Rio Bravo qWeek

qWeek is the official podcast of the Rio Bravo Family Medicine Residency Program. Residents and faculty routinely present key topics and relevant discussions, coupled with medical jokes and Spanish medical terminology.

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  Rio Bravo qWeek

  Episode 228: Our Personal Generator, Heart Failure (Pidgin English)

  Aug 14, 202616 minS1

  Interview: Dr. Ozoemena: Welcome back to our community health podcast, where we discuss important health topics in ways everybody can understand. Today we will be talking about Heart Failure. Many people have heard this term before, but it often causes fear and confusion. Here to talk about this important topic is Dr. Ken Nweke, a resident at our program, and he will be discussing this topic in Pidgin English so that some people in our community can understand it. Dr. Nweke, welcome to the program. Dr. Nweke: Thank you very much. I happy make we discuss dis very important mata today. Dr. Ozoemena: Let's start with the basics. What exactly is heart failure? Dr. Nweke: First make we understand one thing. The heart na our generator. Just like generator dey provide light for house, the heart dey pump blood carry oxygen and nutrients go every part of the body. Every organ for body depend on the heart to survive. When person get heart failure, e no mean say the heart don stop work. E mean say the heart no dey pump enough blood and oxygen reach the body the as e suppose. The generator still dey run, but e no get enough power again. That struggle fit make different parts of the body begin show signs say wahala dey. Dr. Ozoemena: What are some of the common causes of heart failure? Dr. Nweke: Many things fit cause heart failure. One common cause na high blood pressure wey person don get for long time. If blood pressure high for many years, the heart go dey work harder pass normal every day. After some time, the heart fit begin weak. Heart attack fit also damage the heart muscle. When blood no reach part of the heart muscle, dat part fit damage and the heart no go pump blood well again. Sugar disease wey oyibo dey call diabetes also fit cause am Kidney disease fit contribute too. Some people get heart valve problems. Some oda people fit get heart problems from when dem born dem. People wey dey drink alcohol like water or people wey dey smoke fit develop am. Certain yama yama disease or infections fit affect the heart muscle. And for some families, heart problems fit run from generation to generation. Dr. Ozoemena: What symptoms should people watch out for? Dr. Nweke: One big sign na shortness of breath. At first, person fit notice am when e dey walk fast, climb stairs, or do heavy work. As the condition worsen, breathing fit become difficult even when person just dey rest. Some people go wake up for night because dem no fit breathe well. Some people go need plenty pillows before dem fit sleep well. Leg, ankle and foot fit swell. Water fit gather for body. Some people go notice say dem gain weight because water don full for body. Person fit tire easily. Things wey dem fit do before without problem fit become difficult. Some people fit get cough wey no gree go. Others fit notice swelling for belle because fluid don gather. Heart fit dey beat fast or anyhow. Dr. Ozoemena: When should someone seek medical attention? Dr. Nweke: If person dey notice shortness of breath wey no dey improve, swelling for leg, tiredness wey no dey normal, cough wey no gree stop, or weight gain wey sudden, e dey very important make e go see doctor. If person suddenly no fit breathe, get serious chest pain, faint, or collapse, dat one fit be emergency. Make dem go hospital immediately. Dr. Ozoemena: How do doctors find out if someone has heart failure? Dr. Nweke: Doctor go first ask plenty questions make dem sabi wetin b d kasala - doctors dey call history taking. Doctor go examine the patient. Dem go check blood pressure. Dem fit listen to the heart and lungs with stethoscope. Dem fit check for swelling for leg and foot. Blood tests fit help. Some blood tests fit show whether the heart dey under stress. Chest X-ray fit show whether fluid don gather for the lungs. EKG fit help weda electricals for d heart dey ok. One very important test na echocardiogram. Na ultrasound of the heart. E fit show say d heart don weak as e dey pump blood. e dey also check weda d heart valves dey ok. Heart valves na small small doors wey dey for heart wey dey open or close as the heart dey pump. Sometimes doctor fit request other tests depending on the situation. Dr. Ozoemena: Can heart failure be treated? Dr. Nweke: Yes or Better treatment dey. Although some cases no fit cure completely, treatment fit help people make dem live longer and feel better. We get medicines wey fit help the heart work better. Some medicines help remove extra water from the body. Some medicines help reduce the work wey the heart dey do. Others fit help protect the heart make e no weak For some people, doctor fit recommend special devices or surgery depending on the cause. But medicine no be the only thing. Lifestyle changes important too. Dr. Ozoemena: What lifestyle changes can help? Dr. Nweke: Person wey get heart failure suppose reduce salt for food. Too much salt fit make water gather for body. Dem suppose take medicines exactly the way doctor prescribe. Regular exercise fit help if doctor say e safe. Make dem avoid smoking. Too much alcohol no good. Try maintain healthy body weight. And make person keep all clinic appointments so doctor fit monitor the condition. Dr. Ozoemena: Can heart failure be prevented? Dr. Nweke: For many people, yes. make we control high blood pressure - taking medication, go see your doctor regularly Control sugar disease/diabetes. Make we try dey exercise regularly. Make we dey eat healthy food. Reduce salt for food. Avoid smoking. Avoid too much alcohol. Keep healthy weight. And go for regular medical checkup. Many times, if we control these risk factors early, we fit reduce the chance of developing heart failure. Dr. Ozoemena: Before we close, what would you like everyone listening to remember? Dr. Nweke: Remember say heart failure no mean say the heart don stop work. The heart still dey work, but e dey struggle. Think of am like generator wey still dey run but im light weak, e no dey carry wetin e dey carry before. If you notice shortness of breath, swelling for leg, unusual tiredness, cough wey no gree go, or sudden weight gain, make you go see doctor. No wait until the condition become serious. Dr. Ozoemena: Thank you, Dr. Nweke. And thank you to everyone listening today. Remember, heart na our generator. Take care of am. Until next time, stay healthy and stay informed Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________ References: Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/ . Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! 

