Season 1: Episode 10: Samuel Merritt University - Dr. DeRosa

Unknown Speaker  0:08  
Welcome to this episode of the PA path podcast. I'm your host, Kevin Lohenry. We are glad you could join us as we seek to better understand the PA profession.

Unknown Speaker  0:20  
And I don't think there's any magic bullet for that you build trust by doing what you say you're going to do.

Unknown Speaker  0:26  
Well, hello, and thank you for joining us today. I'm excited to talk to Dr. Michael DeRosa, who's chair of the physician assistant department at the Samuel American University in Oakland, California. Born and raised in Southern California, Dr. DeRosa attended Occidental College and UCLA, earning a doctorate in neuroscience as part of the first generation in his family to seek higher education. He joined the SMU pa faculty in 1999, and gave the first lecture in the first year of the program for the human gross anatomy course that he led. He later went on to earn his master's degree in public health and PA and became the director of the program in 2008. Dr. DeRosa, and I spoke about his path to becoming a PA, his passion for education and clinical practice and family medicine. We spoke about Samuel Merritt University and the amazing things they've been doing, and his organization that he helped co found the hands for global health.

Unknown Speaker  1:28  
Well, I'm really excited to have you on Mike, it's been a privilege getting to know you over the past few years, probably actually the past decade, I think we first met when you were testifying up in Sacramento, when we were there for a Office of Statewide Health Planning, development meeting or some testimony there. After that I went up for kappa with you on separate reasons. And you have just always impressed me from afar. And then our opportunity that will I'm sure we'll get into a little bit related to batata in Panama was just another great opportunity to get to know you. But before we get into our bromance, for the Bruin and the Trojan, we'll probably first let's start with just talking about your path to becoming a PA, I think it's a really interesting path. And I think the audience would enjoy hearing it.

Unknown Speaker  2:13  
Thanks a lot, Kevin. I appreciate it. Let me start by saying thank you for the invitation. And I really think this is a great idea, and really well executed. So far, I had an occasion to listen to some of the the previous episodes, and I truly don't belong in this company. But I'm privileged to be here. And I appreciate up. I think I was trying to think about this before we got on on the meeting here. And I think that I have a sort of the typical a typical path to the PA profession that a lot of folks had in the early years of the profession. It's uh, you know, as a, as you well know, for the first most of the first 50 years, I would say it was a secondary career option. So we have a lot of folks in the profession who came at it from different angles in different backgrounds. So I, as I mentioned, gone to Occidental College and done a degree in psycho biology in the 80s. And that was the decade of the brain. And I was interested in studying the brain. And there was a lot of money flying around. And I was able to land National Science Foundation scholarship to go to grad school at UCLA, and do a doctorate in neuroscience. And while I was there, one of my doctoral advisors told me that if you could teach anatomy, you can always get a job. I think it was just because he needed a TA for his anatomy course. I took him up on it. And I taught anatomy in the dental school, I did it the old fashioned way. I never I've still to this day, I've never taken a human gross anatomy course. And I did it as an apprentice basically doing the dissection the night before with him in the lab, for dental school with 20 cadavers. And so by the time you've done it 20 times in a night, and then taught it the next day, you feel pretty good about it. Sure. And so I came out of grad school and I followed the path that put me on I did a postdoc in New Jersey at the end of university medicine and dentistry in New Jersey. And at some point, I realized I was having the traditional last of the bench postdoctoral experience. And this wasn't the teaching career that I'd always wanted. The other thing is, you know, you should never take a native California out of California. So my first order of business was get back and I did that with a second postdoc. I think the

Unknown Speaker  4:23  
rest of the country actually buys into that philosophy, Mike. Yeah,

Unknown Speaker  4:26  
they should just stay in California. Yeah, I think that's true. It's I got a second postdoc at a place called Berlitz Biosciences here in Richmond that had just fallen into a patent on a FDA approval on a beta serum for multiple sclerosis. And when I got here, I started looking for teaching jobs teaching gross anatomy. And within about four months, I was teaching anatomy in the community colleges and eventually I answered an ad to teach gross anatomy to OT students at same American University. And I interviewed for that job. And I didn't get it, but the Dean liked me. And the next year when Dana Sarah Stanhope was starting a PA program, the first master's creating PA program in the state of California, and I got a phone call. And they asked me, How would you like to teach anatomy to PA? And to be honest with you, I said, What's a PA? I didn't know. You know, my bad, but it was what I can't teach

Unknown Speaker  5:23  
you everything at UCLA Mike.

