Shireen: Podcasting from Dallas, Texas, I am Shireen and this is the Yumlish podcast. Yumlish Is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

In today’s episode with Dr. Wendy Mobley-Bukstein we will be discussing better ways for physicians to personalize healthcare for their patients and the tools and resources available to a clinician to enable them to personalize that care. 

Dr. Wendy Mobley-Bukstein PharmD is an Associate Professor of Pharmacy Practice in the College of Pharmacy and Health Sciences at Drake University. She is a Certified Diabetes Care and Education Specialist, Board Certified Ambulatory Care Pharmacist and Certified Health and Wellness Coach at Primary Health Care, Inc. a Federally Qualified Health Center in Des Moines, IA.

Wendy:  Thank you so much for having me.

Shireen: An absolute pleasure, Dr. Mobley-Bukstein. I wanna dive right in and ask you what led you to a federally qualified health center in working with the physicians to just better understand individuals, their cultures, when it comes to healthcare, what was that journey like?

Wendy:  Well, I will tell you, I, you know, I grew up in a very small Midwestern town where everyone in the town looked like me, so we were all white Caucasian. You know, not really very diverse at all. I decided that I wanted to become a pharmacist at a very early age when I was in sixth grade. And so I I really worked hard throughout all of my schooling just to make sure that I was prepared and I chose to come to Drake University which is where I teach now.

And Drake has always been a very known for its very diverse, cultural nature, a very welcoming nature as far as students are concerned. And so it was. It was really there that I learned a lot more about diversity and culture and race and ethnicity, and a lot of things that I feel like I kind of missed out on in my childhood  to be really honest.

And so I went back home and I worked in a critical access hospital in Illinois for about 10 years. And then the position at Drake became available and I applied for it and I actually got the job. So I now have worked in the federally qualified health center that I'm at currently for about seven years since 2015.

And what I've found there is just, I love to be able to, I think, utilize my curious nature and be able to. Questions and learn more about people's traditions and some of the different ethnic foods that they like and how are those things going to affect perhaps their chronic diseases. And so I think it's probably just the passion of learning about things and, and learning more about just different people in different cultures and in different places to know more about just how they live and how we can incorporate those things that are very important to them from culture or perhaps family tradition, those kinds of things. How can we incorporate those things into their life and not perhaps ask them to stop doing something that's important.

Shireen: Dr. Mobley-Bukstein, you bring up a very interesting factor. So you're talking about all of this diversity in the way someone grows up in the environment that they have and how important it is. Especially when it comes to talking about delivering care. Now there's several factors there to consider when medical professionals are seeing patients

I mean, it, it can be very loaded, right? Because you've got religion, gender, ethnicity, race background, lots of different things. How do you sort of sift through all of that? How do you meet the individual where they are?

Wendy:  Sure. So I, I am again, very curious by nature. So I ask a lot of questions. A lot of times, you know, I.

Probably the, the old me or the previous me before maybe coming into the federally qualified health center, I would've assumed a lot of things.  and you know, I don't, I don't really do that anymore. I ask a lot of questions and I think sometimes people think I'm a little too nosy. I. You know, just because I, I do, I'm curious and I want to know more about it, you know, so we have a very large Bosnian refugee population here that we see.

And so, you know, in the beginning, I just, I felt like, well, would, would every single person that is Bosnian perhaps celebrate Ramadan or observe Ramadan and no, not everyone does a majority do, but not all. And so then we had to talk about, especially with my diabetes background, we really had to talk about, well, how does fasting during Ramadan affect your blood sugar and how are we going to work around some of the different parameters that, you know, each different

perhaps I don't know, I guess denomination or, or maybe, you know, of, of would perhaps celebrate, you know, and so sometimes the children have certain maybe rules that they follow versus the adults who maybe follow different rules. And, and then you get kind of the, the tweens or teens who are kind of like in between following the kids' rules and the adult rules.

And  some of those things. So I think it's important to ask, you know, where you're at, in your, you know, in your religion or you know, we also have a very large population of Hispanic patients. And so asking, asking a lot of questions there, because I think, you know, when I think of traditional, let's say just Mexican, for example, food, I think of rice and beans and tortillas.

