Dorothy: [00:00:00] What are the chances that not having insurance actually can be a death sentence for breast cancer patients? Dr. Popp returns to the podcast to discuss the healthcare challenges for the uninsured woman. We explore the work of Christus St. Mary’s Clinic in Houston, focusing on breast care, on preventive care, and on early detection.
Dr. Popp shares some shocking statistics. Like when an uninsured person is diagnosed with breast cancer, 60 percent of the time they will die of breast cancer. 60 percent of the time more often than an insured woman. We’ll discuss how our mobile mammography coaches going to St. Mary’s are bringing a new and different solution to bridge that healthcare gap. Today’s episode will give you some incredible insight into what happens to the uninsured woman and how often they have voided before they even make that next step to have a mammogram.
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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 frank discussions about tough topics, and you’re going to learn why knowing about your breast could save your life.
It is so great to have you here again, Dr. Popp, and I just have to tell our audience one more time that you are our top referring physician and we have had a long, long partnership. No matter where you went, you kind of took The Rose along.
Dr. Popp: I know a good thing when I see one.
Dorothy: Oh, thank you. Thank you for that. So I want you to tell us a little bit about Christus St. [00:02:00] Mary’s Clinic.
Dr. Popp: Okay. Christus St. Mary’s Clinic is a Part of the Ministry of Christus Health, and our Christus Foundation for Health in Houston is our sponsoring group that allows us to serve. We are located in the east end of Houston, and we serve a large population, uh, not only in the Houston area, but in the surrounding areas, uh, of people who have, who are uninsured and have poor access to healthcare for whatever reason.
Dorothy: You do all kinds of things.
Dr. Popp: That’s correct. We, we mainly focus on adult health because those are the people who have the least access to health care. And then we also, um, work with vaccines for children and other programs like that.
Dorothy: Male and female.
Dr. Popp: Oh, that’s correct. That’s correct. Uh, yes, pretty much, uh, the full scope of primary care, and as I said, we focus on those people who, who don’t have access or resource to other health, forms of health care.
Dorothy: And I know when we take our mobile out, which is how we normally best [00:03:00] serve you, I think, we seldom have no shows.
Dr. Popp: That’s correct. The people that we serve are very interested in their health and if they have access and it is something they can afford, they will take advantage of it.
Dorothy: Yeah.
Dr. Popp: Uh, there’s, I think, a myth that uninsured people or people with few resources don’t care about their health or don’t, especially preventive health. But that’s not, that’s not true.
Dorothy: That’s not what you’ve seen, not in all the years that we’ve, that we’ve brought here.
Dr. Popp: If it’s available, people will take advantage of it. They will, they will do, especially the women. I would say their primary obstacle to preventive health, not just breast health, but you know, other women’s health services are access and affordability.
Dorothy: Yes. Absolutely. Tell us about Dr. Popp. A little bit about your background. Uh, I always think of you as being a woman on a mission.
Dr. Popp: Well, I guess I am. Uh, I’m a sister of charity in the carnet word from here in Houston, and I’m also a medical doctor, um, graduate university of, of Texas, San [00:04:00] Antonio, primary care. And my, my passion and my mission has always been to provide care to people who otherwise don’t have access to basic preventive and restorative healthcare.
Dorothy: How long have you been a doctor?
Dr. Popp: Oh, 20 plus years.
Dorothy: Right, right. Lots of people then you’ve seen during that time. So, you did a recent Report which just stunned me.
Dr. Popp: Well, yes, it actually stunned me as well. one of our communications directors asked us to look at our breast health programs because uh, as you know, october is breast cancer awareness month So she said give me some information. So I thought well, let me look at the people who come to Saint Mary’s Clinic and See what their needs were when they first came for breast health and. Oh, I did a back search over the last six months of all new patients that were aged between [00:05:00] 40 and 75 who would would be qualifying for for mammograms, and I was shocked to learn that we, number one, I was shocked to see that we had more than 600 women Uh, new patients in that time frame, which is about 100 a month, and of those, only two had, were current on mammograms.
Dorothy: Two.
Dr. Popp: It was, it was like, you know, I went, this can’t be right, but it was, and it’s true because part of our new patient intake when we’re doing a history and we’re doing, you know, setting up for whatever they want, is 99 percent of the time is scheduling a mammogram. So, it’s like, wow.
Dorothy: But, you know, we read these statistics, national statistics, that are a lot better than that, but we’re talking about real data, real time data. I just, I said they’re going 2 out of 600 patients. I mean, oh my gosh, that didn’t even, correlate. Now you had a total of [00:06:00] what was it, 1,300 total that all of your patients, I’m sorry, 15.
