Whirlwind conversation from community organizer and champion of public health and education, Katrina Doughty. She is currently Regional Testing Coordinator for OHA, Region 2. She has a passion for making lives better and more informed in creative and compassionate ways. I was put in touch through Oregon’s Universal Preschool Now coalition. We talked about the importance of meeting people where they’re at, and doing so in creative ways. We briefly touched on abortion and reproductive rights.
The views expressed here are Katrina’s personal views and not those of her employer OHA or the MESD school board
Transcript:
keevin bybee 0:00
Welcome to the one-school podcast. This is keevin Bybee. I’m a family physician exploring how we might turn schools into 24/7 365 safe spaces for our children by having conversations with experts or people with experience and all of the ways that we need to make this happen. Today I’m speaking with Katrina dowdy, she is the regional testing coordinator for region two of the Oregon Health authorities. COVID-19 response unit. Katrina, thank you for being here and talking with me today, I’d love to give you an opportunity to tell me a little bit about yourself and how you came to be on the other side of the internet microphone with me today.
Katrina Doughty 0:40
Thank you, keevin. Thank you for that introduction and the opportunity to chat with you today. So as was mentioned, my name is Katrina dowdy, I use the pronouns she, her and hers. And I come to this work in a multifaceted way, as we all do it, there’s no straightforward line. And so really, the interests that I have in this project and the support that this can mean for our community is, as I said, multifaceted, one hat that I wear is as a public health professional during the times of COVID, that has looked like an outbreak coordinator work that has looked like vaccination and testing coordinator work, both at the county level on the regional level on the state level. During non COVID times, I have always been focused on health education for our communities. And then I also wear the additional hat of regional school board as well as state school board director. So I am a director on the Multnomah Education Service District, which is for the entire county of Multnomah County, as well as part of osba, which is the state school board. So between my focuses on education, education, reform, equity and changes that need to happen with our schools and school board, as well as how that directly affects student health outcomes. And public health is why I think this project would be so wonderful for our students.
keevin bybee 2:16
Well, thank you so much. I really love that you’re involved in health and education and community organizing, my brain does really good with certain kinds of problem solving and math. And I am always intimidated, but also impressed by people who are actually out there doing the work with the scope that you do. So I want to say thank you for that.
Katrina Doughty 2:44
My pleasure. Mostly,
keevin bybee 2:47
it certainly does come with its challenges. And we were also put in touch through the universal preschool now group. And I think that’s a wonderful dovetail with this whole program, because it’s how do we make sure that kids from ages zero to not kids are in some way having a place to spend time when their parents need to work or are occupied? Do you have any intersectional role with the universal preschool group?
Katrina Doughty 3:14
Yeah, so I had the privilege to get to work alongside a lot of those wonderful organizers for universal preschool. The ways that I was involved with universal preschool now was specifically creating cohorts. I felt like it was really important to help guide why some folks may want to be engaged with universal preschool now and build specific involvement in those ways. So I created two cohorts, one for folks who consider themselves public health or health care professionals that see the direct correlation between preschool and health care outcomes, as well as I created a secondary Coalition for folks that are school board members and elected officials that have vested interest in what what the preschool program looks like, and how that benefits our students directly.
keevin bybee 4:16
Well, great, I love how it’s the importance of bringing people together to show how all of the current areas of life that we have chunked into rather independent silos really aren’t all that independent and what we care about is living a good life, right?
Katrina Doughty 4:34
Mm hmm. Yeah, there’s definitely no way to differentiate education from health care realistically, and one fully aligns with the other. I always joke but it’s not a joke that I can make a justification for anything being a public health topic, and it’s really true. You know, education is a public health topic. Housing is a public health topic addictions as a public health topic. and those are not silos and those all directly affect our families, our youth and the education they receive. So, yeah, give me any topic, and I’ll tell you how it’s public health.
keevin bybee 5:13
Exactly. And I’m slow to that realization as a family physician. I mean, my background was in engineering, and then I went into medicine. And then you realize, really quickly how each of the uncontrolled diabetics are really just having an unmet social need on some level.
