Shireen: Dr. Illan Shapiro has always had a passion to convert health information into action by improving the well being of local communities. He is the pediatric physician for alternate, and he's also their medical director for health education and wellness. Welcome, Dr. Shapiro, how are you?

Ilan: Good, it's a pleasure to be here. 

Shireen:  

It's an absolute pleasure having you on. So diving right in with that, Dr. Shapiro, I want to learn a little bit more about your background, what led you to become an advocate for Hispanic health and pursue medicine in the way that you do?

Ilan: Well, I'm born and raised in Mexico City, a small city, only 20 plus million people. And my entire family came from different parts of the world, and then that up in Mexico, that's why I have this Elijah po name nada next again, and being completely fell upon your throne, then, you know, I'm there completely. Then I had the pleasure to do all my medical, you know, medical degree there, I started actually working as a liaison between the Secretary of Health in the who, early on after finishing my my MD degree, and I loved it, you know, that transformation of understanding what's happening on the ground in little towns in Mexico and big cities in a very complicated and effective preventive health system. And they ended up in the WHO where I was, you know, talking about problems at a global scale regarding public health policies regarding alcohol, smoking, and other interesting topics that we were having at that moment. And of course, you know, the health of kids, I always wanted to be a pediatrician, and I wanted to be an international doctor. And in Spanish, when you translate public health policy, it translates to public health politics, there's really no good word for policy. And it was when I was telling my family that I wanted to be an international doctor that does public health politics in Spanish, they were like, okay, you saw for so many years, and now you're going to be a politician, you know, that doesn't make sense. And I ended up going to I, I actually, when they saw me in Geneva, and doing public health stuff, who they kind of started glancing at me go like, well, maybe he will, he will be okay. And I pursued my pediatric passion at Mount Sinai Hospital in Chicago. It's a urban, very complicated area of Chicago, it's a hospital that has been there for, for, for a lot, a long time, and has been serving any community that it's needed. And it was when the corner between the Puerto Rican, Mexican, African American and different ganglions there and you know, that the middle point, the hospital was where everybody would, would put differences aside, and we'll be safe and be taken care of. And they understood the complicated part of, of, you know, like, the New World, then you know, how kids were, you know, especially the demons of hell, the zip codes, and all these stuff, and I got to experience a 21 pandemic there. And it was very frustrating for me to see that there were a lot of communications towards that community. But the, the information was not being heard. And it was not because they didn't understand the language or anything, but it was the culture aspect of it, that we were missing it. And the information that we're giving with a 21 was kind of, we're going to die. And, you know, and the permission of the community, they were hearing it, you know, like if you're from a different community, you could actually get your, your immigration status revoked. And, you know, a lot of complicated stuff that you do not want to have, when you have a pandemic, you want them to be made sure that the, there's no medication, or a vaccine that the kids have h1 in one, that you actually do something about it, then, and I, I created a couple of good public health communication strategies with local, you know, with a mixing controller with a lot of the local newspapers and spine especially, is popular media because it was not trickling down. I was seeing, you know, a lot of late complications from just waiting at home, and not, you know, just calling and I translated a lot of those stuff. And I started actually communicating that in radio, TV and reading media. And I loved it and I love them. Why because, you know, in my regular day in my clinic, she kept like, I could see, you know, like maybe 20 plus patients and they It was really, really bad and we have a long day. But you know, having done message ETB and we're reaching more than 200,000 people, then with a specific message that was key for everything else. And yes, it's a smaller message but with that bigger audience than and wanting to combine both. And following that, I had the pleasure and opportunity to work a lot with a, with a spinner community in Chicago and ended up in Fort Myers, Florida. Beautiful, amazing place, real Florida, by the way. Yeah, two hours away from Miami and one of the things that I had, there was the opportunity to see what was happening with migrant communities on the field. I already experienced a rural part of it, the origin part of it right now I was seeing the rural part of it, the communities that were on the fields, picking strawberries, picking tomatoes, one of the actually poorest parts of the country, it's there in near Fort Myers call emo Cali. And there's no running water, it's fields and we're actually helping those migrant families there. Then I spent there five years. And after that I have an epiphany that I wanted. Something that will combine media location, wellness, and all this stuff. And my wife asked me, you know, what's the name of that job? Or how, how do I help you search for this? And I told her, I don't think that there's a title for the things that I do. And and you know, and in these regarding me via social media, making sure that location is being transferred to the community, making sure that there's a strategy behind it. We were creating employee that we were creating weight management programs for those very important, especially in summer, then there was a lot of things that did not love technology, I love translating, you know, using right now, you know, there's no excuse right now that we don't have enough apps or or community culturally appropriate apps for underserved communities or communities of color testers, we don't have an excuse. Right, right. And before that, that technology divide, right now, it's actually just making sure that, they that we show them the way because we all have, if you have a smartphone, you have an email, if you have an email, you can actually have access to apps. And most of the tough ones right now have all those things that is just making sure that we have time to teach what's done up there. And ended up in alpha men. Things aren't, I have been here for almost four years. I'm the medical director for health education and wellness, also a pediatrician, practicing pediatrics, so you know, a couple times a week and they love it. And that the combination between calcification and wellness that part of, of, you know, of the media part. And of course, the pediatric part is a beautiful combination, because I get to touch from people from zero to 120. Right now we switch all the other stuff that we were doing were West kind of face to face and not a lot of videos, not a lot of media and not a lot of, of the digital part of it. But right now we're moving towards that, and I'm loving it. 

