Shami Mitchell
Now to begin, we’re going to start our conversation off by addressing and discussing some of the ethical issues that surface concerning transplantation and just general knowledge about the transplant list. So Dr. Modlin, could you address actually how the transplant list works?
Dr. Charles Modlin
So, kidney transplantation is a subspecialty that both urologist and general surgeons are engaged in. Currently, there’s approximately 120,000 individuals on the national kidney transplant waiting list. Yet, there’s only about 25 to 30,000 kidney transplants performed per year. So you can see the number of individuals who need kidneys greatly outnumbers the number of individuals or the number of organs that are available for transplantation. An individual’s nephrologist, which is a medical kidney doctor will make that referral to the kidney transplant waiting list, but you cannot get on the waiting list until your overall kidney function is at 20% or below. Again, there’s a number of medical evaluations you have to go through, we have to make sure that you’re a suitable candidate, that receiving a kidney transplant is not going to do any harm to you that you know, the risk is taken into serious consideration. So individuals have to get a heart evaluation, we have to make sure the lines are strong, we have to make sure you don’t have any camps or any ongoing or existing infections, we have to make sure that psychologically, you’re in condition to be able to undergo the kidney transplant, because we have to make sure patients are going to take care of the organ, once they receive it. We want to make sure you’re compliant with your medications, there’s a lot of medications you have to take after receiving a kidney transplants. So there is a plethora of evaluations, you have to go through physical examinations, CT scans a number of things to be placed on a waiting list. And then once you’re placed on the waiting list, and so that transplant evaluation, in many instances can take six months to a year, or even longer to complete. A number of visits to the transplant center are required, you also have to demonstrate that you have social support, that you have some individuals around you that are going to, you know, help you through the process. You know, we want to make sure that you have adequate transportation to get to and from the transplant center for your appointment. So we’re looking at a lot of social situations as well. You know, again, it takes about six months to a year to get placed on a waiting list. Once you’re on that waiting list, then you stay on the waiting list. In many situations, the average waiting time could be it really depends on your blood type, it could be three years, five years or even longer, where you’re waiting on that waiting list for a suitable donor. And then that donor actually has to be compatible. We call it Histocompatibility so that you will not reject the or automatically reject the kidney wants to place it on your body.
Shami Mitchell
You mentioned that there is oftentimes the criteria of blood type that depends on how long you stay on the list. So what blood types are usually more likely to be taken from the list and given a kidney.
Dr. Charles Modlin
A lot of it depends on whether or not an individual has had many previous blood transfusions. You know, when you’ve had a lot of previous blood transfusions, regardless of your blood type, your body can develop antibodies, you know, against potential kidney donors. And so that actually can raise what we call your panel reactive antibody, which lowers the chances that you’re going to, you know, get a kidney transplant. Women who have had multiple pregnancies also have more preformed antibodies that limits the number of potential kidneys that they can receive. So the most common blood type is type O, but individuals who are type A A lot of times may wait a little bit longer. And again, people who have had a lot of blood transfusions, women with a lot of pregnancies may wait a little bit longer to receive, you know, organ transplants. Okay,
Shami Mitchell
and also another follow up question. So if a patient who has been diagnosed with a condition such as alcoholism is looking for a kidney and needing a kidney, are they equally considered for kidney transplantation? Or is there some type of social factors that weigh in on that decision?
Dr. Charles Modlin
Somebody who’s actively abusing alcohol would not be considered a suitable acceptable candidate to receive a kidney transplant for a variety of reasons. I mean, it could affect the liver and cause cirrhosis and can lead to all kinds of other problems. It can affect, you know, one’s behavioral health, lower one’s immune system, you know, when you have a kidney transplant, we give you anti-rejection immunosuppressive medications, which can make you more susceptible to infections and cancers. And so, we don’t want anybody abusing any substances including alcohol. So yeah, we do a deep dive and assessment in terms of, you know, whether or not anybody’s using any illegal substances or abusing alcohol or tobacco. Many times, most patients have to have social work evaluations. And sometimes we even refer people to psychologist, psychiatrist. Because we don’t want to just automatically exclude people, we want to be able to work with them, get them the help that they need, you know, to overcome whatever addictions they may have. Because our ultimately we want people to be candidates for kidney transplants.
