Kymberlee Montgomery

Transcript

Girls Just Want to Have Healthcare – Transcript

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KYM MONTGOMERY
You need to have trust and change. And the health care system has a lot of change to do.

MAURICE BAYNARD
Welcome to Drexel’s 10,000 Hours podcast. Our goal is to mine the stories behind our region’s innovators, inventors, and thought creators. We’ll be talking to experts in subjects from fashion to neuroscience to find out what lies behind the passion for their work, the inspiration for their ideas, and the motivation for their creativity.

I’m your host, Maurice Baynard.

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MAURICE
Kymberlee Montgomery is an associate clinical professor of Nursing and Medicine at Drexel University’s College of Nursing and Health Professions. As a clinician, Kim specialized in women’s health, specifically HPV and cervical cancer prevention and treatment.

Where did you grow up.

KYM
Far Northeast Philly. Went to Catholic high school.

MAURICE
Catholic high school. Where did you go?

KYM
Nazareth Academy.

MAURICE
What kind of a student were you as a teenager?

KYM
I was a good student. I didn’t have a choice.

MAURICE
Like straight A?

KYM
Straight A. Had to be. My dad was a police officer and didn’t want me hanging on street corners. So my place was to make sure that I had a career for myself.

MAURICE
What about your mom?

KYM
My mom was a stay-at-home housewife who made sure that everything I had was sparkly clean and very ironed.

MAURICE
How many brothers and sisters?

KYM
I have one sister.

MAURICE
So just two of you.

KYM
Just two of us.

MAURICE
So you guys have a close relationship? What kind of siblings were you?

KYM
We’re very close. We’re six years apart. So there’s a bit of a generation gap, a little bit there. But yeah, we’re pretty close. I was with her yesterday.

MAURICE
So what kind of Catholic school girls were you? Were you–

KYM
The kind that wore saddle shoes and blue blazer with your emblem being perfect, or else you were sent home.

MAURICE
Absolutely. And good, not like the smoking in the bathroom kind.

KYM
No, no.

MAURICE
Never.

KYM
I was a Goody two shoe.

MAURICE
Friends of the nuns?

KYM
I worked for them actually. When I was 16, I worked in their infirmary. So that’s kind of interesting.

MAURICE
That’s really interesting. So how did you get into the infirmary. How did that opportunity come about?

KYM
By then I knew I wanted to be a nurse because I wanted to wear the hat, which we’re obviously going to talk about. We used to bring cakes up to the infirmary, up to the Mother Katharine Drexel House, believe or not, every week.

MAURICE
Apropos.

KYM
Apropos. Isn’t that weird?

MAURICE
It is.

KYM
I didn’t think about that until now. So then they were asking for people who wanted to be assistants to help out. And that’s really where I started.

MAURICE
Can you think about a time before then when you realized that you really wanted to help people?

KYM
So my mom tells me that when I was a child, including the pedals on the flower that would fall off. I’ve always wanted to put things back together and to fix things. So I think really that is where it started.

MAURICE
Talk to me about the hat.

KYM
The hat. So everybody always asks me. And it’s the Year of the Nurse. And Nurses Week is coming in May. And people always ask me, so how did you know. When did you know you wanted to be a nurse? What was your first memory? Who did you idolize?

And I really don’t have a good story about somebody in my family who is a nurse, or somebody that I knew, that that’s how I wanted to grow up after that person because she was a nurse or he was a nurse. But it really was that my mother was a stay-at-home mom who really liked General Hospital.

So every day that was part of her routine as she ironed. And I–

MAURICE
The wicked Laura show.

KYM
Well, right. So one of the characters on that show who’s still was on the show– the last I checked. I don’t even know if it runs anymore– but she had this beautiful white hat and very starched white outfit, uniform. And my mother used to iron all the time. So I really loved the hat. And I wanted to be whatever it was to be that made me able to wear that hat.

MAURICE
It occurred to me that there were also like really interesting hats on nuns at the time.

KYM
It wasn’t white and starched.

MAURICE
That’s true. So you didn’t want to–

KYM
It was white, clean.

MAURICE
Grow up to be like a flying nun.

