Season Finale: Reimagining Healthcare with Dr Noha Aboelata, MD

Dr Zeest Khan (00:01)
Welcome to Long COVID MD. I'm your host, Dr. Zeest Khan, a licensed and board certified physician who's also a patient with long COVID. I've applied all of my medical expertise and understanding of the healthcare system to my recovery. And now I want to share what I've learned with you. On this podcast, we talk about my own experience with long COVID. I share evolving science behind this disease, and we discuss safe

reliable treatment strategies that you can consider with your healthcare team. Remember, nothing I say here replaces personalized medical advice from a licensed medical specialist. Now let's get started. Welcome back. This is the last episode of Long COVID MD for a few months. We're taking a break for the summer and we'll be back with some fantastic content. ⁓

Stay tuned until the end. I'll share ways that you can stay connected with me until the next episode launches. But I wanted to end the season on an aspirational note. Since I started the podcast in October of 2023, I have learned so much about the experience of the chronically ill, especially in ways they interface with the health care system.

The short story is that the healthcare system was insufficient before the pandemic started and it has been damaged severely since. So what do we do when we don't feel like we can trust our healthcare system to meet our needs? What is a model we might be able to use ⁓ that has a better way of doing things? Well, today I have a guest who might be able to answer that question.

Dr. Noha Aboelata is the founding CEO of Roots Community Health based in Oakland, California. Their healthcare system is quite unique and takes a very holistic approach to patient care. They understand that health is influenced by much more than prescription medications and what happens in the exam room. They identify and try to improve several determinants of health for each patient.

This is really what supportive healthcare looks like. And I'm so honored that Dr. Noha took time to share the foundations and the founding principles of Roots that allows it to serve its patients so holistically and so effectively.

And it is effective. When the pandemic hit, Roots was able to protect its community because the community trusted its messaging. The community took precautions that Roots suggested and were tested at much higher rates than surrounding areas. In fact, Dr. Noha and her team became a public health resource, not only for East Oakland, but for the greater Alameda County of the Bay Area.

When so much medical care feels disjointed and subspecialized, I was really interested to learn and share with you just how Roots maintains a cohesive approach to healthcare. I'm so pleased to be able to share this conversation with Dr. Noha Aboelata with you.

So Roots does a lot. I started by asking Dr. Noha, what is Roots Community Health?

Dr Noha Aboelata (03:30)
Roots is a community health is interesting. We just did a rebranding. We were called community health center, Roots Community Health Center since the beginning. And over the last few years, I think we started to realize it's so much more than a center. And it really is outside of the four walls, so to speak, of the exam rooms or of the clinic.

and it's really about community health. And so our mission is to uplift those impacted by systemic inequities and poverty. And so if you think of a traditional health center, that's a very different sounding mission. Of course we treat diseases and of course we want to control chronic diseases and we want to prevent suffering, but we know that that's a lot more than just the medical care.

And so in addition to full scope primary care for the life spectrum, we also provide behavioral health care. We provide what we call navigation, which is really, we have a significant workforce of folks from the community who share life experiences with the members that we serve, who we train as community health workers and health coaches and systems navigators.

and they have their own panel of members that they work with. And that's really a big part of, think, the secret sauce of Roots ⁓ because it really is, ⁓ I think, honoring and harnessing the brilliance that's already in the community and the assets that are already in the community to help ⁓ address some of really pressing challenges.

We have a street medicine team that goes out to the encampments and takes care and other services directly to the encampments. We have ⁓ services inside of the jails, in the jail parking lots We speak with people right when they're coming out. We provide food and a lot of benefits enrollment into not just Medi-Cal, but also CalFresh food stamps and other

entitlements and benefits that can help folks really get stabilized and get on their feet. And sometimes our greatest hope is that they won't be eligible for those benefits after we've been working with them for a while, because we also address many of the direct barriers to good health, which have everything to do with poverty. And so we actually have two social enterprises where we train folks in light manufacturing and really help them.

overcome barriers to employment. So it's really designed for folks who have been marginalized from the workforce for one reason or another. And we do quite a bit of training and assisting folks with either their educational or their workforce employment goals. And so we really work with folks across a number of different areas of life, domains of life, we call them, and help them move into a place certainly of security.

one of the key parts of what we do is to advocate because we know that we can't really address all of the disparities and the challenges that we face sort of in one patient at a time. ⁓ Many of it was caused by systems. And so in order to really get to that place, we'll have to work to address those systems.

