Featured Blog Posts from Lab Members
Written by Cirila Estela Vasquez Guzman
I was standing in the middle of the Redwood National Forest with gigantic trees, 21-foot-diameter trunks, which have a way of putting everything into perspective. The COVID-19 pandemic was never-ending and so my mom and I decided to drive and meet my brother halfway (who lives in California) to hike the famous Big Tree Loop for some fresh air. As a post-doc during a pandemic, things were not only uncertain in terms of job prospects, things were unpredictable in life in general. Being able to see my brother again was no small matter. Navigating the post-doc journey during COVID-19 was unique for me and it required me to be even more intentional in how I wanted to shape my career. Our country was in the middle of a national pandemic and it forced the world (especially me) to slow down, dig deep, and reflect on my passions, assets, and skills as well as needs. What are my roots?
They tell us to count all of our wins no matter how small, and I have always had trouble with that. You see, I am the girl who showed up to the first day of high school with my four-year plan and told my high school counselor that I will be the first person in my family to make it to college. I did the same thing in college, but during my post-doc years, things became less clear. I had trouble to be honest. All I knew was that the next step was assistant professor, but it was not as clear as getting into graduate school. I started to intentionally plant many seeds.
My transition was rough. I moved to Portland Oregon in late 2019, but within two weeks I got into a pretty bad bike accident that took me out for the rest of the calendar year and now 2020 was not looking good. Our studio apartment was not going to work out for me and my husband, who had already been working from home even pre-pandemic. I quickly realized that the nature of my post-doc in this context required “active me” to engage in cultivating community. As a post-doc, I created a Monday Motivation e-mail thread where I included all kinds of colleagues, mentors, and even friends to help us stay positive. I knew I needed to be kept active on tips and tricks to be productive while maintaining true to myself. I also created a virtual writing group so that writing did not feel so isolating. Writing is also not my strongest skill as an ESL and 1.5 generation student, but I knew I needed community and support in this area. During those uncertain months, I also cultivated a very wide mentoring structure as a result of seeking, signing up for, and completing the Post-Doc Academy Course, the NIH Resiliency Series, and the National Center for Faculty Development and Diversity series. I ended up making many cold e-mails to network and set up multiple one-on-one meetings with colleagues, which led to me becoming part of amazing communities of scholars. The seeds I was planting were blooming and led to many opportunities. Those decisions to reach out and build community are what made a world of a difference and got me to my current position. I started to see myself out of a massive and complex forest.
I have survived a lot. My family has overcome a lot. And even my ancestors have overcome multiple intergenerational traumas. The COVID-19 pandemic made existing inequities worse and was a wake up to the rest of the world of how interconnected our personal and professional lives are. I not only live and breathe in two different worlds, but I body switch often, not just code switch. My brain is not only going in between languages or cultures but my entire body feels that disconnect between who I am at my roots and my professional self. The status quo of the fragmented and dysfunctional healthcare system has not served me nor will it serve the next generation of doctors, nurses, dentists, scientists. I needed to stay grounded in my background. My personal mission in life has always been to transform the face and practice of modern medicine.
As a trained medical sociologist, I have always been the zebra, the one who stood out at post-doc gatherings surrounded by many hard scientists at OHSU. I don’t like to call myself a soft scientist because there is nothing soft about what we do; instead I like to use the term critical scientist. We look at and ask critical questions about the structure of this institution we call medicine, and the social, cultural and political dynamics related to that structure that affect the people who staff and are employed in healthcare as well as the clients and served populations. And as I reflect on my transition from post-doc to assistant professor, I can honestly say that my decision to be active in building community virtually helped this zebra to find a home here. I realized that there are many paths in the academic space and as I talked to a plethora of colleagues through my one-on-ones with them, I started to see the pieces and parts that I would like to have in my dream job as well as in my personal life. These relationships opened up doors of opportunities to me that otherwise would not have occurred. By combining my critical skills with the community of mentors and colleagues I had developed, I was able to successfully secure two grants, become the Community Leadership Director of the RELATE Lab Team, be the first Lead Structural Competency Faculty at the School of Medicine, become a board member of the Northwest Narrative Medicine Collaborative and Enlace Comunitario, as well as expand my writing group! I am currently an Assistant Professor in the Department of Family Medicine.
For me, the road from post-doc to assistant professor did not have a clear map. I had no blueprint to follow, but what was intuitive and felt natural and necessary was to actively cultivate meaningful relationships as well as experiences, and keep showing up as my full authentic self. As a girl many years ago, I walked down the halls of the OHSU Doernbecher’s Children’s Hospital and spent many holidays there as a sick child. It was then when I made a promise to myself to come back to this very hospital and give part of myself and my career to it. I was thrilled when I was able to come back as a post-doc and now I get to stay as an immigrant, indigenous, hike-loving, passionate Latina woman. I flashback to the Big Tree Loop where these gigantic trees have been forever growing long, strong and unwavering roots. It has been one year since my transition to a professor and in this year, I still have so much growth yet to do. We all have complex lives and navigating out of a forest is no small matter. I urge you to plant your seeds actively building community because you never know where growth and opportunities may come from. I am a believer of breaking down our silos and the power of micro-actions. One of my favorite quotes that kept me grounded, “Sometimes when you’re in a dark place, you think you’ve been buried, but you’ve actually been planted. Bloom.” Gracias
How we tell stories with quantitative research
Written by John Heintzman
Human beings tell stories. All of us. Every culture and time tell stories. They may not always look or sound the same; they are different stories. But we all tell them, and it is an enduring and uniting part of our humanity. However, the stories we tell are not just family legends and scary tales told late at night around campfires. We tell them at work, at play, and in everything we do. We, as a society, increasingly tell stories with numbers. The U.S. Census drives certain policies because we believe those numbers tell a certain story about our communities. At the PRIMER lab, we tell stories with numbers too, and we are conscious, more and more, of the power of those stories. That power can help heal or irreparably harm, and it is wise for us (and for all who do what we do), to think how the narratives we write with our science play out. What story are we telling?