KYM
No.

MAURICE
It was always–

KYM
Absolutely not.

MAURICE
Always a nurse because of the white uniform and the hat.

KYM
Right, but for me I went to Catholic school my entire life. So I was taught by nuns. So to me that was probably normal. It wasn’t something that–

MAURICE
Wasn’t aspirational.

KYM
Well, it was normal.

MAURICE
Like a starched white outfit.

KYM
This was white, clean, great hat. And then when I graduated college, nurses don’t wear caps anymore. So I bought one anyway. And I had my pictures taken–

MAURICE
That’s worth saying.

KYM
With the hat. Yes. It still hangs in my mother’s home.

MAURICE
Do you still have the hat?

KYM
No, but I have the picture.

MAURICE
So where did you go to college, and what did you major in as a youngster?

KYM
So I went to Holy Family for the first two years, majored in nursing. And then I transferred to Thomas Jefferson University and I finished out my BSM the last two years.

Then I went to University Pennsylvania and I got my MSN. And I became a certified women’s health nurse practitioner. And then I went to Drexel University and I got my DNP.

MAURICE
So when I think about doctors, it may be the cases that sit with them. It’s always about the one that got away, the person who didn’t survive or the procedure that didn’t work out. But when I think about nurses, it’s always about the person who’s recovered and went home.

KYM
For me, it’s both. So for the person who recovered and went home, you made that world of difference to that person. So you’ve helped them recover. You’ve helped them through something very difficult.

But for the one who didn’t work out so well, or somebody that you lose, in my opinion as a nurse you didn’t lose. It’s a privilege. I tell my son who’s a nurse, it’s a privilege to help somebody into the world. It’s a privilege to help them conquer whatever it is that they need to– illnesses, problems in their lives. But the greatest privilege is to help them leave the world with dignity. So I think it’s across the lifespan of a nurse.

So it’s not about the one who you lost. It’s sad, it’s horrible. We’ve all had it. It’s not fun. But you have to look at it as the big picture.

MAURICE
Do you have a patient that you’ll never forget?

KYM
Yes, I do.

MAURICE
Do you want to share it?

KYM
Sure. So I worked labor and delivery. It was a happy place to work. And I was pretty new. And when you’re new as a nurse, you’re really worried about just making sure you don’t kill anybody, right?

MAURICE
Right.

KYM
Happy, sad.

MAURICE
That’s the goal.

KYM
You just want to go to work and make sure that–

MAURICE
Just going to come home.

KYM
That you come home and that that patient was OK. Because no matter how great your schooling is, every experience is different. So I had a patient who came into labor and delivery, and her baby was diagnosed with a cardiac defect. And the cardiac defect could have gone mild to severe, but they couldn’t diagnose how bad it was going to be until the baby was delivered.

MAURICE
Right

KYM
So the baby came out and crying and pink. And it was great. So we all thought everything was OK. And within 30 seconds, it started to get pretty blue. Transported right to the NICU and had some really difficult days.

And I checked on the baby a lot. I worked night shift. Checked on the baby a lot. Baby had up and down. And then I got a call when I came in saying, Kim, they need you in the NICU.

And I’m thinking, the NICU– I don’t do the baby part of this. Please don’t pull me there. Not expecting that I was going to the NICU for what I was going for.

So I went up to the NICU and they said, the family felt that you were here and brought their daughter into the world. They’d like you to be there with them when she leaves. And that’s a story that still makes me a little teary eyed. And I share that all the time. And I still do keep in touch with mom and dad.

MAURICE
So you mentioned you did women’s health. That’s your area of expertise.

KYM
It’s my thing.

MAURICE
So I mean, we could talk about that all day. We could ask, how do you think the way in which women are focused on in health care differs from men, both locally and globally. Let’s start there. What are the issues?

Well, yesterday was International Women’s Day.

KYM
Yes.

MAURICE
So from your lens, what are the things around women’s health that we are still ignoring or still needs the attention, both of the world and the medical community?

KYM
All of it.

MAURICE
Everything.

KYM
Yes.

MAURICE
We don’t understand anything about women.