Dr Zeest Khan (07:03)
Given how embedded Roots is in the community, it's easy to see why Roots was considered a trusted resource when the COVID-19 pandemic hit. I asked Dr. Noha about those early days of the pandemic and how she and her team decided to respond.

Dr Noha Aboelata (07:24)
⁓ I think first off we were watching it very, very closely from the first moments that we heard about it. and when SARS-CoV-2 started to make its way over, ⁓ to the United States and to sort of the West coast, and even locally that one of the early cruise ships actually was docked.

in Oakland provided access for those folks. And we immediately were, you know, we kind of shifted immediately into ⁓ advocating, learning more, making sure that our community was going to be okay. Because with an impending sort of crisis along the way, we sort of knew like no one's coming to necessarily to East Oakland.

⁓ we're going to have to figure out what to do. And one of the first things around the docking of that ship actually was the workers, the folks that work at the docks, the folks that drive the buses, the folks that work at the airport and how all of those individuals that were in what was really a terrifying situation of being on this ship with this massive outbreak and

We didn't know what that was going to mean. And many were coming back home to the Bay Area, but many were traveling onto other places. And just the alarm around just making sure that our community would be protected when they came back to their households, many of which were low income and multi-generational households. What was that going to mean? How are we protecting them? And so really thinking about their safety and protection.

And then how are we going to be able to respond? And so we were ⁓ very quickly mobilizing to figure out how are we going to get enough PPE for ourselves? How are we going to be able to test? We began testing in March of 2020. And I remember, you know, was like this, test and the PPE, know, together because, you know, and just figuring out how you're almost going to like ration these very limited supplies and not knowing where you were going to.

get your next supplies from. We stood up the region's first walk-up testing site. That was in April of 2020. So up until then, definitely some companies had stood up ⁓ some drive-up sites. But you really had to have a car and a computer to book the appointment and time to be able to go get that done. And we said, well, that's not going to work for our community.

Dr Zeest Khan (10:12)
So, Roots designed its own COVID testing centers, ones that met the needs of this specific community. Not only were the testing sites physically accessible, they were also emotionally safe run by people that the community already trusted. This is the opposite of cookie cutter medicine.

Dr Noha Aboelata (10:31)
We're gonna need a way for people to walk up with whatever they have and get what it is that they need and not have to set up an email account or whatever all of the barriers that were being put up at the time were. But I think even more importantly is like we were already trusted in the community. Folks already knew who we were. ⁓ And there was so much.

Speaker 3 (10:43)
or

Dr Noha Aboelata (10:58)
misinformation right from the beginning and so much mistrust that it was very helpful for folks to come to our site and to be able to see folks that they know and understand, like we're not ⁓ taking your DNA to do anything with it or any of the other things. And this wasn't the first time that we had heard things like, ⁓ know, fears about them putting something in the nose, you know, when there was testing because...

We heard the same thing at the time of the Affordable Care Act with Obamacare, like, if you sign up for Obamacare, you're going to get like a GPS or like a chip, you know, or something like that. ⁓ And so, you know, the mistrust of health care within our community is very well earned and ⁓ is a real factor that has to be considered with anything that's going to be implemented at all.

And so I think, you know, at some point we were having lines just all the way down the block and wrapped around and everything. And of course, you know, we wanted to be able to serve everyone, but we wanted to first and foremost make sure that our community had direct access and was going to be able to have, you know, the most low barrier way to get not only, you know, testing and then later vaccination, but just information. And I think that was one of the biggest things is that.

