"Who are you? What's your support system? Do you have a family? What are your reasons to be alive and fight this disease? Do you have the means to care for yourself of both like, psychologically and economically and physically? Like, are you able to take care of yourself? You know, like, if you have to inject yourself, or your fingers functioning well, but is your mind functioning?" - Sandra Arévalo, MPH, RDN, CDE
Shireen: Sandra Arevalo is the Director of Community and patient education at Montefiore Nyack hospital working as a bilingual private consultant, researcher and spokesperson has helped her expand her horizons to continue her mission and commitment to provide health care to the most underserved and diverse families. Welcome, Sandra.
Sandra: Thank you, Shireen for having me here.
Shireen: An absolute pleasure. So Sandra, I want to dive right in. And I want to start out by asking you what really led you to a career in dietetics. And working with people from different cultures and backgrounds?
Sandra: Well, I think anything has started since I was a little girl, because well, not so little. I was 15. I'm originally from Colombia, in South America. And I, you know, I was very lucky because my father had to travel internationally a lot. And you know, we are a very close family. So I started traveling with my family, and we travel through a lot of countries in Latin America, then a few years later, we were able to move to Europe, and I was living in Holland for over three years. And then from Poland, we used to travel to like many other different countries, and, you know, being always international girl in a foreign country, you know, you make friends who are international as well, you know, most of the time, that's how it happens. So I had the pleasure and the advantage, I think over growing up with people from many different parts of the world, like, you know, for example, when I was in Holland, I have friends, you know, obviously from Poland, but also from Chile, Spain, Suriname, Africa, India, you know, so I've always lived in language, try to find a way to communicate, and play around with everybody. So I think that that's, that's how I became so passionate about diversity and cultures and all of these. And then, you know, later on, I definitely wanted to be in healthcare, and start doing something in healthcare, I just quite couldn't find what, you know, my, my true. passion was in healthcare, I knew I didn't want to be a doctor or a nurse, but I definitely wanted to in healthcare in and then I found nutrition and nutrition, you know, it's so diverse as well, because you can do so many things in nutrition, you can food service, but you can't be a clinician public health and research, you know, so it's, it's also a variety of things that you can do. And you're not especially food, and I love cooking, and I love healing, and I love prevention rather than the season. I think that's why I called them via lobster. And, you know, nutrition provided me with that, like healing and prevention and how we can use food and culture to help people live healthier lives.
Shireen: Oh, interesting. When you, you know, through one of your interviews, you mentioned, you know, caring for the patient and not the diagnosis, I want to I want to go right into that and even touch upon that a little bit to say, what does that really mean from both the patient standpoint, as well as from the provider standpoint and your approach?
Sandra: You know, I think our approach is not that different for both the patient and the provider, a person, a person, that's what I think, and unfortunately, the way that medicine is practiced overall, is like we practice our disease Nunan. Especially, for example, we talk about diabetes, right, which is our interest here is like, I'm gonna treat the diabetes, I'm gonna know if you have diabetes. Now which medications you need for your diabetes, if you need insulin, how many units will you need? You know, you're not thinking about the person per se. You're thinking about what the disease needs, you know, and you need this many units of insulin to control these diabetes or you need that these medications to control these diabetes, but you forget that diabetes wouldn't be diabetes if you weren't a human being, you know. And the human being is so complex, it is not just the diabetes, or it's not just how much the sugar was this morning, it's not a glucose of 300, or glucose or 50, or 120. Like the person eats at a multitude of factors, it's, you know, it's mental is better and not just feel better in terms of health, but a spiritually as well. So that's why I think that we need to look up people in not that he sees that he sees is just one small part of that person, you know, and the person has to they see that he sees that thing, how like, when they smell the person, like, Who are you? What's your support system? Do you have a family? What are your reasons to be alive and fight this disease? Do you have the means to care for yourself of both like, psychologically and economically and physically? Like, are you able to take care of yourself? You know, like, if you have to inject yourself, or your fingers functioning well, but is your mind functioning? Well, like, can you stand needles? I've had people who, you know, they're prescribed insulin. And when they come to me, and I, you know, usually when they come to me, because nothing is working for them. I just say like, are you really injecting your insulin? And they say, to me not terrified of needles, and I'm like, oh, how can you help with heroin, so every time I see a needle, I think of my brother, it's obvious, like, you're not gonna be able to use needles until you work on that other aspect of your life that is so powerful for same thing with a patient that, you know, if he kept