Shami Mitchell
Okay. And you mentioned prior to this conversation that individuals who have type A individuals who have previously been pregnant have preformed antibodies that kind of limit their ability to receive a kidney, that kind of just brings up some ethical concerns about whether or not the benefits of kidney transplantation are equitably distributed amongst everyone. Have there been any developments in the field of transplantation that are trying to somewhat diminish the likelihood of an individual not being able to get a kidney because of something that they can’t change, like their blood type or their previous pregnancies?
Dr. Charles Modlin
Well, and I might add, you know, in some instances, I mean, there are other individuals who at times can wait longer I mean, blood type O can only receive kidneys from other individuals who are Oh, there are some situations where they might be able to receive kidneys from blood type A, but these are, you know, some extenuating circumstances. But type B can wait longer also. And again, a lot of it depends on their previous exposures. You asked the question, what ethical considerations go into it? Can you repeat the question?
Shami Mitchell
Sure. Because the risk and the benefits of receiving a kidney are not equitably distributed, because of factors that people can’t change, like blood type, or being pregnant previously, is there anything within the field of transportation that’s being done research wise, or clinically wise, to kind of help those individuals to be more likely to be considered as a result of things that they can?
Dr. Charles Modlin
There is some research that’s been done, and actually, this has actually occurred. Some individuals who are blood type A, can donate to individuals who are blood type, oh, but that’s a subset of Type A individuals if they’re actually a versus a. So there’s more research also being done with respect to ways in which to lower an individual’s pre existing antibody levels, their panel reactive antibodies, and some of that involves hyperfiltration of their blood to filter out some of those preformed antibodies. There’s always ongoing research with respect to newer types of anti rejection medications, you know, to suppress the immune system, you know, so yeah, there’s always research ongoing because the need is so great. I think one of the major responsibilities of physicians transplant surgeons nephrologist is to educate the community about ways in which to avoid developing kidney disease in the first place.
Shami Mitchell
Can you talk to our listeners about what is it like to remove a kidney from one patient and transplant it into a different patient what is kind of like a high level procedure look like?
Dr. Charles Modlin
Those individuals who wish to undergo donor nephrectomy or donating one or their kidneys to somebody else, they actually have to undergo a very extensive medical evaluation also, to make sure that this is going to be a safe proposition for them to make sure that donating one of their kidneys is not going to resolve and they themselves developing kidney disease. At some point in their life, the majority of us are born with two kidneys. And so you know, we have to make sure that they’re not being coerced, you know, being forced to donate one of their kidneys. they undergo psychological evaluation, social work, evaluations, medical surgical evaluations, we check their blood test to make sure they have normal kidney function. We check their urine and make sure there’s no evidence of blood or protein in the urine, which could suggest early stage kidney disease, we screen them for, you know, certain cancers, we make sure they’re not smoking. We do x rays to make sure they have two functioning kidneys, we look at the anatomy on the X rays, CT scans. So they undergo an extensive evaluation. Again, sometimes it may take six months or longer for them to undergo the evaluation. The good thing is that the recipients health insurance will actually pay for the donors medical evaluation. And so that’s an added incentive. You know, one of the things that we’ve noticed and we are aware of is that when you look at Black populations, African American populations in particular, we see that African Americans are less likely to have suitable potential living donors, family members, The reason is not necessarily that their loved ones relatives friends are less willing to donate. A lot of it has to do with health literacy and awareness that they actually can actually approach individuals to ask them to be donors. A lot of individuals are not aware of the fact that living donors are a possibility. Also a lot of their loved ones, a lot of African Americans who potentially would like to be kidding, donors are afflicted with high blood pressure, diabetes, or having a strong family history of diabetes or hypertension, they may be on medications to treat these conditions. And that in most situations will exclude them as potential living donors.