Because we were testing so many people and we started so early, we started far in advance of any other community sites. ⁓ And because we were so accessible to folks within our community, we were really testing people in the zip codes that really already had some of the biggest challenges. And so we were able to share the information that we were learning.

at the testing site because at some point we were really testing a large percentage of people who were actually getting tested and getting those results.

Dr Zeest Khan (12:51)
Pay attention to what Dr. Noha is saying here. Not only was Roots providing acute clinical care in the form of testing and then later in vaccinations, they were actually doing real-time community-driven public health work.

Long before officials named the risks for essential workers and for low-income neighborhoods, Roots was seeing the patterns and then sounding the alarm.

Dr Noha Aboelata (13:23)
So we were able to say, this zip code is really facing some challenges. We've got an 18 % positivity rate in this zip code with all of these hundreds of people ⁓ or folks who are working in construction, in groceries. We were lifting some of that up earlier than we were really hearing it from any leaders or anything like that, just because we were asking those questions.

you know, what type of living situation, what type of work, what type of transportation, really so that we could not just learn for ourselves, but to be able to give that information back out into the public. And so we found ourselves really ⁓ being placed kind of in a role of, you know, helping to educate and inform as things were sort of unfolding. And, you know, with all the challenges that obviously posed as well. So I think we kind of

were already sort of in this role, certainly for our patients and our immediate surrounding community, but then everything just became very, very amplified in those early days of the pandemic. And we really stepped in early and in a significant way, I think, to be able to inform what it is that we all should be doing.

Dr Zeest Khan (14:39)
What Roots did in the pandemic wasn't just a public health service. It was a demonstration of public trust. Dr. Noha and I talked more about the relationship between healthcare and public trust. And I asked her how medicine can earn back that trust, especially when people have very valid reasons to distrust the system.

Any conversation about rebuilding trust has to start by understanding where the distrust stems. In this next section, Dr. Noha was kind enough to explain some of the structural barriers to healthcare that have existed, often along racial and socioeconomic lines in East Oakland. This is applicable, however, broadly across the United States.

And as Dr. Noha explained some of the barriers to health care that existed for adult men in particular in 2008 before the passing of the Affordable Care Act, I want you to remember that this conversation is relevant today. The debate over who deserves access to health care is ongoing and a big part of the current budget spending bill in Congress right now.

Here's House Speaker Mike Johnson arguing why some people should not be able to access Medicaid even if they qualify by income.

Mike Johnson on Fox News April 13, 2025 (16:06)
We have to eliminate people on, for example, on Medicaid who are not actually eligible to be there. Able-bodied workers, for example, young men who should never be on the program at all. When you have people on the program that are draining the resources, it takes it away from the people that are actually needing it the most and are intended to receive it. You're talking about young single mothers ⁓ down on their fortunes at moment. The people with real disabilities, the elderly.

And we've got to protect and preserve that program, so we're going to preserve the integrity of it.

Dr Zeest Khan (16:38)
Tell me more about your thoughts on how healthcare can be a trusted resource in a community.

Dr Noha Aboelata (16:45)
Yeah, I think it is ⁓ complex and I'm sure that for each community it looks a little bit different. ⁓ For our community, when I first set out as that two-person volunteer operation back in 2008, really looking to understand why do we see the health disparities that we see in Oakland in particular? And what is the reason for this?

you know, 15 year life expectancy difference between African-American man, you know, in East Oakland versus ⁓ maybe someone else that lives up the hill, just a few miles. And so really 15 years. And when we look deeper into it, and this was back, I just remember looking at maps and just trying to understand what, what is this? What we all, when, when we have, you know, these great,

