Welcome all to our healthy town Culpeper. Good morning to both our panelists and our audience. My name is Dede McClure and I'm a Senior Program Officer at Northern Piedmont Community Foundation. Our particular footprint colors four county calls Culpeper, Fauquier, Madison and Rappahannock, in the Virginia Piedmont. We are considered the gateway to the channel. Among the many roles are Foundation play, he's got a grant maker, and as such, we are always on the lookout for projects which carried long term positive outcome for the health of the communities we serve. Culpeper is an agricultural area. We deal with moral health challenges and challenges of health disparity. We convene four panelists today to talk about Culpeper County and how we in fact arrive at a healthy town Culpeper. The idea specifically is to understand the health risks and then develop solutions to make a goes risk. There are indeed health risks here. With that in mind, I want to direct our first question to Eugene Triplett. Mr. Triplett is a fourth generation farmer here. He's also a sustained a lifelong career as a pharmacist. He claims he's retired, I don't believe it as he works tirelessly for our community. You can be an urban or rural. In fact, healthy foods are key to sustaining healthy community. How are the health and medical sectors establishing and partnering with farmers, producers, and agricultural in addition to mitigate the health crisis we care? Well, look at back on the pandemic that we're currently going through. I think that's raised the awareness that the health community, and the farming, and agriculture community have had to deal with the problems of food shortages, and then all like get I think in the past the health community has not partnered a lot with the agricultural community as far as mitigating issues. As you said, I've been a pharmacist for over 40 years and basically I've benefited from unhealthy lifestyles and people have not eaten healthy and I have basically made my living selling pills to treat diabetes rather than trying to prevent diabetes. I think now there's been a focus more on preventative health and then treating health. It's like I said earlier, just someone not calling a name, but it was the old adage with the Fram oil filter say you can pay me now, pay me later. So do you want to sell the $12 Fram oil filter or do you want to the pay for the $1200 engine repair? I think now the health industry and the farming industry is basically talking to each other and saying, 'What can we do to mitigate this health crisis that we're having right now?" How do you go about making those relationships? Well, I think there's a good relationship and I said, I'm here representing not only the health industrial as a pharmacist but also, I tell everyone I'm a farmer and a pharmacists. Farming has been my passion all my life. But the relationships that we're reforming now, many people are looking at health in a whole different light. I think the pandemic has raised a lot of issues that we're seen how important healthy foods and healthy lifestyles play in our health care system. I always said that if we got everybody healthy and cured all the diseases, Melbourne health and all of the other health systems will be out of business, and we wouldn't have to do anything. But I think there was a great partnership developing now and I think we need to increase this partnership. Tammy LaGraffe, you're on the health side. You spent almost four decades as a nurse and you're now in the Executive Director of the Culpeper Free Clinic. You are part of our solution. Certainly, the Free Clinic certainly is an extraordinary organization. Tell us about your garden project. I also benefit from Eugene's retirement and that he volunteers at our free clinic. When I started there, February of 2020, we had these humongous shrubs on part of the building. They were horrible and we have them cut down. But then we had a lot of discussions about what to do with space. Someone had the brilliant idea of make them into gardens. We had already been benefiting our patients from the Minority and Veterans Farmers in Piedmont would bring us some produce when they could. We thought, well, this is a good way for our patients to get in the mindset of healthy eating and healthy vegetables and how easy it is to grow them. We had a project setup with the Minority and Veteran Farmers in Piedmont and Virginia Tech and we had an educational session open to the community where we had these four by eight garden boxes built in front of the clinic. They videotaped it as an education session and we started planting in them and we plant tomatoes and peppers and zucchini and we really got a lot vegetables out of there. We made the most of it by having our nutritionists keep recipes that were in line with whatever was harvesting at that moment and it's been great. Patients love it. They come in and I have this Pavlovian reaction because we have this little plastic bag sitting on a big table of vegetables. I'm in my office and when I hear those plastic bags start rustling, I start getting this happy feeling like when your dog hears you opening the can-opener. It's just they're really enjoying it and they're taking the vegetables and we're trying to make the most, again, of looking at ways to prevent by saying, now, what do you do with them and can you grow them? How can we use these instead of canned vegetables or can we freeze these? We've been doing a lot with that and making the most of it. Now, that's terrific. Is it volunteers that manage the project or? Yeah. We have another retired person who was actually a nutritionist with the Virginia Tech Cooperative Extension and she and her husband have managed a great deal of that garden and we also have involved some of the participants in options, a local program for youths at risk and even some of our patients and some of our regular volunteers get out there and do everything, from weed, to harvest, to keep the tables set up with the produce, so yeah. There are sources of food cycles to find your way to preventative health. Kim, you're on the healthcare side as well as the Director of Community and Diversity, Inclusion and Equity Engagement, UBA Community Health. Tell me some of the ways that you engage that are on the health side, how you engage with community to promote health and healing and treatment. I'm happy to share and to