Shami Mitchell
I think you mentioned earlier that individuals go through extensive emails before they can provide a kidney as a living donor. And you mentioned one of the evaluations is a psych evaluation. So does that limit individuals who may be diagnosed with mental illnesses or mental diseases from being able to donate kidneys?
Dr. Charles Modlin
It actually does. There are a number of ethical concerns that may impact an individual’s ability to be referred for a transplant placed on a waiting list. I know at Cleveland Clinic, we actually have a bioethicists, who is involved in part of the pre transplant team, you know, to help ensure that none of this occurs, you know, we want to make sure everybody has a fair shot. Again, life span and survival is improved if you receive a successful kidney transplant, as opposed to staying on dialysis. So you know, these are life and death decisions that are being made. And we want to make sure that everybody has been given a fair opportunity. You know, one thing that we’ve seen also historically, which is disconcerting in, especially in African American populations, there’s research in the literature, that shows that African Americans are less likely to be referred, even though we develop kidney disease, kidney failure, at four to six times greater than Caucasian Americans, were less likely to be referred for a kidney transplant evaluation. Medicare only pays for the anti rejection medication for three years post kidney transplant. And so then patients rely on their private health insurance to pay for that medication, which is very costly, very expensive. And so if somebody may not have a job or you know, financially, economically difficult situation, they may have to make a decision whether or not to put food on the table versus taking their medication. So again, there’s a lot of social and ethical concerns that go into, you know, some of the observations that we see. And it’s important that we do have these kind of ethical discussions. And I believe that everybody has a right to healthcare in the United States, the healthier that we all are, the stronger that the nation is going to be, need to find better ways to ensure the availability of organs to everybody, you know, I think it was back in 2016, that the United network for organ sharing, that’s the federal agency that regulates kidney transplantation, they actually changed some of the algorithm and the point system, whereby to make sure to help ensure that minorities, African Americans are more likely to be able to compete to receive these organs. You know, it takes into consideration how long an individual is actually been waiting on a waiting list for a transplant, how long they’ve been on dialysis. And so this, hopefully, you know, better equalizes opportunities for African Americans to receive kidney transplant, you know, the data is still out, because it hasn’t really been that long since we’ve been using the system. But it does appear that African Americans now have more opportunities and more equitable opportunities because of the system.
Shami Mitchell
Well, that’s great. First of all, I like to commend just you and the Cleveland Clinic for implementing and adding a bio at this is to the pre transplant team, because I think that having someone who has that ethical perspective to discuss when risk and benefits are not equitable, and it’s violating that principle of justice. I think a lot more people need to kind of follow suit and look at you all as somewhat of an example. And to know that changes have been implemented to help with individuals who may be at a higher likelihood to experience healthcare disparities just based off of lifestyle and or race. I think that’s just also another commendable act that the transplantation field is implementing. My next question is, are there any risks to having a kidney removed from a healthy individual? And if so, does removing that organ from a healthy person to save a sick person, violate any principle of beneficence do no harm within the field of medicine because you know, cutting the flesh of a healthy person for the If I have another person, I’m just wondering, is there any other risk or benefit to a person who gets a kidney removed?
Dr. Charles Modlin
Yeah. So you know, the thing is, we have to make sure that the operation is going to be safe for the living donor. You know, as far as I know, this represents the only situation where we are actually putting a knife operating on a healthy individual who actually does not need that particular operation for their own physical benefit. And so as a result, there actually is psychological benefit. I mean, research and studies have demonstrated that in individuals who live in donor individuals do derive or seek psychological benefit, you know, based on the fact that they know they are helping save another individual’s life, but there’s no physical benefit that they derive by donating a kidney. anytime anybody has surgery of any kind, no matter how major or minor, there’s potential risk that could be brought to them, there could be harm brought to them. You know, individuals have to undergo general anesthesia when they donate a kidney that actually in and of itself puts people at risk. There are different risk categories, you know, based on age and other comorbidities. But generally we only will operate an agreed to allow somebody to donate a kidney if they’re healthy. So, because they’re healthy individuals, you know, their their risk is lower. There’s probably less than a 1% risk of individual dying after or during donating a kidney as a living donor. But you know, the patient could have a hemorrhage loss of blood they may require blood transfusions. Most living donors these days that kidneys are removed through a procedure called laparoscopic donor nephrectomy. Sometimes we still have to make an open incision, depending on the anatomy of the individual. So you can have pain at the incision site. And so yeah, there are potential downsides, but again, people who have been living donors, they will tell you that they derived a, you know, an instrument of psychological benefit for doing something of this magnitude to help somebody else.