⁓ hospitals and clinics and a safety net and all these things. How could we have disparities this wide? And what is really going on? And, I think if you maybe, you know, read the headlines or things like that, people would say, it's the violence or homicide or something like that. And what we found when we really dig dug into the data was not at all. It's really not to say that that doesn't have an impact because we know

trauma, particularly from childhood and multi-generational absolutely has major impacts on health. But what people were ultimately dying from was the same thing everyone else is dying from, but just earlier. So cancers and heart disease and stroke. so it really kept on bringing up more questions. Well, you know, if we have all this great safety net, ⁓ why is this disparity happening? And so

As we sort of dug into it, I think we found out a number of things. And of course, some of them are really about the environment and just structural reasons ⁓ that have been, you know, purposeful in the history of this country. And so if you go back and look at ⁓ redlining in East Oakland, the redlining map looks just like the disparities map.

So the same area is lighting up in terms of where you couldn't get loans or where people were excluded from economic opportunities or where bad polluting industries were allowed to come in. So now we have, you know, disparities in terms of asthma and heart disease and stroke and all of these other things, much of it directly related to poverty. But that's not to let healthcare off the hook at all. I think

the things that we learned in those early days, and of course this was pre Affordable Care Act, is that there were, of all, sectors of the population who could not access outpatient primary care at all. And to a very great extent, this was our low income men, so-called able-bodied adults without dependents. And it's just one of the policies that have

disadvantaged, think particularly men or disadvantaged families. Section 8, many of the social services were available to women and children. And health care itself was very much oriented around women and children, even in the safety net. And so if you're a man under 65, essentially, you really couldn't get Medi-Cal, Medicaid. And so in

those early days of providing care and going around to places like transitional housing and substance use facilities and things like that and really learning. ⁓ First off, there just wasn't even basic access. And so I would have patients tell me, know, when I would ask them how they got into ongoing care anywhere, and the only place that would have had a chart on them would be the prison. So that would be the place you would get ongoing care.

Speaker 3 (20:44)
⁓

Dr Noha Aboelata (20:48)
but anything else would be episodic and it would be emergency department. And we know that emergency departments are just simply not equipped ⁓ or suited for that purpose. And so the relationship that a lot of folks had was just, you know, wait till you're really dying or really just like where you can't wait anymore. And that's when you're entitled to this. That's when you're even allowed to go access. When you get there, oftentimes you are met with people who don't look like you.

Speaker 3 (21:13)
And then we

Dr Noha Aboelata (21:18)
who don't understand what you've been through, who sometimes don't even really know what questions to ask, and who are not taking the time or don't have the time or are not making the connection enough to have any kind of trusting relationship. And so when you're not in a trusting relationship with someone, but you're in a power position,

and you're also the one who is telling that person what to do, that person who doesn't trust you and who you've not established any rapport relationship with, ⁓ the natural thing for that individual to do is probably not to listen to what you had to say. And so the next time you come back, now you are non-compliant, ⁓ which is a label that healthcare has placed disproportionately on people of color and especially African-American men ⁓ to basically say,

This person isn't listening to what I'm telling them. So that sort of signals to other people who may see that chart or other folks on the care team ⁓ that you might not need to try as hard anyway because this person is so-called noncompliant as if that is some kind of static label or diagnosis to be placed upon someone ⁓ when the actual fact of the matter is that relationships are two-way and ⁓ medicine in general has not

really take responsibility for its end of the relationship and I think has increasingly seen itself as sort of this, know everything, you came to me, I'm gonna tell you what to do next and move on to the next. there's so many demands placed on physicians and healthcare providers in general. ⁓

And so what you often find is that people then are going into the healthcare setting, are expecting to be mistreated. And we know that when people are hurt and have been hurt before and they're coming in with that expectation, you're already now starting off in a more tense situation that can then put those care providers on the defensive because they of course feel that they're just there to help.

Dr Zeest Khan (23:30)
Hmm, this is a good enough time as any to take a contemplative break to reflect on some of the things that Dr. Noha said in that section. There are structural weaknesses of our healthcare and social services, and those weaknesses are most evident and most dangerous among marginalized communities. But you don't have to be part of a marginalized community to identify some of these issues.

