Taking Healthcare by Storm: Industry Insights with Dr. Cathy Slemp

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Cathy Slemp, MD, MPH, board-certified in Public Health/Preventive Medicine and Family Practice, and currently runs her own public health consulting practice. 

Dr. Cathy Slemp discusses her diverse career in public health, focusing on lessons learned from the COVID-19 pandemic, the importance of community resiliency, and strategies to tackle substance use disorders in rural areas. She emphasizes the role of trusted relationships, accurate information, and the need for integrated services in combating public health crises.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-051625-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello, everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the Medical Director of Quality Insights. And in today's episode, we're joined by Dr. Kathy Slump, a seasoned public health leader with extensive experience in epidemiology, infectious disease, emergency preparedness.

Community resilience and substance use disorders, all very important in today's healthcare landscape. With a background in both family medicine and public health, Dr. Schlempp has worked across various sectors, including work with community leaders. policy makers, health care systems, businesses, providers, parents, you name it, she's worked with them.

She's made significant contributions to advancing public health in both rural and underserved communities, particularly in West Virginia. In this episode, we'll discuss lessons learned from the COVID 19 pandemic and ongoing public health Challenges. We all know they just keep coming. I am excited to hear what Dr.

Slump has learned through her career and how she sees the future of public health. Dr. Slump, Kathy, thank you so much for joining us today. Thank you. Dean is wonderful to be here. I'm so excited. Great. So am I. So can you tell us how you came to do what you do and have you always been interested in public health?

Well, I think it's been a circuitous route actually when I went to college, I thought I'd go into international relations and foreign languages and somehow ended up doing a biochemistry degree and then thinking that here I am finishing this It's perfectly good college with with no marketable skill.

It felt like, and I thought, well, maybe I'll go to med school, but I was fairly burnt out. I will say academically. And so I ended up doing a gap year. And in that gap year, I worked with a incredible community development organization in India. It's called Deep Griha Society. And they really work with low income communities around the city of Pune.

And so I had an opportunity to work side by side with them and it was a year of listening to and working with people in community. I was thinking about culture and poverty and spirituality and economy and faith and health and the intersections of all those. And what I didn't know then was it was my intro to public health.

So I came back to med school. I it was actually really hard to do that at first because they were asking me to memorize Krebs cycle enzymes and pharmacokinetics and all those things that just didn't seem like they had meaning. I eventually though did fall in love with and moved into family medicine, which was wonderful.

But I always had this kind of nagging question about what do we, how do we address the bigger picture issues? And what is this public health thing? So I went back to a second residency in public health and it stuck. And so that's what I've done the whole career in essentially. That's really interesting.

I really feel like maybe it'd be very valuable.  To take some lessons from other countries. You said you were in India. I think that would be really an interesting thing. I'm sure you learned valuable lessons there in India. It really, I think, was my first experience really in action and it is a country of extremes, I will say to really listen to people in community and to partner with them on making change.

It is not about. It's just serving someone. It is about partnering and listening and together bridging our, gifts and moving forward to make change.  Cause that's  how we best grow and learn. Yes. So we can talk, let's talk about the COVID pandemic for a bit. So reflecting on your experiences during the pandemic, what were some of the key lessons learned in public health leadership and communication, particularly in West Virginia?

Wow. Well, I think there's some really positive ones that I hope we can sustain. One I think was that  when government and science and industry come together with a clear and common focus and some resources and an urgency to act. We can do a lot together you know, the national level. Look at the robust and rapid production and rollout of a vaccine that did save millions as controversial as it has been.

It really has made an enormous turnaround piece with that and that was built on years of related work applied to a new situation. It didn't come out of the blue. But people really pulled together and use what they knew, built on it fast and mobilized things.  Here in West Virginia, an example of that was with our electronic reporting systems.

We had spent years and millions of dollars building systems to receive lab reports from health care facilities and another place electronically. Knowing that was gonna be a better and more efficient way data sharing ability on as part of our emergency preparedness, but the adoption by our health care facilities have been incredibly slow.

So with the pandemic we were still receiving thousands of reports by fax machines. And when we raised that issue and the and we're in the moment of urgency a public health order, a million dollars and a week of manpower support. And we had 38 large labs brought on board in a week, which just transformed how we were able to get information and to work with it.

