Collaborating with Communities to Improve Health Equity

Loren DeJonge Schulman: 

From the Partnership for Public Service, this is Profiles in Public Service—a podcast that shares the stories of the public servants who work on our behalf every day to make our country safer, healthier and more prosperous.  

We talk to career public servants, emerging leaders, journalists and more to better understand what it means to be a public servant… the incredible variety of careers possible in government… and how public service impacts all our lives.  

I’m Loren DeJonge Schulman,  

Rachel Klein-Kircher: 

And I’m Rachel Klein-Kircher. Today, we’re kicking off a special series of episodes highlighting some of our incredible 2022 Service to America Medals finalists.  

Loren DeJonge Schulman: 

For those who don’t already know, the 2022 Samuel J. Heyman Service to America Medals, known as the “Oscars” of government service, are a highly respected honor given to exceptional federal leaders who break down barriers, overcome huge challenges and achieve results that make a lasting difference.  

Rachel Klein-Kircher: 

We are starting off our Sammies series here on Profiles in Public Service with Suma Nair, the director of the Office of Quality Improvement in the Health Resources and Services Administration’s Bureau of Primary Health Care.  

Suma and her team at the Health Resources and Services Administration, or HRSA, support nearly 1,400 health centers operating more than 12,000 service delivery sites, including community health centers, migrant health centers, health care for the homeless centers, and public housing primary care centers. 

Loren DeJonge Schulman: 

Under the direction of Suma, HRSA launched a major initiative in 2021 that provided community-based health centers across the country with resources they were otherwise lacking to adequately respond to the COVID-19 pandemic.  

More than 20 million COVID-19 vaccines, 50,000 antiviral doses and critical medical supplies were delivered to communities in need.  

Rachel Klein-Kircher: 

We’ll also hear from two community health center representatives: Ian Munar from International Community Health Services in Seattle, WA, and Noah Nesin, the Chief Medical officer at Penobscot Community Health Care in Penobscot, Maine. 

Ian and Noah discuss the direct impact that Suma’s work has had on their health centers’ ability to deliver care to their patients and increase access to health care for vulnerable populations throughout the pandemic.  

Loren DeJonge Schulman: 

Welcome Suma, Ian, and Noah!  

Transition Music 

Suma, I want to start with you and ask, why were you drawn to working with the federal government with so many opportunities available to you, and what did you see in working at the Department of Health and Human Services that allowed you to pursue some of the goals that you have around expanding healthcare services? 

Suma Nair: Yeah, thank you. It’s a great question. I’ll be honest. Working in the federal government was not something I had ever really considered growing up. In fact, growing up, I didn’t really know of any federal employees. I think looking back, I must have known a nurse at [Veterans Affairs], or a friend had a parent that was in the FBI, but I didn’t really connect that with federal service or working in the government. And it wasn’t until graduate school that I really learned about the Department of Health and Human Services and the different programs within HHS, and finally the Health Resources and Services Administration that I work for today. I think as I learned about that and the programs they did, that’s when working in the federal government as a career became a real consideration.  

I joined federal service and at the Health Resources and Services Administration where I have been for my entire career, so that tells you something about my passion and the amazing work that our agency does. I joined via a fellowship program and that really afforded me the opportunity to learn about several parts of the agency. Our agency has over 90 plus programs that range from providing grants for direct service care delivery, primary care, HIV aids care, to training programs that train the health workforce of today to up their skills and of the future. And so, building those career pathways. They also invest in infrastructure in rural communities, building out maternal and child health services for our whole country, focusing on organ transplantation. So, there’s such a diversity of programs, it was here that I learned about the underserved safety net communities, and it really helped galvanize the fact that I always knew I wanted to help people and somehow in the context of health and health improvement, but it wasn’t until I learned about HRSA’s programs and their impact that my passion for the underserved was really ignited. 

And now through my almost 20 years here at HRSA, I’ve seen firsthand the direct impact of our programs on people’s lives and frankly, many millions of people’s lives. You know, I think people who go into healthcare or public health it’s because they want to help improve an individual’s life or in the case of public health, many, many people’s lives. 