Unknown Speaker  5:28  
And I know you're going to get the dig in somewhere. So I came on board with Dana and I talked gross anatomy that first year and then the second year became an Academic Coordinator. And eventually it became advantageous for me to become a PA, and with a lot of support from my faculty and PE department, many of whom are still my colleagues and the university and the folks at Turo in Vallejo, I was able to get get that done in 2008. I got my master's in public health and my PA degree, I started practicing clinically with the preceptor for my family practice rotation where I still practiced clinically, great, great physician, the marshal just know so much. And really treats family medicine like a specialty. And I've always appreciated that about I came back to salmon, right, and it really never left. But I came back to full time at Samuel Merritt and took over as the program director in 2008, in the director ever since. So, yeah, my path is a little bit different, probably being sort of an academic first and basic sciences first, and I know some other folks have done that before me and blazed that trail. But it's not the typical path to the PA profession.

Unknown Speaker  6:41  
So after you had completed your master's in public health and PA, did you have a moment where you were really wrestling with? Should I go back in academe? Should I stay in clinical practice? And do that for a while? Or had you really felt like teaching was a calling at this point. And so you were going to make the best of both? Yeah, for

Unknown Speaker  6:59  
a second. I since high school, I wanted to be an educator and wanted to teach at a high level in a graduate program of some sort, or medical program or something. And I am very, very happy with both of my professions. You know, and I'll be very frank with you that becoming a clinician did exercise some demons for me, you know, I, I made a choice not to go to med school when I left college. And you know, when the postdoc doesn't work out that great and you're feeling kind of, like I said, last at the bench, maybe you wonder if you made a mistake, or maybe you wonder if you are just covering for the fact that you didn't think you could hack the training or, or be a decent clinician. And you know, the day I got my PA done and got certified and started practicing, I didn't think about that anymore. And so I'm happy to practice, I really love practicing. And I love being an educator. And to be honest with you, I wouldn't want to do either one of them full time. So I'm sure I've been really, really grateful and happy for what being a PA has afforded me.

Unknown Speaker  8:01  
That's great. I mean, after spending time with you in the Panamanian experience, I can see why you just have a natural passion for serving people. And it really comes through very evidently and everything that you did on that trip,

Unknown Speaker  8:14  
you have always been a way to kind of make them appreciate.

Unknown Speaker  8:17  
I usually try to measure it with my UCLA job. So not for those who don't know, USC, which is where I'm at. and UCLA are notorious enemies, although I will admit, USC and UCLA are both outstanding institutions, for their own reasons. So you clearly talked about your current education to some extent, but tell us about Samuel Merritt University, you've been there for a while now. What do applicants need to know that really helps you stand out as a program?

Unknown Speaker  8:47  
You know, I have been there 22 years, and we've done a lot of work on our admissions process, like a lot of PA programs, like come aboard 99, I came back in 2008, to become the director. And in 2010, we admitted a class that had no black or Hispanic students in it. And clearly there was a problem. And as we all know that there's been a problem throughout the profession for a number of years. Absolutely. And we're all working to fix that. And so we had to work to fix that as well and put an emphasis on on diversity. But one of the things that we did in that process to try to figure out where the pressure points in our process were and where the hang ups for, for students that might not have the most traditional path or the most one of the classic credentials, was we did a bit of soul searching exercise in in our department to try to identify like, what is it we think that clinical experience gives a candidate? And are those virtues or values evident in other parts of their portfolio because I truly believe that while we talk about GPA as biased and standardized testing as bias, I think previous clinical experience is a category privilege. You know, if your uncle's a doctor or you live in an urban environment, that clinical experience is a lot easier to get. Sure. And so some of our disadvantaged students, our rural students are students that, you know, have suffered generations of wealth inequity and educational disadvantage. They don't have those sorts of resources, a family member or friends is a provider that can help them get that previous clinical experience. So I really wanted to get to a point where we did away with it, my faculty didn't let that happen. And they're probably right, you know, there probably is some value for the PA profession, pulling people who've got some experience. But what I also wanted to do was, was have a frank conversation with the Faculty Fellow, but what do we think that means about the candidate that they have that experience, and are there other ways that they could demonstrate those attributes, so a candidate to Samuel merit should take our website seriously, and should look at the values that we have listed, we listed them in our order of preference, you know, things like teamwork and responsibility, and, you know, all those sorts of things that we are looking for in a candidate, the commitment to community service, and, and so on. And they should use every opportunity in that application, whether it's a personal statement, or a job description, or, or whatever it might be to demonstrate to us how they possess those those attributes, and to show us reflections of those attributes in their record, whether it's in clinical practice, or, you know, whether it was being captain of the football team or doing the Peace Corps, I care less about where it comes from, of course, you know, and more of the candidates or the people in the process, the kind of values and attributes that we're looking for. So my advice to a prospective student for sangomar, and for probably most of our programs, is take what we have on the website seriously, and use every opportunity you have in that cast application to demonstrate those things that we're looking for.

