Healthy Wealthy & Smart 438: Diversity and Inclusion in Physical Therapy
LIVE from Graham Sessions 2019 in Austin, Texas, Jenna Kantor guests hosts and interviews Lisa VanHoose, Monique Caruth and Kitiboni Adderley on their reflections from the conference.
In this episode, we discuss:
-The question that brought to light an uncomfortable conversation
-How individuals with different backgrounds can have different perspectives
-How the physical therapy profession can grow in their inclusion and diversity efforts
-And so much more!
Resources:
Handling Your Health Wellness and Rehab Website
The Outcomes Summit: use the discount code LITZY
For more information on Lisa:
Lisa VanHoose, PhD, MPH, PT, CLT, CES, CKTP has practiced oncologic physical therapy since 1996. She serves as an Assistant Professor in the Physical Therapy Department at University of Central Arkansas. As a NIH and industry funded researcher, Dr. VanHoose investigates the effectiveness of various physical therapy interventions and socioecological models of secondary lymphedema. Dr. VanHoose served as the 2012-2016 President of the Oncology Section of the American Physical Therapy Association.
For more information on Monique:
Dr. Monique J. Caruth, DPT, is a three-time graduate of Howard University in Washington D.C. and has been a licensed and practicing physiotherapist in the state of Maryland for 10 years. She has worked in multiple settings such as acute hospital care, skilled nursing facilities, outpatient rehabilitation and home-health. She maintains membership with the American Physical Therapy Association, she is a member of the Public Relations Committee of the Home Health Section of the APTA and is the current Southern District Chair of the Maryland APTA Board Of Directors.
For more information on Kitiboni:
Kitiboni (Kiti) Adderley is the Owner & Senior Physical Therapist of Handling Your Health Wellness & Rehab. Kiti graduated from the University of the West Indies School of Physical Therapy, Jamaica, in 2000 and obtained her Doctorate of Physical Therapy from Utica College, Utica, New York, in 2017. Over the last 10 years, Kiti has been involved in an intensive study and mentorship of Oncology Rehabilitation and more specifically, Breast Cancer Rehab where her focus has been on limiting the side effects of cancer treatment including lymphedema, and improving the quality of life of cancer survivors. She has been a Certified Lymphedema Therapist since 2004. She is also a Certified Mastectomy Breast Prosthesis and Bra Fitter and Custom Compression Garment Fitter.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly YouTube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. And here I am at the Graham sessions in 2019 here. Where are we? We're in Austin, Texas. Yes, I'm with at least. And we're at the Driscoll. Yes. At the Driscoll. Yes. I'm here with Kiti Adderley, Monique Caruth and Lisa VanHoose. Thank you so much for being here, you guys. So I have decided I want to really talk about what went on today, what went on today in Graham sessions where we were not necessarily hurt as individuals. And I would like to really hit on this point. So actually Lisa, I'm going to start by handing the mic to you because you did go up and you spoke on a point. So I would love for you to talk about that. And then Monique, definitely please share afterwards and then I would love for you to share your insight on that as well. All right, here we go. Awesome.
Lisa VanHoose: 00:52 So first of all, thank you so much for giving us this opportunity just to kind of reflect on today's activities. And so, I did ask a question this morning about the differences in the response to the opioid crisis versus the crack cocaine crisis. And I was asking one of our speakers who is quite knowledgeable in healthcare systems to get his perspective on that. And he basically said, that's not really my area. Right. And then gave a very generic answer and as I said earlier to people, I'm totally okay with you saying you don't know. But I think you also have to make sure that that person that you're speaking to knows that I still value your question and maybe even give some ideas of maybe who to talk to and this person would have had those resources. But, I guess it was quite evident to a lot of people in the room that they felt like I had been blown off.
Lisa VanHoose: 01:48 So yes. So that was an interesting happenings today.
Jenna Kantor: And actually bouncing off that, would you mind sharing how this has actually been a common occurrence for you? You kind of said like you've dealt with something like this before. Would you mind educating the listeners about your history and how this has happened in your past?