It has been such a privilege in federal service to be able to see how you take resources that are given to us and really can employ entrepreneurism, creativity, innovation, collaboration across to maximize the impact of those programs and see how they help individuals and communities across the country.  

Loren DeJonge Schulman: This happens, Rachel, in almost all of our conversations where we ask someone, how did you find your way into the federal government? And at least half of our respondents say like it was, you know, it really was not on my horizon, and it found me at the right moment and demonstrates that so many possible careers are available in public service. Anything you could want to do has some link to the federal government in some way. And there’s so many paths to get there. So, Rachel, I feel like we need a bingo card for this at some point.  

Rachel Klein-Kircher: Yeah, absolutely. Loren. Suma, you mentioned briefly underserved communities. So, can you tell us more specifically, who is using these community-based health centers and why does this network of health centers matter? 

Suma Nair: Yeah, well, more than 29 million people across the country.  

Rachel Klein-Kircher: Wow.  

Suma Nair: One in every 11 people living in the United States is served by a community health center. One in eight kids, and one in three people living in poverty. Health centers serve almost a million migrant seasonal agriculture workers, more than 1 million individuals experiencing homelessness, 5 million residents of public housing, 60% of the patients served by health centers are racial, ethnic, minorities, and over a quarter are best served in a language other than English.  

Health centers are community-based and patient-directed organizations and I think their critical opportunity is based on the patient profiles that we just shared, they are able to integrate access to pharmacy services, medical services, mental health services, substance use disorder services, oral health services in areas where otherwise it would be very hard for the reasons of economic barriers, geographic barriers, cultural, or linguistic barriers, or frankly other health related social barriers, or sometimes referred to as social determinants of health, that limit an individual’s ability to afford healthcare, access healthcare, or frankly, even if they’re able to, access healthcare, really implement the treatment plans and care that’s necessary to improve their health outcomes. 

 And so, health centers are in those communities, and they really focus on this idea of a one stop shop. They bring all those services together. They coordinate them for the patients, really taking a holistic, whole person view of the patient’s needs. And that, including leveraging the best of health information technology, partnerships with other social service agencies to make it easy to get all of the services in one place and make sure people have all of the things that go towards improving health really allows us to support the health and wellbeing of the communities and patients that we serve. 

Rachel Klein-Kircher: So, this is really remarkable. And I would love to know from Ian first, and then Noah, you know where the two of you are working, I think Suma has made it very clear like why are people coming to these health centers. Are there other alternatives for folks in these communities?  

Ian Munar: So, in Seattle it’s a very diverse community. There are four other FQHCs federally qualified health centers in the greater Seattle area who provide language and cultural support in diverse regions like ours. ICHS, our International Community Health Services, were deeply rooted in the Asian Pacific Islander community in Seattle and we’ve been providing affordable and culturally linguistic healthcare to King County over the past 49 years. And in 2021 alone, we serve 29,684 patients, approximately 68% were Asian, 59% had incomes under 200% poverty guideline, 48% were Medicaid and 20% are seniors over 65 years old. With us, ICHS really provides culturally and linguistically appropriate services in 70 languages from Asia, East Africa, Latin America, And Eastern Europe. 

Rachel Klein-Kircher: That was 70 languages?  

Ian Munar: Yeah, over 70 languages.  

Loren DeJonge Schulman: Wow! 

Rachel Klein-Kircher: And how about for you, Noah?  

Noah Nesin: Maine by some measures is the most rural state in the country. And our practices are in very different kinds of settings. So, here in the Bangor area where I’m working, there are definitely alternatives to our services in primary care. Although access is challenging, especially for people who are uninsured or underinsured or have Medicaid. So, we serve those people happily as part of our mission. But also, we have a practice for instance, in Jackman, Maine, which is on the far Western border, in the mountains, on the Canadian border. And not only is our practice there the only primary care practice in town, but it is also the only healthcare service within about an hour’s drive of that community. So, there’s no pharmacy, there’s no home healthcare, there’s no nursing facility. It is just our practice there, for instance, and it provides 24/ 7 access for people around the clock.  