Does your provider understand the context of your life? Does your provider understand your illness? If they do, you will tend to trust them more.

If they have insight into your life and your illness, the provider may be able to identify important medical issues more quickly than someone who doesn't. It is not surprising then that gender and racial concordance between patients and their physicians is linked to improved health care outcomes. This is why we need more physicians who reflect

patients, ethnic and cultural backgrounds. It's also why we need more physicians understanding long COVID and other complex illnesses. Dr. Noha explained how in the context of this history of distrust, how Roots started to gain trust. The first step was humility.

Dr Noha Aboelata (25:00)
I guess for, for me and for roots and from the very beginning, think what we talked about a lot was it doesn't matter how great we are, right? We actually have to work to overcome all of this distrust that has been earned over years or over. That is our job. Even if we didn't do it, even if we've never done it, people are coming with that already because we are healthcare and this, and this institution and the system of healthcare.

⁓ has so many examples of systemic racism baked into it and so many examples of just disregarding people's own lived experience and what they're bringing and what they know about themselves and their health and things like that, ⁓ that our job is now to actually overcome all of that and so whatever that takes. And so there's just a number of things that I think we've done from very beginning in order to accomplish that.

But I think just starting even from that place was so critical in how we have then evolved.

Dr Zeest Khan (26:02)
Roots had identified what the existing medical structure might have done wrong, and the next step was to determine how to do things better. Once again, Dr. Noha and her team took a simple but not easy approach, and that was to listen.

Dr Noha Aboelata (26:19)
think a lot of it is really listening, ⁓ really meeting people where they are in every way, literally as well as just in terms of their state of readiness to listen, engage or anything, but really being ready to listen. ⁓ I mentioned that we started out with kind of more questions than answers and that means

You know, I can have all this medical education and a degree and all this stuff and come with all these tools and information. ⁓ But clearly if I am part of a system that is generating these disparities, there's things I don't know or things we had not figured out as the system. We haven't figured out how to address it. And it's really just not enough to just know about it. Like, yeah, if someone's poor, they might, you know, this has cut my version of what I remember, you know, from training is like,

They might be late for their appointment or maybe if they're missing their appointment, it might be because of transportation or childcare. Okay, yes. And what does that mean? What are we doing about it? Like, how are we directly addressing any of these things? Certainly understanding is a good starting point. So I think listening and I think having folks who are, you know, really part of that community being able to serve. And so I think being able to, ⁓

build the value and be part of it at every step of the way. And so I mentioned our navigators. It's not just the navigators, it's the outreach workers, it's the folks that are going to the encampments or who are in the streets talking to people. And a lot of it was in the years prior to the Affordable Care Act for us initially was even just getting people to want to sign up to get coverage.

because once again, people felt like this isn't a system that has treated me well anyway, and I'm just gonna wait until I absolutely have to engage with it, and I don't need to do all of this signing up. I think for us, we knew that it wasn't just about getting people signed up for healthcare coverage if they weren't gonna have access to places that would be suitable for them and where they could feel welcome and not judged.

And so I think was having to do all these multiple things at the same time because we never want to say, ⁓ you know, you can't trust any of these systems, don't engage in at all. think our perspective has been you are entitled to this. You were entitled to this coverage. You're entitled to this care. You're entitled to know about your health. You're entitled to be able to advocate for what you need. And so it really came along as sort of, you know, what

what we all deserve and what we have a right to because I think at some point from all that listening, I think what I came away with ⁓ was that there was a real ⁓ sense of disempowerment within those systems, within the healthcare system and no even desire to sort of self-advocate.

Dr Zeest Khan (29:35)
So here's another way that Roots is different than a traditional healthcare system. Instead of blaming patients for not utilizing resources they don't know they have access to, Roots focused on rebuilding power within the patient community. One of the most radical things they did was to teach patients how to advocate for themselves in a system that had taught them that it might not even be worth trying.

