S8E10: Building Trust in Indigenous Health Care Through Community and Story

Lilly: I don't know what is happening in the hospital in this new year, but we are packed all the time. The ED is full. The hospital is full. There are so many patients, and it gets really overwhelming. I don't think that people realize sometimes that after a certain time of day, there's only one neurologist in the whole hospital, and we take care of literally everyone. It's so scary and overwhelming because, of course, at 5:00 p.m., that's when you get six consults or brain attacks, and you're like, "What is happening?"

But that being said, I wanted to welcome everyone back to "Bundles." This is one of your co-hosts, Lilly, and I'm so excited to have our guest here today to have a really important conversation that I've been wanting to have on "Bundles" for the past year, really focusing on Indigenous health and Indigenous healthcare outcomes.

This is something that hopefully you all have heard a little bit about, whether you're in undergrad, in med school, doing research. Hopefully, we all have been exposed to this and have some understanding about it. But if this is your first time hearing about this, I'm excited for you to join the conversation.

I really wanted to have a conversation about this specifically because living in Utah, we occupy Indigenous land, and a lot of times I feel like we forget that. And we treat Indigenous patients like their culture is different from our culture when we're really imposing our culture on their land.

When I think about Indigenous healthcare outcomes, I don't only think of this as something that has happened by accident. I think the healthcare gaps that we're seeing today aren't really individual choices or cultures, like sometimes providers want to blame.

I think they're a result of colonization and displacement and systemic neglect from the forced removal from land to disrupting food systems and medicine and community care, to the residential schools and other systems that caused intergenerational trauma that shows up physically and mentally in the health that we see and provide to Indigenous patients.

And really, even today, the ongoing racism in healthcare that we see towards this population has led to delayed cares, to misdiagnoses, to mistrust and distrust of providers because of how patients have been treated previously.

I think it's really important when we take care of patients and think about Indigenous health, it means acknowledging that history lives in the body. It's really important to acknowledge all of those things. And for having lived in Utah my whole life, I feel like we really don't talk about this as much as we should, even though we have so many exposures to it.

So I'm really excited and honored and privileged to have one of my interns when I was a medical student at the University of Utah join me today to have this really important conversation, and I don't think there's anyone better to have this conversation with. I've truly been waiting a year to have this conversation.

So I'm so excited to introduce you all to Dr. Brittany Begaye and have her tell you a little bit more about herself and her story.

Brittany: Thank you so much for that intro. And I'm honored to be on the podcast as well. I think this is, like you said, a super important discussion to be had.

I am a third-year internal medicine-pediatrics resident at The U here. And I'm originally from Arizona in the Navajo Nation area, the western part of the area. Grew up on the reservation. Very rural and remote. I think the community, the last census was about 2,000 people live in the area. You can drive through it within 30 seconds. It's really just kind of a clinic and a couple schools and a chapter house or kind of a local government building, and then a gas station, and then just community housing.

I grew up with a couple siblings, my mom, and then I was actually raised by my grandmother, which I think was probably the biggest integral and inspiration for kind of going into medicine.

She spoke primarily Navajo, so that's kind of how I picked up the language a lot and kind of helped out with her with her health struggles, and that led me into medicine indirectly as well.

So kind of the big draw for me going into medicine is my grandma and I were best friends. We'd share a room. She'd stay with me all the time. And so along with that, she would have these appointments for her doctor. She had diabetes longstanding for a while. So I'd go to the clinic with her, kind of help her there.

And we had a lot of locums that would just kind of come through the community, so different doctors each time, they would come in, didn't really know her and would of just offer kind of blanket treatments of, "Eat less processed food, exercise more." And those are all really great recommendations, but I think for the setting, it just didn't really make sense. My grandma was 70. I don't think she's going to be exercising.

The big food deserts on the reservation make it really challenging just to even get fresh foods all the time. So you kind of rely on buying more shelf-stable things that are unfortunately highly processed.