We have similar practices in other communities across the central part of this state. And I think really what distinguishes us is the kind of services as Suma described that we can offer. So, our mission is primary care. Our mission is to provide care for everybody regardless of their ability to pay for care, and to provide wrap around services. So, we have pharmacists, we have pharmacies, we have support for the cost of medications if people are struggling with that, we have care managers and case managers, we have chiropractors, we have a large dental practice in addition to integrated primary care with medical services and mental health and behavioral health services all working as a team with the patient at the center of the team. 

So not only are we patient-directed through the nature of the Board of the health center, but our patients direct their own care as well. They’re the most important member of their own healthcare team. And that model is appealing so that in the areas where we do have competition, our waiting rooms look like the community. We are not just serving as a safety net organization but as a desired primary care site for the entire community  

Rachel Klein-Kircher: So, one other question, before I give it back to Loren, everything that Suma described is so extraordinary. And then the two of you, you know, are really emphasizing that. Are there challenges partnering with the federal government in this way? 

Noah Nesin: I think the partnership between health centers and HRSA functions at a very high level and that is not necessarily where the challenges are. The challenges are in legislation and in evolving models of healthcare delivery. Often the nature of health centers and the way we are reimbursed are not taken into full consideration than the development of those models. 

So, for instance, even at the inception of accountable care organizations, ACOs, federally qualified health centers weren’t eligible to participate in the early days of ACOs because somebody just didn’t think about that. So, I think that’s where the challenges are. But the partnership otherwise I think is a very important model of success in really meeting the needs of our communities, most especially communities who tend to be marginalized or underserved, as Ian and Suma described. 

Loren DeJonge Schulman: Suma was something we’ve talked about on this podcast a few times before is how COVID-19 as a global pandemic feels like, still feels like it impacts everybody, but as you know, so well, and everyone on this conversation has been working on, COVID-19 has tremendous inequities and disparities in how it impacts certain communities for a variety of reasons. 

And one of the tasks that came to you early on in the pandemic was responding to unequal access to resources to prevent COVID-19, to detect it, and to treat it. This is both a monumental and such an important task and I know there were many people who are part of this, but how did this come to you? How did this project, that it seems like an enormous undertaking land with you and how did you pursue it?  

Suma Nair: Yeah. You know, it’s one of those things that HRSA—we are a grant making organization—and so our federal agency provides on average 20% of the operating budget of any of our community health centers. So, we’re really adept at knowing how to get the dollars out Congress appropriates to the important missions of community health centers. So, when we were asked early on from the Biden administration, how are things going? We’re noticing that maybe there’s not equitable access to the vaccines, and testing. Because of our relationship with health centers, we knew what [their experience was]. They were not getting adequate access to tests and testing. They early on did not have adequate access to PPE, personal protective equipment. They did not have access to vaccine for the healthcare providers in the health centers let alone for the patients and their communities.  

And so, when the Biden administration came in and they said, “well this is a problem because we’re very focused on equity, can you launch a program to help us make sure that health centers have direct access to these supplies so they can quickly deploy them to their communities?” It was built on the understanding that health centers have longstanding trust in their communities. They, as Noah mentioned, are for the community by the community, they’re governed by a patient majority board. And so as trusted messengers, they were the right individuals to bring the vaccine, bring the test, bring the supplies. So, they came to HRSA as we administer the health center program and said, “What can you do? And we understand that there’s a pent-up demand and need, how quickly can you set up a program?” And it was really a matter of a few weeks from when we got that request, which is something we’ve never done before, to when we were able to get the first sets of vaccines to go out into our first set of community health centers.  

How we did it, I think, was because we had the relationship and it’s one of those things when you have a mission of serving the underserved and improving access to care, you can’t say no to something like that. And I will say, especially, from my point of view, and I think a lot of my colleagues here in the health center program at HRSA, I’ve worked with at the health center program for almost 15 years, many of my colleagues in the leadership have also had long 10 years and are so rooted in the mission and connection to our stakeholders that we felt their pain and the challenges they were seeing early on in the COVID pandemic. And when this hope of vaccines came about and we saw that it wasn’t getting to our communities, there was no other answer that we could say, but yes, to this opportunity.  