Dr. Popp: Yes, we did. We did 1,500 mammograms last year and the majority of them were done on our mobile units. Uh, which again speaks to access and affordability.
Dorothy: Oh, absolutely. They’re not going to be able to drive into Houston to do these things. I mean, I don’t think our general public understands that that’s not even an option.
Dr. Popp: No. Well, it’s, it’s not an option on most people. A lot of our women in that age, especially when you get 60 plus, a lot of the women don’t drive or they only, they only have one car in the family. And so that’s not an option. And since the clinic, they come for other services, they’ll, they’ll plan it so that they can do it at the same time.
Get a ride, get a ride. And you know, it’s also cost. You know, it’s like, you know, if you’re buying groceries or getting a mammogram, what are you going to get? You know? So that, that makes a huge difference. And I have to tell you, this is an aside. [00:07:00] The months that we were lower were the months when the mobile units wasn’t able to come.
And, and, cause I was looking at the statistics and the, the person who schedules them, she said, now you’ll see it’s lower this month, but the mobile unit wasn’t able to come. So, uh, when, when there’s something happens that we have to cancel an appointment or cancel a whole session, it makes a huge difference.
Dorothy: Oh yeah. And, you know, with these big mobile units, there are things that we don’t expect. But that’s so interesting, because then you have to think, what would have even been more patients.
Dr. Popp: Well, and then we have to reschedule them, which means there’s another time that another set of people can’t come unless you all give us an extra day. But, but it was interesting. I hadn’t thought about it either. And she said, well, you know, this, this month we only had 80. She said, that’s because one of the mobile units didn’t come for whatever reason. And so, you know, and that’s, you know, [00:08:00] we try really hard to get the people who are scheduled to come. Uh, so, partly because we don’t want to waste the space and partly because it’s out of respect for what you all do. You know, if you take all the time to come, it’s not worth your while if you’re coming for four people. So, we make sure that all our people are, are reminded and, and, you know, help to be able to get there.
Dorothy: But that’s the original patient navigation. You know, I mean, there’s all this literature out there now. Oh, patient navigation. We need to do more of it. You’ve been doing that ever since you started.
Dr. Popp: That’s correct.
Dorothy: Making sure the patient is reminded again and again Finding out what what kind of obstacles or barriers that we have to getting there and then finding a way to get around that. That’s what patient navigation is all about. I I just I amazed that we get a new, tagline for something, and it is what we’ve been doing all along, and [00:09:00] it works. You know, people need to be reminded. And you have that personal touch going on.
Dr. Popp: Well, and we also think people need to be a little bit accountable. Um, you know, we know they don’t have a lot of money, we don’t have a lot of access, but we, you know, we do ask them to make a small deposit, which they get back when they come. But that, that seems to be able to, to make them— it’s not just a gift or a handout. It’s something that they’re putting money in and then, yes, they get it back when they come, but it makes them feel like that. I think it gives them a little dignity and respect because they’re paying something for this.
Dorothy: Right. Absolutely. I, I agree with you. And so many, Uh, programs don’t have that, that extra thing that says, it’s no big deal then if you miss such an appointment, but if you’re going to lose 20 bucks or 30 bucks or whatever, you’re going to show up.
Dr. Popp: And we proved it to ourself that it works during COVID because when we first restarted the mobile units after COVID, we [00:10:00] didn’t, we didn’t do that and just kind of fell by the wayside.
And I said, look, we’re getting more no shows. And they said, well, you know, we’re not charging anymore. And I said, well, that’s good. We need to do that. So again, we started doing the deposit and you know, you get your money back when you come, it makes a difference.
Dorothy: It does. It does. You know, I was, I was thinking about, uh, our partnership last night and thinking that whenever we have like a, uh, funder come in and want to do one day mobile unit or, you know, they, they want to have their money go for a mobile day, basically. We always go to you because your, your day is going to fill up. That person or company or whomever feels like, well, golly, I, I really did something.
Dr. Popp: You know, that, that really is so important because, you know, even talking to you about the mobile unit, if your mobile units aren’t maintained, or not say maintained but aren’t, aren’t [00:11:00] in service because they, they, because you need a new one or because, you know, uh, I mean, I’ve been working with mobile units before and they are high maintenance. Um, and you have to have a driver that can drive them.
Dorothy: Right.