Unknown Speaker  11:56  
Yeah, I think one more to add to that would be shadowing, right. It's Shadowing is also a networking business. It's, it's, there's no guarantee you can find somebody to take you in especially given the ease of which we throw HIPAA in your face. To say that it's not possible, when in fact, we all know it is if you jumped through a few extra hoops that are fairly easy to do. Yeah, 100%. Yeah. So I presume as a Program Director for these amount of years, you have a lot of go to guidance for applicants. What are some of the others when you have applicants at various stages of curiosity, some are in freshman year and are real go getters and they know what they want to do. Some graduated and came to this a little bit later in their career. So what are some of those kind of key things you'd like to share?

Unknown Speaker  12:41  
One of the things I find myself saying a lot these days is own your diversity, right? We're all under the gun, as we should be to diversify this profession. And that means diversifying the student body. And so I think that things that used to be kind of kept under the carpet or, you know, things that you didn't want to really put out there front and center for everybody to see in your application, or now the things that get into school sometimes. So I think people should only have diversity, you know, wherever it comes from. And don't be afraid of that, because we're all out here looking for that. That's one thing I find myself saying a lot. I think that everybody has a different approach to how they read these files, and different things that they look for in a personal statement or what have you. So I should give a disclaimer that this is just one person's opinion in every faculty is full of, you know, 10, or 12, or 15, people that are all looking at these with a different lens, which I think is a good thing. But it's hard to crystallize. You know that down into sure advice. For me, I want to see that you're a good student, I want to see that you have the capacity to learn, I think it's our job to teach you the content. So I'm not real concerned about medical knowledge coming in the door. I think we give you that when you're here. But I definitely want to see a demonstration of the ability to learn and manage the caseload or the curriculum load that we're going to put you on when you get in here. And that can be in your academic record deck that also comes with explaining some of the deficits in your academic record and telling us why that sophomore year your grades tanked because, you know, your mom died or you had to go help with the, you know, family business or you got evicted or you know, whatever it might be, but then point us to how things got better than your junior and senior years or, you know, in your graduate program or your prep program or whatever. Because I'm really interested in making sure that that you're going to be successful when you get here. And then finally, you know, when candidates come the interview, I say the same thing every year, which is that it's all at some level, just different flavors of ice cream, because we're all complying with the same set of standards. And so you just have to figure out who's serving the ice cream you want, you know, meaning you got to figure out where you're gonna fit in You got to figure out where where's the environment in which you're going to thrive. Because if we're all accredited, then ideally, the education you're going to get should be pretty similar. You know. And so if you take that part out of the equation, and you recognize you're going to see all the same titles of courses and all the same kind of structures of curriculum, we might do it in slightly different ways here or there, but it's all coming from that same set of standards, then what's becomes really, really, really important is, where you're doing it and who you're doing it with. And Dana, you saw was, say, You gotta have a fire in your belly to do this. And if you don't have that fire in your belly, it's gonna be really hard. And you're not going to be very much fun to be around. So I'd strongly encourage our candidates to try to envision themselves in that place, wherever they're interviewing, and find the place where they feel good and comfortable and supported and where they feel like it's going to be a place that they can do this really hard thing and come out hole.

Unknown Speaker  15:55  
Yeah, to that point of the fire in the belly, you can, in an interview, you can tell an applicant who has that fire in their belly from the way they comport themselves in the interview, the way they walk around, the way they articulate why they want to do this, Terry Scott from MedX talked about know your why be able to describe your why in a multitude of ways. And I think, from my perspective, and I'm sure you would say the same that when you are clear about your purpose, why you're choosing this path, it just exudes from your pores versus when you're doing it for the wrong reasons. It also is equally evident to the interviewers,

Unknown Speaker  16:32  
Terry had a much more eloquent way of saying it than I just did. That was a very, very good way of saying,

Unknown Speaker  16:38  
Yeah, well, okay, so now, let's let's think positively in the applicants listening, get into PA school, what are some of those classic challenges that PDAs face in school, that you always have to kind of guide them through as a program director,

Unknown Speaker  16:53  
different populations face different challenges, but fairly consistently, I've always felt like, you know, the candidates who come back a little bit older, they've been out in the working world a little bit longer, maybe they've been in the clinical environment a little bit longer, I had no real worries about how they're going to perform in the clinical rotations. But man, sometimes coming back into the classroom is a struggle, by the same token students that are, you know, fresh out of school, pardon the expression, but they're kind of used to being beat up by the academic system. And they just kind of do what you ask them to do. And they're compliant. And they get their coursework done. And, and they're good in the classroom, they've got their skill set, they've got their approach that they've been doing it for a long time. And they fall right into it, and they defined in the classroom, but you're going to worry about their performance in the clinic. So some of it, I think, is agent experience, and maturity can predict some times where you're pitfalls in the bay. But as you know, you know, Pa training is a generous curriculum, we got something to hang everybody up. And it's it's going to find your weak spot, at some point.