build on what Eugene has shared about putting us out of business because that's the space that I work in is really trying to keep people out of the hospital, with that preventative work. We really focus on engagement that facilitates authentic connections and address health needs and that's your partnership. That's partnering with organizations and individuals such as this panel within the community. I guess I would start with saying our goal as a health and wellness organization is really to improve the health of the individuals in the communities that we serve and promoting health and healing and treatment. We know this from our community health needs assessment and what our committee has already shared with us are the greatest health needs. We have outlined specific objectives that we're seeking to achieve through our partnership and relationship with others in the community and it's really inclusive of increasing access to healthcare services and programs. That includes everything from transportation, to medication assistance, connection to programs, promoting healthy behaviors. A lot of it is through education is where education through awareness of risk factors, linking individuals, and getting them connected to resources and that's everything focused on chronic disease such as cancer, so that chronic disease management and prevention. As I mentioned, mental health and substance use disorder. We know that health also starts in our communities to supporting safe and healthy neighborhoods. Again, access to healthy food and food security. We did evaporate really by participating and engaging with our community. This is everything from health fairs, to health education, health screening, collaborative event, immunization, and really looking at targeted care navigation, and a few examples if you allow me the time. An example of an annual event that we host in partnership with our community there's this thing called pepper. Pepper berries we call pamper me pink. That's just one example on the event was really designed to celebrate women's health, breast health, and promote awareness. Through the event, through the partnership open to the community we are encouraging screening mammogram but also taking the opportunity to explain exams and procedures that may be scary to some individuals, the unknown. We bring in our subject matter experts to really have conversation and explain exams like what are the breast MRI? Or what is lymphedema? Through that channel and that partnership through that event and community building as well is really sharing recommendations as well. So much recently with our recent pamper me pink we shared a yoga video and how there are health benefits to yoga, either as a current patient or a cancer patient in their journey or transitioned into survivorship but really could talk about some of the different ways and recommendations. I think of something else or our food services team at the hospital shared a recipe for a healthy movie filled with antioxidants. Then most importantly, sharing of personal stories. In the community, really sharing stories of individuals could promote health and healing, and support and strength. Now, there's a question posed to you or a trainer divergent performance. You're well-versed in healthy living and you also have the opportunity to work one-on-one with people. Can you mention some of these, or this is personal? One person, two people, make a community. Tell me what you do on a daily basis to work with your folks to make sure that they maintain health? Yes. What an awesome opportunity I have now really be in the front line of the health force if you will. We've talked a little bit about some of the pharmaceutical stuff with Eugene. We talked about the healthcare system, the hospitals, but as far as preventative care goes, in my realm, not that I didn't have purpose before, but man, what a purpose we have now post-pandemic here and becoming a little bit more of an educator myself, becoming more well-versed and being motivated to get down some more of the nitty-gritty details of the ins and outs of why. Sleep is so important, why hydration is so important, why nutrition is so important, why? We see people an hour at a time but the conversation is really turning toward what happens the other 23 hours of the day and that's so crucial and so important. I think a lot of times people used to come to the health and fitness industry and they come for an hour at a time and it's almost their workout gives them an out of sort. While that may be true to some degree, it's really not the approach that we want everyone to take. Really making sure that everyone understands that your workout itself, the hour that you spend in here is greatly affected by the other 23 hours. If you don't sleep well, your body's not going to respond well in the workout. If you aren't fueled properly, your body's not going to respond well. If you're not hydrated, your body's not going to respond well. We talk about overall risk mitigation and the strategies to develop healthier communities and healthier people and the better job that I feel like I can do from that personal standpoint and reaching people and then having those discussions. I hope there's a little bit of a domino effect that takes place and they can communicate with their family members. They can start installing a lot of these adjustments and new habits that I'm talking about with them is individuals, and we start talking about making small adjustments. If you drink a lot poor fluids, if it's sodas and high sugary drinks, then we're going to start talking about how to cut some of that stuff down and adding water to the equation. Like I said, it's making those small adjustments at a time and if we can really educate people on how to make those small adjustments, and that's really one of my big missions coming out of this situation. I think we're going to have some fantastic outcomes down the road. I think so, prevention seems to be the word that I'm hearing again and again from all of our panelists , and that's far-reaching. I'm going to turn the attention to cancer. Cancer is a unusually prevalent here in Culpeper, we have a high incidence of cancer here. Eugene, I'm going to come back to you. What tactics are you implementing to your volunteer work, for instance, to stress the importance of building that healthy community in the hope