KYM
We’re not there yet. Well, we do understand a lot about women. And now that women have a seat at the table and they’re being recognized for being beautiful, smart, sassy, everything that they are recognized for, we’re starting to learn to learn a lot more.

MAURICE
I mean, in your lens, have has women’s health improved over the last 10 years?

KYM
Depends on where you are.

MAURICE
But you know what I mean. And have you seen things in movements that give you a lot of hope? And are there things that seem to move slower than you’d like?

KYM
I think it’s a little bit of a mixed bag. So we didn’t pay attention to women heart disease. So now we have Heart Disease and Women’s month. So mammograms that aren’t being done, cervical cancer screenings that aren’t being done, education about sexually transmitted diseases and how to prevent them not being done.

So we’re not doing our job as well as we could. We’re getting there. But we’re not there yet.

MAURICE
If you had to grade the way in which women are attended to by the health professions just locally here in Philadelphia, what grade would you give it?

KYM
It depends on the location. If you have insurance and you can afford to see somebody, I think you get fabulous care.

I do think we have some wonderful, wonderful clinics for people who don’t have great insurance. But it’s educating the women to go to the clinics and to go and get care, and feel comfortable about going there. And that we’re not there yet in Philadelphia. We’re just not there.

MAURICE
What major problem are you working on right now? What do you passion about right now that you’re trying to move the needle on?

KYM
Cervical cancer screening. Women don’t go in for pap smears for many reasons. We’re better here than they are in Third World countries, which I’ve studied previously. But there’s a fear to go in to be screened.

A lot of people don’t even know what a pap smear is. They think it’s screening for cervical cancer, which it is. But some people also think it’s sexually transmitted disease testing. Some people think it’s ovarian screening.

And they’re not educated. And in fact when they come out of offices, they still don’t know they had a pap smear. And they don’t know what we’re screening for.

And then there’s pregnancy reduction or prenatal care, which is another issue, which is a big issue across the country, and infant and maternal mortality.

MAURICE
So it seems like both of those lie in communicating better to the general public. So what is it that we’re doing wrong? What is the message that we’re not getting out? And what are the organs of communication that we’re not utilizing?

KYM
That’s a good question. I think that the education piece, when women come into visits, whether it’s primary care, we don’t have enough time. The insurance company doesn’t give us enough time to spend with people.

So you have to do all your education while you’re taking a history, doing your assessment, doing an examination, and then trying to make a plan for a patient. And if you only have a little bit of time to do that, it’s very difficult to get all the teaching in.

So I’m trying to teach while I’m doing my examinations. So it’s about finding ways to get, as you said, the message out, making it easy, convenient.

We work. Women are now working. They’re not all stay-at-home moms. So how do you bring your child to daycare and go to work and try to get an office visit in? Or if you have only so much to go around that your family comes first, we as women are usually leaving ourselves to last.

MAURICE
So I wonder how much the way in which people have historically interacted with the medical community affects the way they feel about taking control or being part of that conversation? So I’m African-American. I think there’s a lot of skepticism around the medical community, either justified or not justified.

People go, if I go to the hospital, they are going to do something to me and I’m going to end up dead. I think an argument could be made for women who’ve been misdiagnosed or underserved as a group to feel that talking to medical professionals at the point of contact deserves some skepticism.

KYM
Correct.

MAURICE
How do we get over that?

KYM
We have to keep trying. Change is difficult. But you can’t get anywhere without change and reaching out and finding out what your needs are. If I reached out to you or any community and said, so, tell me what you need. How can I help you? What would make you seek care?
And you talked to me. I have to get your trust. And you’d have to trust me, no matter who you are, whether you’re from any community. And once you gain trust, then it’s a slow change over time.

You’re not going to walk into a place that you’re uncomfortable with tomorrow and say, I’m going to do this. It’s just not going to happen. You need to have trust and change. And the health care system has a lot of change to do– a lot of change to do.

And it’s not going to happen over the next year, maybe the next five years. But I think that if professional teams and health care teams really think about the need of the patient and having the patient at the center and asking you what you need– if I ask you instead of tell you you. And I say to you so, how do you feel about that, what do you think about that. And you would be like, well, this works for me or this doesn’t work for me. And I’m listening to you and I hear you? That’s going to make you trust me a little bit more.