Dr. Popp: So, you know, But those, those things down the line really affect our women’s ability to get. So, you know, it’s, it’s, it’s their funding of your programs with the mobile units and things like that, that really make a difference for us down the line.
And, and, you know, we also try to have our staff appreciate what you all do. I know our staff and your staff are on first name basis for, for, you know, scheduling. What do we do for this? Uh, but you know, our staff also tries to make sure that, you know, that your staff is accommodated and then, you know, that, that really, it’s a partnership that, that benefits everyone.
Dorothy: Oh, listen, our, our staff is raising their hands. Who wants to go to St. Mary’s? Me, me, let me go. I [00:12:00] mean, because it is a, it’s a privilege to serve you. It really is. And I’m not just saying that. We know what you’re doing. We know the people are there and they’re in need of help and, you know, even when I looked at your stats from that report, you had something like 164 women that needed follow up.
Dr. Popp: That’s correct.
Dorothy: And that’s high. In the big world of statistics and all of that, we know that if we’re talking to an unscreened population, or if we’re working in that, which is your new women who are not current, then you’re gonna have a higher recall. And it’s, it’s clear. It is always found in the uninsured.
Dr. Popp: That’s right.
Dorothy: You know.
Dr. Popp: Well, you know, I still remember the statistic that blew me away from your report. I don’t know if this last, your financial report or your community report, probably maybe a year before you last that in the last [00:13:00] seven years or eight years, every woman that presented with stage four cancer was uninsured.
Dorothy: Uninsured.
Dr. Popp: And that’s just like, That can’t be true. And I know two of those were from our clinic. So, it’s like, in this day and age, there’s just no reason for that.
Dorothy: And it was the same last year.
Dr. Popp: So, it’s like, it just makes what I do so important and what you do. It’s like, you know, when I have women who say, well, you know, I don’t want to go because I don’t like them squeezing. I’m like, look. Do you want to discover cancer when it’s this little bitty pea and they can take it out and you’re good or do you want to discover cancer when there’s nothing to do except say a prayer? I said, so I said, you know, you know, you, screening is important and you, for women who, who aren’t used to that, you know, you kind of have to say, or there’s, there, you know, like, oh, I don’t want to know I have cancer.
And I said, well, you know, you’re going to have cancer whether you know or not. So. You know, what do you want to do? You want to get treated or you want to wait [00:14:00] till it’s miserable? So, you know, sometimes we have to say, you know, you have to just kind of say to them, you know, these are the facts I mean, you know, you you can be cured.
Dorothy: Mm hmm. Oh, absolutely.
Dr. Popp: So because they’re you know, their equation is cancer is terrible and that’s it. So.
Dorothy: Yeah, we haven’t got a, a whole lot further from that equation. Even in the last 38 years I’ve been doing this. Yeah, I know. In all the years you’ve been doing it. I can see why you have that reputation though. Of your patients say, we don’t want, we don’t want her calling us. We, we don’t, we don’t want Dr. Popp to call us and, and fuss at us because you will. You’re gonna tell them.
Dr. Popp: Well, you know, like I said, we’re. I believe in, in saying, I always tell them, I’m not your friend, I’m here to make sure you understand the consequences of doing or not doing preventive health.
Dorothy: That’s strong.
Dr. Popp: You know, because I said, you tell me you understand and you’re okay with it, then I’m, I’m, [00:15:00] I’m, you know, I’m not, we’re not having this conversation again. But at the same time, you know, the whole thing of like, well, I’m just scared or, you know, I don’t like, I don’t like mammograms. They need to know the consequences, and I think it’s important for me to say that to them.
Dorothy: Oh, absolutely. Absolutely. What were some of the other, uh, Information in your report, I remember, uh, thinking that bottom line was the majority of uninsured women want to have screening.
Dr. Popp: That’s correct. Yes.
Dorothy: If, if it’s, if they have access, if it’s affordable. And the other part was that, you know, a hundred new patients a month. That’s a lot of new patients.
Dr. Popp: Yeah, yeah.
Dorothy: For a clinic that’s been established for a long time.
Dr. Popp: We’ve been there, what, 13 years. Well, you know, we have, because of our population, we do have a lot of transient people, uh, of [00:16:00] people who come and go. People who just show up, you know. I had a lady that hadn’t showed up for 10 years. She’s back and of course, what did she need? A mammogram. So, uh, and they know we do them. Uh, this wasn’t real recent. This was a couple of years ago. I had a lady who came for, it was her first visit. We sent her for a mammogram and she had an abnormal mammogram. Biopsy, luckily it wasn’t cancer, but, um, so the next, in the next week, I had two more people and they said my friend said to come over here because she had an abnormal mammogram and y’all will send me for a mammogram so I can get checked too.