Katrina Doughty 5:33
Yeah, most certainly, I heard described really interestingly, as a friend was going through nursing school, they were presented a case study, and it was someone who was currently facing house lessness, who was in the clinicians, diagnosis of obese and and who had diabetes. And the question frame to students was, what is something that you would focus on? And kind of what would be the the care and suggestions that you have for this patient? And the first answer that most people said was something about diet and exercise, completely ignoring the fact that this person was facing house lessness. So that would be a primary concern and a driver of what food choices, what exercise choices and what sleeping choices this person had to make for themselves, even what drugs they may have chose to utilize for safety or survival. And so I think just just really helping our systems of education, whether that’s nursing school, or provider education, or literally kindergarten, helping them recognize all the systemic levels that are involved in population and individual health. And I think that that directly ties into programs like yours that you’re hoping to create, which is that without a space, health is not really possible.
keevin bybee 7:03
We pay a couple $1,000 a month, sometimes for patients prescriptions, yet, we won’t pay for a nutritionist or for rent. And so it’s just the juxtaposition is frustrating for lack of a better term.
Katrina Doughty 7:19
And no one makes money when we don’t pay for prescriptions, but we pay for housing.
keevin bybee 7:24
Yeah, our incentives are just maybe not slightly, but misaligned on several levels, which you stack up five degrees of misalignment after 20 levels, and you’re, you know, pretty far off course, yeah, most certainly, one thing I really like about what I’ve seen your work was on the vaccine clinics, you decided to put one near a casino, you know, meeting people where they’re at, and tell me a little bit how meeting people where they’re at can make everything better?
Katrina Doughty 8:01
Yeah, most certainly, um, well, I think that’s a big loaded question. But I’ll take little pieces at a time is, I think far too often there’s this gatekeeping with healthcare especially, which is if you do this, then you can have this and this like reward system. If you lose this way, you can have the surgery, if you eat healthy, then you deserve to be happy, or whatever the case may be. And I don’t think especially during a pandemic that I need to dangle any carrots or have any justification for someone to receive the health care that they need. And so whether that means that they are working at attending, enjoying spending money at whatever a casino, they need to be vaccinated just as much as anyone else. And what I was recognizing is that in a lot of rural areas, for example, rural em Hill County, there were not many clinical options other than the fantastic tribal health center. But I do know that the Tribal Health Center has so much on their plate, and they really should be able to focus on the tribal community that they serve. And I wanted to have a No Wrong Door clinical approach to vaccinations and testing. So I connected with Yamhill county public health as well as the casino to say can we have a every person is welcome. You can work at the casino, you can attend the casino, you could just drive by the casino, you could live near the casino and just come and get a vaccine because bringing something to you is going to make people way more able to receive something like a vaccine or a test. And we know that if folks have to drive if folks have to take time off work that can be additional barriers for these resources. So what was great is we had a lot of people in many different clinics that I created this summer, not just at the casino, but where they said, I’m getting vaccinated because you came to me, because it, I didn’t have to drive all the way to Portland, I didn’t have to drive to the nearest city 45 minutes away, I didn’t have to decide, do I eat this meal or buy this meal or pay for the guests to come figure out how to get vaccinated. And what was really great is I had the opportunity to also order things like food boxes, and other resources to help also offset some of those costs that people might have. Even if we were close to them, they still had to get to us. And so it was great is really giving us the opportunity us as an Oaj, the opportunity to really meet people where they’re at, and really say, we are here to vaccinate you. But we also recognize you have additional needs. So we have the food boxes, I could refer people to other services with 211. And really, I tried to tap into the county and local public health to say what other resources do you want me to provide. So some also had people tabling for transportation needs or dental care services or OHP application assistance. So for me, I really just appreciate being able to figure out how to meet people where they’re at. And and I think that that helps slowly remove kind of the white coat syndrome, that is connected to a lot of clinical care as well as public health care. Because ultimately, the patient is the one needing the care. And so that’s where we should focus our efforts.
keevin bybee 11:52
100% Yeah, like you said a lot to unpack. And, you know, it’s unfortunate where, you know, I feel like a gatekeeper sometimes, which is not the right way to do it. But misaligned incentives with how I am reimbursed as a physician through insurance, and it’s functionally a paid by the widget, instead of paid by the how well people are doing. So I think I’ve said it before, and I’ll say it again, we really need to restructure how we compensate people for the work they’re doing, and recognizing that we’re paying for it already, on some level in terms of lost income, emergency room visits, etc. Because we’re not paying up front by doing preventative outreach kind of work.