Loren DeJonge Schulman: So, I want to build on that. You mentioned the importance of trust, and trusted relationships in this. And this has been a theme as we’ve talked about COVID 19 response in the conversations on our podcast, because there’s so much around health and public health that is not just the science. The science is so important, but also communication, relationships, trust, and the engagement that goes with that. How did the relationships that you and your colleagues have built up over time in those years that you talked about? How did that support you in leading this nationwide response? 

Suma Nair: I think the trust and the relationships were the secret ingredient to our success. We knew our health centers. We knew the communities that they served. And we knew our partners at the local, community health center level, our state primary care associations and our national partners that we had. 

And over our years of working together on all sorts of quality improvement initiatives. Because of the health centers, communicating with us and us engaging with them, we had a good handle on what our patients looked like, the diversity, and what their needs were. We had a good handle on the care teams in the health centers and the needs, and considerations of health center, leadership or administration and the health center care teams. The needs of the communities more broadly in the health centers. 

And so, when this came to be already out of that relationship, even when we had no resources to supply, we were listening regularly to, “what is your experience in your community? How is this impacting your staff? How is this impacting your finances and your health center?” And so, we had a good grounding in what the challenges were so when the opportunities came, we were able to quickly leverage our data and insights on our communities to model out how we would distribute the vaccines. We were able to leverage our IT systems and all the contact information and kind of relationships we had and the known ways of working together to kind of tweak them to work in this context. 

We were able to build upon different IT tools and get health nurses to connect on those. As a grantee and a grantor, you work together maybe on a monthly basis, maybe every quarter… The cadence of the vaccine distribution was daily sometimes, and at a minimum, weekly interaction with our organizations. 

Right? And so, I think it was those relationships that helped us from the federal level communicate all the way down to the local. But then have amplifying voices and the ability to organize at the state level and understand state specific concerns and issues, so that at the state level they could partner with state public health and others, and then raising those concerns to the national level so we could partner across HHS and across government to make sure we were able to respond to the needs.  

Loren DeJonge Schulman: Can you tell us a little bit about the, impacts that these efforts have had to close that gap in treatment and access to vaccines?  

Suma Nair: Absolutely. We’ve been so proud of our program. The whole focus and goal of our program was to ensure equitable access. And so, of the 20 million vaccinations, and it’s more now, that health centers have provided to their patients and communities across the country, over 70% went to racial ethnic minorities. And when you look at the doses that came directly from HRSA, 76% went to racial, ethnic minorities. A third went to our most vulnerable populations: individuals experiencing homelessness, farm workers who are putting the food on our table, individuals with limited English proficiency. So as, as our partner Ian mentioned right, 70 different languages, not only is it the vaccines, but then when we had, at home test kits, another important layer of mitigation for COVID-19, we were able to get the tests out into the communities and partner with our colleagues in HUD. So, we worked with HUD assisted housing and made sure they got access to these supplies. We worked with the aging and disability communities to make sure they had access to the supplies. 

So, not only were health centers caring for their own patients, but they were really extending these support services to the communities more broadly. Not only were they handing out supplies, but as Ian mentioned, it was so great to see them take these supplies and translate them into the 70 different languages at the right literacy level. 

We had an anecdote of a health center say, “Yeah the self-test kits are really helpful, but we’re experiencing the patients bringing them back to us and saying, can you do the test on me? I don’t understand this.” Because it wasn’t at the right literacy or language level. And so, we worked to make sure that the resources were accessible. 

We were able to send out masks through direct distribution. And then of course COVID therapeutics. So, when an individual does test positive, if they’re eligible, they can get access to medication to mitigate the illness and keep them out of the hospital.  

Loren DeJonge Schulman: You’ve talked about how the relationships and connectivity with the local and state organizations really sped up during this time period beyond what the normal cadence was and the importance of that having those on hand as this program was launched. But I’m curious, are there challenges of working with local entities as a federal official or a federal agency? Because it’s not typical. It’s something that there are programs like yours that do this on a regular basis, but it’s still something I would imagine you might run into some barriers.  