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  Episode 227: Understanding DVT (Pidgin English)

  Aug 7, 202621 minS1

  Interview: Dr. Ozoemena: Welcome to today’s podcast where we will be discussing an important health topic in a way that's easy to understand. I'm your host, Dr. Ozoemena. Today we're talking about Deep Vein Thrombosis, or DVT, a condition that affects thousands of people each year and can sometimes lead to serious complications if not recognized early. Joining us today is Dr. Okojie, a 3rd year Family Medicine Resident Physician. Thank you for being here today, Doctor. Dr. Okojie: Thank you for having me. I'm excited to discuss this important topic. What is DVT? Dr. Ozoemena: Let's start with the basics. What exactly is Deep Vein Thrombosis? Dr. Okojie: Deep Vein Thrombosis, or DVT, occurs when a blood clot forms in one of the deep veins of the body, most commonly in the legs. Normally, blood flows smoothly through our veins, but sometimes a clot can develop and block that flow. The biggest concern is that part of the clot can break off and travel to the lungs. This is called pulmonary embolism, which can be a medical emergency. Why Should People Know About DVT? Dr. Ozoemena: Why is it important for the public to be aware of DVT? Dr. Okojie: DVT is more common than many people realize. The symptoms can sometimes be mild or mistaken for other conditions. Early recognition is important because prompt treatment can prevent serious complications and improve outcomes. Many cases are preventable, especially when people understand the risk factors. Who Is at Risk? Dr. Ozoemena: Who is more likely to develop blood clots? Dr. Okojie: Several factors can increase the risk of DVT. These include: {Discuss Virchow triad: VEH - Venous stasis, Endothelial injury and Hypercoagulability} Being inactive for long periods, such as during long flights or car rides Recent surgery or hospitalization Cancer Pregnancy and the weeks after childbirth Smoking Obesity A History of clotting disorders It's important to remember that having a risk factor doesn't mean someone will definitely develop a clot, but it does increase the chances. What Are the Symptoms? Dr. Ozoemena: What symptoms should people watch for? Dr. Okojie: The most common symptoms occur in one leg and may include: Swelling Pain or tenderness Warmth in the affected area Redness or discoloration of the skin Some people describe the pain as a cramp that doesn't go away. When Does It Become an Emergency? Dr. Ozoemena: You mentioned that a clot can travel to the lungs. What warning signs should prompt someone to seek emergency care? Dr. Okojie: That's a very important question. People should seek immediate medical attention if they experience: Sudden shortness of breath Chest pain, especially when taking a deep breath Rapid heartbeat Dizziness or fainting Coughing up blood These symptoms could indicate a pulmonary embolism, which requires urgent treatment. How Is DVT Diagnosed? Dr. Ozoemena: If someone visits their doctor with symptoms, how is DVT diagnosed? Dr. Okojie: The healthcare provider will first ask about symptoms and medical history. The most common test is the ultrasound of the leg. It's painless, noninvasive, and allows us to see whether blood flow is blocked by a clot. Sometimes a blood test called a D-dimer is also used to help determine whether further testing is needed. How Is DVT Treated? Dr. Ozoemena: Once a clot is diagnosed, what treatment options are available? Dr. Okojie: The primary treatment is medication known as anticoagulants for those with contraindications to anticoagulants, IVC filter is recommended These medications help prevent the clot from growing larger and reduce the risk of new clots forming. Treatment usually continues for at least several months, although the exact duration depends on the individual's situation and risk factors. Most patients do very well when treatment starts promptly. Can DVT Be Prevented? Dr. Ozoemena: That's encouraging. What can people do to reduce their risks? Dr. Okojie: There are several practical steps: Stay physically active Take walking breaks during long trips Stay well hydrated Maintain a healthy weight Avoid smoking Follow your healthcare provider's recommendations after surgery or hospitalization Common Misconceptions Dr. Ozoemena: Are there any common myths about DVT that you'd like to address? Dr. Okojie: One common misconception is that blood clots only affect older adults. While risk increases with age, DVT can occur in younger adults as well, especially if they have risk factors such as recent surgery, pregnancy, certain medications, or inherited clotting disorders. Another misconception is that leg swelling is always harmless. Persistent swelling, especially in one leg, should be evaluated by a healthcare professional. Key Take-Home Messages Dr. Ozoemena: Before we wrap up, what are the most important messages you'd like listeners to remember? Dr. Okojie: I'd emphasize three key points: First, know the symptoms—swelling, pain, warmth, and redness in one leg. Second, understand your personal risk factors, especially after surgery, hospitalization, long travel, or during pregnancy. And third, seek medical attention promptly if you have symptoms of DVT or signs of pulmonary embolism, such as sudden shortness of breath or chest pain. Early diagnosis and treatment can save lives. Dr. Okojie: Thank you for having me. I hope today's discussion helps listeners better understand DVT and recognize when to seek medical care. Dr. Ozoemena: And thank you to our listeners for joining us today. Remember, this podcast is intended for educational purposes and should not replace advice from your healthcare provider. Until next time, stay informed, stay healthy, and take care. This is Rio Bravo qWeek… signing off! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org , or visit our website riobravofmrp.org/qweek. See you next week! References: American Academy of Family Physicians. Venous Thromboembolism: Diagnosis and Management. UpToDate. Overview of the Treatment of Lower Extremity Deep Vein Thrombosis (DVT). Updated September 2025. American College of Chest Physicians. Antithrombotic Therapy for VTE Disease. American Society of Hematology. Guidelines for Management of Venous Thromboembolism. Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/ . Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! 

