Providing medical care for refugees, for foster children and for movie sets: Upstate Medical University's HealthLink on Air for Sunday, Jan. 16, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a doctor discusses how she helps refugees from Afghanistan settle into new homes in Central New York.

Andrea Shaw, MD: Every individual is going to take a different path to how they're going to get through that and what's going to help them heal or what's going to help them stay healthy or functional here in the United States.

Host Amber Smith: A pediatrician explains how caring for kids who are in foster care differs from caring for kids who are not.

Steven Blatt, MD: They may have untreated asthma. They may have a lot of dental caries, but have never made it to the dentist. They may not have their eyeglasses.

Host Amber Smith: And a paramedic shares what it's like providing medical care on movie sets in Syracuse and around the world.

Heather Drake-Bianchi: You hope that the medic on a movie set is largely not doing anything, but inevitably, you know, you're there for traumatic incidents and illnesses of acute nature.

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, a system of medical care for kids in foster care marks 30 years of service.

Then we'll hear about CineMedics, a company that provides medical care on movie sets. But first, Dr. Andrea Shaw talks about resettling Afghan refugees.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is HealthLink on Air. The United States accepted more than 65,000 people from Afghanistan after the U S and allied troops left the country. And less than a month later, Upstate's refugee health team was caring for the first families of Afghan refugee.

That work continues. And today I'm talking with Dr. Andrea Shaw. She's a doctor who specializes in internal medicine and pediatrics, and she leads the refugee health team. Thank you for making time for this interview, Dr. Shaw.

Andrea Shaw, MD: Thank you so much, Amber. Happy to be here.

Host Amber Smith: Syracuse is a "sanctuary city," which means we support the arrival of immigrants and refugees. And part of that is making sure these people who are new to our community have health care. How are the refugees connected with your team at Upstate and who pays for their healthcare?

Andrea Shaw, MD: This was a big topic of discussion that was decided very quickly, as things turned very quickly in August. So mid August, when that, when the U S troops pulled out of Afghanistan and they evacuated this massive number of people, they had to figure out a safe pathway to move them along. The United States and Syracuse was not specifically built or organized for humanitarian relief effort, which is what many countries that typically shelter refugees are set up for. We don't have refugee camps. We don't have humanitarian medicine missions. We don't have a UN (United Nations) foothold that helps to support and keep people safe and support basic health needs. So the only system that we had in place, set across the United States, was a long history of resettling refugees. So the United States used that same pathway to move these 65,000 refugees.

Along the pathway that a hundred thousand refugees were already set to come on this year, which is along national organizations that have local branches like Catholic Charities and Interfaith Works, who then partner to assign families and support their resettlement needs. So among those resettlement needs is healthcare, and the federal government allows newly resettled refugees to be supported by Medicaid insurance. Each state has a different plan for Medicaid insurance. We're fortunate to live in New York State where we do have Medicaid expansion that covers most of these refugees for many years after arrival, until they're able to surpass the poverty level and provide for themselves, or be in jobs that provide them alternative insurance. So they are supported by Medicaid health insurance, and that's how we're able to provide service to them in our institutions.

Host Amber Smith: What are the first visits like? Do you, do you typically see an entire family together, or are they separately scheduled appointments?

Andrea Shaw, MD: So I've been very fortunate to have supportive staff at Upstate that have helped me to think outside of the box because most medical systems won't allow you to schedule more than two people from a family at one time, because they don't want to lose a whole clinic day, if the family can't make it. So. I said there's really no other way that makes sense for me to serve these families. They've been through a highly traumatized process. Syracuse was not the place they thought they would land months after their whole lives turned over in Afghanistan. And they come from all different backgrounds. We're getting everyone from translators who worked with the US Army, people who worked as Afghan nationals with the Army for years, people who were just medical students who jumped on the plane to get to a safer life, to people who lived very rurally in Afghanistan, who may not have been offered education or health care where they came from. So we see patients who are across this entire spread, and for them to come to Syracuse and be introduced to Western medicine, a new language, a new culture, not to mention snow, has been a big transition. So I feel like the more we can do to center our own resources, and really basically get everybody to rally together. It really takes the whole clinic to make this happen. If you don't have everybody on board, these patients aren't going to feel supported. Whether it's from the point where they first meet somebody, where you set up a live interpreter and our interpreter services helps us to get the right dialect so that we have the Pashto interpreter or Dari speaking interpreter ready when that family comes, that takes a lot of community clinic partnership to coordinate that.

So the community has to be there to help them with transportation. Our side of clinic has to be there ready to receive them. That first visit we'd like to have a live interpreter present because even though we have great interpreter services through the phone or through video, it's really hard for them to understand what's happening in the setting, when you have two parents and seven children, and you're trying to get them all through a basic health screening, a basic physical and triage any medical complaints. So the nursing staff basically it takes everybody to just step out of a standard encounter and really be there to just serve the family where they're at.