Shami Mitchell
Right, right, exactly. So that’s good to know that there is some type of benefit for donors, but also in noting that there is also some risk when it comes to going through surgery to provide that help for an individual. So now we’re going to redirect the segment toward more of the urology part of your background. My first question is, are there any cosmetic procedures that a board certified urologist can perform on individuals like testicular implants, penile implants, circumcisions, and so what risk are what benefit does these procedures provide individuals?
Dr. Charles Modlin
You know, different urologists have different training backgrounds. There are some urologist who I’ve known in the past actually will do like a plastic surgery fellowship, which is additional training after they receive their board certification in urology, but there are not really many individuals who do that have the procedures you mentioned? Many or if not most urologists are board certified and capable of performing, you know, penile implant surgery, testicular prostheses circumcision, but for the most part, we’re not really performing these for cosmetic purposes. Usually, like for example, circumcision, and we perform in adults, because they may have a condition we call find Moses. And that’s where they have difficulty retracting the foreskin. And there’s a higher incidence of infection, you know, locally, you know, down in the your genital area, which can translate into urinary tract infections and other infections. So a lot of times we’re doing this for medical purposes. Sometimes an individual may have actually already had a circumcision, but it may not have healed the way that they wanted. And so, you know, we’ll go back and maybe for cosmetic purpose for that reason, men who have had testicular cancer, testicular torsion, where we had to remove you know, one of the testicles, you know, oftentimes, we’ll put in a testicular prosthesis in a lot of times that’s in younger gentleman. So there are things that you know, that we do and, you know, penile implants. We don’t really do it for cosmetic reasons, for the most part, I mean, there are some situations where maybe an individual has, you know, been traumatized, but for the most part, we do those implants for functional reasons to restore potency, you know, so they can, you know, function and have moral moral lives and, again, that affects their psychological state, you know, status, you know, if they’re unable to be potent or perform and so, we take that into consideration. There are different types of you know, implants that we do inflatable or semi rigid but you urologist are specialists who are the ones who actually perform this kind of surgery. And again, it’s just another example where a lot of men there, there are disparities and along racial ethnic lines where a lot of black men don’t even know that these are options that they actually can even undergo penile implants are things that we do before we get to that stage. I mean, we try other therapeutics, other you know, things that we try before we get to that point that a lot of men of color, don’t even know that they have these options.
Shami Mitchell
Wow. And that’s really important, because I believe the last time that we were in the hospital, an individual had, I think, high blood pressure, there’s some sort correct me if I’m wrong, because I’m not sure of all the medical terminology, but have high blood pressure of some sort and was unable to have an erection. So was in need of a penal implant it because African Americans are more likely to have hypertension, high blood pressure, they would be more likely to benefit from these procedures. Am I right? Or am I just kind of guessing here?
Dr. Charles Modlin
No, no, absolutely. I mean, that and again, the those are some of the leading causes a lot of times we we may not be able to put our finger exactly on what is causing the erectile dysfunction. But you said it it really, you know, I blood pressure, diabetes are the leading causes. And yeah, we try to get the men to give them their options. Sometimes they don’t really know what the reason is. And we may treat them empirically with Cialis, Viagra. You know, some of these these medications you hear about on TV? But yeah, I would encourage all men to go in and get evaluated and don’t just suffer in silence.
