< Previous With treatment possibilities opening in more hospitals, clinics, and health care community centers, funding from the federal level has helped to aid in the fight against COVID-19. Many clinics have been able to utilize those resources and create viable options for the communities most effected by the virus. In Harrisburg, PA, a community health care center, Hamilton Health Center, has made strides in how they are managing the Coronavirus out- break and maintaining healthy communities during the ongoing epidemic. Hamilton Health Center, a Federally Qualified Health Center (FQHC), is serving an underserved population by providing comprehensive services, offering sliding fee scales, and serving as one of the city’s leading health care centers for minority urban communities. Serving under the “Patient Centered Care” care delivery model, Hamilton, similar to many health- care facilities in urban and underserved minority areas, has had to develop unique systems for ensuring that their clients continued to receive ongoing healthcare when needed, but also create newer systems for COVID related illnesses in order to identify, diagnose and treat their consumers. CEO Jeannine Peterson has been tackling the assignment of providing quality services to underserved communities for decades. Throughout her time as CEO, she has identified new and innovative ways to handle wide- spread illnesses that mostly effect underrepresented and under resourced communities and has utilized her FQHC to serve as a haven for commu- nity members. With the COVID-19 epidemic becoming so widespread in a short amount of time, CEO Peterson took a proactive approach in developing telemedicine and telehealth care services to help keep consum- ers engaged in their ongoing healthcare. When FQHC funding arrived in August 2020 from the federal government to support COVID specific initiatives, Hamilton Health Center began to set up community COVID Testing. After hiring staff, they developed a model to provide testing for both Asymptomatic and symptomatic individuals ,a task that at that time was not being completed by local healthcare clinics. During the early peri- ods of testing, focus was only placed on symptomatic individuals and was limited to those who belonged to certain healthcare facilities or who held insurance coverage for testing. Hamilton’s initiative conducted the testing of both asymptomatic and symptomatic individuals for the communities that are considered the highest risk. When asked how her system for testing was unique in its model. CEO Peterson identified a broader audience of those in need as her unique mod- el. “Hamilton is broadening the consumer population that can be tested”, she states. “We’ve been conducting testing at our main location using our in-house Quest Diagnostic Services. Our current model is testing outdoors with the nasal swabs and issuing self-testing sites for individuals. Medical personnel oversee and collect the tube, but the test is self-administered”. This system began as a one time program., running for several hours during one day of the week at their main location, but has since expanded to testing in the evening, and now, with hired staff and mobility options, expansion of services will be- come mobile as well. Funding has gone to acquire equipment, hiring, and training staff, and retrieving supplies. CEO Peterson relies on community partnerships with the faith-based community to set up several sites on the parking lot of their churches to conduct testing. Further partnerships with local housing authorities will allow for public housing communities, with statistically more individuals living within closer proximity, to be tested as well. The plan is to develop and run a calendar, accessible to the communi- ty at large, for what will be an almost daily accessibility to testing locations right in their communities, until the winter season. Mobility for services has long been an advantage in tackling one of the most prominent social determinants of health, transportation, and access. “In this community” Peterson states, “the minority community had been asking County Commissioners when testing would occur in this community, as minorities are disproportionately impacted. There is ongoing difficulty in getting to hospital testing sites and difficulty in being eligible for that testing”. Originally, this was a problem because Hamilton was only provided 50 How Treatment Has Moved Into Communities In Need Covid-19: by Fiordaliza White With approximately 95 million diagnosed cases and an estimated 217,000 deaths, the ongoing need for treatment services remains a priority across our nation. With racial and ethnic minorities disproportionately affected by the disease, healthcare officials have been working to address the already existing and persistent inequalities among racial minorities, while also developing systems which can address the epidemic in order to keep both under control. 18 | TALK MAGAZINE • FALL 2020WWW.TALKMAGAZINEONLINE.COM | 19 tests. With the low number of tests, there was an inability to advertise on a larger scale. During that time, the clinic used its limited capacity to create a small ‘study group’, creating small exit interview style assessments to work out their processes so they would be better prepared when more supplies were provided. Earlier testing numbers showed approx. 