of preventing an illness? They can really ravage a your community like cancer. As we're talking about cancer right now and we talk about education and awareness, I think one of the things we have to do is we have to educate the public that we do have a problem. You can't treat something if you're not aware that there is a problem. I think as far as, we need to let the community know that Culpeper has a high incidence of cancer. We have a problem here and once people are aware of a problem, then they are little more up to want to find a solution to the problem. One of the things I have found out and I've tried to do this for about five years and it hasn't worked with Madison County, I think in the African American population has one of the highest incidence of prostate cancer. My solution to that at one time is with me and I know we were just talking about pamper me paint as far as women getting that annual mammogram and all, I get African American man when you tell them we need to go have a prostate exam, they cringe and that it's old adage of the finger and they're not aware of the blood tests. One of the things I've always said, African American man go to the barber shop once a month, I mean, that's what we do, and if somehow we could have a PSA tests administered in barber shops I think we would get a lot of African American men diagnosed before they realize they have prostate cancer. I'll say education and awareness and you have to be aware of a problem before you can find a solution. Most people are unaware that they have a problem, and so I think one of the things we've done with the Free Clinic, we've had educational, I said with the nutritionist coming in the end especially with healthy eating. A lot of people don't know how to cook all the foods. They don't know how to, new foods that are out that are healthy and so once you educate them, prime example, list is we had at The Carver Center. Last year we donated over 9000 pounds of produce from The Carver Center to local food banks, but at one time we had so much zucchini that we didn't know what to do with it, but we took it up Rappahannock. One of the chefs up there started cooking zucchini lasagna, and they've cooked a lot of zucchini lasagna. They gave it to a lot of families up there on a Saturday, and then all of a sudden people said, "Man this is good, I never know you could make lasagna from zucchini." So that's education and awareness. That's what you have to do to to let people know and as Chris said, we only always see people for one or two hours. It's what they do, the other 24 to 23 to 22 hours of the day that really impacts their health. We have to educate people and make them aware that hydrate, sleep well, and all of these preventive things will help. Tammy, what do you see at the Free Clinic in terms of cancer patient? I'm also a reluctant to seek medical treatment. Do you face some of those challenges? Yeah, absolutely. In fact, one of the things that we come up against right from the start is that some of our patients, not only have they maybe not gone to a doctor in a long time, some of them have literally never been to a doctor. Some of our patients who are coming in, who are from Central America and recently arrived they have never been to a doctor and definitely never been to a doctor here in this country. I apologize for that sound. What we come up against right away is that. Then trying to show the importance of looking at their lives and looking at what they're doing and what they could do differently. They really have no idea that maybe there's healthier ways to do things. Then do they want to change how they've been doing things their whole lives in their families before then, and that's how they were taught. It is a big challenge and compliance is a huge challenge. We really have to explain, teach to try and get people to do defense to get ahead of those. It is a challenge for us absolutely. Well, I'm going to shift a little bit here. These are all of you talk of very personal stories in terms of working one-on-one with people in terms of how you approach community. Kim, you have a way in which to use data to inform strategies and decisions. I'm curious about what UVA community health does in terms of their use of data to inform. Yeah. They're usually utilizing data to understand community needs. Really good strategic direction to the work that we lead and its varying data points. We use public health data. Obviously, data that we see from the hospital, the community health needs assessments. That really guides our work. The hospital conducts a community health needs assessment every three years. As a collaborative approach that we work with many partners, such as the panel here today and key stakeholders in the community to really survey and ask the community what are the greatest needs? What are your greatest concerns and health concerns? Then we take that information and with the help of partners rarely look at building out a plan and solutions. The strategy they vary, and it depends really with what the specific problems are that are being addressed and the community demographics. What are those patient populations? Or where are the specific geographies like Eugene mentioned? Seeing high incidence of prostate cancer in Madison. We take all of that information and that informs basically our strategy with our partners on the solutions on where we should go for more education in specific geographies or communities or neighborhoods. I would like to turn the attention now a little bit from present-day to the future. Chris, in the work that you do, how do you do future planning? Taking what you know now from understanding how you work one on one with people how do you think about down the road and what to bring your folks down the road. Well, I think it starts with short-term goals versus long-term goals. We're talking about short-term strategies, how we're going to lay the foundation for, starting to produce some good outcomes and starting to feel good, and then understanding how those short-term goals, the small adjustments play a much larger role in the long term. One of the great things about making adjustments in your life is that they can be done at any time, then they're going to have a positive outcome. Whether you're 30 years old and you haven't lived the healthiest life or maybe you have and you just need to continue that