Katrina Doughty 12:43
Yeah, and one way, I definitely noticed that too, was people’s hesitancy early on with a vaccine to, for example, only certain populations were qualified to get the vaccine early on, which, you know, was important to prioritize folks, however, very often the wrong prioritizations in my mind were happening, which is, for example, teachers were prioritized, and I love our teachers. And I think our educators are incredibly vital. And we saw that for some students, and for some teachers, online education really helped bridge that gap and actually was more successful for some students as far as eliminating barriers, whether that’s parental work, schedule, you know, transportation, those kind of things. So our teachers were able to work from home. And so during that time of early vaccination prioritization, I actually got on a call with Governor Kate Brown, and some of my fellow school board members. And we were talking about prioritization. And I just said, although I love my teachers, and I really do, and I’m so grateful for all the work they do, I think that who should have been prioritized. First is grocery store workers and farm workers. Because those folks cannot work from home, and they are feeding our teachers, and they are feeding our families. And they often don’t have health insurance, which teachers do. And so I thought it was really It spoke to being more business focused, then then individual focus, because getting schools opened, helped businesses return to quote unquote, normal, as opposed to supporting the least supported and perhaps most vulnerable in our communities. So I’ll just say that I’m willing to have those arguments as far as prioritization. And and you really, you really did see that play out. And so what I noticed is at a lot of events, we tried to have zero waste events. And what that means if we had leftover doses at the end of an event, we would go around to local communities and try to figure out who would like a vaccine. And I can’t tell you how many times at the end of the Night, we did, you know, a 10 hour vaccination day and we’re trying to find folks to vaccinate. And people would say no initially, not because they didn’t want to get vaccinated, but because they were worried about taking a vaccine that they felt was designated for someone else. And so just like really helping let people know that I’m offering this because we have it, we want to give it to you. And also, you being healthy and you being able to receive this vaccine is far more successful for the system than you getting COVID and being in the ER, that’s better for you, that’s better for the health system that’s better for everyone, our providers. And so just having those conversations with people about, like prevention and upstream and how that’s still best for the system, which I don’t love, but that is in place was some really interesting vaccine discussions that happened.
keevin bybee 15:56
Who would have thought there would have been a downside to appropriate civic concern? What you mentioned school board, and you mentioned that you’re also on the school board, which is fantastic. And again, something that I think my skill set is very not well suited for so and you mentioned that you were the only health care provider on the board now Is that something the board says we need one person or you saw that they didn’t have one, and you’re like, we need one on the school board.
keevin bybee 21:10
Well wait to identify a need and see how you can fill it. That’s very, very cool to see. One thing I am trying to do is figure out where there’s blind spots or hurdles to this project that I just might not see because of where I am coming at it from. So based on what you’ve gleaned, and what we’ve talked about, what are some ways that you think we might run into barriers? And what are some ways that you think we could circumnavigate them?
Katrina Doughty 21:48
I think it’s always just hard to contemplate something that hasn’t been done. And so I think that the first hurdle is just mentally, for me, at least. And I think for a lot of folks, as you’re sharing this idea, and as I hopefully can share this idea, is just really thinking about what is possible. And it’s hard to really have those discussions when it just hasn’t necessarily been a model that people have experienced before. And that doesn’t mean it’s not possible, whether we’re talking about universal health care, like actual universal health care, or housing for everyone and radical ideas like a basic human needs. I think, I think that that’s just the first like mental and emotional hurdle, and which I know you are prepared for but I just want to like echo that that is a difficulty is just like showing people something that just does not exist at the moment. I think the other difficulty right now is how our schools are set up and and the way that all kinds of legalities and different things work with schools. inclination