No one family that comes through is the same. No one family has the same needs. And so whether it's the dialect that we're focused on, whether it's certain medical problems that we have to triage or whether it's their social needs, even people in the clinic who get together with donations and make sure that the kids have a stuffed animal that's age appropriate to hold, or a bag full of things that their Medicaid or their food stamps doesn't cover. When you have eight children and they all need boots, how do you make that happen? So our clinic works closely with the community to coordinate around these services, and it's everything from the little things to the bigger things like making sure the Medicaid insurance is working and making sure they can get to the pharmacy, making sure they can get medicines available, working with the health department and making sure we've done public health screenings for tuberculosis and gotten people treated appropriately for parasitic diseases, all of it as part of the process.

And over the last three months, we've found a system that has gotten smoother and smoother each week. And we hope to provide Afghan families a safe place where they can come to get their medical needs met and to keep them healthy in their transition to Syracuse or whatever the step is after that.

Host Amber Smith: So, as the physician, what is your goal of this first primary care visit? It sounds like you have a lot of ground to cover.

Andrea Shaw, MD: I always tell the community it's going to take me all morning, whether you send me a family of three, or you send me a family of 11. We're just, we've got the morning, and that's what it's going to take. Because the amount of education and the amount of building bridges of trust and creating a safe space where people have never really been introduced to a system like this, where they have a primary doctor where they have a primary care medical home. They're coming from a system where they're used to only waiting until the wheels fall off or a serious problem is there, and they're going to go pay for somebody to fix something. But that model only works in America in the emergency room. And that's not the best place for these families to really get non-emergent problems dealt with.

Host Amber Smith: This is Upstate's "HealthLink on Air. "I'm your host, Amber Smith, talking with Dr. Andrea Shaw. She leads the refugee health team at Upstate, and we're talking about settling refugees from Afghanistan into the Syracuse area.

I wanted to ask you how often you see mental health conditions that were either caused by or exacerbated by the traumatic experience of leaving Afghanistan so abruptly.

Andrea Shaw, MD: So I should say, there's no way to predict how trauma is going to affect an individual until you're working with that individual in front of you. Because we know by definition, any refugee, no matter where you are in the world, has fled persecution. So everybody has a baseline level of some degree of trauma, but human beings are incredibly resilient, and everybody processes that trauma into the fabric of their being very differently. And it's impacted by everything in their social environment as to how they're going to cope with that. So their genetics and their environment is going to predict how they respond to that baseline of trauma. So when I teach about refugee health, we think about it like iceberg.

So the very tip of the iceberg is what we deal with when CDC and the state put forward guidelines that suggest we need to screen for these infectious diseases, because we're seeing cases of measles, we're seeing cases of hepatitis A, we are at risk of polio concern, given the fact that Afghanistan is one of the last places on earth, where wild-type polio is thought to exist. These are public health, infectious disease concerns that are at the tip of our pyramid and amongst the things that we screen for and address right away.

The middle of the pyramid or the middle of the iceberg there is really the bulk of what people who have had a lifetime of trauma and poor connectivity to regular mental health and preventive health care. They're going to identify chronic diseases. So, whether it's a lifetime of stress that puts you at higher risk for diabetes, hypertension, or heart disease, or whether it's just a lifetime of chronic stress that's changed your metabolism and puts children at higher risk of obesity once they find themselves in a food secure place, all of these are chronic diseases that we deal with in refugees. And then what sits underneath the iceberg, that's in the water, is that underlying history of trauma. And so that history of trauma and how it plays out to that individual may come forward as something that appears like a diagnosable mental health condition.

It may come forward as an impaired function that the individual has. But every individual is going to take a different path to how they're going to get through that and what's going to help them heal, or what's going to help them stay healthy or functional here in the United States. And so it certainly takes a creative team to be able to respond to the individuals of that individual's need, because there's no one... One of the residents asked me, "well, don't you just refer everybody to psychiatry when they first come into the country?"

And there's a lot of challenge taking a global population, or even a population focused from Afghanistan, and simply referring everybody to a psychiatrist when they first come in. You have challenges of language, you have challenges of culture, and you have challenges of accepting discussion about mental health and what that means to that individual and the cultural perception about mental health. And that's influenced by a lot of things -- the individual, their social environment, their religious context. So, mental health is very important to the work that we do, but it's very much tailored to the individual's need, and thankfully we have a lot of collaborative partners, both through social work and through school counselors and through a lot of people who recognize this underlying trauma and take a trauma-informed approach to how we provide care to people.

Host Amber Smith: How long do you see a refugee family as a patient? Do you become their primary care provider, or do you help them find long-term physicians that will follow them throughout their time in Syracuse?

