Episode 3: Rewriting The Prescription
Dr. Cheryl Holder
Dr. Cheryl Holder is a physician who is witnessing and creatively responding to the way a changing climate is impacting her patients’ health. Her previous experience treating HIV patients offers crucial context for what it looks like to pursue a collaborative and social justice driven healthcare model.
Episode Transcript
Dr. Cheryl Holder: And why is nobody recognizing that there are people now that are impacted with this climate. And it's not polar bears. And it's not just the buildings. And by the same time that my patients were coming in, I would hear about King tides and would hear about the buildings, and we hear about the sand being washed away. And I'm like, nobody's talking about the people. And my people are suffering right now.
Cameron Peters: Welcome to New Climate Narratives, a podcast investigating our changing climate through the voices that are seeing, imagining, and creating new ways forward. I’m your host, Cameron Peters.
On a daily basis, clinicians and more specifically primary care doctors see patients about everything from wellness exams to sinus infections to the illnesses and diseases we face throughout our lives. They are on the frontlines of our health and wellness, and often our first point of contact for our most common and intimate health questions and concerns. Because of this, they are also one of the first to see emerging patterns and trends in real-time within the communities they serve.
Climate change is affecting our health now and will increasingly affect it into the future. According to Florida Clinicians for Climate Action, an organization leading the way on climate health education for healthcare professionals, climate change impacts include heat illness, exacerbated heart and lung conditions, asthma, traumatic injury, water, and foodborne illnesses, allergies, vector-borne diseases, and emotional stress. But, as they also note, not all of these impacts are felt equally – low resource communities are often the first to feel the effects, making climate change a social justice issue.
Today, the story of one doctor whose experience treating patients with HIV surprisingly offers a model for more equitable treatment of climate change’s impact on health.
Cameron: Can you begin by introducing yourself?
Dr. Cheryl Holder: I'm Dr. Cheryl Holder. I'm an Internist at Florida International University, Herbert Wertheim College of Medicine. I'm also the Associate Professor in the Department of Humanities, Health, and Society, and currently Interim Associate Dean of diversity, equity inclusivity, and community initiatives.
Cameron Peters: Dr. Holder is a leader connecting the dots between our health and climate change in South Florida. She is a doctor who is witnessing and creatively responding to the way a changing climate is impacting her patients’ health. Through her work as a doctor, professor, and Co-Chair of Florida Clinicians for Climate Action, Dr. Holder educates fellow clinicians on the impact of climate on our health and speaks out for an equitable healthcare model, one that is rooted in her experience working with HIV patients. Her story offers us crucial context for what it looks like to pursue a collaborative and social justice driven healthcare model.
Dr. Cheryl Holder: I've been a doctor now, 84 is when I left medical school. So, we're going back 36 years and before. I tell the story of when I was a child when I came from Kingston, Jamaica to East New York, Brooklyn, totally different world. And a particular incident where a child was doing one of the usual activities they did in that community, which is jumping on the back of the bus and ride down on roller skates. Roller skates back then used to have those with the keys. You guys have never seen it, but they used to slap it onto your shoe, and then you would have a key that would open it and tighten it. And so, folks would ride around and hitch rides onto the cars onto the buses. And this one unfortunate afternoon evening was sundown, the kid fell off. And she just laid there and no ambulance.
Cameron Peters: Sharing this pivotal moment during the TEDMED conference in March 2020, Dr. Holder recalls one older man telling the police officer at the scene, that ambulances don’t come to that neighborhood. Eventually, it was the police officer who took the child to the hospital.
Dr. Cheryl Holder: And just listening to my community at that time just talking about the disparities and the lack of response of the ambulance and the police and just the overall problems in that poor community. And it always stayed with me. Just how do you get help?
Cameron Peters: As a teenager, Dr. Holder witnessed the disparities between those who get access to resources and those who don’t. As she moved through high school, she began to find inspiration in the work of healthcare in underserved communities.