Shireen: Lovely, thank you so much for sharing that. Given the, given the current times, Dr. Shapiro, what are you noticing in terms of the impact of COVID-19, specifically on Hispanic families? 

Ilan: Well, it's quite interesting, because a lot of people are asking me, you know, Dr. Shapiro, do you think that these buyers has an affinity for communities of colors for, for Hispanic, specifically? Because it seems that they're being you know, there's percentage points, it's not like point 00 1%, it's like, actually, they're being statistically hit, hit harder than the lighter communities. And from the minority communities, the Spanish and African Americans are actually suffering more. And I tell them, Well, actually, this virus is just a, you know, the cherry on the cake. This has been cooking for 50 years, or like 5678 decades, this is something new, wherever it's actually, like, amazed that this is actually a reflection of what we have, that they haven't read, you know anything about social determinants of health. You know, this was completely expected. After so many years of defining your life by cipco, defining your life of all that stuff that we now call social determinants of health, it makes a huge difference of where we are and where we supposed to be. My learning right now, it's not a conversation of why are they being hit harder, because we already have that answering. My question is right now what are we going to do about it? And that's when I started that conversation.

Shireen: Okay, and so, it seems like there's an impact of social determinants of health, not only on the existing chronic illnesses and the patterns that we were sort of seeing the impact on from chronic illnesses like diabetes, heart disease, so forth. But all of that is now translating into this virus and how it is impacting these local communities. So how are, you know, lower income minority communities disproportionately impacted by COVID-19? And what is the impact that you were seeing on children?

Ilan: I'm going to walk you through a couple scenarios. One is actually the reality. Most of these Hispanic communities are, are right now is essential workers. They are in specific parts of the economy, they're the link of what we do every day. And they're kind of the basis of this of our society, and a lot of the things from, from most of the people that are picking up, you know, our fruits and vegetables on the fields, to the people that are actually driving it, the people that are actually serving it. Then we have in and just giving a couple of weeks, there's more, but you know, just to pick a couple of them. Then you have a lot of people that actually, first of all, even if they wanted to stay home, they cannot. And they need to start working and being exposed. And first of all, they don't have the luxury to stop for 14 days and be at home, they need to go out and do their stuff. Because they're essential, then they need to work, they're more exposed. When you're exposed in certain places. Like we have heard of other meatpacking districts, we have heard about, you know, that rich cultural fields, we have heard about all these different places. And this is key because you know, the only thing that we actually did, there's a couple of things that we actually know about this virus. One is that it just means human to human. It goes from saliva. And after that, you know, social distancing works, or masking washing our hands, that's the five things that we actually know about these viruses. We don't have a vaccine we'll have on vacation, we kind of still learning about symptoms, signs and symptoms, there's a lot of things that we're still getting there. But right now, the important thing is what are we going to do with this. And we're going to choose to evaluate the spinal community and not do something because we need to understand that's a what almost a larger minority on the country, then if you're not already that you're having all this issues there, and you're not investing in manpower, and, and application of pipelines, and actually creating services that are appropriate for them. And I'm not saying that they need to speak Spanish, but culturally appropriate for them. And, and, and in creating that equity part of building on the system. This is something that is going to continue repeating itself. And it's not going to, it's not going to improve, it's really not going to improve right now we know if we invest in public health, we invest in those social, you know, like, I have the pleasure of my, my entire team is 70 people. I have community health specialists, I have nurses, I have, are these, I haven't, you know, I am a master in public health. I have an amazing research, they have an amazing team that go, they, their only mission in life right now is making sure that social determinants of health are being taken care of. And right now we're moving to the basics of you know, actually spending time with a patient, making sure that they need stuff. Right now, a couple of the winds that, that we're seeing, and they're extremely important is we have a lot of patients that are the high risk diabetics. And we are actually going right now there were a couple of them that were very sick with COVID and they needed food to be delivered home. Then part of the community health specialist, it's kind of promoted as the solution. They actually went, got food, touch less, drove it to the house touchless and contact less and making sure that they actually had food. Because without food, you know, you cannot discuss medicine, you cannot discuss diabetes, it's a basic things of life, then making sure that all of this are aligned, then then we can talk about diabetes, then now Okay, now you have this you have food, let's talk about your insulin, let's talk about this, then you start actually planning for the long term with the things that you have there. And a lot of the times is our reality in and one of the things that I'm liking right now technology is that for the first time, we're entering back again, to their houses to have that interaction with them because in the old times, I actually remember my pediatrician bringing you know the little bag and with the, with the shots, with with the medications and you know, thinking he will take my blood pressure, absolutely everything. And right now, we lost that for decades. And right now we are, thanks to COVID, that's one of the things that I am loving is that my team is spending a lot of times in, from like, since I was here, they have always been there for the patient, hearing them. And some of the things even though that I'm a physician, they spend more time than us hearing what's happening with their families, what, what anxieties or problems are having, if they have transportation or not, like little amazing things that can make a huge difference.