50-70 individuals being tested. To date, there have now been 300+ tests being conducted, with anticipation to kick up in the next few months. Among those 300 individuals, there are several sharing success stories of their ability to be diagnosed and treated right in their communities. One individual, choosing to be referred to as “Nick”, stated that he felt symptoms of COVID-19 within the past 2 months. “I thought I was just suffering from a cold. I did not think anything of it. Just a chest cold.” As the hours progressed, however, conditions for him felt much worse than he’d imagine. I thought to myself, this can’t be COVID. I tried to go to one of those drive up clinics the same day, but my insurance would not cover the test. I didn’t’ understand why I needed coverage for something that was effecting everyone around us. I couldn’t get a test”. That was when he decided to visit Hamilton during a Saturday walk in testing he had heard about the next day. He was not only able to get tested free of charge, he was diagnosed and able to quarantine himself and prevent further spread of his illness to other family members in the home. Other family members were then able to take part in the walk-in procedure as well to assess for their conditions. Fortunately, they were not affected. With consumers coming in to be tested at a higher rate, one of the things that CEO Peterson would like to see is the ability to have supplies which provide quicker results, since she is looking at identifying both symptomatic and asymptomatic people. “In the Latino and Black Communi- ty” she says “we have a large setback because results are still taking 3-4 days to come in. But think about it, if you come in asymptomatic and you test positive, but we do not know that for another 3-4 days, you’re walking around and could be infecting others. Having the rapid tests available in this community is nec- essary to help those we can faster”. Her sentiments align with the idea that in urban areas, where there is a sense of overpopulation, housing with multiple families in one household, or increased transient families, the spread of in- fection can occur too quick to manage. Because of this, rapid testing would ensure that once diagnosed, the spread of the infection can be managed quicker. This, along with presumptive winter conditions worsening the epidemic, are CEO Peterson’s main concerns. “We’re coming into flue season. There’s great concern about the second wave of COVID and the symptoms are like the flu. We’re not only having to treat COVID 19 but looking at ensuring more people are getting their flu shots. We offer free flu shots to ensure we are able to rule out symptomatic behaviors for the community and preserving more testing equipment and lowering who we think would have COVID-19”. For people like “Nick” this news is valuable, as he can pass it along to his friends and family, many of whom are unin- sured. “I was just glad that I was able to have a test done nearby, since I didn’t have transportation, and now I’m going to be able to get a flu shot with the rest of my family nearby as well, so if they are sick, we can at least minimize concern if it is COVID or not”. “Had I not heard about the walk-in clinic; I’m scared to even think of what might have happened” he adds. For CEO Peterson, this word of mouth into local resources is one that she values as well. “Getting information into the hands of people in our communities is what I’d like to see. We don’t have black radio stations, nor Latino radio stations, so word of mouth to our communities is important". Mobile Testing Units are critical and necessary, but much to the point of CEO Peterson, relaying that information to community members, like “Nick” is one way that mobile services like Hamilton Health Center’s will thrive in addressing the pandemic. Fully recovered, “Nick” states the information provided through the health clinic has helped to keep him informed of what symptoms to look for when diagnosing COVID-19 within his own household. He has since not had any reoccurring symptoms and credits the health system with following up with him, aiding him in coordination for self-quarantine resources such as food banks and local distributors, and even mental health telehealth support services. “Finding a mechanism to getting information into the hands of our communities to let them know testing is available, flue shots are available in their own communities, free of charge is important for this area” she adds. “Information sharing from trusted community members is important for getting information and resources to individuals”. This is how the mobile system will work, with widespread communication and adver- tising to let those in the most effected communities know that aid through mobile services is literally, en route. Finding a mechanism to getting information into the hands of our communities to let them know testing is available, flue shots are available in their own communities, free of charge is important for this area WWW.TALKMAGAZINEONLINE.COM | 1920 | TALK