Dr. Cheryl Holder: I went to a Math and Science High School. And that school, a lot of folks are being docs and I was able to get into a program that took us on the streets of South Jamaica to do blood pressure screening and work in the community health center. And even though I thought about being a doctor being in that environment just opened up a whole new way of caring for people and doing the help that I always wanted to do. And seeing black folks as it was the black community, the administrator was a black woman. And the top doctor was also a black female. And it was just amazing to see the kind of work we could do for the community.
Cameron Peters: To afford medical school and the associated living expenses, Dr. Holder enrolled in the National Health Service Corps, which covered tuition and provided a living stipend, in return for a commitment of service based on the time you spent pursuing your degree.
Dr. Cheryl Holder: And since I wanted primary care, and I love working in low resource communities. I am not afraid of that whole thing. These are just -- they’re people like me, they're my neighbors, they're my friends. They're who I am.
Cameron Peters: After earning her medical degree, Dr. Holder applied to programs across the country to fulfill her scholarship service commitment.
Dr. Cheryl Holder: And Miami, Florida was one of the areas I applied. And I was fortunate enough to get selected at a clinic and a hospital system, Jackson Hospital in Miami Dade County. Back in 87, when I got here, when I was in New York, HIV, of course, was rampant. And so, during training, there was a lot of HIV and a lot of TB. And so, I was pretty experienced when I arrived in Miami based on my training.
Cameron Peters: As a young primary care doctor, Dr. Holder witnessed the HIV epidemic in South Florida through the lives of her patients.
Dr. Cheryl Holder: So, I had to jump right in. They weren't separated into special clinics; they were your patients. They were patients that you've been seeing before, who then got infected or had been infected, and we didn't know it. So, it was just my regular primary care patient. As an Internist, I see teenagers all the way through. So, I saw the entire spectrum of who was vulnerable to HIV. And that allowed me to provide care to a very vulnerable population.
Cameron Peters: Early on, Dr. Holder became the medical director of an outpatient community health center, similar to the one she worked at in High School. Here she had the opportunity to be involved with HIV management and prevention by building a more community-centered approach.
Dr. Cheryl Holder: So, we had Ob/Peds, internal medicine, school-based clinics, we had the whole full spectrum of care. And with that, I was able to get involved in direct treatment and management of HIV. But then I'm primary care, prevention is key. So, I got involved in prevention programs.
Cameron Peters: As she was hearing the stories of patients’ lives and their challenges, Dr. Holder became immersed in the larger community dealing with HIV care management and prevention.
Dr. Cheryl Holder: So, we wrote a lot of grants, we got involved in NIH with Community Based Practice networks, with all the Miami Dade County systems. Because if we're going to impact our community, we can't just treat, we've got to stop the flow. And so that's how I got involved in HIV. Because that's what medicine was when I came into practice. It wasn't a specialty, it wasn't separate, it was your day to day care of people who came to see you from our communities. So, that's how I got very involved in HIV care management and prevention. And you can't do that without getting involved with the communities. When you hear these people's lives you hear how they've just had difficult times.
Cameron Peters: Because of her specialty in primary care, Dr. Holder approached HIV with a perspective of the patients’ whole life.
Dr. Cheryl Holder: So, HIV medicine, I didn't separate it that I went looking for HIV patients. And it's why I just do primary care, taking care of you from teenager to grave if I'm fortunate enough to be your primary care doctor, and you end up with a disease that we call HIV. But I came to care for you, and your health, and hopefully, your family’s and make that difference in your life as a physician. And at that time, it was HIV. And now it's Coronavirus, but my role is still the same. I'm still your primary care doctor to help you get through life. I always tell my patients, I want you to live till at least 90. Let's work together to get through the 90. I don't care what disease you have. If we work together, let's see if we can make it. And I got that from my HIV patients who, in the beginning, we didn't have a lot of drugs, we didn't have a lot.
Cameron Peters: To stop the spread of HIV, a collaborative approach known as wraparound services, was implemented to support a patient’s medical care and wellbeing.