Suma Nair: It’s a kind of two-sided coin. I think the challenge is also for me personally, what makes it so rewarding. As you can imagine, we have 1,400 organizations and they have 14,000 service delivery sites across the country to care for these more than 29 million patients. So, when we talked about distributing vaccines, we were trying to get to all the service delivery sites and you had to have a site point of contact set up and everything. And so, it became quite the opportunity and challenge to contact individuals, make sure that [they’ve] done the training, you have the, you know, SOP or guidance, but people need to hear things many times. So, it really challenged us and tested our ability to develop on demand resources, create office hours, create regular standing webinars using every communication channel and all of our partners that we could.  

I think that was the biggest challenge really the message passing all the way from the national federal level, down to the thousands and thousands of sites that we have across the country and the wonderful staff who are really busy administering vaccines and providing care who also have to hear from us, “here are the things that we need for you to get your next allotment of vaccine.” And so that regular cadence was a lot, but, that was in some of the hardest times of this vaccine program and the many hours it was the conversations that we had with health centers, where they said, oh my God, I just vaccinated a family, and they were all so happy it was their 90-year-old mother’s birthday and this is what they did as you know, together to get the vaccine. Those were the kinds of things those one-on-one interactions, although challenging at times, is what was really, really rewarding through our effort.  

Loren DeJonge Schulman: All right just a quick aside on that. I was talking with some colleagues the other night about that first wave and later waves of vaccines of how celebratory it was seeing how communities react. And just how it was a very kind of community-minded moment. And it came in waves which is so incredible to see across the country and in a very equitable and even-handed fashion overall.  

Rachel Klein-Kircher: And we’d love to hear now from the ground level, from the community health center level. We’ll start with Ian and then Noah to share your perspectives. Everything that Suma just described from the federal focus on down, how did that look from the ground up? And I also love that she talked not about your patients, but the staff, they are also part of the community. They are also part of the population that needs to be served. 

Ian Munar: Sure. So, it’s funny how Loren had said when the vaccines came out, it was like a celebratory moment. It was, but like on the ground level, it was also very anxious, you know, and a lot of anxiety as far as how to get it. Prior to the HRSA COVID-19 vaccine program, it was very tough for organizations like ICHS to access vaccines. 

It was tough accessing the test to begin with. We were competing against hospitals and larger healthcare organizations, and then later on with mass testing and mass vaccinations. And we understood the importance of getting the vaccines out, but the most efficient and expedient way of doing that is not necessarily the most socially and racially equitable method. 

And so, ICHS early on decided to remove those barriers for patients that were like limited English speakers and that had had difficulties in accessing those, those vaccines because of technology. And if you remember, when it first came out, there was like a mad dash of people going online to make an appointment and imagine being an elderly, you know, limited English, proficiency Senior trying to navigate through the internet, finding information, finding which websites to check it was nearly impossible. 

And, so for us, we really made it a point to make these vaccines accessible to those that have those barriers. And it meant taking a little bit more time and making phone calls. It meant working with different organizations who had also culturally and linguistic backgrounds to leverage their relationships with the community and also to be able to help guide them through the process of getting a vaccine through us. 

It was like, one of the stories that really came to mind to me is when one of our community partners that we were working with on outreach, had told us a story about one of the elderly ladies that they had called to help set up an appointment. And when they had called her, she started crying because she didn’t know, you know, she didn’t know how to access these vaccines. 

And she thought she had been forgotten. And like that story, I mean, it’s such a short story, but it really encapsulates really our mission for health equity for all. And it is just that importance of being able to reach out and remind those that are the most vulnerable that they haven’t been forgotten, and that we are still looking out for them. 

Rachel Klein-Kircher: Thank you for sharing that, and you’re right, it doesn’t have to be a long story to pack a punch. That one hit for sure. Thank you. And how about with you, Noah?  