MAGAZINE • FALL 2020 Older people and people with many serious medical conditions are the most likely to experience lingering COVID-19 symptoms. The most common signs and symptoms that linger over time include: • Fatigue • Cough • Shortness of breath • Headache • Joint pain Although COVID-19 is seen as a disease that primarily affects the lungs, it can damage many other organs as well. This organ damage may increase the risk of long-term health problems. ORGAN DAMAGE CAUSED BY COVID-19 Organs that may be affected by COVID-19 include: Heart Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscle, even in people who experienced only mild COVID-19 symptoms. This may increase the risk of heart failure or other heart complications in the future. Lungs The type of pneumonia often associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to long-term breathing problems. Brain Even in young people, COVID-19 can cause strokes, seizures and Guillain-Barre syndrome — a condition that causes temporary paralysis. COVID-19 may also increase the risk of developing Parkinson's disease and Alzheimer's disease. BLOOD CLOTS AND BLOOD VESSEL PROBLEMS COVID-19 can make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from very small clots that block tiny blood vessels (capillaries) in the heart muscle. Other organs affected by blood clots include the lungs, legs, liver and kidneys. COVID-19 can also weaken blood vessels, which contributes to potentially long-lasting problems with the liver and kidneys. PROBLEMS WITH MOOD AND FATIGUE People who have severe symptoms of COVID-19 often have to be treated in a hospital's intensive care unit, with mechanical assistance such as ventilators to breathe. Simply surviving this experience can make a person more likely to later develop post-traumatic stress syndrome, depression and anxiety. Because it's difficult to predict long-term outcomes from the new COVID-19 virus, scientists are looking at the long-term effects seen in related viruses, such as severe acute respiratory syndrome (SARS). Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens with physical or mental activity, but doesn't improve with rest. The same may be true for people who have had COVID-19. MANY LONG-TERM COVID-19 EFFECTS STILL UNKNOWN Much is still unknown about how COVID-19 will affect people over time. However, researchers recommend that doctors closely monitor people who have had COVID-19 to see how their organs are functioning after recovery. It's important to remember that most people who have COVID-19 recover quickly. But the potentially long-lasting problems from COVID-19 make it even more important to reduce the spread of the disease by following precautions such as wearing masks, avoiding crowds and keeping hands clean. by Mayo Clinic Staff COVID-19 symptoms can sometimes persist for months. The virus can damage the lungs, heart and brain, which increases the risk of long-term health problems. Most people who have coronavirus disease 2019 (COVID-19) recover completely within a few weeks. But some people — even those who had mild versions of the disease — continue to experience symptoms after their initial recovery. COVID-19 (coronavirus): Long-term effects COVID-19 (coronavirus): Long-term effects Coronavirus disease 2019 (COVID-19) can cause a wide range of signs and symptoms. The most common are fever, dry cough and tiredness. Other symptoms include shortness of breath or difficulty breathing, muscle aches, chills, sore throat, headache, or chest pain. But COVID-19 can also cause symptoms you might not expect, including: • Gastrointestinal symptoms. COVID-19 might cause mild gastrointestinal symptoms, including a loss of appetite, nausea, vomiting and diarrhea. These symptoms might only last one day. Some people with COVID-19 have diarrhea and nausea prior to developing fever and respiratory symptoms. • Loss of smell or taste. COVID-19 might cause a new loss of smell or taste — without nasal congestion. This typically lasts nine to 14 days. Some research suggests that loss of smell or taste might be an early predictor of COVID-19. • Skin changes. Younger people with less severe COVID-19 might develop painful, itchy lesions on their hands and feet that resemble chilblains, an inflammatory skin condition. Sometimes called COVID toes, this symptom typically lasts about 12 days. However, new research suggests that these lesions might simply be chilblains caused by sedentary behavior and failure to wear warm footwear during lockdowns, rather than by COVID-19. • Confusion. COVID-19 also has been reported to cause confusion in older people, especially those with severe infections. • Eye problems. COVID-19 might cause eye problems such as enlarged, red blood vessels, swollen eyelids, excessive watering and increased discharge. The infection also might cause light sensitivity and irritation. These symptoms are more common in people with severe infections. Signs and symptoms of COVID-19 may appear two to 14 days after exposure to the virus and can range from mild to severe. If you think you might be experiencing symptoms of COVID-19, call your doctor. Research increasingly shows that racial and ethnic minorities are disproportionately affected by coronavirus