Andrea Shaw, MD: We are one of four sites that accept new refugees to Syracuse. So Compassionate Family Medicine, Syracuse Community Health Center, and St. Joe's, and Upstate are the four sites that new refugees will come to. So we will take new refugees who have Medicaid insurance. And certainly after people move out of Syracuse or move to the suburbs or simply change their primary care doctor they will transition in whatever way works best for their family. But those who decide to stay or receive services that fit them well will stay within our group, and we just look to how we can expand that. As we move to the new ambulatory building and the Nappi Wellness Center we'll have a separate center for international health, where the providers who right now provide various levels of part-time support for this group will be able to come under one umbrella that Upstate will support in the center for international health, moving forward.

Host Amber Smith: Do you know how health care in America differs from health care in Afghanistan?

Andrea Shaw, MD: I've not been there myself, so I can't speak directly. But for the most part, many of our patients give two different answers. Those who were connected to the American forces on the ground, who either worked as translators or as engineers or consultants with the U.S. Army, said they were able to access care at U.S. Army bases. And they said that was very timely, and they liked it because they didn't have to deal with Medicaid insurance and the frustrations that they're struggling with me now on a referral process that seems to be taking longer than they wanted it to take. But then there's many others who are part of the Afghan national army or who were Afghan nationals themselves, and they said insurance was very hard to come by because any sort of national or social supported plan covered very few things. So most things you had to pay for out of pocket. And people typically just went to the doctor when they were really sick with something.

Host Amber Smith: So preventive care really wasn't a thing for some people, at least, there?

Andrea Shaw, MD: MD: Not commonly.

Host Amber Smith: Do you have a feel for how welcomed the refugees feel in the Syracuse area? How are they settling in?

Andrea Shaw, MD: I think it's a tough transition when their lives, when they didn't expect this. I think some of them mentally had gone through the motion of, this could potentially be something someday. The fact that some of them already worked with the U.S. Army suggested an openness to that. But I think for many others, especially who were, who had lived in Afghanistan their whole lives, they did not expect their whole life to turn upside down in August. And they were not ready for their families to be split apart. So I think that's been the most jarring thing for those who are here, without a clear path forward as to how they're going to reunite their families. When you have one parent here with young children and another parent there, or another parent of missing and children that remain in Afghanistan, I think that's the hardest thing for people.

We don't have an immigration path put forward that really gives them any hope of reuniting. So even though they could take their Afghan IDs and save up and get on a plane and go back home, there is no way to bring their family to safety, and they left an unsafe environment. They just don't have a way to reunite the rest of their family. So I think that's the most unsettling thing. So no matter how friendly or how many nice faces or many of our services that open up to them, at the end of the day, as long as they're family members back home in Afghanistan are in the unsafe situation that they're in, I think it's going to be hard for them to really settle in to life here But they're doing the best they can. And I can say with certainty that they are very resilient and the children are already engaged in school, and they fully recognize... I've had families tell me, "Doc, we've spent the last 20, 30 years of our life in war. We never thought we would leave war. So to be in a place where we're not at war is an incredibly settling moment, even though we don't know what the future will bring for sure, and we don't know how to get the rest of our family to safety, we're certainly safe now."

Host Amber Smith: If anyone who's listening to this would like to help out in some way, what would you advise? Are there organizations they can connect with?

Andrea Shaw, MD: There's three organizations in town, Catholic charities, Interfaith Works and Rise, the Refugee Immigrant Self Empowerment Group are all local, community-based organizations who have been long supporting refugees who come to this area and really took up the call when the government said we have 65,000 Afghan nationals who need homes. They stepped forward, and they said, "we will stretch our staff, expand our services, do everything we can to provide them a safe new home." And so that's access to social services. That's access to safe living conditions. And a network of people that are here to really see that their transitions and safe assimilation happens. It takes a lot to do all of that and to really support people in the setting that would normally be supported in a humanitarian camp. In any other country where people fled across the border, there's humanitarian emergency relief set up and our country, even though we weren't originally set up to do this, I'd say everybody stepped forward and heard the call. Just human to human, people are all doing their best right now.

Host Amber Smith: Well, I thank you for making time to talk about your work. My guest has been Dr. Andrea Shaw. She specializes in internal medicine and pediatrics, and she leads the refugee health team at Upstate.

I'm Amber Smith for Upstate's "HealthLink on Air."

Dr. Steven Blatt has cared for kids in foster care for 30 years. Next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." A health care program for children in foster care marked 30 years of service in 2021. And today I'm speaking to its director. Dr. Stephen is a professor of pediatrics at Upstate, where he also directs the ENHANCE health care services for children in foster care.

Thank you for taking time to talk with me again, Dr. Blatt,

Steven Blatt, MD: it's my pleasure to be with you. Amber.

Host Amber Smith: ENHANCE health care services for children in foster care has been operating for 30 years. Can you tell us how it came to be?