Noah Nesin: Yeah, I would echo what Ian said about there definitely were mass vaccination, mass testing efforts in Maine, in this area. Again, we have 15 practice sites, spread all over the place. So not everybody had access to those, but even within our service area, there are populations of people for whom a mass vaccination site is just not feasible. Transportation issues, mobility issues, literacy issues. Doing it by telephone was somewhat cumbersome as opposed to, for instance, signing up online for it and if you’re not adept at that, that was a big challenge. So, these resources, that, as I think about them, I think about first of course, the PPE for our staff and employees that was so vital when that came through in giving them a sense of improved safety in the context of a big unknown in those days of the pandemic. The vaccines of course, first for our staff, and then for the community and through the efforts of Theresa Knowles, our chief quality officer, our organization was able to administer 29,000 vaccines and we did it in a number of ways.  

One was a much smaller centralized clinic that we ran at our administrative building. We turned it into a vaccine site where lots of people who weren’t comfortable going to a civic center were able to come to that. But more importantly, Theresa and her team ran a program where they went to people’s homes, they went to churches in synagogues and mosques, they went to shelters we have our own shelter for instance. They went to the blueberry fields in Maine and other agricultural centers to work with migrant workers as they came into the state to test them and to vaccinate. The story I have is of a very elderly woman on palliative care, in fact, but who was not able to be get vaccinated and her caregivers who were her family and friends, were severely limiting their contacts so they could continue to provide care to her. And when Teresa heard of that as she did in many other cases, she herself drove 35 miles to administer a vaccine to this woman so that not, not only did it help protect her, but it helped her caregivers gain more freedom in their lives because they could feel more comfortable about that and allowed her to have more visitors. 

So, I’m sure, you know, we’re all rife with stories similar to that. And then the other thing I would add that these kinds of resources, the populations in particular that we were able to serve with these resources are people in recovery. We have hundreds of people in our recovery programs at any one time and, and, you know, a mass vaccination site or testing site can be very challenging in those circumstances, people with persistent mental illness, for instance, our more personal approach to it was, was more desirable for them. So, it has just been an incredibly satisfying experience and all I had, if I may, on a personal note, it was really the capstone achievement for Theresa Knowles in her career sadly, a year ago we lost her to a cancer diagnosis that occurred and resulted in her death, you know, within a matter of weeks. But her heroic work using these resources is really her legacy, and people know that it’s, it’s been a marvelous legacy.  

Rachel Klein-Kircher: And thank you for making all of this visible, right? Like the things that you’re describing, like those who are in recovery, those who have other challenges and a mass vaccination site, while it might be like a blessing for a larger community. There are so many pockets where that’s just not the answer and to hear stories like this, you know, literally one individual making a difference. That’s really amazing.  

Noah Nesin: Right. It’s never, it’s not really one way or the other. It’s [these] complimentary efforts of the big systems and organizations like ours, to really serve the entire population.  

Loren DeJonge Schulman: Suma that really just drives home this next question I was going to ask, which is around this incredible national asset of community-based health centers and the amazing individuals who work with and among them are just an amazing opportunity, resource, miracle to access equity and healthcare. 

Are there things that individuals can do or steps that they can take in their communities to help improve the access that we’re talking about today? Any advice that you would have for people who are hearing these stories and are thinking, this is, this is amazing. I want to help be a part of this and help advance  

Suma Nair: Yeah, absolutely. I think first and foremost: find the closest health center to you. There are, as I said, almost 14,000 service delivery sites all across the country.  

So, go to Google, put in, find a health center and follow your first search result. That will link you to a place that you can put in your zip code, your city or state, and find the closest health center to you. 

I think once you find where that community health center is in your community, you can reach out to them and learn more about the work that they’re doing and how you can contribute. If you don’t have a medical home or a primary care provider, find out about their services, they could be a phenomenal opportunity for you to get that whole person integrated care. As they were saying, they’re not only for underserved communities in many communities, they are the ideal spot for integrated care, especially for different communities because there’s like linguistic or cultural competence. Health centers are kind of centers of excellence for certain communities and so seek them out. 

If you don’t need to get care there, or you already have another medical home, see how you can support. So, as I mentioned, we’re about 20% of the funding for any given health center. Health centers do get reimbursement through Medicaid and Medicare, but to provide the best most patient centered, Holistic care, there’s a lot of services they provide and other programs that they provide to address the needs of the patients that reach far beyond health services that are reimbursed or covered. And so I think there are many ways in which members of the community can partner with their community health center to see how they can bring their unique talents to serve in, communities. 