Shami Mitchell
Our next question is, as a physician in when you’re in the hospital, are there circumstances where a patient has requested a procedure that was not medically necessary? And as a physician, with the knowledge that you have, what was your approach? And what was your advice to the patient when a procedure is requested that isn’t medically necessary, but may pose some risk to the patient,
Dr. Charles Modlin
you know, the operation, you know, for penile implant, you know, we some of these procedures, we consider the lector procedures. And we’re not saying that they’re not medically necessary, because we know that, again, patients can derive a psychological benefit. And it restores their lifestyles, and it’s very important. But there are some situations where we feel that a particular operation may put a patient and a risk that is that outweighs the benefit. You know, if they have heart disease, respiratory disease, if they’re on anticoagulation, maybe they had a heart valve, and they’re on anticoagulation. And their cardiologist or cardiac surgeon says that they cannot be taken off this, you know, blood thinner, this anticoagulation, the risk goes up, you know, tremendously. I mean, there are certain individuals who may be anemic, have a low blood count. So I mean, there are certain underlying conditions that make some surgery too risky. And we just have to explain to patients that we, if we consider it to be an elective procedure, you know, it’s not an emergency procedure, it’s not cancer, there are some times that we actually just have to sit patients down and let them know that this is not something that we would advise they go through or something that we actually will do. So there are many situations where we have to turn patients down and offer them alternative therapy for a particular condition. And most patients will understand that they’ll accept that the other thing is I always tell them, most doctors will encourage patients to go get second opinions will get third opinions, they have a right to do so. We’re not offended when patients go to other physicians to get you know, additional opinions they have to do whatever they feel is necessary so that they have a full and complete understanding what their options are. I’ve seen a number of patients that have been to several different doctors that come to me for second opinions and third opinions, etc. You know, so, there are some times when really, we advise patients against surgery, there are some situations where we will absolutely refuse to do particular operations if they’re not urgent or emergency situations.
Shami Mitchell
Okay. And the reverse side to that, had there been circumstances where you’ve actually suggested or hoped that a patient would get a particular procedure, but the patient was very insistent on refusing the treatment.
Dr. Charles Modlin
Yeah, I’ve seen the situation where we will make a certain treatment recommendation, whether it’s a patient with prostate cancer, bladder cancer, kidney cancer, I’ve seen young patients on dialysis for a number of years and I try to explain to them that they may want to look into getting a kidney transplant because again, kidney transplantation is preferred over a long term dialysis, there are more complications staying on dialysis over a period of time higher death rates. I’ve seen certain individuals refuse to want to use be considered for kidney transplantation. A lot of it’s because they lack the knowledge in terms of the benefits. A lot of it’s a fear factor. I’ve seen individuals and I’ve seen this in not only black populations, but white, and other populations, but more predominantly in black populations. There’s a myth. And I encounter this at least three or four times a year. There’s a myth that in some of these individuals who have cancer, we recommend surgery, there’s a myth or misconception or fable going around in the black community that if they have surgery for whatever type of cancer it is, Doctor makes that surgical incision and exposes that cancer to air the air hits the cancer. There are several people in the black community, especially that believe that that cancer is going to then metastasize spread, because they’ve had that cancer exposed to air. I’m not sure where. And when that misconception started. I started hearing about that, when I was in training at New York University. And I’ve heard many individuals at Cleveland Clinic tell me that whether it’s surgery for kidney cancer, bladder cancer, or prostate cancer, some people still believe that and so really, it’s incumbent upon us, as physicians to get out into the community dispel a lot of these myths, misconceptions. It’s important with respect to transplantation that we define and raise awareness about the benefits the merits of living, transplantation, deceased donor transplantation, over stain on dialysis, there’s a lot of work that we need to do to raise the levels of health literacy in the black community in one way in which we can do that we’ve had success is using surrogates by you know, developing community networks and collaborations, the United pastors and missions of one such organization in Cleveland, it’s a group of several pastors that represent probably about 400 churches or more in the greater Cleveland area, predominately African American churches. And again, because they have these pastors have credibility within the community, they can actually help support and help pass, you know, these important life saving messages along to their parishioners, and, you know, members in the candidates about building trusting relationships. And it’s important that we understand this as healthcare providers and not just stay within the confines of our hospital offices and exam rooms, get out there and network with people and help raise their health literacy and awareness about how they can actually contribute and help in improving their own health outcomes.