disease 2019 (COVID-19) in the United States. According to recent data from the Centers for Disease Control and Prevention (CDC), non-Hispanic American Indian or Alaska Native people had an age-adjusted COVID-19 hospitalization rate about 5.3 times that of non-Hispanic white people. COVID-19 hospitalization rates among non-Hispanic Black people and Hispanic or Latino people were both about 4.7 times the rate of non-Hispanic white people. While there's no evidence that people of color have genetic or other biological factors that make them more likely to be affected by COVID-19, they are more likely to have underlying health conditions. Having certain conditions, such as type 2 diabetes, increases your risk of severe illness with COVID-19. But experts also know that where people live and work affects their health. Over time, these factors lead to different health risks among racial and ethnic minority groups. Where you live and who you live with can make it challenging to avoid getting sick with COVID-19 and get treatment. For example, racial and ethnic minority members might be more likely to live in multi-generational homes, crowded conditions and densely populated areas, such as New York City. This can make social distancing difficult. The type of work you do also may contribute to your risk of getting COVID-19. Many people of color have jobs that are considered essential or can't be done remotely and involve interaction with the public. In the U.S., according to the CDC nearly 25% of employed Hispanic and Black or African Americans work in the service industry, compared with 16% of non-Hispanic white workers. Black or African Americans also account for WWW.TALKMAGAZINEONLINE.COM | 21 Answer From William F. Marshall, III M.D. What are some of the unusual symptoms of the new coronavirus? Answer From William F. Marshall, III M.D. Mayo Clinic Why are people of color more at risk of coronavirus complications? continued on page 28West Chester University's Nursing Program Students, faculty, and staff from across the University pulled together to help. Among the College of Health Sciences’ outreach efforts were collections and donations of PPE to local health care providers by the Nursing, Kinesiology, and Sports Medicine departments; Nursing students arranging for lunches to be delivered to their professional counterparts in hospitals where Covid patients were being treated; and Nutrition students, faculty, and staff donating food and healthy snacks for hospital workers. These are just a few of the signs of how well WCU is preparing the next generation of front line workers. Another is that WCU has posted the top NCLEX pass rate – 100% – for the past two quarters and has consistently been in the upper 90%-plus pass rate prior. For the reporting period October 2019 – March 2020, the WCU Nursing program is ranked #1 among 1,229 programs in our jurisdiction. With an abundance of hospitals and health care facilities in the region, West Chester University is positioned to provide its College of Health Sciences students with a multitude of clinical opportunities by which they gain hands-on experience and knowledge from practicing professionals. The University’s programs with clinical components are continuing to adapt to the pandemic while ensuring students gain valuable real-life experiences this fall. This fall, the WCU Nursing program continues to have students complete clinicals at our affiliated healthcare agencies such as Chester County Hospital, Main Line Health System hospitals, A.I. DuPont Hospital for Children, Tower Health Hospitals (Brandywine and Pottstown), VA in Coatesville, Christiana Health System, Senior Health Link, Mercy Home Health, and the Chester County Health Department. When clinical agencies are not available, our students are supplementing their learning using the lab to improve skills, practice simulations, engage in real-life scenarios, Live ATI, and NCLEX board preparation. The Department of Nursing at West Chester University provides the highest quality undergraduate and graduate education to diverse student populations, ultimately preparing students to become leaders within the nursing profession. The baccalaureate program prepares graduates for entry into nursing practice. The master’s program prepares graduates for advanced practice in adult health/gerontology or nursing education. The DNP program prepares advanced practice nurses to fully evaluate and implement evidence-based findings, further enhancing delivery of nursing care. All WCU’s Graduate Nursing Programs accept applications throughout the year. All nursing courses are taught by faculty who are clinical experts in their area of specialization, not by graduate assistants. RN TO BSN This program is 100% online and was developed with the working nurse in mind. Most of our students work full- time and have the ability to balance work, school and family responsibilities. Some courses require online check-ins with faculty and peers when working on group assignments. Time to completion varies among students and is based on prior coursework and the ability to complete the program on a part time or full time basis. Once prerequisite courses are complete, the core nursing