So I think when we had that ability to pull together, it makes a big difference. So that was one lesson. Yeah, that's amazing. Yeah, Yeah.  We could do a lot more than we do every day sometimes. And I think we, in disasters, we find our way to do that.  We had a clear focus and that sense of urgency.

 I think the other lesson that I think was very positive is, it's always a great reminder how creative and innovative and community focused people can be.   When people were turning bourbon plants into hand sanitizer production facilities and manufacturing PPE, and we leapfrogged forward with home test kit explosions.

I used one this morning on a family member.  We Yeah got virtual telehealth up and running and virtual schools up and running in like record time. We had school buses that were delivering, doing reverse delivery of nutrition and lunches and assignments. We had wifi access via school bus.

You know, There were these incredible things that happened. So I think again, we have real gifts that if we connect and work together and let people have that freedom and creativity, they use it. So I think those are two really positive ones. I hope we can keep going. I also think there were some challenging ones that we might not be learning as much as we ought to.

  COVID reminded us, I think that the health of one of us affects the health of all of us. And too often we try to make things way too simple because the world is really pretty overwhelming today. And I think the reality is in emergencies. And in fact, probably most of life  it's not about safe versus unsafe or good versus bad, or me versus you.

It's not that black and white. It's really about, I think, managing risks and benefits both individually and collectively. And about navigating uncertainty together, and that's really tough. And there's a lot of things it takes to do that. So I think  being willing and open to recognizing how complex it is, and not trying to oversimplify it, but, and understanding how important it is to work together to do those things that were positive is really critical.

I love that. Risk versus benefits working together. I mean, we're going to get into more. But I think those things are seem simple, but they are really profound. So you know, it's such, it's such a tough area. And, you know, I think when you think about the house and we can get into that more, I think it really is about that being able to, Have an environment of trust and positive social connections and good information.

Yes, definitely. So given your work with community resiliency and leadership development, how can we better prepare rural and underserved communities for future public health emergencies? That's probably the million dollar question, right? Yeah. Well we really, again, like we talked about when I was working in India, we work with communities to repair themselves and to build systems.

And we know that communities that function well every day function well in disasters.   And so it certainly involves all the things you'd normally think about in emergency response planning and it involves building infrastructure and Logistics and resource planning and engineering and environmental controls for floods and getting people vaccinated against flu for flu pandemics and all those other things that you would think about it, it involves.

Working on the physical and mental health of your population, because if they're healthier before the pandemic, they can withstand more  or before the flood or before the storm then they have the ability to respond in more effective ways. So those are the obvious ones. But interestingly  I worked at one point on developing a national model of community resiliency.

It had all those things in there. But the area that most communities are interested in exploring was not those. It was the domain of social connectedness and social cohesion of a community. How strong are the connections between neighbors? Are people engaged with community organizations? Do they vote?

Because the more we are engaged in our community, the more we form relationships. And the more networks form and the more trust develops and the more we care for each other. And this can actually be a really strength in a rural community. So I think it's something we can build on.

There's ways to actually build social cohesion and get folks engaged in community and create places to connect. And help people own that community they live in.   And really be family with those that they share it with. And I think in those ways, we actually strengthen  preparedness and every day community resiliency  for  the routine ups and downs in life.

That's amazing. I mean, I feel like that's so very important. Getting people involved in their community, again, very simple concept seems common sense and profound. It can make, it can really change a community and make it stronger. Just a great idea. Yeah, it's you know, we all have power to do something there.

We really do. It's not waiting on somebody else to do it for us. It's, we can shape where we live and who we, how we intersect with each other to be supportive. Yes. So, West Virginia. We know has faced significant health challenges, continues to face significant health challenges, including high rates of substance use disorders  probably no nationally for  the high rate of substance use disorders.

So how do you see this issue intersecting with the state's public health infrastructure and what have, what are the most effective strategies to address substance use disorders? Yeah  it's great question on this intersection between substance use disorders and broader public health.

And I think I'd go back to this understanding that the health of one of us really does affect the health of all of us. And it's certainly, we talked about it with the COVID  or infectious diseases, but it's also true with chronic disease and with substance use disorder and mental health. I mean, when.