Unknown Speaker  17:57  
Do you run into imposter syndrome and some of your students?

Unknown Speaker  18:01  
Oh, absolutely. And I think that's something we're probably all facing is where we're diversifying our student body that our cohorts and, you know, we're bringing in people who maybe don't have the sometimes a family tradition of higher education, and they don't have that support behind them in, in a family structure, and not a student years and years ago. Got to be careful about FERPA here. So I'm obviously not going to mention any names or anything but and the student's background was Cuban. And she came from a Cuban community within the United States and very heavily so and I'll never forget, sitting in my office with her and having her talk about the weight that she carried for her population, that she needed to get this done to support that. And to honor their belief in her. I remember saying that, that's great. And you know, and that's awesome. But you shouldn't be doing this for anybody but you. And if you can find it within yourself to make this about you and do it because you want this and not because there's 100 people out there from Cuba that want you to do this, it might get easier. And her grades went up by like half a GPA point, the next semester, after that conversation, once you kind of had that sort of change of approach change of mentality and realize, no, I really want to do this, and I want to do this for me. And all those other things will happen if I do this too. But I can't worry about letting everybody in the world down. My father, my parents, you know, a community.

Unknown Speaker  19:36  
Yeah,

Unknown Speaker  19:36  
that's a lot to share.

Unknown Speaker  19:38  
There's a real complexity to all of the individuals we train that some are more transparent than others, but the ones that aren't, it never surprises me anymore to hear of their journey or their path or the people that are expecting this out of them like you alluded to, and from all walks of life, and my sense is I think sometimes As educators, we forget how complicated it can be. We forget how expensive it can be. I spoke to an applicant recently from a project we're doing in California over the Coachella Valley, looking to help build a pipeline of migrant farm working families, to PA schools in California. And we talked about the average applicant and the average applicant from the data, I've read it, Pa and through Casper has a better success rate if they apply to 10 or more schools, yet, that has serious financial consequences to the average applicant. And for somebody coming from a family that has economic challenges that that's daunting, and then add on to that, that traditionally, outside of a pandemic, we all want to see them in person for interviews, and we generally all want them to fly up. And we oftentimes don't give them much more than two to four weeks notice. And then we spend a day with them, and we crush their dreams, that may not be the right time for them. And I think we you know, because we have evolved into a profession that provides significant financial security for all of us that RPAS. It is, I think, sometimes shameful on us that we forget where we came from, or how hard it is for some to navigate our chaotic processes.

Unknown Speaker  21:23  
Yeah, I know, we spend a lot of time talking about disparities. And we spend a lot of time talking about disadvantage. But then we routinely disadvantaged candidates, whether it's with requirements or an in person interview, if we did, as many programs did, and I'm sure I think you guys did, too, we did a virtual interview because of COVID. And I was thrilled, and I was thrilled with the access that it gave to students who might not otherwise have been able to fly. And like you said, on a free day weekend or something to come in, come in and do our interview, and leave and have to pay for hotel, and everything else. That's not a cheap proposition. And so I hope we keep doing virtual interviews for candidates, I think it dramatically improved access. Yeah,

Unknown Speaker  22:04  
I think you did it. And we're going to keep it ourselves. And I think it also dramatically improved access for our alumni from around the world to participate, which is really great. We have a grad who's an author, PA, in England, in the UK, in London, who was able to participate a former class president and you know, there's just, they want to be part of the experience, but it's not always conducive to them to fly back. So absolutely. Well, okay, so your program, let's talk a little bit more about it. So how many months 2727. And you have 12 months of didactic and the rest rotations are 15 months and 1215

Unknown Speaker  22:45  
minutes? Well, we have four didactic semesters and three clinical semesters.

Unknown Speaker  22:50  
Okay. gross anatomy lab. Yes. And that's that continued since you were anatomy instructor there at the back in the day? Absolutely. Yeah. And then other way to learn? Yeah. And then the typical topics in medicine, clinical skills, kind of courses, things like that. Do you have elective rotations, to, to Okay, and and when your grads leave, what are the things that you hear from them about your program that brings you the most proud

Unknown Speaker  23:19  
to be honest with you, I think some of the most pride that we get is when they come back. And when they teach for us when they preset for us. We have a number of graduates on the faculty, whether their principal, fact my clinical coordinator, and as a graduate of the program, that's really probably the most gratifying, you know, thing, that thing that happens we and you know, the other thing is, of course, when they're out in the field, and we get that feedback that, you know, their preceptor talked about Sami American students and how well trained we are. Or, you know, how better trained we are than those se students.

Unknown Speaker  23:57  
Might might wake up, Mike. I'm sorry, I think you're sleepwalking.