coursework can be completed in three semesters (spring, summer, and fall). All students must complete 120 credits to earn a BSN. BACHELOR OF SCIENCE IN NURSING (BSN) West Chester’s BSN program is for those interested in becoming a Registered Nurse. Students in the BSN program have access to a wide variety of clinical experiences including acute care, community health, day care centers, schools, retirement centers, nursing homes, and veterans' hospitals. Individualized instruction is provided in the clinical setting with a 1:8 faculty/student ratio. A learning laboratory on campus enables students to practice their psychomotor skills prior to actual contact with clients. Most BSN graduates continue with graduate study after a few years of experience as a professional nurse. As the Covid-19 pandemic took hold of the world this spring, students in West Chester University’s College of Health Sciences were undeterred when they had to shift to remote instruction, and WCU nursing students were no exception: They demonstrated the quick thinking and adaptability that is required in their profession, not only continuing their studies, but also supporting local front-line workers in health care. 22 | TALK MAGAZINE • FALL 2020 The Baccalaureate degree in Nursing, the Master's Degree in Nursing, and the Doctorate of Nursing Practice (DNP) programs at West Chester University are accredited by the Commission on Collegiate Nursing Education. In addition to nursing, other programs offered within West Chester University’s College of Health Sciences are grouped under the departments of Communication Sciences and Disorders, Health, Kinesiology, Nutrition, and Sports Medicine. For more information, visit the website or contact the Nursing Department (610-436-2219) or the College of Health Sciences (610-436-2825). West Chester University is an academic powerhouse that is home to more than 17,700 students enrolled in 118 different undergraduate programs, 91 master’s degree programs and four doctoral programs (the DNP was WCU’s first doctoral program!). Ranked a top university by US News, Forbes, and Money Magazine, WCU is preparing to celebrate its 150th anniversary next year while continuing to meet Pennsylvania’s workforce needs with its newest program, the Bachelor of Science in biomedical engineering. That program and the rest of the College of Health Sciences’ departments will be housed in the University’s largest academic building to date – The Sciences and Engineering Center and the Commons – scheduled to open in 2021. DOCTOR OF NURSING PRACTICE (DNP) ONLINE PROGRAM WCU’s DNP Online Program is for the advanced practice nurse with a graduate degree in nursing. The 35-credit program is designed for nurses seeking a terminal degree in nursing practice and offers an alternative to a research-focused doctorate. The first 2-credit course, NSG 701 Transition to Doctoral Studies, is held on campus. The DNP will assist nurses to actively engage in an increasingly complex health care system. With a focus on skills such as collaboration, innovation, and evaluation, supplemented by advanced practice nursing skills, nurses will shape the future of health care. Courses are taught by qualified WCU faculty, many of whom are advance practice nurses. For more information, contact Dr. Cheryl Schlamb at Veronica Wilbur at vwilbur@wcupa.edu SCHOOL NURSE CERTIFICATION Applications are accepted throughout the year for this 14-credit, post-baccalaureate program that prepares students for initial Pennsylvania Department of Education certification as an Educational Specialist I – School Nurse. This program prepares registered nurses to meet the health needs of children and adolescents in schools, pre-K to grade 12. Students who complete this program, hold a valid RN license in Pennsylvania, and have a bachelor’s degree in nursing are eligible to apply for the School Nurse Certificate (Education Specialist I) issued by the Pennsylvania (PA) Department of Education. MASTER OF SCIENCE IN NURSING (MSN) The MSN program offers two options: Nursing Education and Adult-Gerontology CNS. Students can complete the MSN curriculum on a full-time or a part-time basis; however, all requirements for the degree must be completed in six years or less. The course format for both MSN programs offers a mixture of hybrid and online learning. On-campus courses are held in the late afternoon or evening hours. The online courses offer synchronous and asynchronous formats to enable working professionals the flexibility to pursue a graduate degree while still maintaining their full-time employment. Graduates of this program may seek employment in educational settings, acute or long-term care settings, or community health care agencies. ADVANCE-2-BSN (ACCELERATED SECOND-DEGREE NURSING PROGRAM) This very competitive program is for the student with a previously earned baccalaureate degree who wants to earn a Bachelor of Science in Nursing (BSN). Upon successful completion of the program, graduates are then eligible to take the NCLEX-RN exam (National Council on Licensure Examination for the RN) for licensure as a Registered Nurse. One cohort of 40 students is accepted each year into this intensive 18-month program. Each