When more people are sick, it drives up our health care costs. It costs businesses millions of dollars in worker productivity and turnover. It interferes with our family lives. And when we're dealing with diseases that actually change our brain chemistry, like substance use disorder or mental health disorders or dementia  our behavior is truly moved beyond being choices that we can just control.

And you do get these. Crazy, complex  difficult  secondary consequences, whether it be crime or STDs or unplanned pregnancies or increasing jail costs and suicides, et cetera. So you know, I think if you really do it right and you really go for prevention, then substance use disorder is actually the perfect disease to tackle, not to not just address addiction and the effects of substance use, but also to increase health outcomes more broadly. And you might say, why? And the reality is, and I guess I'll pose a question back to you. Jean, if you were to go on the street and ask the average person, what do they think is behind our health?

Or what's behind substance use disorder? What do you think they often say?  Probably for substance use disorder they would say mental health challenges. And maybe some people would say that doctors are prescribing too many opioids. And  which caused a lot of that, but  I would think it's mental health is maybe at the root.

Right. People will say it's mental health. It's  it's poor individual choices with our general health. People often say, Oh, it's nutrition and exercise and medical care access. And those are all true, but they're not the real root causes. So if you really go down deep  substance use disorder and most other disease is impacted by a lot of other things  including trauma  especially early in childhood.

Because we talk about ACEs or adverse child experiences and all of those stresses that actually change how a child's brain develops and how they handle the normal stresses of life and how they function.   And as adults, similarly. We, we have that same biology is challenged when we have financial stresses or job access issues or loneliness.

We've got epidemics of loneliness in America now and so if you think about intervening way upstream, that's where you make the biggest difference. so it really if we tackle substance use disorder at the prevention level, not just individually, but across population, we're going to get a bang for the buck that's unreal because we're not just preventing substance use disorder, but we also reduce heart disease and cancer and obesity and teen pregnancy and tobacco use it, it all feeds in there because we know that how we address these deeper root issues help us make a real difference long term.

So I think what that means is we have to look at it as a generational work. We start with early childhood. We know that creating a more stable environment in early childhood makes an enormous difference. We know that even when there are adverse childhood experiences, creating positive ones counteracts that and changes how we experience the world as an adult.

  so tackling things early is really important is one. And then I think the other really way upstream one is to really tackle and accept this interplay between health and economy. So   If you look at there's the United Way has some really interesting data called Alice data. It's asset limited income constrained employed.

And if you look at the Alice population is the folks that live above federal poverty level, but below what it really costs to just get by in life. And it's, a high proportion people in our state. So if you look at federal poverty level in our state, it's roughly run in West Virginia runs around 17, 18%.

If you look at the gap between federal poverty level and what it really takes to get by that kind of a survival budget, living budget  is 31 percent of our state. So that's almost 50 percent of our state living below what is really a just get by kind of thing living paycheck to paycheck. If you look at that among African American population, it's 60 some percent.

If you look at that for single headed female headed households, it's 80%. People living below that Alice level. And so  that means we've got to think about how do we really invest in folks that they have that financial stability. What does it mean in terms of our living wage or our minimum wage.

What about our child care supports our transportation to jobs or to medical care. helping people really get into support to, um, affordable housing.  Those are the things that if we can help people be financially stable it's going to play out a long way, both for those individuals themselves, for their children down the road and for the rest of us in society.

Yes. I love that.   Going back to the very beginning and childhood, it makes. complete sense. Yeah, it's not only that. I mean, you can have a healthy child and still end up a substance use disorder. There's many other factors, but it is a core piece that really is critical. And I think all of us need to understand the effect of trauma, not just in early in life, but later in life as well.

I would agree. So shifting a little bit, talking about something that is It's really been in the news, been in our focus recently, vaccines. So vaccine misinformation and hesitancy have been a major concern not only during the pandemic, before the pandemic, now after the pandemic, we're getting  there's a measles outbreak in Texas.

So what are some approaches you found successful in combating misinformation and building trust in vaccines, especially in rural communities? Yeah. Yeah. You know, It's so interesting  vaccines they've been one of the most amazing successes in history and I remember when my kids were little we had a sort of the sort of West Virginia grandmom and she would tell us stories of sadly losing two of her siblings to diphtheria and I'd never seen a case of diphtheria in my life, but you know, it was so real then, but because of vaccines, it's not now.