And I think nurses do a great job of listening and bringing that message back to the team. So I do think it’s about listening and change and trust. But change is hard. Change is really hard.

MAURICE
Let’s just talk about some of the challenges in women’s health locally. What would you say are the leading two or three issues?

KYM
Well, women are still dying in childbirth. Women still have a high rate of diseases such as diabetes, heart disease. And we’re still getting cancer. And we’re not going in for screenings.

What keeps people from going in for screenings, although there seems to be a huge public messaging that you should be screened, should be screened, should be screened.

I think that’s that goes back to what we talked about before. One is fear. People are afraid to find out. I mean, you want to know, but you don’t want to know.

MAURICE
You do and don’t want to know.

KYM
You want to know, but you don’t want to know.

MAURICE
And when you say cancers, are we talking breast cancer, cervical cancer?

KYM
All of them.

MAURICE
The whole sheboo shebang.

KYM
All of them. We’re still dying, we’re still dying. We’re not dying at the rates that we previously did. We have vaccines. But you have to be comfortable to go get a vaccine or to get your child vaccinated.

We have mammograms that are improving. We have access to mammograms where we have mobile units that will come to your community.

But people are afraid to know. There are people who have not seen a provider in 15, 20, 30 years. Or they’ve only seen a women’s health provider to have childbirth, and have never gone. And they’re 70, 80 years old, because they’re afraid to know.

Then there’s the education of what they’re getting when they go in. So what questions do I need to ask? I’m afraid to talk to somebody. I’m afraid to give them history. I’m just afraid of what they’re going to tell me.

So there’s a fear. There’s an education issue. And then there’s life. So there’s, I work full-time, I cook and I clean, I drive my kids to where they need to go all day. And this is men and women, by the way. I don’t have time for myself.

And the only appointments I can get are six months from now. And when I make an appointment and I plan to go in, something happens at home. And I have to cancel my appointment. And then I can’t get another appointment for six years. And you know what, I’ve just given up.

I mean six months. I’m sorry, for six months. And I just give up. I’ve tried to get in. They can’t fit me in.

Or when I go in, I have to wait two hours. And I have to wait two hours and I have to pick my kid up from school.

MAURICE
And then there’s, how much will your insurance pay for. What is your copay?

KYM
Absolutely.

MAURICE
And if it comes to dinner on the table versus a copay, there’s not really a decision there.

KYM
And then there’s follow-up. And follow-up costs money as well.

MAURICE
So you mentioned infant mortality. And I think most people would find it shocking in the sixth largest city in America or here in the middle of the United States that infant mortality was high. What are some of the contributing factors that that’s the case?

KYM
So it’s care. It’s all about care. So if you get pregnant and you don’t go in for care or you don’t continue your care, for whatever reason, the diagnosis on a fetus or a baby is not made, and then the baby’s delivered. And there could be lots of different reasons, lots of different diseases, lots of different conditions that require follow-up.

And if you don’t know about it, that doesn’t mean that every baby who comes out we know that there’s– everybody’s not perfect.

MAURICE
Absolutely.

KYM
But then there’s also follow-up. And all of that follow-up on a baby, education about SIDs, education about what you put in a crib and what you don’t put in a crib, and what allergies and immunizations and all things that happen. And if the education is not there and the care is not there, we don’t have great outcomes.

MAURICE
What do we need to do improve that?

KYM
Education.

MAURICE
Like one thing that we could do.

KYM
Access to care. Period. Access to care. Make it easy for you to come and see me. Make it easy for you to come and talk to me. Make it easy for your life that you can come in, whether it’s your workplace, your home environment, your community center. It can be in a shopping center, but access to care.

And a lot of women, including third world countries, but in the United States, here in Pennsylvania, in Philadelphia, they don’t have great access to care.

MAURICE
Feels to me like there should be a nursing station in every supermarket.

KYM
Every corner.

MAURICE
We should be bumping into nurses everywhere.

KYM
Well, they’re trying to do that with urgent care. But that comes at a cost.