Shami Mitchell
Definitely, I think you really touched on the fact that there is a balance that comes when you’re trying to balance the patient’s autonomy, but also the physicians autonomy, because the patient has the ability to choose which medical procedures they would like to go through that aren’t emergency or necessary. But the physician also has the ability to refuse if they are unwilling to perform the procedure based on any number of reasons, including the health complications that come or also the maybe religious opinions that they have. So our next question kind of talks more about best interest and the beneficence that comes along with patients going through surgery when patient or a surgery does not go as planned and the patient may be harmed as a result of something that happened with the our team or something that happened in the surgery that was unexpected. What are the steps that a physician takes to ensure that the best interest of the patient is still upheld in that alar and outside of the or when you’re now communicating what happened to a family member,
Dr. Charles Modlin
you know, in lies, as in surgery, I mean, things don’t always go as planned. I mean, it’s unfortunately, a fact of life that I mean, complications and surgery can occur and do occur. But what’s important is that when these circumstances and situations occurred, it’s important that we have transparency with both the patient and the family. And there are mechanisms in place at Cleveland Clinic in all hospitals across the United States. I mean, these are their regulations that require that we disclose certain unfortunate events, complications to the patients and families, but also that we have discussions internally as a group in our department, with our risk management team. And we call these you know, root cause analyses we try to get to the bottom in terms of what happened, why it happened and what steps we could have taken to prevent such occurrences we have, for example, monthly, we call them m&m, morbidity and mortality conferences where we get together and review cases of other surgeons and our own particular complications that may have occurred. And we go through, you know, the case scenarios and detail review x rays review of the decision tree that went into, you know, determining whether or not a particular patient should have a surgery. So we do all these things to try to ensure that certain complications do not occur to try to understand why a particular complication occurred. And so yeah, there are safeguards that are built into the system, to where we don’t just dismiss such complications, we actually talk about it and try to get to the root cause. And, you know, again, we want to be as transparent as we can, you know, with a patient in the family so they can understand what happened, why it happened. So again, unfortunately, like I said, in medicine, and surgery is in life, you know, things don’t always go the way that we would like them to go.
Shami Mitchell
Definitely, definitely. So we’re going to shift our last segment to listening to you explain to us a little bit more about the minority Men’s Health Fair speaking to us about some of the work that you do in health care disparities, and with the minority Men’s Health Center. So if you could please just give us like a high level overview of kind of the work that you do. And also what is the intended impact.
Dr. Charles Modlin
You’re one of the areas in which I’ve dedicated a lot of my career has been in the area of disparities in racial and ethnic minorities, came to Cleveland Clinic in 1993. Between 1993 96 I did my kidney transplant fellowship. And
then I joined the staff of Cleveland Clinic in 1996. And after I finished my kidney transplant training, I was able to step back and take a broader view of the medical landscape. And that’s really when I became aware of the fact that these racial health disparities and differential outcomes along racial and ethnic lines was occurring. I learned about this initiative called Healthy People 2000. It was an initiative from the Department of Health and Human Services, under Bill Clinton’s administration to eliminate health disparities in a variety of areas. And so I became quite interested in I wanted to know what Cleveland Clinic was doing to play a role in eliminating these health disparities. I looked around I did not see any formalized programs at Cleveland Clinic to address these healthcare disparities. So I went to the Chief of Staff at the time, Dr. Rob Kay, I said, Listen, you know, we should play a role in helping address these health disparities. My initial intent was not to establish a minority men’s center, most center just for men. But we decided that in order to I wanted to start at what I call a theme of center for Minority Health enterprise wide, but we decided to start such a program, we should start more focused initially. Being urologist, one of our major target diseases is prostate cancer. And we know that black men develop and die from prostate cancer twice as often as white men. So that’s how we came about to establishing the minority, Men’s Health Fair in 2003, library Men’s Health Center in 2004. Again, anything we do at the clinic is open to individuals, regardless of race or ethnicity, or even gender, but we target men of color, because they have not only the highest incidence of prostate cancer, but