that a lot of schools have to think about safety from a perspective of involving law enforcement or having school resource officers SROs on campus, I think some of those things are probably not aligned with the intention of what your vision of safety would be for our students, and what this resource would look like. So the first thing that popped into my head is like, Are schools the ideal setting? Or would something like libraries be an alternative setting and being that they have, you know, restrooms, they often have break rooms? It would it be easier to change how libraries are used with their meeting rooms and different things, as opposed to all the really complicated, like legal issues and shenanigans that have to do with school settings and school premises. Not to say one is right or one is wrong, it was just the thing that popped into my head. Also, as you were talking about coming from a clinical setting and what clinicians get reimbursed for, and kind of our current healthcare system, it did remind me that a good direction to look into would be our CCO. So our coordinated care organizations. And that is for non Oregon listeners. Basically a way that we have broken down the state and our Medicaid population, and created regional approaches to figuring out how to utilize Medicaid money and support folks that are on Medicaid in certain regions, because we know that what works in one region may not work in another because of different resources because of transportation because of location because maybe a primary care provider desert, all those kinds of things. So, for example, the thing that popped into my head would be if we wanted to do a trial region like we did with preschool, I think that a county like Yamhill county would be a wonderful pilot project. And the reason I think that although they do have a electeds, who are less than favorable to public health, and progressive education, is because they are one of the only if not the only county that has one CCO for the county. So you have one organization that is focused on Medicaid and children’s health care in the entire county, and they receive funding to promote health in their county, and they receive funding based on metrics of student health, patient health, in their county. And so I am all about CCO accountability, and they get a heck of a lot of money for meeting these metrics, and don’t always have to do the work that helps them meet these metrics. For example, Oh, ha is doing a lot of vaccinations for COVID-19. And I know vaccinations are a metric for CCOs. But many CCOs are not needing to help fund or support the vaccination efforts that are happening, but they will directly benefit from those. So something like a 24 hour support center that helps students give students a place to get food and resources and, and really meet the gaps in, in the needs that they may have, would directly benefit, their health would definitely benefit some of the metrics that the CCO gets paid for. So I would love to see them be a part of the solution, both for funding and strategic decisions. So, you know, whatever that setting exactly looks like, I don’t have my heart set on it. But I am just thinking about our current systems and the funding that exist, and how we could utilize some of that accountability, because I see in most other healthcare systems that it would be really tricky as far as billing for certain services and those kinds of things. So if we can really go out of the billing world and more think about like the metrics and incentives that some of our healthcare systems get, I think that could make this maybe feel like more of a reality.
keevin bybee 27:34
Yeah, I love how you’re already thinking way more practically than I had any details on. So yeah, I love the eye library idea. Maybe I’ll try to reach out to somebody in library administration to see what they think about and the, it’s, it’s a shame how you say that, for example, the county, CCO gets to say their vaccine numbers are better because of the work you’re doing through like an independent state run level organization, right?
Katrina Doughty 28:04
Yeah. But also that’s like our job as the you know, Oh Ha, and the Oregon Health Authority and state public health or local public health. That’s our job. And it also just speaks to the silos that we all work in, instead of the collaboration. So I’m always here to strengthen that collaboration.
keevin bybee 28:22
Very cool. Well, you know, one thing that’s fresh on my mind and sounds like your nose danger, or shy or away from controversy, I don’t know if you saw Saturday Night Live recently with the clown sketch.
Katrina Doughty 28:36
I have heard of it. I didn’t see it, but I heard of it.
keevin bybee 28:39
Yeah, I just saw goober the clowns, abortion and I was in medical students for choice. And I saw that you are part of an organization called Northwest quality care. Is that something you’d like to plug?