MAURICE
They’re almost on every corner. But it comes with cost.

KYM
That’s absolutely right.

MAURICE
I just saw on a TV ad that you can walk into a pharmacy, a certain pharmacy chain, and you can see a nurse practitioner, and you can get a prescription and take it right to the counter. And they’ll even get the medical equipment that you need.

KYM
But that costs money.

MAURICE
Absolutely.

KYM
It’s not free. None of it’s free. So access to care. We’re not doing a great job.

MAURICE
So just to follow-up, I would like to ask you a question about women’s health care specifically and those things that are cost prohibitive and how you see this nexus of the cost that it takes to do procedures or be screened, and how that relates to what access women do or do not have, do the things that are vital.

KYM
So let’s just talk about birth control.

MAURICE
Let’s just talk about birth control.

KYM
Birth control. So I believe that reproductive rights is a human right. And there are people who are pro-choice. We can get into that whole discussion.

But birth control option for a woman– in order to get a prescription for birth control, you have to see a provider. So if you don’t have insurance, that limits what you do.

And then there’s cost of birth control. So depending on what you can and cannot do. Some for medical reasons can do certain types of birth control.

Then there’s medical history, allergies, lots of things. So then when you settle on the birth control that is right for you, for many reasons, you have to go and pay for your birth control, which is cost prohibitive for many women in any form,

MAURICE
This would seem like a silly question. But in my entire life I’ve never thought about birth control or its cost. So if I were a woman and I were 18 years old and I wanted birth control, how much would that cost?

KYM
Depends on the kind that you’d want. So birth control pills can range up to $70 a pack.

MAURICE
That seems like a lot of money.

KYM
And more. It is a lot of money.

MAURICE
For a month’s worth of something.

KYM
Right, one month.

MAURICE
Right.

KYM
And if you’re 18 years old and you don’t have a job or you’re trying to feed a child that you might have at the age of 18 or 27 or 30.

MAURICE
So in your mind, how should we change the way in which money is a hindrance to care? What would you like to see?

KYM
Well, then we’re getting political.

MAURICE
As health–

KYM
I’m the type of person who would like to give everything out for free. And I understand it’s a business and you can’t do that.

MAURICE
As health czarina.

KYM
As health czar, I would be able to give women access to care for free. And I would give them access to follow-up for free. And I would give them access to whatever they need for free. I would actually do that for anybody, not just women.

But of course, the world is a business model. And we have to pay for things. And that’s why we work. And the costs of things are very high for so many reasons. And I think getting at that problem, why is the cost for everything so high, which, as a nurse, I can’t fix that problem.

MAURICE
I mean, this is a really interesting question. Is that a political question or is that just societal will? Not everything that costs money is passed on to the consumer.

For example, public education is free. And everyone gets to go to public school. Whether you argue about the quality or not, it’s free to everyone because we’ve made a collective idea, this is super important. And everybody should get to do it. And so we underwrite it.

KYM
So public education is free, but in order to go to school you have to have shoes and you have to have clothing and you have to shower.

MAURICE
All of that’s true.

KYM
And not everybody has that.

MAURICE
That’s right.

KYM
Accessibility. There’s women and children that live in shelters. And they can’t get to school. They can’t even get to a school. There’s transportation.

So it’s not about it just being a free ride. There’s lots of variables that you have to think about. It’d be great if we can just send all our kids to school and just go. But that’s not really the way the world works.

MAURICE
But we are agreeing that birth control should be free.

KYM
I believe birth control should be free. There’s a lot of people who will definitely disagree with me. But I do believe that birth control should be free. I think prenatal care should also be free. Making sure that you’re healthy and see a provider and making sure that everything’s going OK and answering all your questions about what you can and cannot do that will give you the best possible outcome for you and the child should be free. But it’s not.

MAURICE
Dr. Kim Montgomery, thank you for being here on 10,000 Hours.

KYM
Thank you for having me.

MAURICE
Drexel’s 10,000 Hour podcast is hosted by me, Maurice Baynard. Our producers are Shaun Fitzpatrick and Nathan Barrick.

KYM
Drexel’s 10,000 Hours podcast is powered by Drexel University Online.
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