So part of it is word of mouth, knowing that the service is available and that we can, that, that we can help women get those. And we’re also very proactive in the sense that people, women come for whatever they come for, and they, we reform from them. We find that, and this is, this is a pet peeve of mine.
We [00:17:00] have people that are uninsured, insured, uninsured insurance. There’s insurance kind of comes and goes depending on their jobs. So I’m like, did you get a mammogram when you had your insurance? No, I said, did the doctor talk to you about it? No. Did you ask for it? No, and I’m like, why not? You had insurance.
So, the point I guess I’m making is we’re much more proactive at promoting mammograms than a lot of other places are. Because I mean these docs for primary care docs they, you know, could have easily just given them an order for a mammogram and say, you know, you have insurance, they’ll pay for it. Go. But they didn’t.
Dorothy: No, it’s not top of mind.
Dr. Popp: So for us, screening for uninsured women is top of mind because otherwise they don’t do it. And other, you know, whether it’s it’s pap smears or mammograms or colon cancer screening, we have partners in our community who are willing to help us with that and, you know, [00:18:00] I feel obligated to, to present this to women and men who otherwise wouldn’t have this opportunity.
And geez, if we can get a breast cancer or early stage cervical cancer or fine colon polyps, I mean, geez, what’s that do for the community health? You know, it’s like, you know, they stay working. They don’t cost or they don’t cost the community a huge amount of money in services. I mean, chemo, radiation, you know, job loss. When all they needed was a mammogram or a pap smear or a colon cancer screen. I mean it’s just, you know, even if you have no compassion, the economics says do this.
Dorothy: There are so many myths about uninsured people. And I want you to think of some others that we need to bust today. But the other thing about mobile screening, now remember we’re not, this is, you don’t have any issues, there’s no, haven’t found a lump in your breast, there’s nothing going on.
The [00:19:00] insured have the same exact outcomes as the uninsured. I mean, it’s just amazing. They’re all found at a small, you know, a lower stage. They all, it’s like a, it’s like it’s leveling the playing ground. Where the majority of our uninsured that are coming to the centers, Already have found something. That’s not true in our, in our insured population. You know, the uninsured have waited, have found something, and it’s much more advanced. But if we could get every uninsured woman screened before it gets there. They have the same advantages as the insured.
Dr. Popp: And that’s our goal. Yeah. You know, that’s, that’s one of our goals. When, when funders come to our clinic to talk about helping us, that’s one of the things we tell them is like, you know, your dollar goes a whole lot further for prevention than it does when we have to treat, you know, and we, we do the same for chronic diseases as well, you know, for high blood pressure or cholesterol or diabetes. If I can keep you [00:20:00] controlled before you have that heart attack.
Dorothy: Right.
Dr. Popp: Life’s a lot better. So, it’s the same thing, and it’s— The unfortunate thing is because the uninsured have some many other priorities usually, health isn’t their first priority. And it’s the thing to go. Cuz one of the things I do when, uh, I asked a woman, I said, Oh, you didn’t, have you had a mammogram?
No. Um, any special reason? You know, why, why haven’t you gone? Oh, well, I didn’t know where to go. I didn’t have the money. Um, I didn’t go to a health provider cause I wasn’t sick, you know? And, and I have all these other things, you know, my kids are in school. I have to work, you know, my boss gets mad when I take off. So, you know. Unfortunately, health isn’t one of their priorities when you have to pay the rent and the electric bill and put food on the table.
Dorothy: It would be anybody’s. I mean, [00:21:00] yeah. It just, the other part of, of some of the stories that we hear here. is the insured woman almost invariably feels like she’s going to be cured. I mean, there, there’s not that concern of survival because she has access to the treatments, to the best, to this, but that uninsured woman is as worried about if it, when it’s diagnosed, is worried about, is worried about what’s it going to cost than she’s about surviving.
Dr. Popp: And I think that brings us to the other part of how you all help, um, because I have a rule for myself. I never work with the group that can’t take care of an abnormal. Because you can come to me and say, I’ll do all your mammograms. What are you going to do to find an abnormal? Well, no, no, you have to deal with that. And I’m like, right. That, that’s, that didn’t work. So. You all help take [00:22:00] that next step. I mean, if a woman needs a diagnostic, an ultrasound, a biopsy, that all gets done, insured or uninsured.
Dorothy: Right.