Lisa VanHoose: I think, anytime, you know, not just within the PT profession but also just in society as general when we need to have conversations about the effects of racism. Both at a personal and systemic level, it's an uncomfortable conversation. And so I find that people try to bail out or they try to ignore the question or they blow the question off and ultimately it's just, we're not willing to have those crucial conversations and I think they almost try to minimize it. Right.
Lisa VanHoose: 02:41 And I don't know if that comes from a place of, they're uncomfortable with the conversation or maybe they just feel like the conversations not worth their time. But, I can just tell you as just a African American woman in the US, this is a common occurrence. As an African American PT, I will admit it happens a lot within the profession. But I do think that there are those like you and like Karen and others that are willing to kind of move into that space because that's the only way we're going to make it better.
Jenna Kantor: Thank you. Thank you for giving me that insight. Especially so because people don't see us right now, so, so they can really get a fuller picture of it. And now, Monique, would you mind sharing when you went up and spoke, how that experience was for you, what you were talking about and how you felt the issue that you are bringing up was acknowledged?
Monique Caruth: 03:37 Well, as Lisa said, we're kind of used to talking and it going through one ear and out the next day and our issues not really being addressed. I think it comes from a point where a lot of Caucasians think that if you try to bring it up, they would be blamed for what was done 400 years ago, 300 years ago. So it comes from a place of guilt. They don't want to be seen as they have an advantage. And I think as blacks we had a role to play in it by saying, oh, you’re white and you’re privileged. So you had an advantage, which structurally there is an advantage. There is structural advantages as I was discussing with Lisa and Kiti last night that as an immigrant, even though I'm black, they're more benefits that I've received being here than someone who was born maybe in Washington DC or inner city Chicago or maybe even, Flint, Michigan.
Monique Caruth: 04:51 I can drink clean water, I can open my tap and drink. What I don't have to worry about, you know, drinking led or anything like that. I can leave home with my windows open, my doors open and feel safe that my neighbors will be looking out for me and stuff that I can walk my neighborhood. So there are privileged even though I'm black, that some people that can afford and would I be ashamed of being in that position? No, acknowledge it. And even with an all black community, there are a lot of us, we may not have been born in a world of wealth. I wasn't, my parents sacrificed a lot to get me where I am today, but not because I have somewhat made it means that I have to ignore the other people that have struggled.
Monique Caruth: 05:43 And this is a problem that I'm noticing in a lot of black communities, like when someone makes it or they become successful, Aka Ben Carson, Dr Ben Carson, we feel that if I can make it, why can't you? And because some of those people were not afforded the same privileges that you were afforded, and it's kinda not fair to make that statement that if I made it. So can you, and you can't tell people that you worked your butt off and pull yourself up by your bootstraps when you were afforded welfare stuff. Your, you know, your mom benefited from stuff. I was afforded scholarship so that I don't have to have $200,000 in debt. So I could afford to purchase a home after I graduated and all that stuff because I was not in debt.
Monique Caruth: 06:47 And a lot of people do not have that luxury. So I can tell people if I can do it, you can do it too. I have to try to find ways to address their concerns and see how I can better help them to move forward and live better. And the problem within our profession is that many in leadership, even though they see themselves as making it, they don't want to have acknowledge that not everyone comes from the same place. It's not a level playing field. And they try to dismiss those by saying, Oh, if I can make it, everybody else can as well.
Jenna Kantor: Thank you. Well said. Well said. Kiti. would you mind sharing in light of what everybody said, some of your thoughts on this matter?
Kitiboni Adderley: 07:30 While it was interesting to watch the conversation, listen to the conversation today. I have a unique perspective in that I don't practice in the United States. I don't live in United States, but I frequently here taking part in education, but also watching the growth and development of the physical therapy profession. So I'm from The Bahamas and it's predominantly African descent population. Right? And so some of the issues that people of color in the United States deal with, we don't really deal with those in terms of that limitations and privileges. And you know, it's more of a socioeconomic for us. And once you can afford it, then you go and do. And, and I think we're pretty fortunate if we talk about while across the board that most people can afford some form of education and get it.