cohort begins in May and graduates December of the next year. The program follows the same curriculum as the traditional BSN program but at an accelerated pace with the same tuition and fees as the traditional BSN program. Billing is by semester. Classes are held weekdays in the summer semesters. In the fall and spring semesters, classes are held weekdays with clinicals on weekends. This is subject to change. WWW.TALKMAGAZINEONLINE.COM | 23 During the last six months, the size of Pennsylvania’s medical marijuana program has surged due to the anxiety-producing effects of COVID-19 and some favorable changes to regulation. The number of patient visits at cannabis dispensaries has risen by more than 70 percent -- rising from 70,000 a week in February to 120,000 each week in August. Retail sales also have exploded. Since February, dispensaries have sold as much marijuana as they had during the previous two years combined, according to statistics released last week by the state Department of Health, which governs the cannabis program. Patients bought about $385 million in legal marijuana products from the state’s 89 cannabis dispensaries during the period, according to the state Office of Medical Marijuana. Until February, total retail sales since the inception of the highly regulated industry two years ago in the Keystone State had totaled only about $400 million. There are at least 27 dispensaries now operating in the five-county region. “The program is doing really well,” said Chris Woods, CEO of Terrapin Care Station, a cannabis grower and processor upstate in Clinton County. “It’s hard not to draw a correlation with COVID-19. In unsettled times, cannabis is a medicine that seems to help people cope with anxiety.” Anxiety remains one of the most cited reasons for getting a state medical marijuana card. It comes in second only to chronic pain. Post-traumatic stress disorder is a distant third. Why has marijuana suddenly taken off? It is chiefly attributable to temporary changes to the regulations implemented by the Wolf administration. Marijuana dispensaries were among the first businesses deemed “essential” by Gov. Tom Wolf. But Wolf also streamlined access to medical marijuana in ways that made it safer to join the program. Patients once had to scramble to find a doctor who could write them a recommendation for legal weed, and then go to the doctor’s office to pick up the recommendation. Now it’s all done electronically. Wolf made it possible for patients to find and see those doctors by using telemedicine after COVID-19 caused people to shelter in place. After receiving their marijuana cards through the mail, patients are able to place orders at dispensaries by phone. Temporary regulations allow for easy curb-side pickup to reduce the risk of acquiring the virus. Some clever dispensaries found a way to provide home delivery for those patients who did not want to venture out into the pandemic world at all. About 230,000 Pennsylvanians now are registered and have been issued cards that allow them to buy marijuana products, according to the Department of Health. “Pennsylvania really has become the model for what medical marijuana programs should do across the country,” said Woods, of Terrapin. “Obviously, there have been a few problems. But the Department of Health and the governor have worked hand-in-hand to increase supply to patients, and increasing patient access has accelerated things.” The problems are well-known. Stronger than expected demand has led to periodic “flower droughts,” during which customers can’t find the inhalable -- that is, smokable -- form of their medical marijuana. Due to scarcity, when they can find what they want, it’s also expensive. The price per ounce is stuck at about $350. Another bottleneck is the state’s required seed-to-sale tracking software, which has been prone to crashing, and can hold up sales for long stretches of time. Yet those concerns haven’t kept sales from rising. And counter- intuitively, some of the industry’s growth may be spurred by the flagging economy. “People are at home, they’re stressed out, and many are unemployed,” said Jeff Smith, who reports on legal and regulatory issues for Marijuana Business Daily, a leading trade publication for the cannabis industry. “For those that were jobless, many were getting a $600 a week enhanced jobless benefit. Some of Medical marijuana sales soar amid COVID-19, making Pa. one of the nation’s fastest growing cannabis markets by Sam Wood 24 | TALK MAGAZINE • FALL 2020that money has gone to purchase marijuana.” With the reduction in the jobless benefit and a continuing recession, Smith is not sure how the national industry will be affected. But he’s certain of one thing: “Pennsylvania is one of the strongest and fastest growing medical cannabis markets in the country.” “We had estimated 2019 sales [in Pennsylvania] at $225 million to $275 million,” Smith said. “We were expecting it to nearly double to $400 to $500 million in sales this year and are expecting sales of $1 billion annually in three to four years.” Those projections do not include legalization. Because of the budget shortfalls triggered by COVID-19, even some Republicans in the state legislature are