or you're 65 just you didn't really have a focus on your health. There's no time in one's life where you can't start making these adjustments and they're going to have positive outcomes. Wherever you're starting, it's so important to understand that it's never too late to find what you need in your life to get moving and get healthy and understand all the positive benefits that are to come when you surround yourself with those habits and how those habits play off on the people around you. We're talking a little bit about the hour that I see people in the building, but I'm also encouraging, you know, these folks, like we said, these other 23 hours a day. Do you love to dance? Do you love hiking? Do you love nature? Do you love swimming? What is it? Is there something that you really enjoyed doing as a kid that you all a sudden started telling yourself that you can't do as an adult. What, why is that? Go back to those roots, go back to what you really enjoyed as, as a kid and find a way to make that come to life. Really see how that plays into your confidence, plays into your well-being, I mean, everything. It's trying to really understand the individual themselves and getting them to understand and see maybe movement and a different light. Like we talked about. Most people don't think about dance as a form of movement, but it's a beautiful form of movement and it's healthy, it's fantastic. It's really trying to, I guess, form those long-term strategies and align them with some of those things people maybe enjoyed one time in their life for or gave up. Or maybe it's something that they wanted to do but they never got involved in. But helping them find their way in movement and how to develop a strategy that is going to be something that they can sustain. Sustainability is huge in this whole conversation. That's true. A little bit of looking backwards in order to go forward, which is nice. I like that idea. Yes in some sense it's true What do you see down the road and currently the future of the organization that you're involved with and some other collaboration and partnership. What's your hope? Well as far as partnering, I have a lot of ideas and implementing those ideas. Tammy and can allude to this, we have a volunteer organization. It's hard to get volunteers to do something. One of the homestead, we wanted to start, I've been talking to our organization to come up with UVA health. But one of the thesis in the hospital are you serve and held that boots to your patients and your employees. That's one of the net's up my and with a lot of people, they always complain about the food and the hospital. But are you serving healthy, nutritious foods in the hospital? One of the things I wanted to work with them to partner with is, we have a lot of local small farmers here in the Kebab community. I wondered if maybe the hospital would partner with some of these small farmers and purchase healthy foods from them. Which I think Chris said something about sustainability. But if we don't support the local small farmers. I think the pandemic let us know when the supermarkets ran of the aids and milk and meat and all of that, it was a small farmer that got everything back together and got people feared again in the small farmer and the local farmers or what's going to, make this partnership work. Most terrific. Tammy, what's your hope for down the road? How do you see the free clinic participating in a more deep relationship with community? I think we have some really good partnerships. I'd like to keep growing them. I will say that the hospital has been amazing to our patients. They help with screenings, lab work, all of that so that our patients don't have to pay for that because frankly, they wouldn't involved in. They did have they just couldn't afford it. That in itself is very preventative for our patients. We have such a great partnership with the carvers school and minority and veterans farmers. We've even connected some of our patients through a program that is working with Hispanic farmers to develop more of them, encouraging that population to get involved with environments. We're hoping to keep that going and grow it to more since a large population of our patients are Spanish speaking individuals. I think there's lots of ways to keep people involved. We have some students through with school, we had some of the participants at options, a local youth program who also help with the gardens. I think that there's just lots of ways to keep going, and think about all ways to be preventative and proactive. I think so much of health is expensive for our patients. I hate to say that, but healthy food is expensive for our patients. We have been able to get some of our patients in for some fitness programs that they might not be able to afford also. I think all of that, hopefully, we can keep going forward with. You know how we can mitigate some of the cost of food by having remarkable guiding. Are there other tactics you take to mitigate that very real problem of cost? Yeah. There's a lot of good partnerships and quite happens to a lot of good programs for food between the churches and food bank. We try to make sure that they're aware of all of that as well. As Part 1 of our programs what we hoping to do next year is, we have some gift cards for some of grocery stores and our nutritionist work is to take patients into the store and teach them how to shop healthier. We'll have shopping around them outside of the store and in the middle of the store where all the canned goods are and all the saltier things. That's something we had planned to do this year, but COVID limited lot of that outing programs. That's something we're hoping to grow next year too. Kim, what's your hope for down the road? What program or programs would do like to see, to help mitigate these health risks? For cost should not be a barrier to ones health and well-being. I'm excited even just hearing more about some of the initiatives here with the partnerships and the opportunities that exist with the hospital and the health system. Again, forming these partnerships with local farmer and hosting, conducting free PFA trainings in communities. That I'm just really excited about the opportunities. I'm working more closely with each other to really bring these to our community and to neighborhoods that really need it most. Looking forward, I've seen the other side