Steven Blatt, MD: Sure. So as with many communities back in the late 1980s, Onondaga County was going through a crisis in foster care, and the children's division for the county was developed at that time. And the deputy commissioner, a woman named Diane Erné, contacted Dr. Howard Weinberger, who was in charge of general pediatrics, and said, "How could we at Upstate help the county? So we met and planned and the county did the same, and we came up with the model, back in 1991, that is still pretty much the same today.

And it was based on what was then the best practices, the best available models that we knew of. And it's held up over the last 30 years.

Host Amber Smith: Why was there a crisis in the early '90s?

Steven Blatt, MD: So in the late '80s, early '90s, there are a number of things that had happened. One is HIV was reaching its peak, and, so many young mothers had to deal with thathorrific disease at the time.

It was also the peak of the drug epidemic, with cocaine especially. So we had a lot of people suffering from substance abuse as well as HIV. And the number of children in foster care were just exploding. And when we started in the early '90s, we had a thousand children in this county in foster care.

And so we had a lot of kids. We had a lot of parents who were not well equipped to handle the kids or to take care of themselves. And there was no organized system in place. One of the things that we've learned, especially during COVID, is that an organized medical system is much better than a disorganized one.

So back then there was no system in place to take care of the children. So the first thing that we did is, we established the system. We had one place, which was ENHANCE, at Upstate, back here for all the kids in the county in foster care. And we also had the proper staffing for it. Back then, as we do today, we have pediatricians, nurse practitioners, a child psychiatrist and a case worker from the county to provide care to this very complex population of children.

Host Amber Smith: What does ENHANCE stand for?

Steven Blatt, MD: ENHANCE is an acronym that was created by one of our colleagues, Maureen O'Hara, when we started ,and it stands for Excellence in Health Care for Abused and Neglected Children. And I just want to focus on the first word, excellence, because that's been our guiding philosophy: to make sure that these kids get the excellent health care that they deserve. So I've seen it described that youprovide primary health care and comprehensive health care. What's the difference?

That's a great aspect you picked up on.

So, primary care: People today, although not so much 30 years ago, but people today are familiar with the term PCP or primary care physician or primary care practitioner. And that means somebody to do the routine health care of children. So for children, it's a lot of immunizations, looking at child development, looking at the structure of the home, how they do in school, but comprehensive care acknowledges the situation these kids are in.

When you look at children entering foster care, they have a tremendous amount of mental health needs, developmental delays, unmet health care issues, such as asthma, children that have a high rate of being exposed to drugs and alcohol intrauterine. So we need extra services to provide for these kids.

And then on top of it, once they're in care, we're very active. Placing them into care creates new issues. You know, most kids do not have a judge who's going to oversee their care. Most children live with their family, and you don't have to make visits to visit with your family, and all of these types of issues and more create new opportunities for anxiety, depression and turmoil in a child's life.

So we need a lot of help to take care of these children.

Host Amber Smith: You said when this started, there were a thousand kids in foster care. What is that like now? How does that compare to today? And can you talk a little bit about how things have changed in 30 years?

Steven Blatt, MD: Sure. One of the biggest changes locally and nationally for kids in foster care was the 1997 Adoption and Safe Families Act, which is called the ASFA, A-S-F-A.

And what that did from the federal governmentis, it refocusedwhat we do in foster care to pay attention to a lot more of the child's needs. So one of the big ways that this is implemented is that when a child comes into foster care, the clock starts ticking. And within 15 months of placement into foster care, the county and the court system have to move towards either reunification with the biologic family, so send the child back to the mother or father, or to move forward with what's known as a TPR: Termination of Parental Rights. And what that means is the judge will decide that this child will never go home to the biologic family and will be free for adoption. So prior to ASFA, kids could stay in foster care for five years, for seven years, for nine years, for a very long time. Now with ASFA, the decision is made much sooner in the child's life to decide to reunify with the parents or to say they're going to be free for adoption. And partly because of ASFA, the population of children has decreased significantly. So now in this county we have between 450 and 500 kids in foster care, as opposed to a thousand 30 years ago. It was even lower than that, but it goes up and down depending upon what's going on. I think the other thing that has happened to help keep kids out of foster care, Is, I think there are a lot more services available to biologic parents to help them get back on track, because it's important to remember that for the vast majority of kids who go into foster care, their parents are not bad people.

They are people that have big-time problems. They suffer from alcoholism or mental illness or drug abuse, which is an illness. And they need help. The vast majority of them are people in poverty, and they lack skills, and they need help. So the goal is to help the parents become better parents, to become more independent, better citizens, so they could take their kids back.

And so there are more services to help these parents, who, I just want to emphasize again, are, by and large, nice people. There's some people who are not good parents, but most of them were just people with a lot of problems. And so there are a lot more services for these folks.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air."

I'm your host, Amber Smith, talking with Dr. Steven Blatt, professor of pediatrics and the director of the enhanced Health Care Services for Children in Foster Care. From a pediatrician's point of view, how is the kid in foster care, different from a kid who was not?