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  Rio Bravo qWeek

  Episode 226: Optimizing Sleep

  Jun 12, 202625 minS1

  Introduction Dr. Arreaza: Hello, everyone, today we continue with our series about sleep. I invite you to listen to Moira Wilson on Episodes 220 and 221 about the approach of insomnia and CBT-I in adults. Today we will discuss not only what to do, but also why it works. We frequently hear advice like ‘get more sleep,’ but we need to dig deeper into the physiology behind it. So, Dr. Kim and Dr. Carlisle are here to briefly explain the physiology of sleep and what we can do to support better sleep. But before we start, let’s welcome Dr. Carlisle, who recently matched to our program. He will start his residency soon, and Dr. Kim, who will soon become a PGY2, welcome doctors. Dr. Carlisle: [Introduce yourself]. Dr. Kim: [Introduce yourself]. Dr. Arreaza: Let’s start simple. Why does sleep matter clinically? Why Sleep Matters Dr. Kim: Sleep is one of the most important biological processes we have. It’s not passive; it’s highly active and tightly regulated. It affects cognition, metabolism, immune function, cardiovascular health, and hormonal balance. When sleep is disrupted, you see downstream effects in almost every organ system. Dr. Carlisle: Yeah, and one thing I always emphasize is that sleep deprivation isn’t just about feeling tired. It actually puts you in a physiologic state that’s very similar to being intoxicated. There are studies showing that being awake for about 24 hours can impair cognitive performance to a level comparable to being above the legal driving limit for alcohol. Dr. Arreaza: That’s actually kind of scary when you think about it. Dr. Carlisle: It really is. Another way to think about it is sleep deprivation doesn’t just make you slower; it actually changes how you make decisions. People become more impulsive and less risky. And in medicine, we see that translates into increased medical errors, decreased attention, and poor decision-making. So, from a clinical standpoint, sleep isn’t optional; it’s foundational. Dr. Kim: Delay caffeine (but not too late), avoid alcohol, and focus on behavioral strategies (put away your phone 1 hour before bedtime). Dr. Carlisle: And sleep is the foundation of performance. If sleep is off, everything else is compensating. Dr. Kim: And even beyond cognition, even one night of poor sleep can impair immune function and shift hormones that regulate hunger, which is why people tend to crave more food when they’re sleep deprived. Dr. Arreaza: I think it’s wise to dispel the myth of the “Russian Sleep Experiment”, have you heard about it? Dr. Carlile-Dr Kim: [reaction] Dr. Arreaza: The “Russian Sleep Experiment” is an internet horror story claiming Soviet scientists kept prisoners awake for several weeks using a gas. They developed extreme paranoia, violence, and self-mutilation. Then, the experiment got out of control, the subjects became unrecognizable, they refused to sleep, continued to deteriorate, and went insane. Even though the story went viral in 2010, it is fictional (reaction), with no real evidence that it really happened. So, it is just a made-up horror story. But there are some real studies about sleep deprivation in humans. Dr Kim: Yes, the most famous case was Randy Gardner (1964) who stayed awake for 11 days. He developed hallucinations, memory problems, and mood changes. He recovered after sleep (no permanent “madness”). Dr. Carlisle: Sure, but as I mentioned before, even one night without sleep significantly reduces performance and accuracy. Dr. Kim: Another myth we fall into is “catching up on sleep”. It is a myth! Sleep Architecture Dr. Arreaza: Sleeping is a state when you reset your brain and your energy, but what actually happens during sleep? Dr. Carlisle: Sleep cycles between non-REM and REM stages. Non-REM sleep, especially deep, slow-wave sleep, is where physical restoration happens. That’s when you get growth hormone release, tissue repair, and metabolic recovery. Dr. Kim: And one of the most fascinating things is what happens in the brain during that deep sleep. The space between brain cells actually expands, which allows cerebrospinal fluid to circulate and clear out metabolic waste. Dr. Carlisle: That’s the glymphatic system. And what’s interesting is that this clearance is most active during deep sleep (Stage 3, Delta waves). It clears neurotoxins like beta