated population.

We don’t look for profit in having more literacy. We just know that a more literate population just increases the productivity of a society and the quality of life of the [00:34:00] society. So I think that those are things that we just have to prioritize. We choose to prioritize them. You know, and, um, I haven’t been a Texan for as long as many people.

We got here in 2003. But the state has always been very business friendly by lowering the costs of, uh, public works, you know, and, and, and things like that. But the truth is that we’re all suffering now from the long term repercussions of that. The infrastructure doesn’t have a lot of public transportation, so we have more cars and we have more roads and all those things need maintenance, which we don’t take care of.

And so. Um, and our water quality and our air quality, all those things are suffering and then there are long term effects of those things. So I think that we have to have, uh, in public policy a commitment to improve our, um, the health of everyone, not just the people who can afford to pay into a health insurance system.

Dorothy: Right. Right. Um. That’s exciting if we could do that. If, you know, healthcare would be turned on upside [00:35:00] down, it would be so different. You didn’t have to worry about all that. Now, you are, uh, the daughter of immigrants?

Lori: Yes.

Dorothy: And you must see a lot of cultural differences in the work you do. Do you think that cultural ideas, attitudes, differences, impact, even having women’s health.

Do you ever see that?

Lori: I think that every, many, many cultures don’t want to talk publicly about health. That is certainly true.

Dorothy: Health in general.

Lori: Health in general. You know, we don’t want to talk about We don’t want to acknowledge that we’re ill. We don’t want to acknowledge mental illness. There’s many, many cultures which are like that.

Um, I think that we have to be sensitive to those things. I think that really successful medical practices are aware [00:36:00] of those barriers and help people achieve them. But, usually, for example, the Cleveland Clinic, I would meet people from the Middle East, and once we were alone, You know, all of those barriers would often come down, and they could talk freely, um, about their, what they were worried about, what they were concerned about.

But there are a lot of, I think the more we’re aware of the different cultures, and how they are going to react to diagnoses or need for treatment. It’s very, very important, um, because it can impact the ultimate outcome and how well they’re going to accept need for rehab and therapy, etc. For example, I took care of someone from the Middle East who, who, uh, after surgeries, multiple surgeries, heart surgery, leg bypass surgery, she didn’t want to get up and walk around.

And in, in U. S. hospitals at this time, we regard that you have to get up and walk around. Otherwise, all kinds of bad things are going to happen. You’ll start to get bed [00:37:00] sores. You’ll get weaker. You’ll lose your appetite. And you’ll get depressed. It’s just an endless cycle. So quick mobilization is a key part of pretty much every operation nowadays.

But in her culture, apparently, it was very common for a person to check into the hospital and just not get out of bed for months.

Dorothy: Oh, my goodness.

Lori: And, um, if I had known that in advance, we probably wouldn’t have done any of those operations because we would have known that they wouldn’t be successful.

Dorothy: And put her at risk even more than she was.

Lori: But if she was never going to walk around anyway, then we, she didn’t, she really didn’t need any of those things. Those operations were needed for someone who was going to continue to be active and, and, and. Up and Adam. So that that was very eye opening for me to try to understand more about the background and the health the culture how they embrace wellness or illness it was really important.

Dorothy: And that’s what we’re learning to just of course in our role The whole idea of someone else touching your breast or [00:38:00] even talking about breasts It’s it’s I keep thinking that whenever I’m talking to different groups, you know, that go, well, in our culture, well, it’s here too. I mean, you know, 36 years ago, women didn’t talk about this when The Rose started. And, and I, I know it’s not isolated to any one culture. It’s just part of that being a woman. And, you know, you’re going to know everything there is to know about your kids. I mean, they, you know, uh, immune is like, what do you call it?

Lori: Immunization.

Dorothy: Yeah. Yeah. Are you going to know everything you need to know about how they’re growing. And if they’re, uh, but your own, no, that, that never has that kind of attention.

Lori: Well, I’m encouraged by the women I work with, uh, at I’ll Have What She’s Having because for example, when we had the mobile last mobile mammogram day, at least four women posted the pictures of themselves getting their mammograms and talking about getting your mammogram, just normalizes it.

Dorothy: Yes.

Lori: You know and talking about [00:39:00] I mean, we’re giving free IUDs um, vasectomies and other, I stated our contraception now as well and for people to be out there talking about hey, I got my IUD is normalizing the fact that yes, the burden of avoiding unplanned pregnancy does for the most part fall on women And that this benefits available for restaurant workers, but before no one wanted to talk about those things either, right?

And, but I do think that the younger feminists now are acknowledging that this refusal to normalize all the things about women’s health, monthly periods, period pain, you know, chronic pelvic pain. All of those things has, is, is part of the problem. And they’re pushing that conversation, which I really appreciate.