Steven Blatt, MD: So I spend time clinically taking care of kids in foster care and kids who are not in foster care.

And there's a lot of similarities and there's a lot of significant differences. To begin with kids in foster care need everything that every kid needs. They need a stable home and nurturing parents, loving parents. They need developmentally appropriate environments and good schools. If they're sick, they need their medications.

Kids in foster care need all of that, but there are a few things where kids in foster care are anticipated to have extra needs. So many of the kids coming into foster care have not been getting routine health care, so they could come into care either lacking appropriate immunizations or lacking health care.

So that they may have untreated asthma. They may have a lot of dental caries, but have never made it to the dentist. They may not have their eyeglasses. Kids in foster care, by definition, come from the neglected homes. So that increases their risk, that they will have different mental health issues. So many kids come into foster care, either needing counseling, or what they all need is a stable home and a stable foster home could really help stabilize many of these children and the different,things they're going through, such as anxiety, depression, conduct disorder. So they need stability and everybody needs that, but kids in foster care, by definition, all need it.

And that's why they need access to a lot of professionals. So we provide them with a lot more doctor-patient time. We have a child psychologist. Many, many of them end up in counseling or come in with counseling and continue that. And then the foster parents, they need a lot of support too, because these are kids who, even if you take a child and put them into a nicer home and a more stable home, with more resources, it's still not their home. And that is very anxiety provoking to anybody. A child an adult, an adolescent, anybody out of their home, they get homesick in one way or the other. They miss their home, the smells, the food they eat, their friends. They move to a different neighborhood, maybe different schools. And so it's very anxiety provoking. It's upsetting, it's depressing. And so the foster parents have to take care of these kids day by day and support them. And then, the kids have to learn a new way of living, and the foster parents have to guide them through this.

So the foster parents need a lot of support also.

Host Amber Smith: Do you see, among foster kids, do you see a higher proportion of chronic medical conditions? In addition to some of the mental health things you described?

Steven Blatt, MD: Absolutely. When you look at kids in foster care, some of them, when they come into care, the neglect that they have has created medical conditions, such as poor growth is one, certainly mental health issues.

There are some kids, unfortunately that come in, they've been physically abused or sexually abused. And all of these things have physical and mentalproblems that persist. And then other things: I mentioned asthma before; we have great medications, great tools to treat asthma, but if you don't have access to them, you're going to be in bad shape. And many of the kids that come from environments, where, because these kids are in poverty, they may have environmental factors, such as mold and mildew and smoke that just make their asthma worse. So a lot of kids come into care with a history of chronic illness and recurrent illness, and once in care, a lot of these get remarkably better. Another thing that kids come in with are developmental delays. Some of it has to do with being in a neglected environment. Some of it has to do with just the genetics that they had; they were born with problems. But those kids need extra services, and if you're a parent that's struggling to begin with, you're not going to be able to get those extra services.

Host Amber Smith: How has the pandemic impacted kids in foster care and the foster care system in general?

Steven Blatt, MD: That's a great question. And it's an important question. To begin with, the kids in foster care, like everybody else, nobody has come out of this pandemic without having issues without having bad things happen.For kids in foster care it's even worse. So let me share some of the things with you. So in the height of the pandemic, children were not allowed to visit with their biologic parents because everybody was on lockdown. So not only were you in foster care, but you couldn't see your parents, and yes, a lot of kids would do Zoom meetings, but if you're 6 months old, 15 months old, that doesn't work very well.

Similarly, if you're a parent and you're told, OK, what you need is to go to, drug rehabilitation and the rehab center was closed down because the COVID, you can't begin your therapy. Soyou're in lockdown like everybody else, you don't have access to your kids, you don't have access to therapy, you're going to continue doing drugs. So it was not good for the biologic parents, then for kids and their parents in foster care, the judge would say, come back in six months, so we can check the progress on your case. But six months later, the courts are closed down. So you can't meet with your judge. So you're stuck in limbo even longer. And whether the judge wants to reunify the child with the parents or terminate parental rights, nothing happens. So there's a huge backlog in the courts.

So everything is just magnified for the kids in foster care, and then even things such as um, some of the health care things, and the biggest one is for COVID vaccine. Because when COVID vaccine first appeared for each age group, including the adolescents, and then the kids, it came out under emergency use authorization and we needed informed consent and the state and the county want the biologic parents to do that, so kids (in foster care) didn't have the same access to COVID vaccine as other kids.

Host Amber Smith: I had not realized that.

Steven Blatt, MD: Yeah, it's just one more barrier to getting COVID vaccine into kids. And we're getting some in, but it's very cumbersome.

Host Amber Smith: As the vaccines are becoming more widely available and more people are getting vaccinated, at least in the U.S., how soon do you predict that things will get back to normal in the foster care system? Because you mentioned there's quite a backlog.