amyloid, which is one reason chronic sleep deprivation is linked to neurodegenerative diseases, such as Alzheimer’s disease. Dr. Arreaza: So, your brain is basically cleaning itself while you sleep. The “glymphatic system” is relatively new. It was described in 2010, and it clears substances like beta-amyloid, which is linked to Alzheimer’s disease. Dr. Carlisle: Exactly. Then REM sleep is more focused on brain function. That’s where memory consolidation, emotional processing, and learning really happen. Dr. Kim: And REM sleep tends to occur more in the second half of the night. So, when people cut their sleep short, they lose a lot of that REM sleep, which affects mood, focus, and overall cognitive function. What Drives Sleep Dr. Arreaza: So, what actually makes us feel sleepy? Dr. Kim: There are two main processes. The first is the homeostatic drive, where adenosine builds up in the brain the longer you’re awake, creating sleep pressure. Dr. Carlisle: And the second is your circadian rhythm, which is controlled by your brain’s internal clock and influenced mainly by light exposure. Dr. Arreaza: So, in summary, one process depends on how long you’ve been awake, and the other process depends on your body’s own timing. Dr. Carlisle: Exactly. I think of it as pressure and timing. Adenosine builds pressure, and your circadian rhythm determines when that pressure gets released. Dr. Kim: And when those two systems are aligned, sleep happens naturally. When they’re out of sync, that’s when people start having issues. Morning Routine Dr. Arreaza: Let’s talk about practical tips. The morning seems to be a key element in our sleep. What can we do in the mornings to help us sleep at night? Dr. Carlisle: Morning sunlight, without a doubt. Getting light exposure within the first 30 to 60 minutes of waking helps anchor your circadian rhythm. Dr. Kim: And outdoor light is much stronger than indoor light, even on cloudy days. Dr. Carlisle: The mechanism is that light activates specialized retinal cells that signal your brain’s clock. That sets the timing for cortisol release in the morning and melatonin release later at night. Dr. Kim: And it also increases dopamine early in the day, which helps with mood, motivation, and focus. Dr. Carlisle: So, you’re not just waking up; you’re setting up your entire day’s physiology. Caffeine and Hydration Dr. Arreaza: Light exposure; I like the idea. That’s why phototherapy works for any kind of depression, not only seasonal depression. What other suggestions can you give us about our morning routine? Dr. Carlisle: Hydration first thing in the morning helps restore plasma volume and improve alertness since we’re mildly dehydrated overnight. Dr. Kim: It is also a good idea to add electrolytes to the water. And caffeine timing is huge. If you drink it right when you wake up, you’re interfering with your natural adenosine cycle. Dr. Carlisle: Exactly. Caffeine blocks adenosine receptors, but it doesn’t remove adenosine. So later in the day, when caffeine wears off, all that built-up adenosine hits at once, and that’s what causes the crash. And that’s why some people feel wired but still tired because the underlying sleep pressure is still there, just being masked by the caffeine. Dr. Arreaza: So, what should people do instead? (I say people because I personally don’t drink coffee, and occasionally I drink caffeine) Dr. Kim: People should wait about 60 to 90 minutes before having caffeine. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________ References: 1. Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med 2000;57(10):649-655. 2. Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373-377. 3. Walker MP. Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner; 2017. 4. McMorris T, Harris RC, Swain J, et al. Effect of creatine supplementation and sleep deprivation on cognitive performance. J Sports Sci. 2006;24(3):305-313. 5. Turner CE, Byblow WD, Gant N. Creatine supplementation enhances corticomotor excitability and cognitive performance during sleep deprivation. J Sleep Res. 2015;24(3):307-315. 6. Gordji-Nejad A, Matusch A, et al. Creatine supplementation and brain energy metabolism during sleep deprivation. Sci Rep. 2024;14:54249. 7. Wienecke E, Nolden C, et al. Magnesium and sleep quality: systematic review. *Med Res Arch.2021. 8. Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/ . Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! 