And then along with that, just kind of the social and strain of living on the reservation as well. So I think all of those together just kind of manifest as poor health outcomes in a multitude of ways.

And so along with that, her only speaking Navajo, I would help translate for her. And speaking Navajo, even as someone who speaks Navajo, is a really hard language, honestly. It's an oral language originally, so there were never any written books or anything like that. So the way you would talk about medicine was kind of just describing it. For example, for diabetes, we would just call it áshįįh łikan, which translates to sugar. It's kind of how you would explain what diabetes is.

Lilly: That's so interesting and kind of crazy that that's what you guys say for diabetes, because in Dari, we also say "maraz e shakar," which literally means "a disease of the sugar."

But you try to explain it to family members, and things just don't translate very well. I remember I was trying to explain to someone that they needed to get a certain test done to look at their pancreas, but we don't have a word for pancreas. It's just pancreas. And if you know what that means, great. And if you don't, you don't.

And this patient did not know what that was. Then I was like, "It's the organ that helps make sugar." It was so bad because you're trying to translate this medical terminology that just doesn't translate well. And therefore, I feel like sometimes the meaning and some of the complications and things like that of the disease also get lost.

Brittany: That, to me, I think just kind of shows how the language discrepancy can really manifest. And speaking about death or serious illness directly to Navajos is very taboo. The thought is you talk about death of someone or a really bad prognosis, you're basically wishing that upon them.

And then what I would recommend is kind of just asking it in a third-person point of view, like, "If someone was in the hospital and their heart stopped, we would do CPR. Would that be an intervention you would want?" Kind of still asking it, but in a roundabout way without wishing that upon them.

I tried to use the iPad interpreters, couldn't find anyone. Tried to request an in-person one. I went up the chain of interpretation services, and it's unfortunate, but they told me Navajo is a really scarce interpretation to get, which is kind of wild when we live right next to the Navajo Nation.

Lilly: Exactly. Oh my gosh. Wow. I love it when cultures overlap because we have this in our culture as well. It's taboo, it's evil eye, it's wishing it upon you if you talk about these things. Even if you have a terminal illness, you don't talk about death. We don't do advanced directives, we don't do wills, we don't do medical power of attorneys in our culture. No one talks about it because if you talk about it, you're wishing that upon me. You want this to happen to me? Why would you want me to think about my death?

It's really interesting because culturally, we're just not prepared in that sense. And I love the golden nugget you gave us of thinking about having the conversation in third person. I think that's so pivotal and so important because you can still get the information that you need, but this is such an important way that you can provide that patient with comfort and also not be taboo in their culture or be disrespectful by saying, "Well, if you die . . ." I don't know. That's a whole other conversation that's just conversations and dialogues in the hospital.

But I love that you said that because I think that's something we all can do in practice, and it just takes a moment of acknowledgment of, "This is their background, and this is how I can treat them more holistically."

And I'm sure "Bundles," for those of you who have listened to my other episodes, I also have had a very similar story as to why I went into medicine. I love those kinds of stories, because when you have a true meaningful reason as to why you are pursuing medicine, you have a deeper connection, I think, to your patients and their healthcare outcomes. You've seen what will happen when things get missed, when things get lost, when there's no follow-up, when there are poor recommendations.

I mean, we're guilty of this. In neurology, we tell people all the time, "You're pre-diabetic, you're diabetic, you need to get your A1C under 7 to reduce your stroke risk." And we always just recommend Mediterranean diet, exercise, all these things, and then we also will put five new medications on you before you leave the hospital.

It's interesting because I was actually in Page, Arizona, which for anyone who has not been to Page, Arizona, it is absolutely beautiful, and you must visit. And I really loved my time there. But it was so interesting because when you're in those kinds of areas, sometimes we'll say, "Focus on the perimeter of the grocery store to get your groceries. Don't go in the aisles." But a lot of times, in smaller rural towns, there are only aisles. You're not really getting a lot of perimeters.