Dr. Popp: And then you all Uh, work with our navigator and your navigator to make sure they get some kind of treatment. You know, I have patients who are just coming to us for whatever they come for that are breast cancer survivors because of these programs, you know, uh, you know, they, they’ve found, they’ve got an oncologist, they’ve got some, they’ve had radiation or chemo or whatever they had, but it’s because you not only are the first step. But it takes that next step because otherwise, you know, you know, it’s like the thing in the gospel when you says, oh, you’re hungry. Well, blessings on you. Have a great day. You know, if you have to give food the same thing, it’s like, oh, you have an abnormal mammogram. Oh, goodbye. Look for a look for a biopsy somewhere. It, you can’t do that. It’s, [00:23:00] it’s, uh, so.
Dorothy: And it happens over and over because ultimately we’re the ones that they will find after they’ve spent all this money.
Dr. Popp: And we’ve actually done a little begging ourselves of saying, you know, that we really didn’t start with your program, but this poor lady needs help. Please help. And you do. So, yeah, I think that’s really, really important to, that it’s kind of the back, sort of what happens in the back room that the, that the people on the street or sometimes even the funders don’t see. They see the mobile unit, they see all the people who didn’t get mammograms, but it’s what happens after a mammogram is abnormal that, as you said, makes the woman’s life, um, difficult or, or, it impacts your survival.
Dorothy: It does. It really does. And you know, one of the things that I do believe, one of the reports that we’ve seen, and it continues to be the same percentage, when an uninsured person is diagnosed with breast cancer, 60 percent of the time, they will, [00:24:00] more, they will die of breast cancer than an insured woman.
Dr. Popp: I see, and that’s, that’s sad.
Dorothy: That is sad. And what it, what it says to me is, there wasn’t that great follow up, there, there wasn’t even access to begin with, and it’s just you know, in this day and age, you shouldn’t have to die of this.
Dr. Popp: No, you shouldn’t. And, and again, it speaks to the fact of how many of those people were late stage. You know, how many people didn’t get a screening, didn’t, didn’t follow up, didn’t even follow up on a lump because they couldn’t take off work, or they didn’t know where to go, or, you know, if I look the other way it’ll go away because I have all these other things to do. Um, I, yeah, it just makes a huge difference. I think your work is helping level the playing field.
Dorothy: And, you know, isn’t it, last year we normally serve about 7, 000 uninsured people. Last year it [00:25:00] was 81.
Dr. Popp: The more often you send us the mobile unit, the more people will put on it.
Dorothy: I know, but we’re headed in the wrong direction. True. You know, I keep thinking, so many uninsured. And you know my horror is there’s someone out there with a lump that doesn’t know anything about The Rose. And we’ll never get any kind of care, but oh my gosh, that many more. And that is one of the reasons why this year has been a hard year for us. We’ve had to scrape and look everywhere for funding, but that’s what we do.
Dr. Popp: Yes. Well, I, I, um, I, I’m a firm believer that if we keep serving that, that the mission will, will serve itself in a sense that, that people will, will help us. will help us fulfill that mission.
Dorothy: Yeah, someone asked me yesterday, do you believe in, do you ever have God things happen? I said every day. Yeah. I mean, [00:26:00] really, you know, if we didn’t believe that, there’s no way our little tiny organization could could keep going.
Dr. Popp: And God works through strange ways. I mean, you know, sometimes, sometimes very obvious. Sometimes things just fall into place and you go, Oh, thank you, God. You know, that, that, that. This person said yes to, um, that their Medicare was accepted or, you know, that they got their, their Harris County card for, for care. You know, it’s like those kinds of things. Yes. Yes. All the time.
Dorothy: Well, we are certainly thankful for Dr. Popp.
Dr. Popp: And all our physicians because remember there’s a whole group of us that see that, those 600 women.
Dorothy: I know, but I kind of know who the stirrer of the pot is and always has been. We are grateful for you.
Dr. Popp: Well, thank you. And we are very grateful to The Rose. I, you know, our partnership, as you said, has been very long, very fruitful. And, uh, you know, it’s, it’s hopefully [00:27:00] when, when, but we’re both sitting in our rocking chairs that this will still be going strong, our legacy will be gone.
Dorothy: It will, but I have a feeling they’re going to carry us out.
Dr. Popp: Well, that’s probably true. That’s probably true.
Dorothy: Which is fine with me.
Dr. Popp: That’s true. Yes.
Dorothy: All right. Until we have you back again.
Dr. Popp: Thank you. Well, thank you for having me. I enjoyed this.
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.