Steven Blatt, MD: Things are beginning to move again. Right now it's in December when we're talking, and last month was National Adoption Month, and, there were a number of adoptions, that happened in the county, which is nice because those children and families had been in limbo and the courts are operating again fairly regularly, although there are still some delays. So it's like everything else; it's coming slowly back online.

Host Amber Smith: Thank you for taking time to tell us about this. My guest has been Dr. Steven Blatt from ENHANCE health care services for children in foster care, and he's also a professor of pediatrics at Upstate.

I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," a paramedic tells about providing medical care on movie sets in Syracuse and around the world.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is HealthLink on Air." Heather Drake-Bianchi is my guest today. She's a Syracuse native who is specialized in critical care medicine as a paramedic and who has a set-medic business called CineMedics CNY. Thank you for taking time to talk with me, Heather.

Heather Drake-Bianchi: Of course. Happy to be here.

Host Amber Smith: Now, let me start by asking, did you do your paramedic training at Upstate?

Heather Drake-Bianchi: Yes, I did.

Host Amber Smith: How long ago, and what was that like?

Heather Drake-Bianchi: Oh boy, that was roughly eight or nine years ago. And I chose Upstate because it had a longer and more in-depth, more comprehensive program. It was, oh man, I did it at the same time as doing my second master's degree, which I don't recommend, but it was one of the toughest experiences, next to undergrad, I would say.

Host Amber Smith: OK. Well, now, Syracuse is becoming a bit of a film hub, where lots of movies are being made.

Did you start CineMedics because you saw a need for providing onset medical care in Syracuse?

Heather Drake-Bianchi: Yes. Myself and my colleagues, we're all movie-set production medics, providing medical support, you know, everything from small productions to hundreds of people at a time. And then when COVID happened, our scope as on-set medics expanded beyond just medical support.

There had to be a system put in place and designed from the ground up on how to keep people at work, but how to do it safely. And our background as first responders with managing large-scale incidents, especially taking that experience from working in the city as a paramedic, was instrumental on making that actually happen.

Host Amber Smith: Interesting. Well, I imagine that COVID has changed a lot of things, but I'd like to understand, what does the set medic do in normal times when COVID isn't a concern? What is your job like on the set?

Heather Drake-Bianchi: Yeah, absolutely. You hope that the medic on a movie set is largely not doing anything, but inevitably, you know, you're there for traumatic incidents and illnesses of acute nature. But what actually ends up happening is when you work with the same film crew over and over again, you become their most trusted resource for a number of their medical questions and concerns. So in addition to treating any injuries or acute illnesses that come up or helping to just make somebody feel better, a lot of times, people in the movie industry works such long hours, that money isn't their currency. It's free time, and they don't have the free time to seek out what are much-needed resources for their personal care. So a lot of it is not just acute (care), but recommendations for who they should go see, why it's important that they see their primary care physician. Helping them to navigate when it's time to go to the hospital versus when they could go to an urgent care or when they should go see their primary care doctor.

And then to a surprising degree, it's helping them navigate who's accepting new patients, when they should go, encouraging them to actually be seen, getting their yearly blood work drawn, because it just doesn't happen. They're some of the most under-cared-for population that I've come across. And that was very surprising.

Host Amber Smith: Right, because they go wherever the movie's being filmed. They're not at their home. They're not where they can go see their regular doctor, I guess. Right?

Heather Drake-Bianchi: A lot of times. The film crew locally, some people are from New York City or from other parts of the state, but even the local people end up working 16-hour days.

And so even though they're here and might know where to go, they don't have time to go. So a lot of it is being a trusted resource and encouraging them like, "Yes, you have this high blood pressure, and you know, we have been talking about your high blood pressure for six months now, you really need to be seen for that." And educating them about the importance of self-care.

Host Amber Smith: Well, you mentioned COVID, so in order for movies and shows to still be filmed, there's all these COVID protocols that you've had to put in place, and that applies to the stars and the crew and everyone on set, right?

Heather Drake-Bianchi: Yes, everybody.

Host Amber Smith: So are people generally daily tested or every week are they tested?

Heather Drake-Bianchi: So similarly to an incident command system, there's various zones: that inner zone where the talent is acting and they don't have their masks on, the people that are in that zone and around it have a more frequent testing cadence than people that are working, say, in a separate building or on the periphery of that. And so in that central zone, they'll either test daily or multiple times a week, depending on the incidence of that geographical area.

When COVID first hit, we were testing every day to three times a week. When Syracuse waned to become a low-incidence area, the frequency of testing relaxed a little bit, but as numbers have ebbed and flowed, so has the testing cadence. It's meant to be a scalable protocol.

Host Amber Smith: This is Upstate's "HealthLink on Air." I'm your host, Amber Smith, speaking with Heather Drake-Bianchi. She's the paramedic who founded the CineMedics mobile medical services and risk management business in Syracuse.