coming to the local coming to the doctor, and the sugars were so high, and the doctor kept raising the insulin, pricing the insulin, then again, you know, they call me and they're like, Sandra, you go and talk to those patients. I don't know what else to do with this patient. And, you know, as soon as I come in, I'm like, why don't you tell me what's going on? I mean, the doctor doesn't know what to do with you anymore. Why don't I help you? What can you do? Like, how can I help you like, what's really going on? And he says, well, the disease, so went to the pharmacy, I get the insulin, but I'm homeless, I don't like to put the insulin. So first, but at the same time, it's like, if consistently, something is not going well, and you're trying and trying, you know, it's time to also for the providers to look outside the box. If I keep raising the insulin a few times, and it's still not working, ask yourself like maybe something else, right? I mean, it makes sense. It does what I mean, get to know your patients get to know you know, I had another case where this older lady, she will not get better. same issue, you just keep increasing the insulin and keep you know, switching medications around and you don't know what's going on and, and these lady will not get better. She's to us, like over 60 of the time. Well, just with talking to her and asking, How can I help you, you know, I need you to get better help me help you, she was finally able to disclose Well, I'm getting the insulin and sending it to my son in Ecuador, because my son also has insulin, there is no insulin in Ecuador, and he cannot afford it over there. So I'd rather just inject myself just a tiny little bit of my sent the older insulin to me, it's so many stories that I have, yeah, I could save here. And, you know, talk for hours, all these stories, but it's like, it's what people the way to me that you're really gonna be able to help them. Because again, we are monitoring the person not really sees is not about the medication, the right medication, oftentimes it's not like that. And we have so many people, the poorly controlled diabetes, and we're not doing enough for them as providers, we're not doing enough for them. And then people themselves, you know, patients are not doing enough for themselves, because they should speak up. That's what I always say, it's like, why didn't you say this six months ago, you know, like, there are people who have already an amputation, oh, it's when you're looking for help. And that's when you're opening your mouth, it's too late. So I also, you know, encourage all of my patients like you need to realize is that we know it. You know, unfortunately, the healthcare system nowadays, it's hard. It's not ideal, it's expensive, doctors have to see 18-20 patients a day. So you gotta move super fast. And you don't have all these time. But the thing is, you know, me myself when I go to the vault are in the low 30s. Like, okay, so this is what we're gonna do. And this is the next treatment, this is your next appointment. Do you have any questions and I get to ask one question, then they're like, okay, so nice to see you after the answer. And then like, wait, I have four more questions to ask. You know, and I'm right there. And I'm like, I make them wait and think, you know, that is me. I'm, you know, educated. I'm in the healthcare system. I know how to talk and advocate for myself. So imagine how many people are out there that don't know how to do that. Even for my parents. I'm scared when they go to the doctor by themselves because I know they are not going to get the quality of care that they deserve. So we are safe. also need to advocate for ourselves like, no, you're gonna sit down you're gonna answer my questions you're gonna explain to me why I need to take this medication you need to hear my side or for you know, it's not just what you're seeing in the chart, what you're seeing in my bloodwork and what you're feeling when you touch me or listen to my lungs, there is a whole bunch of other things that you cannot see. And I'm the only one who can tell you about that, so that you can help me the right way. So you know what I think there needs to be teamwork between the healthcare providers and the patients, patients need to speak up, advocate for themselves, tell their story, tell them what's not working for them. Don't be afraid, you know, like, a lot of us I know, we were raised with this thing, like the doctor is God. And we should just say what the doctor says. So true, like he is a person working with us, not for us, but with us. And we need to provide enough information to help the doctor do our job as well. And the doctor needs to find the time to listen to all these stories, because then then the doctor is not only gonna feel better as a person, but he's gonna have a lot more successful stories to tell. And it's gonna learn from each patient and from what they learn from each patient, they're gonna be able to help the next patient they're gonna be compared to.
Shireen: When you're, you know, when you mentioned the example with the patient, and you know, being scared of needles, or even other patients that you mentioned, you know, how, how does one come about to become an advocate for their care, right? Because, so now we know that if we're able to share and if we're able to do this right, then you know, we can, we can get the help that we need as a patient. But how does one go about doing it? Right? So one, one thing that you mentioned is we take the, you know, the limited time that we have with a doctor, we try to squeeze in as much and then after that the doctor leaves and we may think of 10 other questions later to think of or ask or you know, coulda, woulda, shoulda, right? How does one go about becoming an advocate in their hair?