Dr. Cheryl Holder: But it's basically proper community support, proper way of living that richer people take, they don't even recognize it, that you have a whole team supporting you. You have healthcare supporting you, you have a lawyer supporting you. Your money is able to buy it all but you get it. And when we did that with HIV, to me, that improved the quality of life and lengthened the life. And our data is showing more now that social terms of health is what drives your health outcomes. And with HIV, we're able to do that, because my patients were able to eat better because they got food support. And they are -- so even though the drugs weren't ideal, they were able to stay alive, stay in healthier environments, get their mental health check when they're stressed out. They had support systems. I mean, the case manager had doctors, we had a whole team that was funded to take care of this population.”
Cameron Peters: So, what was the foundation of this equity model? It was a collaboration, across systems, disciplines, and governments from the local to national level.
Dr. Cheryl Holder: I think this strategy we use in HIV worked. And it's not just a strategy for climate change, it’s for life. With HIV, we developed a huge team. Everybody collaborated. The government collaborated, the research scientists collaborated, the community organizations collaborated, public health collaborated. The government put some dollars, private sector put dollars, NGOs put dollars. If you look at the amount of money that we put into HIV, to get the discoveries we did, if we did that with more diseases, I think we'd be much farther ahead. We also as a treatment strategy, looked at the social determinants of health. And we funded it. So, we looked at what would help my patients stay in care.
Cameron Peters: So, what can we learn about this healthcare equity model when confronting climate change?
Dr. Cheryl Holder: And if you apply that equity model to what we're seeing in climate change, we will then have the sufficient support to keep people alive so they continue to be productive members of our society.
Cameron Peters: HIV provided Dr. Holder with a living case study of what can happen when everyone is offered the opportunity of healthcare. But as Dr. Holder reflects, it is also a model that is showing us the consequences of reducing this key support.
Dr. Cheryl Holder: And I'm beginning to see some of the pullback in HIV care and treatment… So, as we pull back, we're seeing the morbidity rise. And we're going to start seeing the disparities if we start pulling back. So, I think HIV has given the perfect model, and especially how the NGOs, government came together. And the society came together to bring that support.
Cameron Peters: So, what does the HIV healthcare model offer our understanding on how we can confront the health impact of climate change, an issue that is placing increased stresses on vulnerable communities?
Dr. Cheryl Holder: And my climate work really started was when I had an aha moment with a patient who I’d been caring for, for a few years. And so my patient was one of those ladies who got a clerical job, did her 30 years of service, retired in our little old house and had lots of health problems and took care of them and I always took her medicine. So, when she came in needing her refills before the time, and she had COPD, she tried. And then I was surprised that she did need this medication refilled early. And so we were just talking and finding out what's going on, you're usually right on time, you never run out of anything. And then she gave me a form about Florida Power and Light. And I'm like, you need a refill and now you need help on your light bill, what's going on? And she explained that she just-- it was so hot. Her house was hot, she couldn't sleep at night, she had to run her air conditioner. And the light bill was high and her decompensation used up her medications and these meds are not cheap. And so she used up her budget, her little retirement pension. And I started noticing more patients like her, just trying to deal with the heat, trying to deal with their allergies, trying to deal with the increasing cost of their medication usage and increase in light bill.
Cameron Peters: And, for Dr. Holder, the connection was made.
Dr. Cheryl Holder: And why is nobody recognizing that there are people now that are impacted with this climate. And it's not polar bears. And it's not just the buildings. And by the same time that my patients were coming in, I would hear about King tides and would hear about the buildings, and we hear about the sand being washed away. And I'm like, nobody's talking about the people. And my people are suffering right now. So, it just made me really become much more active in what it is.
Cameron Peters: We know climate change is a threat multiplier. Those who lack the resources and power are among the first to be impacted.