And I've come to learn that not every single person who is from Central America eats rice, or eats beans or eats both. So I think it's really important to think about. Just, how do you ask those questions? And so we do often do a deep dive into their diet where I'll say, okay, tell me how many meals you eat a day.

What time of day would you eat those meals? What would those meals consist of? Because I think of breakfast in the morning and, you know, breakfast for me might be overnight oatmeal or eggs or something like that, where some of my patients it's, maybe it is eggs, but it's also beans. Wrapped in a tortilla or you know, maybe they're eating something that I would consider lunchtime, but it's really important for me to know what those things are.

And then how they're prepared. So I get really nosy about that too. Tell me how you prepare that what's in this. And so we ask a lot of those questions and I think that, that , you know, that leads us down a lot of different paths and, and again, just more questioning and, and tell me more about what, what that is or how you're doing this, or you know, if you're not taking your lunch every day, where are you eating at?

You know, and those kinds of things to find out, like, are you eating at an, you know, an independent restaurant or are you just going to the gas, the, the gas station, convenience store and picking something up and, and how we can work through some of those kinds of obstacles. 

Shireen:  When clinicians are personalizing healthcare to their patients like you are.

Can you speak to a little bit about the social cultural background, how you navigate for that and how, and I guess another question would be what we hear from federally qualified health centers is to say, well, we're stressed through it thin we don't have time to get to know them that way. So what would you say to that as well.

Wendy:  Well, I the lucky thing for me is that I get to decide how long my appointments are. So when I have an initial appointment, I block 60 minutes. And so, you know, sometimes, especially if we have to do interpretation, so perhaps the, the individual speaks a different language and one that I don't, that I don't speak.

So I'm not fluent in any other language besides English. I know a lot of Spanish.  And I'm learning Bosnian. But I think that you know, there's just a lot of different languages out there. And so I can pick out words and, and different phrases that are being said, because I've heard them multiple times, but we do use a lot of interpreters.

And so when we do use the interpretation, The interpretation facility. Then we are usually looking at maybe an hour and a half for that, in that initial intake. And that's just because, you know, it has to go from me to the interpreter, to the person and then back. And so it does take a little bit more time. For follow up appointments,

I schedule 30 minutes. And again, that's just so that we have ample time to be able to spend on things, really question a lot of things. You know, I think the biggest, the biggest thing that we are seeing, at least I think in healthcare in general is just since COVID, there's just a lot of vacancies everywhere people are you know, for one reason or another, not returning to the workforce and trying to figure out kind of why that's happening.

you know, I think is a, is a key, a key factor to trying to get places back up to full staff again. The nice thing about me being at the qual, the federally qualified health center that I'm at is that I'm fully funded by the university. And so they don't have to worry too much about how they're going to pay me.

And my, my services are not paid.  Or are not charged to the patient. So the way that we work is we work through quality indicators. So we are patient centered medical home within our clinic. And so everything that I do, we're trying to work towards improving that, that person's quality of life, thus, hopefully improving the quality indicators that the patient centered medical home is utilizing this year.

So they are able to choose, I think. Somewhere around 44 or 45 different quality indicators in the different providers with medical providers within our clinic are able to choose a certain subset of those that they're really working on with their patient population. So they've gone back through utilizing different quality markers and had our quality department pull reports from our electronic health record, and then they're able to choose which ones they think are most important to the patients that they  (have) .

So I, I would say I, I make an impact on maybe about five to seven of those quality indicators mainly doing with cholesterol, blood pressure and diabetes cardiac disease, those kinds of things, anything that would kind of, I would say, follow diabetes around. So but I, to your point, as, as far as like this, this social Background and those kinds of things, you know, our patients that are coming into the federally qualified health center, some of them are experiencing homelessness right now.

Some of them have a home, but aren't able to afford food. So. They're, you know, food insecure, we're helping them find food pantry. We're helping them get apply for food stamps. Some of those kinds of things, we do have a mobile food pantry that comes to our clinic in parks, in the parking lot, once a week.

And so there are times when you know, if I've talked with the patient and they said, you know, this week I had to spend my money, that I had budgeted for food on medication. So I, I don't have any money to buy food. And I'll say, Is there a way for me to give you a bus token or a cab fare, to be able to come over to the clinic on Wednesday when the food truck is here and we'll walk through it and we'll find some things for you to take home, to have to eat this week.