considering legalizing marijuana for adult recreational use to prevent cuts in essential services. Legalization would trigger another exponential rise in sales in the state. Researchers, meanwhile, are pressing ahead to understand more about the drug. Pennsylvania was the first state to embed a research provision into the law. And the nation’s first state-authorized medical marijuana research program was launched in Philadelphia in May, state officials said. It will focus in part on the impact of cannabis on the quality of life of patients suffering from any one of 23 qualifying “serious illnesses” required to get the drug in Pennsylvania. Industry analysts with the major investment houses have taken note. In his periodic newsletters for investment firm Cantor Fitzgerald, Pablo Zuanic observed that Pennsylvania is opening dispensaries and growing facilities at a clip that’s much faster than most other states. The number of ailments that patients can cite when asking for a marijuana recommendation — nearly two dozen qualifying conditions — also dwarfs those in other medical marijuana states. Nineteen growers, out of an eventual 33, currently are shipping marijuana products to Pennsylvania dispensaries. The others haven’t started producing yet. Two more growers are expected to come online as soon as their artwork and package designs are approved, according to John Collins of the state’s medical marijuana office. And still, demand outstrips supply. Many patients cannot find a consistent supply of their favorite marijuana products — which is overwhelmingly smokable or inhalable flower — at their local dispensaries. The CEOs of the big multistate marijuana growers are acutely aware of that. They are rapidly expanding the square-footage under cultivation or acquiring older companies with an express purpose of doubling production. Erich Mauff, president of Jushi Holdings, announced the $37 million purchase last week of Vireo Health’s growing facility in Scranton. Jushi operates Beyond/Hello dispensaries in the Philadelphia market and other states. Mauff said he’s making “a large capital investment” in the cultivation center “to turn this facility into one of the top three in the state for volume. And we plan to expand it quickly.” Mauff theorizes that the legal marijuana market in the state benefited in another way from COVID-19. “I have to believe that the unregulated [i.e. the illegal] market took a hit during these past months,” he said. ‘The unregulated market is not as big and robust. In March, April and May there was no traffic in the U.S. It was harder to transport from out of state. The highways were empty. Most flights were grounded. I think that’s why a lot more people started to look to the state-regulated markets.” “Now people know there’s a great variety of product, with high quality and exact dosings, people will continued to go to our regulated market because they can rely on it, buy exactly what they want, and know there’s nothing wrong with it,” Mauff said. WWW.TALKMAGAZINEONLINE.COM | 25The Goals of Care I told his wife I couldn’t imagine what she was going through and promised I’d be her excuse to keep her in-laws away for a bit, if she needed it. She laughed. I told her what I thought about her husband’s poor neurologic prognosis. I explained what I feared life might look like for her and her family if they continued with life-sustaining interven- tions. I explained what comfort care might look like. For the next few days, I became an interpreter, as the team called me back to conduct family conversations. Why could I establish trust that White clinicians could not? Was it just the color of my skin? I believe that in this patient, I saw someone I knew, a story I recognized. I imagined him at barbecues and in his grandmother’s living room. I saw him in my family and my communi- ty. I saw him, and his family knew that. As a biracial neurosurgeon, I’ve had diverse life experiences. I’ve seen the circumstances that can lead to all different life paths and understand that many of them involve love, good intentions, and community. This experience is what I brought to the table. Few U.S. physicians share the experience of being Black while caring for Black patients. Black Americans make up 12.7% of the population but only 5% of physicians Underrepresentation probably explains part of the disconnect between physicians and Black patients. But there’s more to it. I recently coauthored a study revealing that White patients are nearly twice as likely as Black patients to have life support withdrawn after severe traumatic brain injury (TBI).2 I can imagine numerous reasons why end-of-life discussions may differ by race. Decision making in TBI often requires quick consensus between clinicians and families who have just met. It requires trust, and Black Americans trust the health care system less than White Americans do. According to researchers who studied Black caregivers for patients with dementia, for example, “African Americans are often mistrustful of the overall healthcare system because of several disparities: they are often underserved with dementia care and education Why would Black people trust a system that gives us poorer-quality care? Lack