Dorothy: Yes, that’s, that is so, um, encouraging.

Lori: Yes.

Dorothy: Especially in our younger groups. So, have, have you in, um, [00:40:00] your practice, have you seen people who just flat couldn’t afford medicine that had to go without totally?

Lori: Oh, yes, definitely. Um, one of the diseases I deal with is kidney disease. Uh, this is a really interesting problem.

So when people start to have things like diabetes or high blood pressure. Um, we tell them, you know, long term, one of the things that could happen is you could, your kidneys could fail. So you need to treat those diseases so that, that never becomes a problem. So these are medications which would be pretty inexpensive.

Many, many of which have been along for a really long time say they’d be very inexpensive. And we won’t provide a young person with the ability to get those medications. Because if they’re working at, let’s say, McDonald’s, um, or some minimum wage job, they’re going to make too much money to [00:41:00] get Medicaid, but not enough money for them to afford health insurance, and their health insurance is not going to be provided by their employer.

So we won’t pay for that. However, once your kidneys fail, And you are on dialysis, you can get Medicaid, you qualify for Medicaid. Because dialysis per year, per person, $75,000.

Dorothy: Oh my goodness.

Lori: That’s a number from many years ago.

Dorothy: Wow.

Lori: So we’re willing to pay $75,000 a year per person to be on dialysis, but we won’t pay something like in the hundreds per person per year to keep them from needing dialysis.

Um, and that to me is, is shocking and horrible because that, that the people in general who are on dialysis are going to be people of lower income who’ve, who’ve, their disease has gone untreated. And part of it is diet. Um, and you’ve heard of course that some of our urban areas, it’s, there are no local grocery stores with fresh food.

It’s all processed, canned, um, preservative [00:42:00] ridden food. So those, all those problems go hand in hand. We, we, we don’t give the people access to good nutrition. We won’t let them treat their medical diseases, which prevent. can prevent them from getting diseases which are catastrophic. So, um, that, yeah, that to me is just, uh, dialysis and, and how we treat high blood pressure and diabetes is to me one of the great tragedies of, of our healthcare.

Dorothy: That’s. That’s saying it like it is.

Lori: Yes.

Dorothy: Sure. And I don’t think anybody that is insured ever realizes the true cost of trying to get this care if you don’t have it. We just, we, we’re protected somehow.

Lori: Yes, it’s true.

Dorothy: Folks don’t think about that.

Lori: But when I first was, uh, started I talked to a good friend of mine and she asked me why it is, like, why would, why wouldn’t the people in the restaurant just go out and get their own insurance?

Why are you having to do these fundraisers? And I just don’t think that no one’s really gone out to shop.

Dorothy: No.

Lori: Because most [00:43:00] people will get the job, will get it through their insurance. Through their employer. So they don’t even really appreciate how much it costs. But I think that’s changing now because as insurance companies try to uh, insure their profits at a time of rising healthcare costs they’re pushing more and more of those costs onto the person, the individual.

So you may have a deductible which is really, really high or you may have a co pay when you go for a visit, which is really high and those things actually are making even for the insured person, it’s too expensive for them to go to the doctor because they can’t afford the co pay.

Dorothy: That’s so true. And all of these tests that go against their deductible and, you know, who has met their deductible in January or February?

No one. I’ve seen women put off that diagnostic mammogram for 12 months till they reach that point. And you know, that’s just dangerous. In 12 months, so much can change in the breast, especially if something’s sitting there that we could have caught [00:44:00] back when.

Lori: Yes. So I didn’t realize that the mammogram was part of the deductible.

Dorothy: Your diagnostic.

Lori: Diagnostic.

Dorothy: Screening is covered by a law.

Lori: Right.

Dorothy: And yet there are some insurance companies that get around it. But if you have to have follow up, if they see something on that, or, and this is what mostly happens to young women, if you come in with a lump, and you’re trying to get it, you know, evaluated, There, there is nothing that just covers it from straight on.

You’re going to pay the cash price, or you’re going to pay whatever it is that, that isn’t covered. So, it And, you know, that was one of the efforts a few years ago was to get that diagnostic mammogram covered by insurance just like the screener. There, there, there’s some horrible statistics about women that just never went back.

We spend so much time trying to get women back for that follow up and calling them and, you know, invariably it’s [00:45:00] always cost. It’s always, I just can’t afford it right now. And that, again, it’s like what you’re saying, what, what are we doing in medicine if we can’t even do what we know we need to do?

Lori: Well, yes, if we know, we can’t do what we know works.

Dorothy: Mm hmm. Mm hmm. It is.