So there's different ways to do that. We also again, have relationships with a lot of the different food pantries in Des Moines and are able to refer patients to those especially ones that are close to where they live.

So, those are just some examples, but you know, I think that that's, we're, we're trying to connect all those different resources within the community to, to really help individuals get what they need.

Shireen:  And I think that's one of the unique things being associated with the federally qualified health center that it's not, you know, when, when people talk about seeing a physician or even seeing a clinician for that, matter's just, oh, I get the 10 minutes and that's pretty much it cuz they're circling through.

But what I'm hearing from you is as a federally qualified health center, there are those other qualitative measures that have also to be met. And that include. The health and wellbeing of the patient population. 

Wendy: Absolutely. I mean, you know, it's not just about going in and checking out about your chronic conditions because there are a lot of different things.

I'm sure you've heard the, the term food is medicine. And so for a lot of our, a lot of our patients, if they're not able to eat and they're not able to eat in a nutritious way you know, we're really probably not going to get their health conditions better controlled. And so I often talk with About the fact that, you know, yes, we're gonna talk about activity and I'll often tell 'em, I'm never gonna say physical activity.

I'll just say activity seems to, to be a little bit more receptive  when you, when you don't put that whole physical part in front of it. I don't know. But you know, I, I talked to them about the fact that like, you know, exercise or activity only lowers your A1C by about 0.6%, which is not a huge amount.

And, and so we really want people doing activity because it, it helps strengthen their cardiovascular system, which is in the area that diabetes tends to wreak havoc on as it progresses. And so that's really what we're looking for is, is for more cardiovascular health, through that exercise than for weight loss, we're gonna be looking and turning to food and what they're eating and how they're eating and trying to utilize that as a way to really help control or manage their chronic disease in a little different way. So you know, when we, when we see those individuals who are having food insecurity or perhaps live in a food desert where there aren't places besides perhaps a convenience store or at a gas station to be able to buy something at how are they going in and really looking at the things that are available there and making you know, choices that are best for that.

Shireen:  You know, your, your approach, Dr. Mobley-Bukstein is, is very unique and rare, right? Not a lot of clinicians are getting to know their patients at that level over the years. Have you met with any resistance around that either from patients or clinicians around you? What has that been like for you?

Wendy: I think the, the really great thing is that the, the providers in our clinic have been very receptive.

In fact, the internal medicine office, which is where I'm housed at within the clinic was who brought me into the clinic in the beginning. They were moving from another clinic who had had a CES diabetes, education/ care and education specialist in their clinic. And they were moving to this clinic and that person was not moving with them.

And so they were very. About having another person like that in the clinic. And so that was when I was moved into this particular role. And I think that it's I've been fortunate, I guess in the fact that I've been able to really make the, make the position, what it is and, and work at the way that I want to work it.

And so I think that that's, what's probably been the best part of it, but I think having that support. To call providers in the clinic was a huge thing. And having that, that, you know, we have two physician champions that really are like, we need you here. And now I have the residents and the residents, like, it's so great when you're here.

You know, because they come in and they sit down and they ask questions and we review things and they'll say, well, this is what I know. And, and we just share information back and forth. And I think that that's, what's really important is really that information sharing and that communication, because then we're able to really get to know the patient on a, on a holistic level, rather than just kind of this just right under the surface level. You know, of that patient. So really trying to be able to help them in ways that, that perhaps, you know, in the past, they haven't had individuals in their medical care be as involved.

Shireen:  What helpful tools do clinicians, including physicians have in place to work with their patients again, at the level that you do that is so personalized. Are there any programs that are in place today? And I know it's, it's different across the nation or what general programs perhaps are available in tools available for federally qualified health center for hospitals health systems.

Wendy:  There are quite a few, I would say federal programs that are available and it's, I think sometimes you have to go looking for them. So maybe your public health department like our state health department we have obviously the diabetes prevention program, which is for individuals who are at risk to develop type two diabetes.

It's a lifestyle behavior change program. So we have that. We also have diabetes self-management education and support program. So we're able to. We provide individual some DSMES programs provide group where you have kind of the support of one another, and you're able to talk to one another.