Now your website, the CineMedics website, says that you provide event, remote and austere medical services.

What are some examples of places where CineMedics has gone? Because it's not just you, you have a whole team of people that are working with you, right?

Heather Drake-Bianchi: Yeah, there's an extensive team. They come from all different backgrounds from austere and remote paramedics, people that have been in conflict zones; there's a few of us that have quite a degree of experience in conflict zones. There are film experts, there's logistics experts, there's people that just come to make sure that they pick things up and put them down and do a lot of the heavy lifting. There's event planners. There's people that do procurement. I mean, it's a whole collaboration of different backgrounds of individuals.

And as far as where we've been, we've been all over the United States and outside of the United States. We're starting a project in London this week. I have another team member right now in Sierra Leone. We just wrapped a large project for HBO in LA. New Orleans. Florida. Boston was another big project. We were the primary medical resource and PCR (a test used to check for COVID infection) testing laboratory for the film that's coming out this week called "Don't Look Up." It's a large-scale Netflix production.

Host Amber Smith: So you've been all over, lots of travel, it sounds like.

Heather Drake-Bianchi: Yeah, we, the team, basically works and lives together. Because we're traveling at any minute of every day, but it's been an adventure. It's been great.

Host Amber Smith: Now, as a paramedic, you have all your equipment and medications and the ambulance, but if you're on a movie set, or you're out in some remote area, how are you able to fit everything that you might possibly need into something that you can carry, or a backpack?

Heather Drake-Bianchi: Part of the team is that we have a couple of gearheads who just love everything about gear, have a variety of backpacks and it's like a whole field of study. I would say I'm a gearhead as well, but that would be to discredit some of the people that I work with who are just phenomenal experts in this.

So , rather than working out of an ambulance, which is absolutely not the case, in what we do, everything is in a backpack. Everything is collapsible. Everything that can be collapsible is, without compromising the degree of medications that we carry. It doesn't compromise any of our equipment, but everything is portable.

So we have a kind of a series of packs where the medical gear is stored in backpacks, as well as personal gear.

Host Amber Smith: So, what are, can you walk me through some of the most important pieces of equipment that you have? I mean, you have some life-saving medications, but you also have some tools and equipment.

What is most essential that you need to have?

Heather Drake-Bianchi: I think the most essential things are medications or treatments for injuries and illnesses, where if you don't solve it within the next five or 15 minutes, you have a real problem. So EpiPens (to use for severe allergic reactions), for example. There's been times that we have supported a film production that's 40 minutes away from cellphone service, and that's just cellphone service. That's not even 40 minutes from help. And so you really need to have an EpiPen and then subsequent Benadryl (to treat allergic reactions). And then, to be able to treat those injuries and illnesses, obviously gross bleeding and trauma supports.

I was working on a sailing ship in the Mediterranean when there was a wave came up and blew one of the individuals back into the mast, and he actually fractured two vertebrae. Now he was fine. He didn't have any long-term problems, but managing that acutely was of the utmost importance until we could even get to the point of, not just getting to a hospital, but getting to land. And that was a four-hour trip. So you have to think about things a little bit differently than if you were working in a city or even one of the counties, because when you're hours or even days away from help, it's completely different way of approaching medicine.

Host Amber Smith: Wow. It sounds like it.

Heather Drake-Bianchi: Yeah.

Host Amber Smith: Automatic external defibrillators -- do you have those?

Heather Drake-Bianchi: We specifically look for smaller defibrillators that can fit right in the pack. But in addition to medical supplies, some of the most important equipment that we have is various types of communication. If you were to bank on always having cellphone service, you wouldn't be an austere paramedic.

You have to think of various types of communication. So we don't just think of communicating via cellphone service, but also via satellite. And we recently integrated technology where we could text and communicate via radio waves. So there's always safety nets to our initial plan, because if there's anything that we've learned from being a completely self-sufficient logistical laboratory, it's that you have to have backup plans and that's every scope of not just medicine, but how you operate.

Host Amber Smith: So if you have an injury and you're out on a remote set that's, you know, minutes or hours away from definitive medical care, do you drive the injured person or do you call an ambulance service? I mean, how do you get the person, if they need hospital care, how do you get them there?

Heather Drake-Bianchi: t depends on where you are.

Host Amber Smith: There's a couple of us that have worked on various sailing vessels, and when that's the case, you're not calling an ambulance, you're calling, if it even is close or accessible, you might call the Coast Guard. We've had to medevac patients with MIs (myocardial infarctions), or heart attacks, off of a ship in the Bering Sea before, and that, that's complicated. So you treat as much as you can site. And once you've identified that you actually have a problem that needs to be fixed immediately, you have to either call in a helicopter or you have to use local contacts more than anything because you can't be both the transportation and the medical provider. As an austere paramedic, you're not just doing the medical, but you're also doing the overseeing for logistics.