Kitiboni Adderley: 08:30 So I'm in a unique position because I look African American, it was, I don't open my mouth. You don't know. And so I'm privy to some conversations on both sides of the role, you know, and if people are probably, so what do you think about this and how do you feel about that and how does it bother you? And you know, so while I'm not the typical African American and they see them start to take a step back and it sort of gives you the understanding that they don't truly understand that every person of color does not have the same story. And so you can approach us expecting us to have the same story. Right? Cause your three x three women of color here, one's born and bred African American ones born and bred Trinidad and transplanted United States and one's born and bred, still working in The Bahamas and the Caribbean.
Kitiboni Adderley: 09:17 Good. So we all have different perspectives that we all come from different backgrounds and different experiences. But it was interesting and when Lisa asked a question and you know like, you know, people say you will, you know you need to bring it up if we don't talk about these things enough. And it's almost like, okay, you bring up the conversation. So the balls in play, it's tossed from one play at an accident and be like, Oh shit, we can handle, listen to bar this draft again. And so the conversation shuts down and you're like, but you didn't answer the question and you're like, you know, well, yeah, okay, well we'll throw the ball up in the air. And at another time, and I think this is where the frustration comes in for people of color that live in United States because you want us to have these conversations were given quote unquote, the opportunity to ask questions or have these discussions and the discussions come up and at the end of it it's like, okay, we just gave you the opportunity to discuss where do we go from here?
Kitiboni Adderley: 10:14 What's done, what's the recourse, what's our next step? What's our plan of action? And when we talk about inclusion and diversity, if you're not going to take it to the next step, if you're not going to have a call to action, then what's the point? And this is why probably people of color don't come back out again because what's it's a bit, it's a bit annoying. It's like frustration because you stand there, you're waiting for a response. And I was like, oh, well, you know, this isn’t my field and I appreciate the honesty, but then let’s address this at some point we have to address this. So do we need another meeting just to address this? Do we have to have, you know, just, let's pick the topic and work on it. So like I said, it was a very unique perspective.
Kitiboni Adderley: 10:57 I sort of like watching the response of the other people in the room and see how they respond to it, but the conversation needs to keep going for those of us who can tolerate it or have the patience to deal with it at this given time. And, it was a great experience. It was a good experience.
Jenna Kantor: I love it. So I would have just one more question for each of you and it's what would you recommend we do as a profession, both individually and as a collective in order to grow in this manner?
Monique Caruth: 11:37 Well, piggy backing off of what Kiti mentioned, I was sort of blown away too when he said that that's not his field because he's a reporter, he does documentary stuff all you was asking was one opinion you want asking for, you know, an analysis or anything. It was just an opinion and he refused to give that. And his excuse was, I don't know much about it and what was, it wasn't surprising but no one else in the crowd said well we then address her concern and immediately he was, she didn't put it in a way that made it seem or the crack epidemic was black and the opioid crisis as white. He was the one who drew it up cause I was actually praising her for how skillfully she worded it. I'm learning a lot of tack from obviously Lisa I'm not that tactful and my family tells me I need to be tactful, but it's that no one else said, okay, let's discuss it.
Monique Caruth: 12:51 Really. Why, why is APTA making such a big push choose PT. Now. Versus in the 80s when the crack and the crack epidemic was destroying an entire city because DC was known for being chocolate city on the crack epidemic, wiped it out and it got judge all. Alright, it rebuilt it. But now again, it's trying to find like I went to Howard University, you know, I could walk around shore Howard and I'm like, am I in Georgetown? Because you don't recognize, you know, the people live in that. It has driven out a lot of blacks that were living in drug pocket. You know, it's now predominantly, young white lobbyist living in the area. So if we don't have the support of our colleagues, how can we address inclusion? How can we address equity if they're not willing to put themselves out there to say, Hey Lisa, I got your back.