And I think a lot of these concepts that we think are going to work well for our patients only work if you have all of the access to those things, right? You're setting people up for failure by giving them these recommendations and not even acknowledging where they're going.

We see this so much in Utah because we have so many people from rural towns and states that come to us for acute care, and then we send them off thinking, "You have all the support and resources you need," when in reality, we're kind of setting them up for failure.

Brittany: I totally agree. And you can truly never get the idea of how the disease manifests when you're kind of talking in a roundabout way of things. So I think that was probably one of my biggest draws, kind of seeing that disparity and the lack of insight of what it means to live on the reservation and what health outcomes and healthcare actually looks like. And so I think that was probably my biggest draw to kind of going into medicine.

I think it's just really tough to kind of meet patients where they're at, especially in rural communities. And so I think having someone coming from that and kind of seeing what real life actually looks like, I think, is probably one of my biggest drives as well, to get the training and then ultimately go back home after all of this.

Lilly: And how . . . Go ahead.

Brittany: Sorry. Go ahead.

Lilly: I was going to say how privileged we are to have you in Utah, even if it's only for a short while.

Brittany: Yeah, it was actually my number one choice for residency, so I'm super stoked to be here. I kind of stumbled into the specialty of med-peds. I was internal medicine bound all through medical school, did pediatrics at the end of third year, and was like, "Oh, I love treating children. This kind of sucks, but I guess I can give that up." And someone's like, "You should do med-peds." I was like, "What is med-peds?"

And then I kind of stumbled into this amazing specialty where you can provide care from birth until the end of life. I really like inpatient hospital medicine, critical care. So it kind of combined everything in my interests.

I chose Utah specifically because there's a rural health track within this residency, which is unique and probably the only one in the country who offers that. And so I really sought this program out. They put a big emphasis, at least in my program, in talking about Indigenous health, and then really were prioritizing rotations where I could return home to the Navajo Nation during training to kind of get some exposure and prepare me for life after residency.

Lilly: I feel like everyone always says that internal medicine is the mother of medicine because it encapsulates everything. But honestly, whenever I meet anyone who does med-peds, I'm like, "No, you are the true doctor." You have to know so many things about so many different populations and age groups, which they all have different criteria and guidelines. So much research, so much data that you need to be up to date on. I'm always so impressed by all the med-peds residents and attendings that I meet because you truly are the backbone of medicine.

Brittany: At least right now it feels like I'm still trying to stumble my way and figuring out both specialties, but I truly love it. It's been a real privilege to be here.

Lilly: And I feel like not a lot of people know about med peds because it is smaller. Your cohort is three residents, right?

Brittany: Yeah.

Lilly: Are they planning on getting bigger? I don't know. I feel like there's such a need, but . . .

Brittany: I think we're trying to increase another spot here. It's very limited on the West Coast. There are only seven residencies. I wanted to stay close to home, so that was kind of the big draw as well.

Lilly: That is so wild, considering how much you all treat and how much you all do and see, how small it is.

But for those of you who are listening and you're like, "I have no idea what I want to do with my life," or, "I like all my rotations," or, "I really like continuity of care," this is one of those really cool specialties that not a lot of people talk about that you should look into. I think it's really unique, and I wish I would have had a little bit more exposure to it.

Neurology, you have to decide if you want to do peds versus adult before you even apply to residency because they're split, which is really unfortunate because I loved my pediatrics rotation. But ultimately, I had to commit to one and just see it through. So it would've been really cool to be able to do both.

Brittany: Yeah, it's a really good specialty for indecisive people because it kind of leaves your options open. But also, if you're wanting to do rural health, I think it's the perfect specialty to set you up really well for it too.

Lilly: That's a really good point. That is something I really like about Utah and kind of the states around us, is we can have those exposures. You have to seek them out a little bit more, I think, but there's always an opportunity for that.