Unknown Speaker  24:05  
I couldn't use any of my local colleagues. Kevin had to go after the SC program. That's fair.

Unknown Speaker  24:11  
We're the target for many, many, many California programs. We own it. Let's talk about something I know you're super passionate about, which is really I as I learned more about the work that you're doing in Panama, a lot of programs do medical mission work as a tourism kind of thing. It's a checkbox for applicants to say, Yeah, we do that. And you can join us on a trip to go go see another country and maybe help out here or there. And what impressed me so much about the experience that I went with you in Panama to get in the spring of 2019 was just the genuine conscious decisions that you made as a leader to find the most remote place in the country with the biggest need a lot of medical tourism sites go pretty close to the big city so they can do More tourism in less primary care. But in fact, you actually asked for your in country supporters to identify where the real need was. And then you've invested up to 10 years of significant experience in that community getting to know them building trust, developing preventive measures in conjunction with the Ministry of Health. So, why Panama? Why the approach that you take? And what are the kind of future things that you're thinking about related to the people of batata?

Unknown Speaker  25:31  
Well, thank you. And again, far too kind. And I really can't take any the credits. And I have to shout out down to my colleagues, Suzanne Agus, who at the time we started doing this was the chair of the nurse practitioner program at St. Mary's, and Sharon Gorman, who's the professor in the PT department at St. Mary's, none of this happens without them, and the rest of the people that we've worked with who it would take the whole time to name them all. But those two in particular, if done so much, and deserve more this credit than I do. And the way it happened, it was and you're not wrong, I started doing it, because our candidates were demanding it. It was in the early 2000s, I started realizing that every single year I go to these interviews for for the PA program, and every candidate or almost every candidate, you know, a lot of candidates would ask year over year over year, are there international opportunities, and we didn't have one, I started to feel like we were going to be behind the eight ball if we didn't. And, you know, I did a master's in public health when I got my PA degree. And I became very interested in international work and global health, on my own for my own interest as well. And so when I came back, it was one of the things I was committed to, you know, we're going to be more primary care focused, we're going to be more trying to be more intentional about community service. And we're going to try to do something global. In 2009. I was invited by Suzanne August in the nurse practitioner program to join a group of nurse practitioner students and faculty on a trip with Global Brigades to Honduras, folks who know their central American history, maybe know that in July of 2009, there was a military coup in Honduras. And I'll never forget the meeting I had with Suzanne, where I said, Look, we're the faculty work, we need to be responsible here, because we both wanted to go, and we were going to go anyway. But as you're certain you're well aware of how your institution might look at you taking students into a war zone, and with helicopters flying over the Capitol, because kalpa and tanks and streets literally, you know, the whole night. So we made a decision to call Global Brigades and ask them if there wasn't anything else we could do. And they offered us Panama. And they offered us Panama with the caveat that they were only just beginning to do medical trips to Panama, and they weren't sure they could do medical trips to Panama. And we would be one of the first groups to do that. I think we're the second or third group to do medicine in the Global Brigades in Panama. And we said, great, you know, sounds awesome. We went down on that first trip, we had an amazing trip with all of the vomiting and diarrhea and hot sweaty bus rides that you would imagine. And it was a life changing experience. And we met, we met a number of really cool people doing really cool work down there. And one of them was William VyOS. And because Global Brigades had not been doing medicine there, for them, it's like you described, they needed to find a location where they could do as many of the things that Global Brigades does, whether it's water, or small business, or law, or environmental, or medicine, they want to find a place where they can do as many of those sorts of trips from a central location as possible because it saves costs. And you're right, they want to keep the supply lines short. So they don't want to go up into the mountains and into really remote areas. And I'm not saying this to bash them at all, they do really good work. But their paradigm is such that you end up in places where a lot of people go, and our desire had always been to go to remote places, like you said, where the care was really needed. And the need was really great. But over those first few years, we basically got to see the whole country, Suzanne and I work with William, because we're scouting locations. And so one year was all the way out at the western end of the country near the border with Costa Rica. And another year was as close as we could get to the Darien province and the border with Colombia and everything in between. And you know, every year we go down there and William would say, I've got a community, I've got a community we got to go to batata now so keep saying let's go let's do it and he couldn't get global kids to do it. Also, he kept saying, you know, we might not be able to do it if it's raining because we got across streams and the waterleaf too high for the trucks and all this kind of stuff and everything he said just made me want to go more.