Monique Caruth: 14:05 We need to talk about this. We need to discuss it. Let's have a discussion. Your question was not answered. It wasn't even to say that it was acknowledged with a dignified response because we're spending millions of dollars under choose PT campaign. Why is it because the surgeon general is saying, oh there needs to be another alternative because Congress is trying to pass bills to lower the opioid crisis. Why? If you asking people to choose PT what makes it different? Okay. Even with the Medicaid population, the majority of people who receive Medicaid are black and brown. Are we fighting to get make that people have medicaid coverage or other stuff. Or are we fighting running down Cigna and blue cross blue shield and Humana and all those other types of insurances? Because we think the money is in these insurances. When they could dictate whatever they want, then you could provide a service and say you're providing quality service.
Monique Caruth: 15:14 But if they say, oh, we're just gonna reimburse you $60 we are getting $60 and people on our income. So people complain on Twitter and on social media about, you know, insurance stuff. But if I see a medicaid patient in Maryland, I am guaranteed $89 and that person has the treatment. They’re being seen, they're getting better. It's guaranteed money. But a lot of people don't want to treat the Medicaid population because they think they're getting blacks or Hispanics. And I hear complaints like I don't really want to treat that population because we are going to have no shows and cancellations and all that stuff, which is bs. It's excuses. And we have to do better as a profession to acknowledge or biases and work on ways to help work with the population that we serve. Because let's face it, America is not going to remain white? It's gonna get mixed. We're going to have some more chocolate chips in the cookies. Okay. All right. It's going to be more than two chocolate chips in the whole cookie next time.
Jenna Kantor: 16:33 Before I pass it to you, Kiti, I really like where you're going with this, Monique, and I think it's important to acknowledge why, which I didn't at the beginning. Why, why, why we're tapping on this one incident and really diving in and it's because what I learned today from my friends is that this is a common occurrence in the physical therapy industry. It's not just it and it's not just within our industry. It's what you guys deal with regularly. And if we are talking about our patients providing better patient care, we need to really, really be fully honest with where we are at. Even as they are speaking, I'm constantly asking myself, what are my things that I'm holding within me where I'm making assumptions about individuals? There's always room for growth. So please as you continue to listen to Kiti speak next, just keep letting this be an opportunity to reflect and grow.
Kitiboni Adderley: 17:50 Okay, so I recognize that incident was uncomfortable. It was an uncomfortable conversation to have and it's okay to have uncomfortable conversations. As physical therapists, we have uncomfortable conversations with our patients all the time. We have uncomfortable conversations with our colleagues and we have to call them out on some mal action or when they call us out on something that need to do. And because the conversation is uncomfortable, it doesn't mean that we don't have it. We probably need to talk about it more. And so if there's anything that I want to say, I think we need to have more of these conversations and have them until they no longer become uncomfortable until we could actually sit down with, well no, I shouldn't say anybody but, but the people of influence, cause this is what it's really about. We were sitting with very influential people today and all of us there, I'm sure where people of influence and you know, this is what we need, this is what we need to use. And don't be afraid to have the conversation. As uncomfortable as it may make you feel. Why are we having this conversation? We want inclusion, we want diversity, we want a better profession. And those are the goals of the conversation. We shouldn't shy away from it.
Jenna Kantor: Thank you. I'm gonna hand this over to Lisa for one last one last thing.
Lisa VanHoose: 18:43 So I just want to talk about the fact that part of the conversation was this dodging right? Of a need to kind of have this very authentic and deep conversation. The other part of today's events that I'm still processing is this conversation about the need for changed to be incremental, right? Comfortable. And for those of us that are marginalized to understand that the majority feels like there has been significant change and that was communicated to me in some side conversations and I was challenged by one person that was like, well, I think you have this bias and you're not recognizing the change that has occurred and how that this is awesome that we're even in a place to have this, that we're having this conversation today.
Lisa VanHoose: 19:46 You know, that you need to acknowledge that success that we've made. And so I do agree that, you know, what all work is good work and I will applaud you for what has been done today. But I also would say to people who feel that way, step back and say, okay, if the PT profession has not really changed as demographics in the last 30 years, and if you were an African American and Hispanic and Asian American, an Asian Pacific islander or someone of multiracial descent would you be okay with that? Saying that, you know what, I started applying to PT school when I was in my twenties and I'm finally maybe gonna get in my fifties and sixties. How would that feel? Right? That wasted life because you're waiting on this incremental change. And I think if we could just be empathetic and put ourselves in the other person's shoes and say, would I be okay with waiting 30 years for a change?