Even in neuro, we have a lot of tele-stroke and tele-neurology to try and catch some of these areas. And I hope that continues to expand with just how big our populations are and how little access they have.

I'm really curious, with coming to Utah, what you feel like your biggest surprise has been.

Brittany: It's a little more diverse than I anticipated. I came from Phoenix and it's very diverse, and grew up on the Navajo Nation, so was surrounded by kind of my own people. I was not expecting a lot of diversity here in Utah. And I think specifically with my program, my continuity clinics are kind of more in underserved areas, and we serve a very diverse patient population, which I appreciate.

I think with how big both Primary Children's and The U are, I think we get a lot of kind of transfers from rural communities. So I think that kind of brings more diversity than I initially anticipated as well. But definitely way less than Phoenix for sure, though.

Lilly: Was that intentional, that your program created it that way, or did you have to seek out being in those populations when you were doing continuity clinic?

Brittany: It was pretty intentional with our program. So we work at the Redwood Clinic, which has a really big new American population. I'm the PCP for a whole family when they come in, so it's kind of amazing to be that person for them. And then our other clinic is in the West Valley, which is kind of a more Hispanic population. So I feel like we get a really good mix in clinic at least too.

Lilly: When I was interviewing, some programs really had that built in, and then others didn't. So I love that your program focuses on that as an integral part. For neuro at least, I'm actually working on getting a resident continuity clinic at Redwoods. So maybe I'll see you there.

Brittany: Yes, you should. Oh my gosh.

Lilly: We just hired another attending. It's just a staffing thing, but we just hired another attending who could precept me. So I'm hoping in the next few months I'll be able to start actually seeing patients there. I'm so excited because I've done other projects with Redwood, and I love their patient population. I love all the refugees they serve. I was like, "I need to have this exposure in residency."

Right now, we primarily rotate at the main hospital and the VA. And I do feel like a lot of people who come to the main hospital have really good insurance, have really good access, for the most part can afford a lot of their medications. And then at the VA, they have government privileges to be able to get access to medications and things like that. So I feel like I'm not getting that whole real-world experience of people in my community.

But I do think long-term, especially as our communities get older and sicker and have more disease, it's so important that we have that representation of ourselves in medicine.

I know for a fact, just from firsthand experience, how much it impacts a patient when they have one person on their team that they can resonate with. It doesn't matter if you've never met this person. Immediately, they will latch on to you because they know that you understand them on a deeper level than a Western provider could, even if it's the aide or the tech that's rolling you to the OR.

I distinctly remember my mom had an Iranian aide that was taking her to surgery, and they started speaking in Farsi, and you could just see my mom's eyes light up when that happened.

You just need one person that you know is in your corner and looking out for you regardless of what position they're in. But it's even more powerful when it's the doctor because we never see our community in those positions.

We're always asking patients to buy into our treatments, to buy into the care that we provide them with, and we talk about all these different things we can do in medicine, but you always need the patient's investment and buy-in into that care for it to really work.

Brittany: No, I agree. I think that's super big, just kind of meeting people where they're at, especially with . . . And this kind of ties into generational trauma of mistrust of the healthcare system as well.

You touched on some of these topics, but the forced removal of the Indigenous people from their communities to boarding schools. There's also been history of sterilization of Native women without their knowledge, and then kind of just a lot of mistrust of the government but also healthcare. And so I think meeting people where they're at and respecting their cultural wishes is super helpful, and I think helps bridge that kind of mistrust as well.

And then a lot of people, a lot of Navajos, also believe in the traditional beliefs. So in addition to Western medicine, we have our medicine men who can do prayers for us, do herbal supplements, smoking, things like that. That can be in addition, which I think also kind of helps not them physically, but I think also spiritually and mentally.