And we haven't been able to do that because of COVID. We we'll be moving back into some group, small group activities hopefully in the, in the coming months, but we haven't been able to do groups since 2020. Right now we're just doing individuals. So when the patient comes in to see their medical provider, we're also going in them at the same time so that they only have to come for one visit rather than having to come back for multiple visits. We also have I've written a couple of grants where I've gotten grant money. And so I've been able to afford to have professional continuous glucose monitors in the clinic.

So when we have individuals that we're not getting. Hemoglobin and A1C where we would like to have it at we're putting, we're asking, can we put one of these professional monitors on you? And it records their blood sugar for 14 days. And so I get all of this information and I can really see trends of, oh, well, you're always high about 10 o'clock in the morning.

Maybe we're not doing a good job of covering whatever it is you're having at breakfast. Or maybe we need to talk about what you are having at breakfast and seeing how we can adjust. So sometimes it's about food intake. Sometimes it's just that we're not managing the medication to the best of its ability.

And so being able to use those things. Additionally walk with ease is a program that's available. This is a program that's available for people with lung disease. So learning how to build lung capacity and doing it in a, in small increments, but then helping people, you know, with, I would say even mobility issues.

So arthritis. Some of those kinds of things, but it's a program that helps them learn how to walk and and walking for exercise basically, but not having to run or  or do anything you know, too strenuous. So it's a really nice program. Our state health department runs that program as well. We also have one called wise woman, which is a program that assists women in making sure that they're getting all of reproductive health being taken care of. So mammograms, pap smears you know, just all of the different types of, of reproductive health for women. It also allows us to do a medication review with those women as well, just to make sure that they are taking the medications that their provider is prescribing and making sure they're taking them appropriately and that they know what they're for and all those kinds of things.

So there are a lot of programs out there. I think it's just a matter of getting yourself connected with those different programs and finding out what's available. So calling your, your public you know, your county or even your state health department and saying, Hey, what programs do you have available for people that, you know, perhaps are low cost or no cost.

And how can I get involved with those programs? 

Shireen:  How does the, how does the state, or the county, or even federally how do they look at cultural competence in healthcare? What is, what is this place in providing adequate healthcare to an individual?

Wendy:  So I would say most of our programs are available in different in different languages.

So right now, at least at our clinic, we're, we're providing the diabetes prevention program in both English and Spanish. I think the biggest thing would be to find community health workers that could be trained that are from other races, other ethnicities, other cultures, to be able to have them come in and be able to help.

So me as a lifestyle coach for the diabetes prevention program you know, if I could have someone who was from Bosnia or perhaps is from Kenya or Ethiopia. Which is where a lot of my refugees are from you know, come in and help me with, one: with interpretation sometimes with my African refugees, it's harder because many of them speak different languages, even when they're from the same country.

And so sometimes that's a little bit harder. But you know, when you get a group of individuals that all speak the same language and having a community health worker who could be trained to assist in that, you know, lifestyle, behavior change program, that is a big, a big help. And so really trying to find individuals Community who are wanting to help their community and then bringing them in and training them up.

Shireen:  That's very helpful. With that, we are toward the end of the episode. At this point I would love for listeners to know how they can connect with you, and then just learn more about your work. 

Wendy:  Sure. So I am, you can find my, my bio on the Drake University college webpage, it's drake.edu, but additionally social media, I, I tend to post a lot, so I'm on Twitter, WMbukstein.

I am also on LinkedIn. And so there, Wendy Mobley-Bukstein. And a lot of times on LinkedIn is a little bit more professional type of post. So things that are related to pharmacy, diabetes advocacy, I do a lot of advocacy work in the pharmacy and diabetes space. But. Twitter is usually a little bit more my place where I'm posting things related to diabetes and you know, just helping individuals out.

So more than happy to connect with people though really, really looking forward to continuing this conversation online, for sure. 

Shireen:  Absolutely. And with that, Dr. Mobley-Bukstein thank you so very much for your time. To our listeners, they're listening to this episode. Let's continue that conversation.

On Facebook, on Instagram, head over to our youngish page there and answer this quick question. How has your physician personalized healthcare for you? So again, head over to our social media on Facebook, on Instagram, find this podcast post there and comment and tell us below how exactly your physician has been able to personalize healthcare for you. Again with that, Dr. Mobley-Bukstein, thank you so very much for your time. 

Wendy: Thank you. Have a great day.

Shireen:  Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

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