I would also say on the idea of equity. Equity is so multifaceted health equity is one avenue or one way to consider. But if health equity is not your angle or where you can contribute, I think there are opportunities and communities across the country where there are groups who are very focused on understanding some of the causes of inequity and finding community systemic approaches to address it. So, engage in those efforts to figure out how you can work with your community, your friends and neighbors, to make sure that the community is a place that meets the needs of all of the individuals and helps them thrive.  

Loren DeJonge Schulman: On the other side of that question, Suma, for those who are listening to this and thinking, I think I want to try to have this sort of career. I want to work at HRSA and support this mission in that particular way. What sort of opportunities are there for individuals who are passionate about public health and want to work with HRSA?  

Suma Nair: Yeah, absolutely. for those who want to learn more about HRSA, I encourage you to go to hrsa.gov, and you can learn more about our agency and all of the different programs as I mentioned. From maternal and child health, to rural, to organ transplantation and everything in between, you can learn about opportunities from internships, all the way to full time positions that cross all of the different GS levels. In addition to direct employment at HRSA, or if you’re in a government fellowship and you get to do rotations, figure out how you can get a rotation at HRSA to learn more about our programs. But in addition to that, as I mentioned, HRSA has over 90 different programs and we have more than 3,000 different organizations that we fund or support in some way. 

Whether they’re direct healthcare providers, like you heard from our colleagues today, or academic institutions, state, and local governments, national organizations. So go to our website, learn more about the organizations we fund. You might already be working in an organization that supports the HRSA submission. 

If not, if you’re thinking of a career change, you can look to work in an organization that HRSA supports to advance the HRSA mission. 

Loren DeJonge Schulman: Well, Suma, Ian and Noah, it’s been such a privilege to talk to you. And I love it when we’re able to host these conversations that show the full dynamic of how the federal government touches different programs and states and communities. So, thank you all so much for joining us today. 

Rachel Klein-Kircher: Thank you for your work and your stories and all that you’re doing. 

Noah Nesin: Thank you, it’s a pleasure.  

Ian Munar: Thank you. 

Loren DeJonge Schulman: Rachel, I said this during the interview, but I just want to reiterate, I love when we were able to have these kind of wrap-around conversations with the federal leader, the federal program leader and someone he or she is directly interfacing with on the front lines, in another organization in the state local level, like it gives such an amazing picture of what the federal government actually does. We are not just bureaucrats sitting in Washington, they are people who are day to day making a difference in local communities with amazing partners. 

Rachel Klein-Kircher: It was such a human story, and I love that the challenges that both sides talked about, the health centers and the federal government and the challenges that they may have with each other weren’t anything negative from a personal standpoint. It was a more that there are 14,000 centers across the country.’ It was more of a logistics. How do we do this? How do we get to everything? And it really resonated when Suma talked about, you know, ‘normally we have this cadence of maybe quarterly or annual touch points.’ During COVID-19, during a crisis, it’s weekly, if not daily. This also resonated for me with some of the other federal civil servants that we’ve talked with, like what happens in a crisis? And it’s like, all hands-on deck, you just keep going, going, going to try to help as many people as possible. 

Loren DeJonge Schulman: The other thing that really stood out to me, Rachel, is the stories that Ian and Noah told about how the work of these health centers is so tailored to their communities and to individuals in their communities. This is not a factory of healthcare. These are individuals that are driving 35 miles to provide a COVID vaccine who are calling individuals and talking with their families and understanding their circumstances, which are incredibly diverse and unique. I don’t think it’s a natural instinct. When people think about government services, they’re much more thinking about like, this is a very sort of standard, stand at a line, this is what we do. And there was a lot of that when it came to COVID vaccination, but they’re also such individualized, caring, empathetic services too. 

Rachel Klein-Kircher: And I liked when, when Noah said it doesn’t have to be one or the other, it shouldn’t be one or the other, like the mass vaccination site and these individualized care points. You need them both. To have that flexibility, which you don’t expect again on the face of it, the federal government, as this large institution to have this flexibility and these stories were just so great. 