higher rates of diabetes, heart disease, kidney disease, and a number of other diseases, you know, higher rates of colorectal cancer, lung cancer. And so one of the first things we did when in 2003, was established the minority Men’s Health Fair. And again, that came about after studying some of the reasons and the root causes for a lot of these health disparities. Again, a lot of the social determinants contribute to health disparities, but there are some genetic hereditary components, higher incidence of prostate cancer and families colorectal cancer, hypertension, diabetes, heart disease, kidney disease, social determinants, as you know, environmental determinants, behavioral factors, biologic genetic determinants. And so and also distrust of the healthcare system based on the Tuskegee syphilis experiment, that actually keeps a lot of men of color in particular from going to the doctor because they’re they’re fearful of being discriminated against, used as guinea pigs. And so in doing the background research and trying to understand the root causes of these disparities, I went out and develop relationships, networks collaborations with a number of organizations, it took some time. But one of the first things that we wanted to do is open and allow individuals to access Cleveland Clinic, one of the greatest healthcare institutions in the world. And we did that by starting our minority Men’s Health Fair 2003, which is an opportunity for men, men of color old men to come in and get free preventative health screenings for the early detection of disease. You know, prostate cancer, we can cure prostate cancer, we can actually diagnosis in early stages. One reason black men have higher death rates is because they present in later stages. You don’t have to have any signs or symptoms of prostate cancer, so you need to go in and get screened. So we started the health fair 2003 we had 35 men show up, which I thought was actually pretty good turnout at the time. But over the past several years, we’ve done the health fair now. 18 years. Now we have four simultaneous locations for the hill fair. We have 650 volunteers. We get 1500 men, the last several years every year coming in for these free health screenings. The success of the health fair is based on you know, the hundreds and volunteers who devoted their time and expertise and energy to give back to the community. I’m really appreciative. We have outside sponsors, we have outside volunteers, it’s been a great success. One thing I’ve been doing also I never gave up on this overall concept of Cleveland Clinic center for Minority Health I call it now a multicultural center of excellence. Since we started the minority Men’s Health Center again, that’s your rounds. We started April in 2019 and minority Stroke Center. We have a dermatology center we call it multicultural skin and hair Center of Excellence. You know, African Americans have certain issues pertaining to dermatologic and hair issues. We have a multicultural cardiovascular care center of excellence, to address disparities in heart care and vascular disease. We’re developing a minority multicultural respiratory program, we have a minority kidney and hypertension center, that orthopedics and rheumatology center is under development endocrinology colon colon cancer center. So we clinical clinic is structured around the institute model. And so we’re developing these health equity programs, essentially in every specialty area, where we see healthcare disparities. Even in the learner Research Institute, we were developing dedicated initiatives to address and study the basic science and pathogenesis of a lot of these genetic hereditary conditions, we established an African American metal bio repository, or biobank, whereby black individual will donate blood and urine samples. So we can actually use those samples to study the genomics genetic differences in disease. So we also have programming to promote more diversity in the healthcare workforce, we work with students, there’s been a little difficult during COVID times, but we’ve had students come in and shadow and we mentor students and encourage them, students of color in particular to enter the healthcare professions, we understand that more diversification in the healthcare workforce leads to better outcomes, better patient engagement, communication, culturally delivered health care. So there are a number of things we’re doing from all sides to address these health disparities, the social determinants of health, there’s still a lot more work to do. But I’m proud of what we’ve accomplished thus far. But again, a lot more work needs to be done.
Shami Mitchell
Definitely, I definitely agree with you. And a lot of my thesis work actually focused on the inequitable distribution of healthcare disparities and risk of disease and burden of disease in minority and underserved communities. So to finally wrap up, we just wanted to say thank you and on behalf of the voices and bioethics podcasting team, I like to just, again, thank you for providing some really insightful remarks about ethics, urology, transplantation, and healthcare disparities. And we hope this conversation really continues around ethics in medicine. So thank you so much, Dr. Modlin for being here.
Transcribed by https://otter.ai
Shami Mitchell Interviews Charles Modlin, Voices in Bioethics Podcast (2020)