Shireen: And then what is the impact on the young ones on children specifically?

Ilan: I haven't seen it yet. I'm seeing. And let me tell you why I think that because the levels of anxiety and depression, I probably going to start seeing the consequences with reflection of ADD, ADHD, something called oppositional defiant disorders and other stuff will start probably popping up afterwards. Right now, I have treated a couple of anxiety in kids, we're having so insomnia and a little bit of depression, but not as I thought I was going to be hearing from them. And then the other thing is, you know, as a pediatrician, we were very into not making sure that the family's protected. Meaning that you know, if there's like, issues at the family level with, with, with, you know, higher tension and anxiety, making sure that the kids are, you know, there. And your anything is, you know, the thing that for sure I'm seeing that we need to change is that we send a message to a community at the beginning is like, do not come unless you're extremely sick. And if you're extremely sick, go to the hospital cost first because we want to make sure that you're taking care of. That right now we're moving to the second part, okay, we know that COVID, he is going to be with us at least 2021 at the level that we're having this type of conversations, and probably afterwards until we have like a vaccine or mitigation, this will cut the understanding that your kid actually needs vaccines, that that will not stop you. Your kid actually needs vaccines. And that's a very important thing that we need to look to make sure that they're growing well that we touched them when they make sure that we're measuring them, then how can we translate that then that's the message that we're doing right now as a pediatrician, and not only as a pediatrician, but you know, I guess we have copies out there. But you know, diabetes, high blood pressure, all this stuff out there. And they're not helping us. And we will not stop, then those are the things that we need to be making sure that right now that we're moving on the chronic phase of COVID, that we're taking care of them.

Shireen:  

With that what are, what are certain myths that you're seeing in the community right now as far as COVID-19 are concerned is concerned? And how would you must those myths? 