Dr. Cheryl Holder: I've been on the Environmental Justice Panel with the National Medical Association before and that, it started to come together, that these same populations that were talking about environmental justice, that were next to the polluting plants that were living with dirty water, that were living in substandard housing, and all these issues. Were the same people now that we're dealing with the heat, that we're dealing with the allergies, that we're dealing with the mold and mildew and the flooding. And they're paying a huge price. So, that kind of brought me back to where I started back 30 something years ago, 40 years ago, that who's going to help our people, who's going to help the vulnerable? And they remain vulnerable, just like that girl who I still see to this day, when I look back in my mind, I see her laying there and nobody coming. And the cop picking her up and taking her in his car because no ambulance ever came.
Cameron Peters: But here is the difference that Dr. Holder found.
Dr. Cheryl Holder: The climate is particularly vexing because this is not just an infectious disease. This is not blood pressure. This is something that is going to impact us worldwide, already impacting us. And it compounds the existing problems. And so these folks, they don't stand a chance if we don't really do something now.
Cameron Peters: In 2018, Dr. Holder attended the conference Florida Climate & Health Symposium, where she was one of 30 physicians to create Florida Clinicians for Climate Action, an organization built around education and advocating for equitable healthcare that deals with climate change. Dr. Holder believes clinicians have a key role in confronting climate change.
Dr. Cheryl Holder: We have a huge role because all these patients come see us. I wouldn’t know about these issues until they came in, and they had some decompensation of some of their health issues. Or they're having depression or they're having anxiety. So, a lot of their impact shows up in their diseases.
Cameron Peters: Because of her role caring for patients over years and decades, Dr. Holder witnessed how climatic change was impacting them on a personal level.
Dr. Cheryl Holder: And then we are learning more that actual pollution can worsen, exacerbate respiratory problems is related to heart disease. It's now we're seeing just heat and premature labor. So, before we would think it was just around anxiety, depression, and the actual pollution irritating the vessels and the heart and all of that. We're seeing so much direct impact, just from all the changes to people's health.
Cameron Peters: What is the solution? If we are only at the beginning of seeing health effects of a changing climate, what are the next steps?
Dr. Cheryl Holder: So, this health, if we're going to improve the health is just like I said with HIV, it wasn't enough to just give the prescription. We've got to get to the root of it. We gotta find a way to have these patients take these prescriptions. We gotta find a way to have them be in a position where they can overall improve how they eat, how they sleep. It’s the social determinants. So, if you as a physician, and whatever, a clinician are really trying to improve the health outcomes of your patient, it cannot be solely rewriting a prescription for asthma medicine, because the asthma’s decompensated.
Cameron Peters: Our next steps need to be purposeful, and collaborative, and we need to see in a way that actively engages with this moment and through a perspective of lifespans.
Dr. Cheryl Holder: So, economic and social justice is what's necessary if we're going to move with climate change. We can't just say we're going to put up buildings that rich people can afford to live in, and they'll get all the air conditioning and their buildings will be vector proof, so mosquitoes won't be able to come in. No, it can't be about that. It has to be about what is equitable for all of us, for the low resource as much as the rich. And moving against the racism, the homophobia, all those things that we deal with. And that's how we will get real social justice, recognizing what the needs are of the population that is being impacted and address those needs.
Cameron Peters: Dr. Holder sees a pivotal opportunity for clinicians to engage with their patients in thoughtful conversations that recognize their lived experiences with the health impacts of climate change.
Dr. Cheryl Holder: I think how are we going to mobilize those that aren't feeling the effects right now? And that's where I see our clinicians come in, that everybody's being impacted. And that if they can connect the dots for the richer person as much as I can for the poorer people, and talk about their allergies, or whatever else is going on with them because we're all impacted.
Cameron Peters: This begins with understanding the significant connections between a changing climate and our daily experiences.