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  Rio Bravo qWeek

  Episode 225: Why Your ZIP Code Can Determine Your Health

  May 29, 202618 minS1

  Dr. Arreaza : Hello, everyone, my name is Dr. Hector Arreaza, I am a family physician and an associate program director in the Clinica Sierra Vista – Rio Bravo Family Medicine Residency Program. Today we’re discussing one of the most powerful predictors of health that many people rarely think about: geography. Where someone lives can influence everything from access to physicians and emergency care to chronic disease outcomes and life expectancy. Joining us today is Peyton, who will be taking a deeper look into the matter. Peyton, thank you for being here — can you start by introducing yourself, please? Peyton: Hello, thank you for having me. My name is Peyton, I am a 4th year medical student with Western Atlantic University, and I am from a very small town in South Dakota. Dr. Arreaza : Peyton, you are on your last few days in your FM rotation, when are you graduation? Peyton, you prepared this topic and it is great. When people hear the phrase “ your ZIP code can determine your health ,” what does that actually mean? Peyton: It basically means that where someone lives can significantly influence their health outcomes and even life expectancy. A person’s ZIP code can affect access to physicians, hospitals, transportation, emergency services, and preventative care. Arreaza: Talking about prevention. The American Heart Association agrees with you because Zip code is not part of the cardiovascular risk calculator called PREVENT. I invite everyone to take a look at this new calculator. I think a lot of people assume healthcare is equal as long as hospitals or clinics exist nearby, right? Peyton: Yes, patients may still struggle with overcrowded healthcare systems, which can lead to long wait times. In fact, a national physician appointment survey found that average wait times for new patient primary care appointments in major cities can exceed three weeks, with some cities reporting significantly longer delays depending on specialty access and provider availability. Dr. Arreaza : And when patients experience those kinds of delays, they may frequently switch between providers, which becomes much harder to establish consistent long-term care. Peyton: One of the biggest issues many patients face is continuity of care — having consistent follow-up with the same provider over time. Dr. Arreaza : And that continuity really matters in medicine, especially family medicine, it is one of our keywords: continuity of care. Peyton: Exactly. Preventative care and chronic disease management work best when patients have long-term relationships with healthcare providers. But in many underserved communities, patients may wait months for appointments, frequently change providers, or rely on emergency rooms instead of primary care clinics. Dr. Arreaza : And urgent care too. When care becomes fragmented, conditions like hypertension, diabetes, and chronic illnesses can become much harder to manage. Peyton : Exactly. Delayed screenings, missed follow-up appointments, and lack of preventative care often lead to patients presenting later with more advanced disease that could have been treated earlier. Dr. Arreaza : And urban communities may face some of the same challenges, but rural communities are at a different level of barriers to health care. Peyton: Absolutely. Rural communities often experience significant physician shortages. According to the Health Resources and Services Administration, over 100 million Americans live in primary care shortage areas, and nearly 65% of those shortage areas are located in rural regions. Peyton : I think one of the biggest solutions starts with strengthening primary care and investing more heavily in underserved communities, especially rural areas. Dr. Arreaza : And that includes increasing the number of physicians going into family medicine