Unknown Speaker  29:52  
And so finally, eventually, over time, William ended up leaving Global Brigades and starting some group and his own NGO down in pan Have one. And we had a decision to make, we had a decision to keep going with William or keep going with all uppercase. And I struggled with that a lot, because I felt like I didn't want to be disloyal to Go Global Brigades. And we'd started this process with that organization. And to be fair and honest, I pushed back against the decision to start going with William. And it was really Suzanne and Sharon, that chose to try at one time on a trip that I wasn't going to be on, and they could do whatever they wanted. And they went to batata, with William, and they came back and said, You got to go. And you're going to love this. And we have been back every, you know, twice a year since until until the pandemic for about six or seven years. And there were you're right, there were reasons for that. And I was part of the the rationale for that, which was, I don't want to do band aids, I am a strong environmentalists and you know, concerned about climate and concerned about, you know, people go down there and make a bigger footprint, and they then they do good. And we have to think about the costs of what we do to get there. And what we do while we're there and compare that to the benefit that we're providing, there has to be a positive cost benefit, or we're actually harming the community. And so if we go down there and leave a bunch of trash, or create degradation of the environment, or do any of those sorts of things, and we're not really doing good. And so that was, you know, a big consideration. For me, I also felt like in order to not just be putting on band aids, we needed to build trust and rapport and a community. And that meant we needed to keep coming back. And I don't think there's any magic bullet for that you build trust by doing what you say you're going to do, and following through and showing up. And so once we got to the Tata, we were very intentional about saying, we'll be back, and then you better come back, you know, we're learning, we're going to get better at this, we're gonna learn more about what you need. Because we're going to approach this with humility, we're not going to walk in and tell you what you need. But as we do this a few more times, we're going to be able to refine how we do it, to provide better care for the things that we're seeing, every time we come back here, we're going to be able to start to manage chronic conditions, we're going to be able to start to provide long term care for people that need it. And we can only do that if we keep going back to the same place every single time to build that rapport, and build that respect to the community. And you're You're 100%, right. The collaboration with the Ministry of Health in Panama has been super important. The community benefit of in a sense, putting them on the map for the ministry has been very important even when we're not there. They get more care than they used to, because we've been going there and bringing the Ministry of Health with us. And the Ministry of Health provides a tremendous amount of supplies and medicines and support for what we do when we're there. So that was a big part of it, as well.

Unknown Speaker  32:52  
Some some of the public health concepts that I think were really reinforced for me when I was there, nutrition, the short stature of so many of the wonderful people in those communities and the aspects of COPD, and just the physical challenges for the lungs related to the cultural approach to cooking in the homes, which you have all been working hard at to try to ease into the cultural changes that it would require, but also educate about a few simple things that might help reduce the tremendous morbidity and mortality related to those stoves in the homes. What are some of the other lessons that you've learned in in consultation and collaboration with the communities and their

Unknown Speaker  33:35  
leadership? Yeah, I'd like to talk about the smoke for just a minute in the way cooking is done, as you mentioned, is a very traditional thing. You know, taking a big log of b big tree stump and burning it but burning it very slowly over an open pit so that they can use that smoldering log to start a fire when they need to cook. So there's a constant smoke emission that happens in the home. I've read that it's the equivalent of 400 Cigarettes now. So if you could imagine and I always ask the students to imagine your house, the house you grew up in with 100 people in it, and every one of them smoking four cigarettes an hour. That's the amount of smoke and of course it hits the women and the children the hardest, because they're the ones in the home and the women are that are tending the fire and doing the cooking. So there's a gender disparity too. And so we did start doing cookstoves on a model that was a published structure that we can build for a couple $100 And there's an environmental benefit too, because the heating chamber, or the fuel chamber in the stoves that we build is much much smaller than what they burn in those open pit fires. So when they're doing those open pit fires, not only is it COPD, smoke exposure and all that stuff, but it's environmental degradation too because they're different forcing their country or their landscape to do it. These cookstoves have these little small chambers, and that uses a lot less fuel. Now they're not effective. While they're not, they're not effective enough that they reduce the emissions by about 90%. So, you know, instead of 100 people in the house, you grew up in smoking for cigarettes an hour, it's 10 people smoking for cigarettes an hour. And that's still more than any of us would be comfortable with. So we've kind of done some of the stoves and we've promoted it, but we haven't done really whole hog on it. Because we know it's not a fix. We know it's not enough. But it would be some help. So thank you for letting me talk about that. Other things that you mentioned the malnutrition, you know, it's funny that Panama's really, really green, right, and it's really beautiful, and it's forested, and it's tropical, right in this rain forest. And nobody would look at that country in that landscape, or the area around the canal and all that green and believe that that soil really sucks. And it's really hard to grow crops in that red clay, you know, that we see when when we go there. So it is difficult for them to grow very much of nutritional value for a period of time, the area that we go, the Tata had developed tilapia ponds, and they were harvesting fish, and that was giving them some protein and then probably bolstering their nutrition, a fair amount, but the drought dried up the ponds, and they haven't been able to maintain them. So there is malnutrition, there's certainly a macro and micronutrient malnutrition, that contributes to the stature that you talked about. But in addition, there's parasites in the water. And so your diet is deficient. And then you're you have a malabsorption syndrome, because you've got diarrhea all the time, you know, from from the parasites. So, again, one of the one of the most significant benefits I think we've made is turning on the Ministry of Health to this community, because now every time we go, we give anti parasitics. And I think that in and of itself will be community healthier than this the floors, you know, we need to get down there and do cement floors. And that would help with parasites, it would help with the Weiss, it would help with the skin stuff that we see, to just do cement floors, that they can keep cleaner. And that would make the community healthier. So there are simple things that you know, the water filters we've been installing on the last couple of trips cost something like $25 A piece. Wow. And they're really, really easy to use, easier than the stoves. And so I think that the the water filters that we've been installing will probably be a better impact even than the stoves Well,