We have this teaching in Navajo. I think probably the biggest thing we talk about is hózhó, and it really means balance physically, balance mentally, and also spiritually. So if you're sick physically, you're not in hózhó, and that means all parts of your body and spirit and mental health are not in sync. And so hitting all those avenues and kind of reaching out to the medicine people is a way that a lot of Navajos help get back into what we call hózhó.

Lilly: That is really beautiful. And I feel like that's the way we should be practicing medicine, because you have all these subspecialties that focus only on their part of the body. And neurologists, we're so guilty of this. All we care about is the brain. The heart pumps to feed the brain. The lungs breathe to help feed the brain. All we care about is the brain. And the same thing happens when you talk to a cardiologist, to a pulmonologist. That's their priority. Kidney doctors, they just care about how the kidneys are doing.

It's so hard for us to all be specialists in all these different organs because they're so complex. But sometimes, it becomes almost ridiculous because we're all almost fighting one organ over the other. "Which organ are we prioritizing? Because if we do this procedure to intervene on the brain, it could put their heart at risk, and all these other things." And sometimes we don't take a step back to look at the full big picture.

Especially I think in Western medicine, which obviously I practice and I believe in, but I really feel like sometimes we push for so many interventions that really are not indicated or, long-term, are going to really help improve outcomes.

We place so many stents, so many bypasses, we do so many invasive procedures, and I almost wonder if it's just so that we can do that and say we gave that patient a chance versus how much it actually improves their outcomes, versus how much does it cause long-term consequences, bleeding risks, rehab, inpatient admissions, and impossible infections from foreign bodies.

There are so many things that we do that sometimes don't make a lot of sense, but we do it anyway. And sometimes we even will push patients to do this. I see this with other specialties too. They really want you to get the surgery whether or not you really need it.

And it just makes me think that if we were to take a step back and think of the whole body and the person as one full system that communicates amongst all of its organs and amongst the mind and the body, maybe we wouldn't be quite as invasive as we are sometimes.

Brittany: I feel really blessed to be Navajo, to kind of grow up with really those strong beliefs of always being in hózhó. My mom will still check in on me. That was my grandma's biggest fear of me going into medicine. She actually was not the most thrilled, honestly, for me to go into medicine.

Lilly: So funny.

Brittany: She's my biggest inspiration, but was also kind of a little hesitant. She was born in the early 1930s. She had just passed last year, almost a year now. So she's seen so many things in her lifetime. A lot of the people she grew up with were actually taken to boarding schools and never returned home. So my great-grandmother actually hid her from people who would go around and pick up Navajo children on the reservation. So she had a lot of mistrust.

But I think one of the biggest things is going through anatomy and kind of speaking about death and all of that being taboo, being around deceased bodies was also even worse. She could not fathom that I had to do anatomy dissection, and she was very worried about that because she was worried the spirit of the donor we had would latch on to you and cause really bad sickness.

And so she was checking in on me that whole semester when I had to do anatomy, and we did a whole blessing ceremony to break any kind of ties with that as well.

And with her and I being super close, she was super sad that I had to leave for school. So that was her biggest hesitation, and I think she was also just not the most trusting of the world, which I totally can respect her perspective just based on what she's seen in her life.

Lilly: Yeah, I don't trust the world. I agree with her. I mean, especially in today's society, I don't trust the world at all.

I want to first acknowledge your grandma, and I'm so sorry that she passed away. I know that she's immensely proud of you and all the care that you're providing to your community. And although she probably was not the most excited about you going to this field, she probably sees the huge ripple effect and impact you're going to have on so many patients. I just want to acknowledge that, first of all.

But it's so interesting just how overlapping culture can be, because my family also was so terrified of cadaver lab. And we also believe when someone passes away, as you're doing burial or things like that, once the dirt has hit their body and things like that and they're being buried, you're not supposed to touch the dirt. You're not supposed to touch it with your hands, because exactly what you were saying, sickness can attach to you, and then you could end up being very sick.