Lisa VanHoose: 20:53 Would I be all right with that? But I often feel like when it is not your tribe that has to wait, you okay with telling somebody else to wait? Right? And so, I want to read this quote from Martin Luther King and it was from the letters from Barringham where he criticized white moderates and he said that a white moderate is someone who constantly says to you, I agree with your goal, with the goal that you seek, but I cannot agree with your methods of direct action. Who believes that he can set the time table for another man's freedom. Such a person according to King is someone who lives by a mythical concept of time and is constantly advising the Negro to wait for a more convenient season. And that's how I felt like today's conversation from some, not all was going. King also talked about the fact that that shallow understanding from people of goodwill is more frustrating than the absolute misunderstanding from people of ill will. Luke warm acceptance is much more bewildering than outright rejection. And I say that all the time because I would prefer that you be very honest with me and say, I don't really care about diversity and inclusion, but don't act like you're my ally. But then when it's time to have a hard conversation, you say, I can't do that. I'm like, choose a side, pick a side. There is no Switzerland. There is no inbetween.
Jenna Kantor: 22:25 Thank you so much you guys. I'm so grateful to be having this conversation to finish it with a great Martin Luther King quote, which is absolutely incredible. I'm just full of gratitude, so thank you. I'm really looking forward to this coming out and people getting to share this joy of learning and growth that you have just shared with me right now.
Lisa VanHoose: And thank you for being an ally. We really appreciate that. So we're not, I just want people to know, we're not saying that the African American or the immigrant experience is different from the Caucasian experience. I think we all have this commonality of being othered at one time or another, but yes, with being a white female LGBTQ, I think the complexities of who we are as a human, there's always going to be a time where you're an n of one or maybe of two and you get that feeling that, Ooh, am I supposed to be here? But I think what we're talking about is being empathetic and if we're going to talk about being physical therapists, being practitioners and compassionate, and we're going to provide this patient centered care, how can you tell me you're going to provide patient centered care when you can't even have a conversation with me as a colleague, right. When you can't even see me. So I just want the audience to know, that we're not coming from a place of being victims were coming from a place of really wanting to have collaborative conversations.
Monique Caruth: 23:59 I like to view my colleagues as family members. There are times, as much as I love my family, my mom and my dad and my sisters and my brothers in law, there are times we will sit and have some of the most uncomfortable conversations, but at the end of it it’s out of love. It's all for us to grow as a family. And Yeah, you may not talk to the person for like a day or two, but you're like, shit, you know, that's my sister, that's my brother in law. You know, I have to love him. But you know, you try to hear their perspective, you try to make sure they hear your perspective and you come out on common ground so that the family can grow. And we don't treat this profession as a family, the ones who are marginalized are treated as step children.
Monique Caruth: 24:57 And that's a bad thing because stepchildren usually revolt. And when they revolt, the ones who are comfortable with incremental change and are afraid of chasing the shiny new object. Because when I heard that comment today, I felt like the shiny new object was diversity, equity and inclusion that people were trying to avoid without saying it outright. And, someone who feels like they have been marginalized. It was like a low blow. So I, for one, appreciate people like you, Ann Wendel, Jerry Durham, Karen Litzy, and stuff. Who Have Sean Hagy and others, Dee Conetti, Sherry Teague reached out to us and say, how can we help? And you need people like that to be on your side. Martin Luther King needed white people. Okay. Rosa parks needed white people. Harriet Tubman needed white people to get where they're, even Mohammed Ali needed white people to be as successful as he is. We all need each other. If we are saying championing better together, how can you be better together if you're not willing to hear the reasons why you feel marginalized or victimized, it's not going to work. Stop turning around slogans or bumper stickers and start working on fixing the broken system that we have. That's all I'm asking for and we got to start working as a family, as uncomfortable as it may be. All right, we'll get over it and you're going to like and appreciate each other for it later on.
Jenna Kantor: 26:44 Thank you guys for tuning in everyone, take care.
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