Unknown Speaker  37:40  
that's fantastic. Talk a little bit about the culture of the people that you get to experience on a regular basis. What are the things that maybe when you first got there you you had no idea about but after getting to know the population, now you've kind of come to love some cultural aspects of their communities.

Unknown Speaker  37:59  
I know there's multiple indigenous populations in Panama, spread over I think it's five different call markers, which is their word for what we used to call a reservation here tribal land. Within the country, they're very much like the tribal lands in the United States. They're self governing. And there's good and bad associated with that. The government's kind of hands off that the Panamanian government, and there's good and bad associated with that. And they face a great deal of race based bias and in the in the community, just like our Native Americans here. So there's some real parallels there. The population that we work with is it's called the Navi bootleg. And it's a combination of the Navi people and the booklet people, which is the largest and the smallest indigenous population in Panama, that kind of merged into one on the biggest comarca in Panama, and the nadi people are, they're beautiful people with, you know, beautiful customs, and beautiful clothing and the woven bags that they carry and so on. That they're a third reflective and in a in a quiet people, they're not the Beaufort, they're not what sort extroverted in, that's for sure.

Unknown Speaker  39:15  
No boisterous nature whatsoever,

Unknown Speaker  39:17  
not boisterous at all. And, in fact, it would be disrespectful for them to be that way in their mind. And so, again, the need to build trust, right, the need to if you say, you're going to come back to come back and prove to them that you're here to help him I'm here to tell because these are communities that have been taken advantage of for centuries. They, you know, is interesting, too, it's a very, it's a it's a Hispanic culture, of course, it's a very traditional Hispanic cultures paternalistic kind of culture, in a lot of ways. And so for the first several trips, we only saw women and children and there would be a ring of men who would stand you know, 20 yards 30 yards away from the clinic, but not from what company See us. And it took a couple, three trips to start to break through that to where we would see male patients on a regular basis as well. And again, these are things that you only learn by going back to the same place over and over and over again, it's a really lovely group of people. And we've, over the years formed relationships. And we have started to recognize, you know, people trip after trip who come back or, you know, kids that were, you know, babies when, when we were there in the early trips are now in elementary school, and they're growing up. And that's, you know, it's the same wonderful part of family medicine in the states that you're treating people through a lifetime. That

Unknown Speaker  40:40  
and building relationships. Yeah, one of my favorite photographs and favorite memories from that experience was I took a photo of your team, and you were overlooking the land that had been donated to you by the community to build a future clinic. So I wonder if you could talk a little bit about the future of your relationship there. And perhaps we should put in a plug for enhancer global health. So that if anybody is truly interested in this project, they could find you on the web and, and, you know, maybe donate some money for this project.