And it's not this contagion-type thing, like, "Oh, their body is releasing some type of contagion." It's just literally because the body has passed and there's sickness there.

These are all things I've kind of learned as I've gotten older and going through cadaver lab. I was also an anatomy TA in college, so we would teach people cadaver lab as well. And my family just could not wrap their head around the fact that I was in a basement of a building displaying someone's foot or someone's arm or parts of their brain and teaching people about this.

They thought it was so taboo and just wild. And I was like, "Well, if only you knew how this all started was grave robbing bodies to do cadavers on." It's pretty wild, and we have a really interesting history and all of that.

So I can only imagine the joy in your patients' eyes when they get to meet you as an attending and you tell them that you're going to be caring for them. I think that's so . . . it just gives me chills, and it makes me so excited for your career.

Brittany: I know. Honestly, it's such a privilege. And every time I have a Navajo or even an Indigenous patient on my service, it fills me with so much joy just knowing that I could be their doctor.

We have something in Navajo culture called our clanships. So you are given four clans. Your first one is from your mom, your second one is from your dad, and then the last remaining two are from your grandparents on both sides. And so I will ask, "What are your clans?" And even if it's somebody I've never met before, if we have the same clans, we're related. So that's just a way we can develop kinships on top of it.

I've definitely had some patients that we're technically sisters. And so you kind of address them as older sister or younger sister. It's really special and definitely a big privilege and also kind of a lot of responsibility that I'll be stepping into, but I'm excited.

Lilly: I think that just makes it even more meaningful that they will listen to you, because they know that you're their family.

I've always hated this concept that we learn early on in college and before we even get to med school, where it's like, "Well, as a doctor, you should never treat patients like your family or say you're going to treat them like they're family." I never understood that concept, and I am heavily opposed to it. Why wouldn't you want your doctor to treat you like the people they love the most in the world? That means that they're going to look out for you, they're going to want what's best for you, they're invested in how you do.

If I had someone who didn't care and was like, "You're just another number. You're just another appointment at 5:00 p.m., 30 minutes before I get to go home," to me, I'm not going to feel like you care very much about what happens to me or my healthcare outcomes at all.

I think it's important to acknowledge . . . and we do this in neurology when we have certain conversations. Some of our attendings will say, "If this was my loved one, this is what I would recommend to them."

And some people think that's taboo to say or inappropriate, but I don't think so. I think that that furthers the impact of why you're giving them this recommendation. Not only is it backed by evidence and research and things like that, but also when you've weighed the risks and the benefits, this is what you think will benefit them the most. I think that's just a really special connection to have with patients.

Brittany: Totally agree with you. I also practice, "If this was my family member, this is the best care I would want to give somebody." And I think that, for me, just makes the most sense with my own cultural beliefs, but also my own personal beliefs as well.

And I think it kind of ties into treating the whole person as well, not just the medical part, but meeting them as a human and respecting them. And so I totally agree with you with that.

Lilly: Before we kind of wrap up, was there anything else that you wanted to specifically hit on or talk about that we haven't yet?

Brittany: I really wanted to make sure that the conversations around death and how taboo that is, I think that's bread and butter for internal medicine. We ask for . . . I'm sure you remember your intern year . . . code status. Every single patient who comes into the hospital should have a code status discussion, and just navigating that and recognizing that for some, not just Indigenous communities, that can be a really taboo topic for people to kind of talk about. There's just a lot of generational trauma, unfortunately, that has occurred and unfortunately is still occurring now.

There's the missing and murdered Indigenous women epidemic, if I can call it that, where Native women have a 10 to 15 times risk of being either killed or sexually assaulted than the general population.

So I think there are a lot of things that unfortunately have disparities in the Native communities and kind of just recognizing that. And when you have a patient coming in who you feel like is shut down or not speaking with you, I think it's just. . . there's a lot of context behind that as well.