Sandra: And he's like, oh, shoot, I forgot to ask what I always tell my patients is every time that you think of a question, write it down and bring that list with you. And that's exactly what I do when it comes to adultery. And let me tell you, once I had a little turtle once I said, You know, I know you need to wait, because I still have more questions, you know, the response from the doctor was, Oh, well, then you're going to have to make another appointment, because I don't have time for more questions. And yes, I made another appointment with a different doctor, you know, because I thought, this is important to me, understanding my help is very important to me, if you're not going to dedicate my time, this is a doctor, I don't want to make an appointment. Again, we don't different though. And that's pretty much what I advise my patients to do. Like every time you think of a question, write it down and ask it as many times as you need to, until you can't believe we understand what you need to understand. You know, for example, sometimes, you know, unfortunately, as a healthcare professional, we speak this language, but it's so hard to understand. And I have to tell you, you know, I've been both a healthcare provider, but I've been a patient in obviously, my family has been patient as well. And I can tell you, from my own experience, when I'm a healthcare provider, I have a very different mindset than when I am a patient order, order provider, you know, for my family, like I don't understand things that they talk to me sometimes. And he's for a lot of reasons, your emotions are in bold, you, you just can't think as three because you're worried at that moment, either because of your health, or the health of the, of your loved ones. You know, it's like a million things are happening through your head while you're trying to listen and understand a message that's being delivered to you sometimes in words that we don't understand. And that's when we need to pause a little bit. And that's another thing is not only bring your list of questions, but oftentimes like, I have to tell my sister or somebody, like I need somebody to come with me because I know that I'm gonna be nervous. And I know that first I'm gonna forget everything that I'm told. And secondly, probably I'm not gonna understand, because I'm so anxious and so nervous. So I need somebody else to come with me. And that way, you know, when we come back home, we can like, repeatedly, and like go over it again. And like, Oh, that's what the doctor said. Right? Right, I need to do that, you know, other thing, take notes, I know that I you know, like, as the doctor is talking, just take your notes. That way, you can go back to your notes and say, Okay, wait a minute, why is this again? How is this done? How do I need to do it? You know, um, and, and again, it's like, you need to shop for doctors, you know, usually for a number of people, you know, you get an insurance card within so we have doctors names there and you assume that that's the doctors that you have to see and we need to have a good rapport with our doctors and I'm just saying doctors doctors, but you know, it's just healthcare providers in general, we need to have a good rapport is like love at first sight though. When you go there. You can feel like yes, I can talk, I can be myself. I feel that I can tell the soldier anything or the healthcare professional, anything that I Want, you know, while there are some people that just don't have the chemistry where you know, you're not gonna be feeling as much as open, like, it's a little intimidating, I probably is gonna judge me if I do this, I remember once I went to another healthcare provider, you know, and it felt very strange to me, as soon as I got into his office, I saw all these books in a different language, and, you know, a lot of things that were very, very foreign to me. And definitely, you know, when we started the conversation, he was definitely foreign to my culture, you know, and I was pointing to his culture, and he started asking me questions that were kind of inappropriate. And I understood, it's not that they're inappropriate, it's just like it culturally, we don't have this empathy. You know, like, this is a big cultural barrier between this provider and like, you know, again, first time last time, but that's what I mean, it's like you, you can't be afraid of walking out of a situation where you're not feel 100% comfortable, because that's what you need for your health, you know, you need to feel 100%, comfortable, confident, secure, that this is the right person to help you. Because when you feel that way, you start healing right away, because you trust this person, you know, there needs to be a lot of trust as well, in this relationship.
Shireen: It's like, again, it's like a love relationship. You know, like, there needs to be love. There needs to be about first sight and chemistry and in understanding and trust. So with that center, we're toward the end of the episode, unfortunately, how can our listeners truly connect with you, learn more about your work? How can they go about doing that?
Sandra: Yeah, well, the easiest thing is search. Search me up on LinkedIn, I'm right there, you're going to find my bio and part of the work that I do and samples of the work that I do and yeah, if they have any questions, you know, I'll be happy. I'll check my LinkedIn frequently. So I'll answer your questions there. But thank you for sharing this. This has been a wonderful opportunity for me to be able to reach out to people and tell them a little bit of my experience and what I think hopefully we'll be better for them.
Shireen: And thank you for being on the podcast because it's so interesting in your approach, how you're empowering patients and I love that because without a true collaboration, how can we really work toward a better goal and better health outcomes? So I love the approach that you take Sandra so with that, thank you again for being on the podcast.
Sandra: My pleasure.