and primary care specialties. Peyton: Here is an interesting fact: According to the Graham Center, Northeastern states receive high graduate medical education (GME) funding but produce relatively fewer primary care physicians. Northwestern states receive low GME funding but perform relatively better, producing slightly above the U.S. average (70.8 vs 69.8 primary care physicians per 100,000 people). However, even this remains far below Canada’s average of 119 primary care physicians per 100,000 people. Right now, the United States is facing a growing physician shortage. According to the Association of American Medical Colleges, the country could face a shortage of up to 86,000 physicians by 2036, with primary care being one of the most affected areas. Arreaza: Another group that may help address the physician shortage is International Medical Graduates. We’ll cover this in more detail in a future episode, but it’s worth mentioning briefly here. We have highly trained physicians, including neurosurgeons, driving Uber. There is nothing wrong with that work, but their medical skills could be used to help more people. I’ll leave our listeners with that thought: IMGs can help. So, Peyton, are you interested in rural medicine? Peyton: I am very interested in Rural medicine, in fact my next few rotations will be back in South Dakota on the Pine Ridge Indian Reservation. Actually, the Pine Ridge Reservation is the poorest Indian Reservation in the country. Peyton: The measure of any healthcare system is not how well it serves those closest to its centers of power, but how far its reach extends to those who need it most. If we are serious about health equity, the road forward must run through every small town, every county clinic, and every community that has been told to wait its turn. Their turn is now. References Association of American Medical Colleges (AAMC). The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. https://www.aamc.org/workforce American Academy of Family Physicians (AAFP). Rural Practice and Physician Recruitment. https://www.aafp.org Centers for Disease Control and Prevention (CDC). Rural Americans at Higher Risk of Death from Five Leading Causes. https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html Cecil G. Sheps Center for Health Services Research. Rural Hospital Closures. https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/ Chetty R, Stepner M, Abraham S, et al. The Association Between Income and Life Expectancy in the United States, 2001–2014. JAMA. 2016;315(16):1750–1766. https://jamanetwork.com/journals/jama/fullarticle/2513561 Health Resources & Services Administration (HRSA). Health Professional Shortage Areas (HPSAs). https://data.hrsa.gov/topics/health-workforce/shortage-areas Rural Health Information Hub. Healthcare Access in Rural Communities. https://www.ruralhealthinfo.org/topics/healthcare-access Rural Health Information Hub. Transportation to Support Rural Healthcare. https://www.ruralhealthinfo.org/topics/transportation Rural Health Information Hub. Rural Residency Planning and Development. https://www.ruralhealthinfo.org/topics/rural-residency-programs Centers for Disease Control and Prevention (CDC). Health and Access to Care in Rural America. https://www.cdc.gov/ruralhealth/index.html Measure of America. A Portrait of Los Angeles County 2026 . Social Science Research Council. https://ssrc-static.s3.amazonaws.com/moa/APortraitofLosAngelesCounty2026.pdf Merritt Hawkins. Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates. https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/ Fenster, T. L., MD, Park, J., PhD, Huffstetler, A. N., MD, & Topmiller, M., PhD (2026). Graduate Medical Education Funding Does Not Flow to Primary Care Physician Production. American family physician , 113 (4), 321–322. https://pubmed.ncbi.nlm.nih.gov/42101593/ Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/ . Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! 