Lilly: One hundred percent. I totally agree. I think although we practice in Western hospitals, that doesn't mean that that's the only type of medicine that we're supposed to be practicing. And if you truly care about patients and patient outcomes, you need to treat them holistically. That includes having cultural humility and acknowledging where they're from, how that impacts their care, what communities they're a part of, how you can integrate their practices into their care.

I think that for me not being Indigenous, it's just a constant learning and I think just absorbing as much as I can from my friends and my mentors, like you, and then also, most importantly, from patients.

I remember in college I read a book called "When the Spirit Catches You and You Fall Down," and it was such a good book about epilepsy in an Indigenous family. It really talks through the cultural differences and also negative outcomes that can happen when you don't try and bridge those gaps and create those connections of understanding as to why we do the things we do and also how we can understand the perspectives of those communities in the care that we provide.

And ultimately, when you read that book, it's hard to pinpoint blame on anyone because you just see a total disruption of care on all sides, and that really fails the patient in the story.

But it was something that taught me a lot about how important it is that we build these bridges. You can talk at patients all you want, but if you haven't built that trust and rapport with them, you're not going to get the outcome that you hope to have.

In medicine, we're always, always, always constant, chronic lifelong learners. In every field of medicine, I think. And that's really important. That's something I will take away from this conversation, and I hope anyone listening does as well.

Brittany: I totally agree. And I think just be curious and ask if you're not sure, honestly. These are just Navajo beliefs. Each tribe has their own . . . number one, they're their own communities. They have their own self-governing bodies, and so they have their own beliefs too. So I wouldn't take all of this as kind of a blanket term for Indigenous people, but definitely for Navajo, this is the general beliefs.

And I would say if you just come in with curiosity, saying, "I want to make sure I'm providing the best care for you. Are there any cultural beliefs or things that I should be aware of in treating you not just for your physical ailments, but also spiritually and mentally as well?" I think Indigenous people kind of lean on that as well and take everything holistically.

Lilly: Exactly. And whenever we have patients in the hospital, we always have that option of spiritual cares. But obviously, that's limited to a lot predominant religions or something that we have in that city or that state. It can always be broadened. Sometimes patients have their own communities that they want to bring into the hospital, and that should always be something that we investigate a little bit more to see if that's something we can make happen for them.

But this conversation made me really happy, Brittany. I'm so glad that you were able to come on and chat about this a little bit more. I think practicing medicine in Utah, seeing these patients, seeing negative outcomes, and then also sometimes positive outcomes really showed me that there's a lot to learn, there's a lot to do, and we always want to be better providers.

Having these kinds of conversations, I think, opens up that curiosity for people to learn more, read more, and not be so scared to have those interactions or to talk about these things.

Sometimes people want to just ignore that part of the patient and just focus on the illness, but everything is so intertwined that you really need to acknowledge all pieces of a patient when you're caring for them, especially when there's valid distrust with the healthcare system. That's so important.

And as someone who's experienced that break of trust with medicine through my own familial interactions with medicine, I totally acknowledge why patients don't want to see us or be cared for by us. We don't build those bridges initially, and we have to work really hard to rebuild that.

I'm so excited for you when you're able to go back home and practice in your community. That's something I have a dream for as well, is to be able to work with refugees and immigrants and serve the communities that uplifted us and got us here. So I'm so excited to see you already putting that into practice.

But that all being said, I want to thank you again for taking time to spend and chat with us here on "Bundles."

And for everyone at home that's listening, I want to thank you all every week for joining us and listening to these episodes. It makes me so happy whenever I get to see you all in person and talk about episodes and share our thoughts and feelings and have this outlook for these conversations. I hope you all are doing well in the world and safe wherever you are.

Feel free to comment on this podcast, join us on Instagram, our website. Listen to our episodes on Spotify and Apple Spotify. What is it called? Apple Podcasts, wherever you podcast. We will see you and hear from you soon. Bye, guys.