In this blog installment, we consider some of the issue in quantitative research – especially health equity research – that drive the stories we tell. Three issues stand out – there are more, and maybe grander issues, but these three loom large when you do what we do.
From whose perspective is the story?
In much of our work, we focus on primary care delivery to Latino patients. We think this is a crucial area of focus. Therefore, our perspective is often from the health system. We do this not because it is the most perspective always, but because the story of community health centers – their clinicians, staff, and yes communities is oft-neglected in studying health equity. However, when we focus there, our research is not from the perspective of the patient – in a first-person-lived-experience manner. That research too is crucial. And numbers don’t tell that story. But the point is that as researchers, we need to own the story we are telling, and the story we are not telling, with the methods we have chosen.
What is the setting of our story?
Setting is a crucial piece of any story. It sets the mood, provides drama, unexpected challenges and victories, and gives meaning to the resolution. This is no less true in health equity research. We study – most frequently – the care delivered in primary care community health centers (CHCs). This setting has certain actors, certain particularities, and certain obstacles. The story we tell here may have different endings outside of this setting. For instance, we have shown Latino patients to have a higher (than other CHC groups) utilization of routine immunizations1-3. We think this is a crucial addition to a national narrative about vaccine hesitancy. However, it does not tell the stories of Latinos outside of the CHC system, who may encounter unstudied barriers to getting necessary vaccines. Setting matters.
Who are the actors in our story, and how do they appear?
In quantitative health services research, many of us are familiar with the typical actors – the variables (and the concepts they represent) many of use over and over again to understand our outcomes. Race and ethnicity, age, language, income. Chronic medical conditions. We now use community and neighborhood variables that measure education, employment, and economics. But how do we use these? Do we feed them all into a big regression model to “control” for everything? Or do we stratify? Do we describe well? These decisions, which are often routine analytic decisions in any lab, may contribute to very different stories. Recently, a PRIMER scholar, Jorge Kauffman, published a paper assessing the acute care use of children with asthma4. While this paper described important differences in outcomes (presentation to clinic or ED/hospital for acute asthma symptoms), some of the considerable power in the paper came in Table 1, when one understood that outcome differences between racial and ethnic groups were very clearly associated with basic, chronic care use at the clinic. Because of the description, the paper told a much fuller story.
There are many more ways in which we tell stories in health equity research. We at the PRIMER lab are dedicated to understanding the stories we tell, more and more. We hope you join us on that journey.
1. Heintzman J, Bailey S, Cowburn S, Dexter E, Carroll J, Marino M. Pneumococcal vaccination in low-income Latinos: an unexpected finding in Oregon community health centers. Journal of Health Care for the Poor and Underserved. 2016;27(4):1733-1744.
2. Heintzman J, Hwang J, Quiñones AR, Guzman CEV, Bailey SR, Lucas J, Giebultowicz S, Chan B, Marino M. Influenza and pneumococcal vaccination delivery in older Hispanic populations in the United States. J Am Geriatr Soc. 2022 Mar;70(3):854-861. doi: 10.1111/jgs.17589. Epub 2021 Dec 2. PMID: 34854478.
3. Heintzman J, Kaufmann J, Bailey S, Lucas J, Suglia SF, Puro J, Giebultowicz S, Ezekiel-Herrera D, Marino M. Asthma Ambulatory Care Quality in Foreign-Born Latino Children in the United States. Acad Pediatr. 2022 May-Jun;22(4):647-656. doi: 10.1016/j.acap.2021.10.003. Epub 2021 Oct 22. PMID: 34688905.
4. Jorge Kaufmann, Miguel Marino, Jennifer Lucas, SteffaniR. Bailey, Sophia Giebultowicz, Jon Puro, DavidEzekiel-Herrera, Shakira F. Suglia, John Heintzman. Racial and Ethnic Disparities in Acute Care Use for Pediatric Asthma. The Annals of Family Medicine Mar 2022, 20 (2) 116-122; DOI: 10.1370/afm.2771
What we do
Written by John Heintzman
Health equity research, in many ways, is like an old family recipe for a favorite dish. Many people have very specific, and often vigorously held, ideas about exactly how it should be done. This passion and conviction is one reason why we love this field so much. It is comprised of passionate people of focus, conviction, and determination. In this inaugural installment of the PRIMER lab blog, we wanted to discuss our passion and conviction, specifically which piece of the health equity universe we choose to occupy. But before we do that, it is useful to observe that there are indeed many pieces of that pie, with the same goals (equity!!) but with different ways of seeking that out. Let us be a scientific community that has humility, equipoise, and thoughtful consideration about the methods we or our colleagues may choose to use, or not use.
The PRIMER lab focuses on the care delivered to Latino patients in community health centers, and we use a linked electronic health record dataset to do so. We have chosen this approach because we are most interested in how real-world care is delivered. We are also interested in equipping (priming!!) front line clinicians, staff, and community health workers in their work, by observing what goes on in their care systems as well as care systems like theirs. We want to know how data from the clinic may correlate with data from communities, so that policy makers have better information about how community life and wellness affect health. And by using these electronic health records at scale, we fight to balance 2 ideas: using enough data to see clear, important patterns, but also analyzing outcomes that mean something to the doc, and the medical assistant, and the clinic director, and most importantly, the patient, every day. So people, in the long run, can be healthier for longer. That is why we do this. Thanks for reading.