Lori: That to me is the saddest because there are many things that we can’t cure. And there are many things that we can’t change. Traffic accidents. Um. But, there are things that we know we can beat. And, um, the fact that we are instead trying to create, we are creating more problems in health.

And we are obstructing people’s access to care. Um, is, is incredible. So, I like fighting with you though. I like, I like fighting for better care with you.

Dorothy: Oh, yes, yes. You know. [00:46:00] So I’m going to ask you a really crazy question. If you could be anybody in the world, living or dead, for 24 hours, who would you pick?

Lori: Wow.

24 hours?

Dorothy: Just 24 hours.

Lori: I’ll, I’ll, I’ll, I’ll pick Donald Trump.

Dorothy: Really?

Lori: Oh yeah. I’m gonna go on a 24 hour news tear and change it all.

Dorothy: Now that is, that’s ambitious. Whoa.

Lori: I’m so excited now for this this this dream come true I mean that I think that that was really an unfortunate period of our our history and I don’t I think that many of us thought we could just live through it and get past it, but it changed everything It changed how we look at how many people look at media it changed Our acceptance of people spreading misinformation, if not just outright lying, um, it, it just really [00:47:00] changed things.

So if you gave me 24 hours, I could try to fix as much of that as I could. Um, because it’s very impactful. People are getting their news, uh, from, from places that have no commitment to the truth. Um, and, uh, when One of the things that we’re working on at the Women’s Commission is, if we were, if we have another pandemic and we need to disseminate true, um, reliable information quickly, uh, we would want to do it to the women in particular because they’re oftentimes leading their households in, in, in issues like this.

What’s that infrastructure look like? How do we do that? And I really have been stunned to realize how We don’t really have a good, reliable network. People may turn to the news, but they might turn to their news, which is not news. So, um, to be able to fix all of that by, um, taking it back, I take it back.

The media is [00:48:00] not the enemy or, you know, there’s no such thing as fake news. Or, or we can rely on these news people and these sources of information and I’m really pro choice.

Dorothy: Oh, absolutely.

Lori: And things like that. I think that that would um, that’s my fantasy 24 hours.

Dorothy: Spoken like a true surgeon. Let me go in and fix it and make it quick and let’s get it done.

Yes. If you had one other thing to tell our, our, our audience or women in general, women specifically, what would be that advice?

Lori: Well, in 2017 I, when I started I’ll Have What She’s Having, I definitely didn’t know what was, what we were going to be. I didn’t know how much impact we could have. Um, I do think I saw the need.

And I, and I say that you’re my, um, non profit mentor. But the truth is, I think that you and Dr. Dixie were in a similar situation before. You didn’t know what you could do. But the truth is that [00:49:00] one or two people, um, a group of like minded, Individuals can make a huge impact. So if it weren’t for that Uh effort in 2017, I think that especially with SB8 and Roe reversal i’d be at a different level of frustrated I do think that we’ve been able to show that we were in the game and nimble and ready to contribute to people who needed access to contraception or who need access to information about safe and legal abortion.

We’re, we’re, we’re there. And so I would tell any individual who is wondering what to do with the, the frustration that they feel, um, there’s outlets and we would encourage people to really put their, their energy and their discontent to, to work. And then I would also want to say to any individual out there who’s not, Prioritizing their health that we need them to every one of us needs to prioritize [00:50:00] our own health because no one’s going to do that for us but places like yours Help women and individuals take care of themselves And and there should be no barrier that prevents anyone from doing that and in Houston, Texas today.

Dorothy: That’s so true Yes, great advice. So if you don’t like something go start a nonprofit and be a part of the fix not the problem. Love it. Oh, thank you. Thank you so much for being with us today. Lori. You’ve really You’ve really showed us some things We probably didn’t know and especially in the industry that you’re in and you see both sides of the world I mean from the medical and from the restaurant my goodness.

What a what a broad vision you have of what’s going on. I think I think that’s something all of us could have is a little broader understanding of What are communities going through? And it always gets down to community, helping community. [00:51:00] Always gets down to one person reaching out to the other and making sure that they have what they need.

Thank you for starting I’ll Have What She’s Having. Thank you for all the women you’ve helped and of course sent to us. We we love partnering with you. It’s just so gratifying to have like you said that like minded person. Hope to have you back soon.

Lori: Thank you so much, Dorothy, for everything.

Post-Credits: Thank you for joining us today on Let’s Talk About Your Breasts.

This podcast is produced by Freddie Cruz Creative Works 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 #Let’sTalkAboutYourBreasts. We welcome your feedback and suggestions.

Consider supporting The Rose. Your gift can make the difference to a person. And remember, self care is not selfish. It’s [00:52:00] essential.