Dr. Cheryl Holder: Even the playtime, if you live in the suburbs, can your kids go out to play because it is so hot? How do we, when we talk about play with the parent, the richer parent, we talk about issues like that. And the mosquitoes with your child, are you putting on a lot of insect repellent? See how we can get them as clinicians involved in how it's impacting them so they also want to take action. They may never take action for the poor people, but they will want to take action. And then some of the solutions that help poor people like energy efficiency solutions, like electric vehicles. Where the mobilization of electric vehicles for mass transit, for school buses for dump trucks, the garbage collections, those help poor folks. Their pushing for those things will make an impact. So, that's where I see our biggest challenge will be is to mobilizing those who are not feeling the effects as easily as my poor populations, but to bring them in the fold.
Cameron Peters: But we know climate change can’t fall on one profession. Climate change response demands active collaboration, cross-pollination between fields and, critical mobilization. Dr. Holder sees activism as the key to our collective response.
Dr. Cheryl Holder: So, when people talk about black lives matter, why to protest, you have to have activism. You have to have people who are going to shout and yell and say this isn't-- we don't have to do it this way. There's a better way. And they push the pharmaceutical industry to develop those drugs rapidly. If you look at now with Coronavirus, we didn't need the push. The government knew that we could develop vaccines rapidly. Rapid vaccine development is not new. It's always been possible. But there's never been the political will or the dollars to support rapid vaccine development.
Cameron Peters: What do you feel like the public still doesn't understand about climate change and health?
Dr. Cheryl Holder: That it’s happening now, that their health is being affected as much as my other patients' health, and we have to do something about it. And it's not too late if we start now. So, that's the thing that we are hopeful for. And when I started this back in 2016, nobody was interested in hearing about my patients. And they’re like “Oh, she just had the compensated COPD. How do you know it was the heat? How do you know this?” And I'm like, “Yeah, I'm telling you, I'm seeing more of this.”
Cameron Peters: Dr. Holder says her hope is grounded in the movement towards awareness she sees building.
Dr. Cheryl Holder: So, what gives me hope is so much awareness that has come out from this. And the science is finally catching up. The research is catching up, because as people get more interested, there's more research. Again, I see the groundswell like I saw with HIV, increased activism, increased pressure to do the research, increased pressure to respond. And the data shows that more people now believe what we're saying about climate change. There are fewer climate deniers, which 10 years ago, there were a huge number of climate deniers. And there were people who weren't so sure that this really was happening.
Cameron Peters: In All We Can Save - an anthology of women climate leaders edited by Dr. Ayana Elizabeth Johnson and Dr. Katharine Wilkinson – there is an illustration by Madeleine Jubilee Saito with the text, “Any health we have, we have in common. Any sickness we have, we have in common.” These words make me think about how our connection to each other, to the environment, is fragile but also so resilient. And that this resilience is built and strengthened when we see each other, our very bodies, as a part of a really critical ecosystem. One needed if we are to take our next steps forward together.
New Climate Narratives is produced, edited, and hosted by Cameron Peters. Sound Design and music by Miles Shebar. Special thanks to Dr. Cheryl Holder and Melissa Baldwin.
You can write to us at newclimatenarratives@gmail.com. Follow us on Instagram @newclimatenarratives, on Twitter @ncnarratives, and on Facebook @newclimatenarrarives. As always you can be the first to know when a new episode drops by subscribing wherever you listen to your podcasts.
Resources
Book Recommendations by Dr. Cheryl Holder:
Drawdown by Paul Hawken
All We Can Save: Truth, Courage, and Solutions for the Climate Crisis edited by Ayana Elizabeth Johnson and Katharine Wilkinson
Learn more:
Dr. Cheryl Holder
Cheryl Holder, MD, FACP, is President of the Florida State Medical Association, Co-Chair of Florida Clinicians for Climate Action, and faculty member at Florida International University Herbert Wertheim College of Medicine. She is is board certified in Internal Medicine and has dedicated her medical career to serving underserved populations.
Florida Clinicians for Climate Action
FCCA engages Florida health professionals to learn about the health harms of climate change and advocate for equitable solutions that protect the community and support a sustainable future.