of this pandemic and getting back to in-person and being able to really provide these opportunities to our community and that obviously has been challenging, the past year-and-a-half and in a virtual world, be able to really connect with our communities. We need to start to wrap up here. I want to ask all of our panelists, is there anything that you'd like to talk about that has not been mentioned? Either as a unique partnership that has been established, either as something that you or your organization has done that has really made a difference that other people around the country and around the world should care about and could perhaps replicate? I was always taught of the young non-profit person that, one of the key elements of a good non-profit was that, it was replicable. I'll ask you first Eugene because you started, we'll start to end with you first. Well, I think one of the new initiatives that are intended, we just talked about this briefly, but as a pharmacist we talk about a food prescription. We want to do that and basically cost should not be a barrier to whatever, but when a patient leaves the hospital and Chris, he talks about exercise and I never thought about dancing. But in the African American, especially the elderly community hand dancing is something that a lot of people like to do and I think that's something we could get a lot of people to get exercise and make it fun. That's what we have to do, but we've got a lot of projects in this food prescription thing and we want to be able to give a person a prescription when they leave and say, "Okay, we want you to eat healthy." I posted something on Facebook the other day that I got from one place and it says, "The question shouldn't be why is eating healthy so expressive? The question should be, why is eating junk food so cheap?" I think it comes down to dollars. Like I said, it's cheaper to eat junk food than it is to eat healthy. Kim said it's something about removing the financial barrier to healthier lifestyles and I think I said, I know UVA health and I can allude to that with the free clinic. They provide so much free screening, blood work, lab work and all of that stuff. That's something that I think we need to continue those partnerships with. Like I said, we've got a good group of people there. We all work together. No man is an island so, we all work together and everybody works together, preventing, maintaining and doing that. I think it's going to be a good punch, especially in the cup of a community. Yeah. I agree. Tammy, is there a last thought you want to leave the audience with? I'm going to have to say that in the beginning of me starting at the Free Clinic, of course, COVID kicked right in and it limited so much of my ability to meet people and only seeing people on Zoom. But now I really think that the more that I've been able to get out and meet people this last couple of months, at least, the Culpeper community is very supportive and has a huge heart. They love to give. They love to be a part of things. The more people I meet and the more connections we make, it allows you to really brainstorm and really come up with some great ideas. I feel very hopeful that with that heart and with those connections, we can come up with lots of good new ideas and that we will find each other and grow with lots of ways. Perfect, yeah. Kim, do you have some final thoughts? Just to echo and add on what others have shared. I truly believe that community is the solution as we engage with the community to understand what are we facing, what are our greatest needs and involving each other in the solution because we have vested interests in building a plan together. Recognizing that health starts in our families, in our schools, in our workplaces. As we look at all of social determinants of health, it truly starts at an early age and outside the walls of the hospital. How we can work together really to address these root causes that influence health, I think we're going to see greater health outcomes as we really come together as the community and make investments and look at programs and initiatives that are addressing those root causes. Yeah, it's an optimistic approach. Chris, final thoughts. It's time to take action. This is a very crucial time coming off of the situation that we all found ourselves in and with a heightened level of awareness. People are more aware today than they were several years ago and it's becoming more important to people. I think it's really just a matter of providing those programs, the education, providing the opportunities for people to soak this stuff up. Because there is this higher level of sensitivity to the subject material and people want to get healthier now more than ever, I believe. If we can take advantage of this opportunity and not let it slide, it's going to be very important for the long term. Just touching on some of the stuff that we spoke about earlier, and even Eugene you mentioned dancing a second ago, just provide another example of maybe going back to our roots. I've seen in areas where community centers or public works programs have walking basketball leagues. Rather than playing basketball jumping, running, it's just strictly walking. That's all you can do. You can't run. For our older population, obviously, it's a little bit something that might be more enticing. What a great way to get involved in movement again, get back to your roots, find fun. But yes, it's about finding those things. It's important for us as we talk on this panel to take the action. We've got to create these opportunities. We've got to make things come to life. We've got to make people understand that they can trust us to provide those opportunities and provide sustainable programs that are going to help people long term. Perfect. Well, I want to thank the founder of the organization of LessCancer, Bill Couzens, who is producing this show and allowed us to join together this morning to have this conversation [inaudible]. Then we also worked closely with the Office of Continuing Medical Education at UVA with Wendy Sewack. Thank you to our panelists. This was informative and I heard such great stuff going on in the call pepper community. It's a wonderful thing to hear the word hopeful. I'd like to hope that that's how people walk away from this panel, it's feeling a little more hopeful about community solutions. Thank you.