Heather Drake-Bianchi: That's transportation, it's communication. It's getting in touch with the hospital, depending on how extensive the incident is, especially if it's multiple people. And then you can't forget about treating the patient in and of itself, which is an entire job. So an austere paramedic, and this goes back to why I've hired the people that have hired, you have to be able to multitask better than any field that I can think of.

Host Amber Smith: So are you in contact, or do you have the ability to be in contact, with a physician or your medical director, if you need them?

Heather Drake-Bianchi: Yes. You would kind of have to be. You can do it via satellite phone or via communication with radio , or cellphone if you have it. And if you're not calling your medical director, more so than not in an acute injury or illness, you're getting in touch with the local hospital or depending on where you are, the local medical resource.

Host Amber Smith: It's not always a hospital. A lot of times it's a clinic or in some of the more difficult of situations, you are the resource, and that's very humbling.. It's a large responsibility

I saw that you once served as a paramedic for National Geographic. What was that like?

Heather Drake-Bianchi: That was interesting. It was for both film and for National Geographic. it was something called "The Raft," where the premise of the project was that people are stranded at sea in a raft for weeks at a time. And I was the support medic, not just for the various ships that had the filming crew and the support crew, but also for these people that were stranded in a raft for weeks at a time.

Host Amber Smith: Interesting.

Heather Drake-Bianchi: It's a lot. It's a lot of not sleeping. (laughs) It's a lot of like keeping track of people over a long period of time. It's a different way of approaching things because in an, a traumatic injury, you know what the problem is in front of you, but when you are the medical support resource for a multi-week, multi-month project, the changes that you see medically, they're slow.

That's not always acute. So you can't get lazy or complacent, you have to always be on top of things. And so, a lot of that is either not sleeping (laughs) or being sure to just keep communication channels open.

Host Amber Smith: You majored in biomedical sciences at RIT (Rochester Institute of Technology), and then you got a master's in human anatomy and physiology.

When did you decide you wanted a career in science and what drew you to become a paramedic?

Heather Drake-Bianchi: When I started at RIT, I was originally a photojournalism major because I just loved connecting with people. But then as time went on, the recession, back in early 2000, happened. And so, it really changes your outlook on things.

I switched to medicine after a couple, just incidents at school, started taking science classes and finished in biomedicine. Later when I went on to get my master's in human anatomy and physiology, but I actually did a second master's degree from Syracuse University in molecular DNA analysis, as part of the forensic program.

And, that's been instrumental with COVID, but choosing to go into medicine, it comes from wanting to connect with people as much as possible and wanting to help them as much as possible and being advocates for them, especially with the local film community. It was incredibly humbling to make these close connections with colleagues and later friends in the local film community to help to advocate for them. Because that's, that's what medicine is, is helping to advocate. Whether you can help them directly or you're getting them to help. It's the same thing.

Host Amber Smith: What do you look for in a paramedic that you're going to hire for CineMedics?

One, they have to be good with all sorts of personalities. You know, we don't just deal in medicine, but in the Hollywood industry, and they're some of the most intense personalities I've ever met. We're not an entry level company. I trust my team implicitly. I don't micromanage them. There's no trust in that. So if somebody with a work experience and people that have multiple different types of backgrounds, they don't have to have a formal education, but depending on the role, it helps. But by no means is it required. It's somebody who has actual life experience and has an opinion about things and helps to advocate for, not just patients, but for a team. But more than anything, they have to be team oriented because you don't accomplish what we have by working as a solo person, regardless as to what perspective it's coming from. It has to be integral with teammates. And that's what medicine is.

I thank you for taking time to talk with me. My guest has been Heather Drake-Bianchi. She's the founder of CineMedics mobile medical services and risk management in Syracuse. I'm Amber Smith for Upstate's "HealthLink on Air.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week selection.

Deirdre Neilen, PhD: Richard Wu is a recent graduate of the university of Texas at Dallas. He writes, paints and composes at the intersection of art and medicine. His poem "Hospital Moongazers" reminds us that healing can incorporate cultural traditions as well as medical treatments.

"Hospital Moongazers"

On Mid-Autumn Festival

I brought you mooncakes

And we nibbled them

Together in your hospital room,

Our mouths flecked with crumbs

Like the stars strewn

Across the night sky.

We ignored the beeping machines

And the smell of disinfectant

And the doctors and nurses shuffling outside.

But we watched the moon

Glinting through the window,

A full moon -- yellow and engorged

As if it had gotten hungry

And eaten up the entire sun.

We could see the moonlight

Sprinkled over the ground

Before your bed,

The color of early morning frost.

And so you said,

I'm thinking of a poem,

And I smiled and said,

"Quiet Night Thought."

And then we both

bowed our heads,

Thinking

Of home.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe with sound engineering by Stephen Shaw.

This is your host, Amber Smith, thanking you for listening.