Katrina Doughty 28:52
Sure, yeah. Um, so it is something that is just like your project a dream. And it is a project where quite a few local advocates have united to try to figure out what abortion care and reproductive health care can look like in a setting where it’s not siloed off on its own. And I think far too often, we further stigmatize abortion care and reproductive health care by creating independent sites where you can go and receive that care as opposed to your health care. And right now for example, in Oregon, realistically, the only place you can go to receive a actual comprehensive access to primary care which should also include include comprehensive reproductive health care is if you’re lucky enough to have Kaiser because Kaiser does happen to they don’t promote it and they don’t tell anyone but they do offer abortion care. Yep, most people do not know that, but that is not the case for pretty much anyone else in Oregon. And in fact, most Kaiser patients don’t know they have that access. So what we were really envisioning is a primary care clinic. That is the true definition of primary care. And so that includes reproductive health care, that includes gender affirming care, and that can include access to things like tubal ligations, and rep referrals to lowsec dummies and all kinds of things that folks might need. And so, I will say that, like many projects and goals that folks have had, um, COVID-19 has definitely had to pause this dream and this goal, because I, along with other supporters of this idea, really had to jump into either self care. Or for me, I’m really dive into public health and work around the clock on outbreak work and testing work and now vaccination work. So my hope is that in the next few years, this will be able to be a project that again, has energy given to it and time and space given to it. We are right now a 501 C three. So we are able to accept donations. However, I did not promote or request or accept donations throughout 2020 or 2021. Because I really felt that there were places that were up and running and supporting people in these high levels of needs, whether that was for Black Lives Matter, and folks on the ground doing medical aid while being tear gas by law enforcement, or whether it was folks who were helping with housing and food needs for those that were needing to be quarantine are facing loss because of COVID-19. And one of the discussions I will say is, I have seen lacking from a lot of local reproductive justice, or reproductive support systems is the talk about how tear gas is an abortive fuckin. And so what’s interesting is you see a lot of law enforcement and folks aligned with law enforcement that are also anti choice, but are fully okay with spraying a board of chicken in the air that affects people whether they are at a protest or not. And there’s actually a really interesting surveys happening through Planned Parenthood and other organizations that are asking people about what side effects and concerns they had after suffering from tear gas. And that has included up to six months of cramping and bleeding and different things. So when we’re really talking about how everything can be public health, that’s what I mean, literally spraying war crime chemicals, affects our children, it affects our reproductive health, it affects the quality of care the that people can have access to. Because if you think about having a respiratory pandemic,having chemicals sprayed in your neighborhood, where there’s already a lack of primary care, where your children aren’t able to go to school, and trying to navigate all of those things, while maybe not having transportation or not having a safe place to go, is really so many burdens and barriers that our communities, especially our neighbors that are facing house lessness have had to figure out and navigate this year. So all that to say we we have this project, and we want to continue this project and are excited by the idea of comprehensive care. And I knew that it was not our place to promote or collect money in the last two years and really tried to support everyone else doing that work in real time.
keevin bybee 34:05
Well, I appreciate your vision for the long game. And I know that is always hard to give up a passion project or put it aside temporarily. And once again, public education and public health are different words for the exact same thing, when how and if new people come into this world is critical to making sure that the young people already in this world are as resourced and educated as possible. So yeah, best of luck there. I would love to help out in any capacity when you might need have need for any of my resources or thoughts. So
Katrina Doughty 34:51
wonderful. We will be looking for providers for sure. I
keevin bybee 34:55
think we covered a lot of the questions or concerns that I have and I really appreciate everything that you’ve brought to the table this afternoon. Is there anything else that you were hoping to share that I forgot to ask about, or think anybody listening might benefit from knowing? Yeah,
Katrina Doughty 35:14
um, one of the things that I just love to share and you know, the timeliness of this message might change depending on when this gets shared with folks or when people have the opportunity to listen. But I just did want to flag for people that with redistricting, and, and just the general legislative turnover that happens. And there will be the opportunity for a lot of new faces in leadership. And that could be for better or worse, depending on how we are able to really collaborate and coordinate, what leadership looks like and what we expect of leadership for our counties and for our states. And so there will be quite a bit of turnover for representatives and different folks in legislature along with school boards. We’ve seen just this week, how important and in some cases detrimental that could be, for example, this week, just to give a time in place update for folks. We have the superintendent that was wrongfully fired in Newberg for simply just supporting vaccination guidelines, the governor’s mandates for masking as well as supporting Black Lives Matter. And that is unacceptable. And that is the direct impact of who was elected to be on a school board. So I just want to, you know, share with folks because many folks do not realize this, that school board directors are elected and unpaid. And what that means is that the folks making direct decisions for students and affecting student health care, are not seen as valuable enough to compensate. What that also means is that typically you only have people who can afford to do free labor, and who can afford to take time out of their day to attend multitude of meetings, and who have access to maybe childcare or are retired or those kinds of things. So that’s why we see a lot of what I call bad bread lectins.
keevin bybee 37:24
Right after Katrina, talked about bad bread electives. The system quit on us. I didn’t get a chance to say goodbye or Thanks, but I felt this was a wonderful conversation I was about to chime in. On her last comment with a quote from Heath Ledger’s Joker. If you’re good at something, never do it for free. It’s a shame how we don’t pay the people who are doing some of the most critical work enough or at all
Transcribed by https://otter.ai