of trust affects decisions. In the caregiver study, increased trust in clinicians was associated with decreased likelihood of pursuing feeding-tube placement If a doctor cannot establish trust with a Black family struggling through a crisis, the family may think differently about treatment decisions. End-of-life planning also varies by race. In an Oregon focus group involving Black participants, only 11% reported having living wills, as compared with about 25% of the general population Although participants prioritized quality of life, it’s challenging to determine what quality means for someone who has been incapacitated by a TBI but whose wishes haven’t previously been known. Poor communication between clinicians and even between family members also prevents Black Americans from deciding to withdraw life-supporting treatment. The resistance the ICU team encountered to discussing care goals is reflected in related research. A study of Black, White, and Hispanic surrogate decision makers revealed that Black persons felt doctors should be “more approachable, less ‘abrasive’ or ‘in- timidating,’ and more ‘sensitive’”; they also reported greater will to “do everything” for loved ones and commonly referenced faith and religion. It’s often impossible to find a physician like me to participate in a goals-of-care conversation with a family of similar background; and even with similar backgrounds, systemic or personal factors may inhibit development of trust. It’s important to note that the goal is not to have more Black families withdraw life-supporting treatment, but rather to determine what quality of life means for the patient and to pursue it. If failures of trust, planning, and communication hinder this process, we must address these barriers. Increasing trust is challenging, but it may start with movements like the one we’re seeing on the news these days — reflecting a burgeoning effort to better understand what it’s like to be Black in American society. Recognition by clinicians of Black Americans’ history of resilience and depth of culture, faith, and community may reduce feelings of distance and strengthen trust. This effort coupled with improved patient–cli- nician conversations could bring Black families closer to the goal of quality of life they seek for their loved ones. Ultimately, our goal should be to deliver excellence in care at every step of the health care journey. Theresa Williamson, M.D. Duke University School of Medicine, Durham, NC One Saturday morning, an ICU physician called and asked me to talk to a family with whom the team was having difficulty establishing care goals for the family’s loved one. The team knew I’d recently seen the patient for a neurosurgery consult and the family trusted me. The patient was a young Black man who had suffered a cranial gunshot wound. When I reached his room, we listened to the rap music the family had playing for him while I checked his neurologic function. 26 | TALK MAGAZINE • FALL 2020 Is There a (Black) Doctor in the House? The National Medical Association has installed Leon McDougle, M.D., M.P.H., associate dean for Diversity & Inclusion and the chief diversity officer at The Ohio State University Wexner Medical Center, as its 121st president. The NMA serves as the oldest and largest collective voice for parity and justice for 50K African American physicians in their effort to eliminate health inequalities. Celebrating its 125th anniversary, their mission continues to promote the interests of both doctors and patients, specifically those of African descent, to foster the utmost quality of care for all Americans. The association also aims to help the United States' healthcare system prevent and manage disease effectively. The realization that the NMA plays a more important role than ever led him to run for the leadership role, Dr. McDougle said, "the national climate and the need for continued advocacy for African American physicians and the communities that we serve were motivating factors in choosing the seek the position." As NMA president, Dr. McDougle will strive to champion diversity in medicine by advocating for culturally competent training for doctors. As maternal health is a priority with NMA, Dr. McDougle will continue to advocate for affordable, accessible, and safe reproductive health care for African American Women. Recognizing that gun violence has become a national health crisis, he will advocate for safer neighborhoods through education around gun violence prevention and needed policy changes. In the time of COVID, he feels it is especially important to also address environmental health programs. Leon McDougle, M.D., M.P.H., Professor of Family Medicine with tenure, is the 1st Chief Diversity Officer for The Ohio State University Wexner Medical Center. A graduate of the University of Toledo and OSU College of Medicine, he completed his family medicine residency at the Naval Hospital camp Pendleton, California and earned a Master of Public Health degree from University of Michigan School of Public Health, Department of Health Management and Policy. LEON MCDOUGLE M.D., M.P.H. NATIONAL MEDICAL ASSOCIATION ANNOUNCES AS ITS PRESIDENT 121 st WWW.TALKMAGAZINEONLINE.COM | 27Next >