Ilan: I am actually going to a public service announcement. I am going to share with you the Shapiro diet. Okay, I'm going to walk you through all the meats that I have here from how to defend our body on the natural way until the other side. Then the Shapiro diet is the next one is, take out, take out everything that you're eating right now that it's bad, meaning take away snacks, they go wait. So let's take away absolutely everything, make it hard for you to actually eat them. The harder and farther away from you, the better. We're at home, we're spending many hours there, then we have the snacks. We're actually going to get them and we're going to use them. But make sure that you stay away and people go like no, but what about organic, basic things. They go away, that stuff enough that we can actually have the conversation about everything else. The other thing is, you know, moving. We need to continue moving, a lot of people are going Nah, but no, I'm home, I cannot move. And if you want to be healthy and you want to move stuff against Coronavirus, you need to make sure that your, that your body is at least as to as soon as possible, then make sure that you're moving. And one of the things that I'm doing with kids and with adults is that we are spending so many hours in front of a TV screen and everything else that we should actually use that first half an hour to move. Then when you're watching TV, the first hour on your iPhone, whatever application make sure that you're like you're marching in front of that because that way at least you have that half an hour of exercise that you need to have in a wholesome way. And that's actually good for you for your family for everybody and especially as Brian's it's a great example to live with their kids. The third one is sleeping. Right now that we don't have any any type of container like we're now getting to a certain routine, make sure that you're sleeping is important thing and making sure that you're not going to sleep at 4am and waking up at like 1pm more, if you choose to do that, understand that there will be hard to go back. And the fourth one is very important, you know, like about stress management and, and how are we perceiving. Because our limit of stress, you know, when you have a lion behind you or a shark, that it's when you know, you're swimming and you have a shark, you need to swim faster and faster than the lion. If not, you're going to be the meal, then at that moment, stress is amazingly well, you will survive, that's good. But right now we're moving and shifting to, you know, like toxic stress. And that that's an issue that we're having right now. Then making sure that we create, like certain type of guidelines and conversations for, for our communities and ourselves that we're exposed to all this stuff, and TV, radio and social media. One, that it's actually the the community aspect of it, you need to make sure that you're part of the community, it could be, you know, your yoga community could be your your, your your synagogue, religious, whatever, you make sure that even though that you're not going but you're keeping in touch of that community, the family friends, that those actually are very important for, for the entire resiliency part of your life. Understand that basic concepts, that's kind of the rules of actually defending yourself. Then we need to destroy that means. A lot of people go like Dr. Shapiro, I'm taking four pounds of vitamin C. And I'm trying to make sure that my would think, by the way, and I'm trying to this amazing thing with vitamins and the secret portion of my grandma. And on reality, I explained to them that most of the food, especially here in the US, and most of the world, already has extra vitamins and everything that we have, like a semi normal diet, you have enough anything that you need. And if you're doing these cocktails or vitamins, you're probably being them out, then that will be your most expensive pee that you have. Or you will actually, you know, not using it. And then it's not worth it, he hasn't we have tried, you know, winning friends who have tried with so many other diseases, and it's not working. The other one at the beginning was that you needed to actually start seeping water and water around 100 plus every five minutes to make sure that your, your throat will be moist. And that way the virus will go directly through your stomach and will be destroyed by your acids, then, now, yeah, it was a complicated one. The other one that I loved was the, you know, using certain household liquids to clean your mouth and your nose, and all those cleaning household things, actually burn your nose and your mouth and can actually very, very harm you and even kill you. If you do that stuff, then that's one of the ones that I'm like, I'm a lot of people. And I started seeing a lot of dietitians and gurus, health gurus that asking for like, special formulas of, of plant based milkshakes and stuff like that. on reality, you know, sadly, we don't have any. Trust me, I would love to tell you as to this, but we will not have, you know, it's not that we were hiding information, we do not have anything evidence-based that will make a difference. Including, for example, right now, the I'm not going to say the name of purpose of that medication, but the medication that we were using for malaria and lupus. Right now most of the research that was happening is actually closing down because of of risk of side effects without any capitalization, meaning that we were actually harming more of the patient that we were using helping them, then using the type of medications for preventive purposes, doesn't work out. Because this medication specifically has one thing that one of the side effects is something called arrhythmia. That means that your heart actually starts beating differently and this can actually create something called you know, your heart not to move. And without your hind leg moving, then you have bigger issues than that. That's why I am not recommending at all this medication as the FDA or CDC. We know using the FDA and CDC guidelines. There is no recommendation that, for that medication.

Shireen: Okay. So with that, Dr. Shapiro, we're rounding up toward the end of the episode. How can people connect with you, learn more about your work?

Ilan: Thank you for that opportunity. They can actually join any conversation that I have at Twitter or Instagram. It's at D r, underscore s. h. a. p s, again, it's Dr. Dr. underscore shaps, and also Doctor shap.com. And one of the websites that I curate a lot with the medical information screeners and stuff like that is the that we use here at work, the ultimate.org website and it has a lot of information there. And of course, you know, Facebook, Illan Shapiro, MD, and LinkedIn for anybody and I'm always, as you have seen, I'm always looking for opportunities to share ideas, to innovate and to have these types of conversations and thank you so much for the invitation. 

Shireen: It was an absolute pressure having you on. Thank you.

Ilan: You're welcome.

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