And those who are on the ground, directly seeing what services are needed, can reach out to people like Suma at the department of health and human services and say, here’s what we need. How can we make this happen? I was really blown away by the examples of the types of folks who are being served that you don’t necessarily think of, right? 

Migrant farm workers, those who have dependency issues and are in recovery or mental health challenges and may not be able to go to a mass vaccination site, for example. And the story that also really struck me with when Ian talked about having seventy, 70 different languages that they could interpret. 

And the idea that somebody is receiving, you know, a home test kit for COVID is great. I got the kit, but I can’t read this. So, I may as well not have it if I don’t know what to do with it. So many steps in the process that those of us who don’t maybe have all of these barriers, aren’t thinking about day to day. 

Loren DeJonge Schulman: This is actually a really good example of the journey called federal customer experience has been on for the last several administrations. One of the more recent viewpoints around this is that the federal government needs to be very careful to make sure that it is not delivering or prioritizing its benefits and services to the average customer, because then it’s going to leave behind so many who have unique accessibility challenges, or who are not within driving distance, or don’t have Wi-Fi, or speak different languages or any number of other things that makes them fall slightly outside this standard model of what the average customer looks like.  

And this is a priority that’s been put out through the racial equity executive order that was that came out, but also multiple other policies that are trying to not just deliver and tailor to the ‘easiest customer,’ but to deliver and tailor to people who are in some way on the margins for whatever reason, and to make sure that that is as important as creating that standard service as well. And that’s incredibly difficult, but it’s also something that gets to the heart of how government is different than the private sector in terms of how it delivers for the American people. 

Rachel Klein-Kircher: Right. And you can’t choose who to serve. Everyone must be served. And I always appreciate it when these conversations link directly to the research that you and your team are doing with customer experience and with trust and the government’s role here. Thank you for pointing this out because to me this story with Suma, Ian and Noah was such an example of what it means to have equitable service delivery. 

Loren DeJonge Schulman: Absolutely, nd it’s something that I think we should recognize as people, even people who are very in favor of strong, good govern ance, it’s incredibly difficult. Like this is not something that you can simply switch on and off and say like, all right, we’re doing equitable policy and equitable service delivery today. 

It requires understanding so much so much about very unique Americans who are all over the country and in very unique individual circumstances who all live here, and all qualify and should be getting access to the same thing that somebody who lives in the middle of Washington DC. So, I loved the stories that they told. I loved, as you said, how they made the invisible, visible around what COVID-19 vaccination delivering COVID testing requirements looks like when you’re getting into communities. And I love being able to bring forth these kinds of stories through this podcast. 

Rachel Klein-Kircher: And having the eyes on the ground be part of the podcast too also amplifies why policy cannot just be driven from inside of an office in Washington, DC. This just, again, makes me more grateful for the work that you and your team are doing with research to really make this evident and more clear. 

So, thank you so much, Loren. 

Loren DeJonge Schulman: It’s been a wonderful episode as always. 

Transition Music 

Maggie Moore: Hi, I’m Maggie Moore from the Partnership for Public Service. After hearing from today’s guest, you hopefully learned even more about how important the federal government is to the health, safety and security of our nation, and how incredible its employees are.  

If you know an outstanding public servant who deserves to be recognized, we want to know about them! Please nominate them for a 2023 Sammies by going to Service to America Medals dot org or check the link in our show notes. 

Loren DeJonge Schulman: 

 So that’s our show, thanks so much for listening! If you haven’t already, please follow or subscribe to “Profiles in Public Service” wherever you get your podcasts.  

Rachel Klein-Kircher:  

You can also check this episode’s show notes to learn more about today’s topic and be sure to follow the Partnership for Public Service on Twitter, LinkedIn, or Instagram to find out about future episodes!   

Loren DeJonge Schulman:  

“Profiles in Public Service” is created by the Partnership for Public Service.   

Rachel Klein-Kircher: Our writer and producer is Abigail Alpern Fisch.  

Loren DeJonge Schulman: Our script supervisor is Barry Goldberg.  

Rachel Klein-Kircher: And our executive producer is Jordan LaPier.   

Loren DeJonge Schulman: See you next time!