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  Episode 224: Community Health Workers

  May 15, 202624 minS1

  Episode 224: Community Health Workers Dr. Arreaza: Today we will discuss a topic that, frankly, every single person listening, whether you're a medical student, a resident, a nurse, a family doctor, or any primary care provider, needs to really understand. We're talking about community health workers (CHWs). We are joined by our stellar medical student; you may be familiar with her voice from previous episodes about insomnia. Moira, welcome, please introduce yourself. Moira: I want to be upfront about why Community Health Workers matter to you specifically. If you've ever felt frustrated that your patient with uncontrolled diabetes keeps missing appointments because they can't get a ride, or that your heart failure patient was readmitted because nobody checked whether they could afford their medications, then you already understand the problem that CHWs are designed to solve. Dr. Arreaza: We're going to give you the definition of a CHW, the evidence behind their effectiveness, how they fit into your care team, the return on investment, and practical steps for integrating them into your practice. We have pulled information from a lot of peer-reviewed sources, and we want to share them with you. So, Moira, let's start with the basics. What exactly is a community health worker? Moira: Great question, and it's one that even literature struggles with, because there are so many titles for this role. Community Health Worker is an umbrella term that encompasses more than 20 different titles including outreach workers, promotores or promotoras de salud , community health representatives, lay health workers, peer educators, patient navigators, and many more. The American Public Health Association defines CHWs as frontline public health workers who are trusted members of or have an unusually close understanding of the communities they serve. Arreaza: And that trust is so important in health care. CHWs are not physicians. They are not nurses. They do not diagnose or prescribe. But they are like a bridge connecting the medical environment, social services, and the community to reduce gaps in healthcare delivery. Moira: Exactly. In the United States, the role was formally recognized in the 2010 Patient Protection and Affordable Care Act , which includes several sections highlighting the key roles CHWs play in achieving important goals of healthcare. ________________ References: Aguerrebere, M., Rodríguez-Cuevas, F. G., Flores, H., Arrieta, J., & Raviola, G. (2019). Providing Mental Health Care in Primary Care Centers in LMICs. Innovations in Global Mental Health , 1–22. https://doi.org/10.1007/978-3-319-70134-9_95-1 Allen, L. N., Rasanathan, K., Mash, R., Uribe, M. V., Martinez-Bianchi, V., & Kidd, M. (2025). Models of Global Primary Care Post-2030. The Lancet Primary Care , 1 (3), 100027. https://doi.org/10.1016/j.lanprc.2025.100027 Babagoli, M. A., Nieto-Martínez, R., González-Rivas, J. P., Sivaramakrishnan, K., & Mechanick, J. I. (2021). Roles for Community Health Workers in Diabetes Prevention and Management in Low- And Middle-Income Countries. Cadernos De Saúde Pública , 37 (10). https://doi.org/10.1590/0102-311x00287120 Balasubramanya, B., Isaac, R., Philip, S., Prashanth, H. R., Abraham, P., Poobalan, A., Thomas, N., Jeyaseelan, L., Mammen, J., Devarasetty, P., & John, O. (2020). Task Shifting to Frontline Community Health Workers for Improved Diabetes Care in Low-Resource Settings in India: A Phase II Non-Randomized Controlled Clinical Trial. Journal of Global Health Reports , 4 . https://doi.org/10.29392/001c.17609 Battaglia, T. A., Zhang, X., Dwyer, A. J., Rush, C. H., & Paskett, E. D. (2022). Change Agents in the Oncology Workforce: Let’s Be Clear About Community Health Workers and Patient Navigators. Cancer , 128 (S13), 2664–2668. https://doi.org/10.1002/cncr.34194 Das, S., Grant, L., & Fernandes, G. (2023). Task Shifting Healthcare Services in the Post-Covid World: A Scoping Review. PLOS Global Public Health , 3 (12), e0001712. https://doi.org/10.1371/journal.pgph.0001712 Dodd, R., Palagyi, A., Jan, S., Abdel-All, M., Nambiar, D., Madhira, P., Balane, C., Tian, M., Joshi, R., Abimbola, S., & Peiris, D. (2019). Organisation of Primary Health Care Systems in Low- And Middle-Income Countries: Review of Evidence on What Works and Why in the Asia-Pacific Region. BMJ Global Health , 4 (Suppl 8), e001487. https://doi.org/10.1136/bmjgh-2019-001487 Huang, W., Long, H., Li, J., Tao, S., Zheng, P., Tang, S., & Abdullah, A. S. (2018). Delivery of Public Health Services by Community Health Workers (CHWs) in Primary Health Care Settings in China: A Systematic Review (1996–2016). Global Health Research and Policy , 3 (1). https://doi.org/10.1186/s41256-018-0072-0 McCray, G. G., Haynes, B., Proeller, A., Ervin, C., & Williams-Livingston, A. (2020). Making the Case for Community Health Workers in Georgia. Journal of the Georgia Public Health Association , 8 (1). https://doi.org/10.20429/jgpha.2020.080116 Mor, N., Ananth, B., Ambalam, V., Edassery, A., Meher, A., Tiwari, P., Sonawane, V., Mahajani, A., Mathur, K., Parekh, A., & Dharmaraju, R. (2023). Evolution of Community Health Workers: The Fourth Stage. Frontiers in Public Health , 11 . https://doi.org/10.3389/fpubh.2023.1209673 Noel, L., Chen, Q., Petruzzi, L. J., Phillips, F., Garay, R., Valdez, C., Aranda, M. P., & Jones, B. (2022). Interprofessional Collaboration Between Social Workers and Community Health Workers to Address Health and Mental Health in the United States: A Systematised Review. Health &Amp; Social Care in the Community , 30 (6). https://doi.org/10.1111/hsc.14061 None, N. (2022). Walking the Talk: Reimagining Primary Health Care After COVID-19 . https://doi.org/10.1596/978-1-4648-1768-7 Orkin, A. M., McArthur, A., Venugopal, J., Kithulegoda, N., Martiniuk, A., Buchman, D. Z., Kouyoumdjian, F., Rachlis, B., Strike, C., & Upshur, R. (2019). Defining and Measuring Health Equity in Research on Task Shifting in High-Income Countries: A Systematic Review. SSM - Population Health , 7 , 100366. https://doi.org/10.1016/j.ssmph.2019.100366 Pingel, E. S. (2022). Seeing Inside: How Stigma and Recognition Shape Community Health Worker Home Visits in São Paulo, Brazil. Community Health Equity Research &Amp; Policy , 44 (3), 303–313. https://doi.org/10.1177/2752535x221137384 Rifkin, S. B., Fort, M., Patcharanarumol, W., & Tangcharoensathien, V. (2021). Primary Healthcare in the Time of COVID-19: Breaking the Silos of Healthcare Provision. BMJ Global Health , 6 (11), e007721. https://doi.org/10.1136/bmjgh-2021-007721 Rohan, E. A., Townsend, J. S., Bermudez, A. T., Thompson, H. L., Holman, D. M., Reza, A., Tharpe, F. S., & Wennerstrom, A. (2024). Engaging Community Health Workers in Primary Care Practices. Journal of Ambulatory Care Management , 47 (3), 154–167. https://doi.org/10.1097/jac.0000000000000501 Shommu, N. S., Ahmed, S., Rumana, N., Barron, G. R. S., McBrien, K. A., & Turin, T. C. (2016). What Is the Scope of Improving Immigrant and Ethnic Minority Healthcare Using Community Navigators: A Systematic Scoping Review. International Journal for Equity in Health , 15 (1). https://doi.org/10.1186/s12939-016-0298-8 Sisson, N., & Starke, J. (2022). Promotores De Salud in Montana: An Analysis of a Rural Health Care Intervention Rooted in Catholic Social Teaching and Its Place in Medical Curricula. The Linacre Quarterly , 89 (1), 21–35. https://doi.org/10.1177/00243639211059346 The Role and Impact of Female Health Workers on the Well-Being of Global South Communities: A Call for Gender-Transformative Action. (2022). Archives of Women Health and Care , 5 (2). https://doi.org/10.31038/awhc.2022521 Williams-Livingston, A., Henry Akintobi, T., & Banerjee, A. (2020). Community-Based Participatory Research in Action: The Patient-Centered Medical Home and Neighborhood. Journal of Primary Care &Amp; Community Health , 11 . https://doi.org/10.1177/2150132720968456 Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/ . Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! 

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