Unknown Speaker  41:12  
Please do it. You know, if you got a family foundation, or, you know, a rich uncle, I want to talk to you, thanks for bringing that up. So, again, you know, you work to build trust, you work to just keep coming back. And we had a terrible situation, we had a baby die on site, then it's a hard story to talk about. It was the first day of the clinic. And we're just getting started. And you've seen the first day and the way they lined up in the line was 150 people long, probably. And we're just getting ready to start and people are getting the rooms together. And everybody's nervous. And you know, a lot of folks are down there for the first time, and so on. And so I was sort of just walking the road of rooms where we're going to do the clinic and trying to get people moving and get us ready to go. And I noticed a very concerned looking mother and a baby that she was holding on at desks. We do this at an elementary school. So she was sitting on the desk and the baby was laying on the desk and I can from 20 feet away, I could see the retractions and invade it was really labored breathing. Long story short, the baby was very, very sick and didn't make it and passed away had our clinic, suddenly death we've ever had. And it was a real moment. For everything. It was a moment for the group. Like I said, it was on the first day of our clinic, many of us didn't know each other before the day before that. And we're trying to get this thing done. And and it was a real moment where I feel like it could have gone either way for that trip. And and I went to each of the leaders in each of the of the rooms. And I said, I want you to close the door for a few minutes. And inform your team that the baby died. And tell them you know, we got a couple 100 people so that see today, and we're gonna get through this. And tonight we're going to talk about it and process the right now we had a lot of work to do. And I crossed my fingers. And I hope that people will rally and boy did they rally. And they were amazing. And we saw another three or 400 people that day. And then we had the most difficult debrief I think I've ever had down there and everybody was in tears. But the other thing that happened was the community rallied around us. And that could have gone either way, right? They could have blamed us for the death. And for that loss, and they didn't, they took it as evidence of how much they need what we're doing now there. Which, like I said, they didn't have to make that decision. They certainly didn't have to come to that conclusion. But as a result of that, they advocated with their elders, and with the leaders of their community to build our presence. And then the next time we went down there, we were showing this piece of land that one of the community members had donated for us to use to conduct our clinics and to build a place where we could do more. And because of William's hard work, and William, our partner down there in Panama, because of his hard work with the Ministry of Health, the Ministry of Health ultimately agreed to fund a physician, a nurse and a driver full time to help in the clinic. So we now have plans that you know, we're working on plans to build the clinic and to build a facility that our groups could use to sleep in and to meet and eat and all that when we're down there to house our groups so that we can go down to work and I think that will make some of the public health interventions that we've talked about much more likely to happen, because we'll be able to stay there for longer periods of time. Yeah, then and without disrupting the whole school, like we do right now. So it, you know, tremendous support and tremendous respect and gratitude for, for the trust that they've instilled in us. And you never, you know, I hate to say this, you never want anything, like what we experienced to happen on any of these trips. And that the baby passing on site changed everything. And yeah, their level of commitment to what we're doing really skyrocketed. And it's been amazing to go back ever since.

Unknown Speaker  45:41  
Yeah, I think for me, the you share that story with me when I was there. And I think for me the the genuine, authentic respect that I saw from the community to you and your colleagues, and from your students and colleagues. To them. It's special, I think it's palpable, I've done medical mission work in on us and this this is different. It is it is. Because I think the public health component of it is really important. It's so often that that religious based mission work, while wonderful and great opportunities for significant change in people, particularly in us going there, rather than us really changing the community, what you've done is you have focused on very important needs for the public health in the future of the community and educating them about that. And I just think it's, it's amazing. I think if With your permission, Mike, I'd like to put that photo of that site on our website, when we post the episode and a link to your organization so people can learn more.

Unknown Speaker  46:46  
That'd be great. Yeah, thank you. I just want to thank you again, for the opportunity. You know, I'm a kid of immigrant parents. I'm the first generation of my family go to college. My mom was a German war bride was just celebrated her 93rd birthday, she's on my mind. And my dad's parents came here from Italy thrill aside. But I'm also very much aware of even as the child of immigrant families and the first generation build a school that that path was paved for me in a way that it's not being paid for immigrant communities now, and our communities of color. And so I want to thank you for doing this. I want to thank you for everything you've done in the name of diversifying our profession. I think we've been kind of kindred spirits in that we have that process and even a real leader in this in this profession. And I want to thank you for

Unknown Speaker  47:41  
Thanks, Mike. I was almost today years old. I think it was we had the conversation last week. So I was almost today years old minus seven days when I learned that you and I are almost the same age. And I'm not surprised.

Unknown Speaker  47:56  
I look a lot older than you do. But I'm not surprised.

Unknown Speaker  48:00  
You were well, I got the grace comment in this comment Fast and Furious.

Unknown Speaker  48:05  
That's good. Embrace it. Well, Mike,

Unknown Speaker  48:07  
thank you so much for your time today and for your leadership for the profession. We didn't even talk to him. Well, we definitely need to have to come back because we didn't talk about your work with PA and government relations and the important advocacy work that you've been doing. And you've done that at the state level, the national level, there's a lot more to unwrap your scholarship for disadvantaged students that your institution has been so successful with, because of your leadership. So I just want to say congrats for everything you've done to Samri Marin, and we wish you the very best. Thanks.

Unknown Speaker  48:42  
Well, I want to thank Mike DeRosa, for joining us today from Samuel Merritt University. If you can't see a humble leader from that interview, I don't know if you ever will want an amazing guy and really a privilege to get to know him and also share just the incredible work that he and his colleagues are doing down in Panama. I'm always amazed by the power of our influence as healthcare providers and what we can do to write some wrongs around the world through the love and compassion that we provide through health care. Tune in next week, as we speak to Dr. Don Morton Riaz, CEO of the National Commission on certification of Physician Assistants. We'll talk about the NCCPA the PA profession and her path to becoming a PA. Until next time, I wish you success with whatever path you are walking in life. And thank you for joining us. The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views and opinions expressed in this podcast are those of the speakers and guests and do not necessarily reflect the official position or power. Let's see of the University of Southern California