When I moved here 30 some years ago, yeah. I found this old card file in my office, and it had every polio case that had been reported. And there were hundreds and hundreds, and they all had a name and an age and a disability or death that it resulted in.   But now we've actually eradicated two of the three strains of wild type polio.

These vaccines, these vaccine avoidable diseases still do exist. As you just mentioned, we've gotten measles outbreaks, we still have polio tetanus, diphtheria, there's a host of things that are there if we don't protect against them. But they're not, those vaccines are not perfect. Nothing's perfect.

And there always are risks and most commonly they're very slight, but they exist, and no parent Wants to accept even the tiniest risk of inadvertently injuring their child or to miss the opportunity to prevent and protect them and others if we can. So I think it's tough. And so I think what we need as we kind of address those issues is we've got to be able to make sure that people have first accurate information.

  Second a respectful and trusting relationship and the agency to act because it's just like emergencies. You need to have you need to have trust you to have accurate information and you need to have networks and support systems that help you work through making decisions. And so I think With the vaccine arena, it's helpful to work through entities where they already are people already connected and they already trust and making sure those organizations, whether it be a church or a civic group or a boys and girls club or wherever it is that those settings have access.

to, to good accurate information and the ability to hold conversations on the topic. So that can be helpful to work the community organizations, not try to do it all ourselves. Certainly we can do it in the healthcare setting. Um, And when people are there, but that's not the only place people are. And then the other area I think is.

As you mentioned this earlier, meeting people where they are and hearing both their concerns and their questions in an environment of respect and care. So, and I think to put the decision in context.  We make risk benefit decisions every day for our kids. We let them ride in a car to school.

We let them play sports. And again it's not about safe, not safe. It's about managing risks and doing the best we can with information we have. And in knowing that we've done our best, that we're supported by those that we trust and respect. And so how do we create those environments? And I think those are the helpful things.

I think the biggest challenge is not vaccine hesitancy when it truly exists sincerely. But I think the biggest challenge today is that vaccine has been politicized and weaponized far beyond the real risk benefit issues that are at hand. And I think they have dangerously been pulled into culture wars and that we're now seeing policymakers go overboard in ways that actually put us all at risk.

I think that's where the bigger challenges and vaccines today. I will agree with you. I think it is very much a personal decision. And if people have They should talk to their provider and it should be done in a calm, reasonable manner. But  I do agree when it's politicized it becomes I think it can develop into an irrationality which really shouldn't be part of a decision like that.

So. Yes, I'm really worried that when that happens, we are sincerely literally at risk of throwing the baby out with the bathwater and it can be terribly dangerous and it makes it really hard for parents trying to make what are just good healthy decisions as a parent.  Yes. So you talked a lot about the opioid crisis.

 And then maybe I want to generalize this. What specific public health policies or initiatives do you think are necessary to help combat the opioid crisis or other crises in West Virginia  to improve overall community health? Yeah. Well  to give a few examples of real specific policies  or  approaches.

There's several I think integrating coordinating services better is one. There are a ton of really good things going on to combat the opiate crisis and the substance use epidemic more broadly. But they're not always connected. And so we are making efforts to connect and better integrate services. One of the Colleague and I helped co found a organization called the Hope and Action Alliance.

And it's one of the few statewide coalitions around the country that are focused on mental health and substance use disorders and on building family economic stability because of that link. And I think Our main goal there is to connect people  and foster collaborations. So I think that is one area that we can work on which is integrating coordinating services better.

I think also understanding and again, this goes back to people where they are supporting wraparound services. It's not just getting somebody into treatment or getting them into an apartment. It is really providing those other supports that, and that, that partner to walk alongside with that helps draw out their strengths and find their gifts and begin to have them, help them use those to change their own lives.

 And to stay present to the process because it's a bumpy process. So I think those wraparound services are really critical.   Related to law enforcement.  I think there is still room. There's a lot of work being done that's really good. And then there's still room to be to expand our diversion initiatives  that get people into treatment rather than jail  and to better support people on reentry.

So people are embedding mental health workers and peer recovery folks with law enforcement team response teams. And they're integrating, programs into court systems. The reach initiative is doing some really good work related to reentry. That is incredibly high risk time for death from overdose and that 30 days after Entering back in society people have been outside society under a very rigid controlled environment And suddenly are just releasing said here go get started But that's really hard if you don't have housing or health care or a driver's license or a job and so doing better support during those transition periods like re entry is critical.

  And then in the medical arena, making sure that our providers have full  have the full spectrum of treatment options, which includes better access to methadone, and you can put guardrails around that.  Better, best practice use of buprenorphine given today's drugs better ways to treat stimulant addiction.

We have contingency management, but we're not utilizing it much. And then we need other ones for that, for example. So, so there are policies and laws that, that influence that as well. And then I think the other one that I would mention, go on forever. I know, but it goes back to that meeting people where they are.

We can't expect people to come into a health system or social support setting where they feel disrespected and distrusted for many reasons, and there are understandable reasons why that has evolved, but few of us truly change out of fear and anger. It might get our attention, but it doesn't change us.

 And more commonly where we grow and where we change is in places of respect and when the environment around us gives us agency. So I'm going to use the example here. It's controversial sometimes, but of syringe service programs because what the syringes do is really gives people a first step is that agency piece to improve their own health.

It's a first step and it builds relationships in harm reduction programs and SSP specifically. It builds a relationship, creates a safe space. To take that first step to recovery when you're ready with people that you trust, and to know that you're going to be linked into systems that will walk you through that process and support you through that process.

So I think that meeting where people where they are with respect is really critical. Yeah, I would agree. And I heard a lot there, but I'm going to say what struck out to me is the Hope in Action Alliance. I did a really quick search. If, and maybe you correct me, but what I see is the website is wvhopeinaction.

org. If anyone wants to learn more information, and I just, maybe we can talk about that in another podcast. Sure. But what a wonderful organization for bringing bringing people together in collaboration with important topics and addressing issues. So More to come, maybe.  So, last question.

 I've heard and seen a lot of individuals, just because of the current climate, really interested individuals who are emerging leaders really interested in public health. So what advice would you give to emerging public health leaders and students in the field, especially those interested in epidemiology, infectious diseases?

Addressing substance use disorders, specifically in rural and underserved areas, what would you tell someone who maybe wants to pursue a career in public health, particularly in someplace like West Virginia? Yeah, it's in a great place to work. I would say there are a couple of things I'd say. One is  ground yourself on but don't limit your training to the technical details and science of the field, because to really put the science in action.

You've got to equally focus on skills around developing partnerships or working across sectors or your communication skills or your ability to think systems and look at root causes, navigate politics, understand social and cultural change. So, so those are the things that take the science into actual practice and make it effective.

But I think that's the one area, I think, and some of that you just learned over a career, and some of that we still never have good mastered. I don't think we ever fully master all of those.   The second one, I think, is to not be afraid, once you get into it, not be afraid to go big. Public health is a fascinating career to continue learning and adapting through your career.

And it can be as minute, and mine has been, as understanding and intervening in the life cycle of a mosquito. To help prevent disease or as broad and transformative as trying to tackle society's underlying assumptions about substance use and poverty and obesity or mental health so, so the questions you can you have to ask in this career.

can be big.   What, as we talked about earlier with several of the diseases that we talked about and what really affects health  what would it look like if West Virginia made ourselves the most child friendly state in the nation? Other countries have some approaches to this.

They're really interesting. What would it look like if we saw families as our most important small businesses, that they were too important and too many to fail and they need investment. In fact, they could need some venture capital right now. That's a belief that that they'll use those resources wisely and it'll pay off for all of us.

What would it look like if we really work to build social connectedness and community engagement? Those are the kind of things that we can impact in public health. And that, can really be transformative for us individually and as a society.  it's a fun career it's challenging at times and, but it's one that we all need to learn from, and I don't think I'd have changed it for the world.

Yeah, and I think we need, we definitely need more public health leaders now. I will say, we're, I think we're just  teetering maybe on the next pandemic.  So definitely need some new innovation in the space. Absolutely. Dr. Kathy Slemp, thank you so much for being with us today.

Maybe we will have you back on for another conversation. I think we could talk for many hours around public health, particularly in West Virginia.  But I really enjoyed the conversation. I learned a lot and so thank you for joining us. Me too. Thanks so for having me.  

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.