Dr Noha Aboelata (30:03)
And so we really felt initially that what we actually had to do was to work hand in hand with folks to just help build their own sense of self-efficacy within our own systems. And so that is also, I think, a bit of a paradigm shift, even within Roots to this day. If you're not clicking with your primary care provider or with something, you absolutely should.

see a different provider or, you know, we want you to get what it is that you need regardless of where that is. And I think that's also very different from a healthcare perspective because if you are engaged with somewhere and you're doing great, perfect. ⁓ But more often than not, we found that people really just were not engaged anywhere. So even if they had that card in their pocket and some, you know, name of someone was on there, they were not going there. They were not accessing there. And so it was really a lot more about

What is it that you need for your either, you know, your own history, your own age, your family history, all of those things, learning about that and learning how to ask for what you need because you deserve this. So initially that was our, we had sort of like a, I think it was, we were calling it like a healthcare bill of rights or something like that. ⁓ But it was, ⁓ you know, know your, know your stats, you know, so we have like a whole thing around baseline labs.

Everyone should know their baseline labs and their blood pressure. Do you know and know your family history? That was another big push because these are things that sometimes we don't talk about within families. And so this was something we would always encourage patients to go find out more about

And so really building, I think, a sense of self-efficacy because that does make it so that ⁓ even, I think, there's some level of acceptance that some of our systems aren't not changing anytime soon or certainly not overnight. And as great as we can make roots and as much of a home as it can feel like, there are going to be times when we have to send you to other places or where you are going to have to engage with other parts of the health system.

And so do you feel prepared and equipped and being able to say, you know, well, I have a doctor at Roots and knowing that, you know, we're going to be able to advocate for you as well or help you be able to advocate for yourself. And so that was a big part, I think of some of the most effective pieces that still until now continue to be really important because we're sort of helping our own members and our own patients to advocate for themselves even within.

our own systems and to ask for what it is that you need and to be forthcoming about what those needs are. And that's a lot of where the navigators are so instrumental too, because they've been there. So they're also sometimes going to ask the questions that might not get asked within the doctors, within the exam rooms. And so I think that breaks down a lot of barriers as well when you have someone that's really asking like, okay, are you...

you're sleeping on someone's couch, like how long is that gonna last? What do we need to do? How can we assist you with that? Things that we really just don't often have time for within medicine.

Dr Zeest Khan (33:16)
This combination of emphasis on self-agency, self-efficacy, and partnership is really exemplified by the People's Health Briefing, a video series on YouTube hosted by Dr. Noha in which she updates the public on public health issues, including COVID-19 precautions and levels. It began at the beginning of the pandemic as a way to share reliable information.

And it continues today. Here's the clip.

Speaker 3 (33:47)
you

Dr Noha Aboelata (33:50)
Welcome

everyone to the People's Health Briefing, key component of our Trusted Voices campaign. I'm Dr. Noha Aboelata from Roots Community Health, reporting for the week of June 2nd, 2025. After an update on contagious illnesses, I will try to make some sense out of new and confusing guidance regarding

Speaker 3 (34:09)
COVID vaccines.

Dr Zeest Khan (34:11)
Unfortunately, we still need help making sense of confusing guidance. I asked Dr. Noha how the people's health briefing got started and why it continues today.

Dr Noha Aboelata (34:22)
Yeah, so it was back in those early days of the pandemic when we were learning so much because of the role that we were playing in terms of testing. And we were, of course, reading and talking and doing all the things that a lot of us in health and healthcare were doing. And I think all of that kind of made us this resource that people were constantly sort of calling and tapping into to get questions answered. And we were doing a lot of that proactively as well with our

partners, because everyone was just scared and not sure what to do. And so we found ourselves putting out quite a bit of, ⁓ you know, just guidelines of how we're going to, you know, kind of navigate what the CDC was saying and the state was saying and the county was saying, or if anyone was saying anything at all, there was quite a period of time there where it seemed like most of what we were hearing was sort of at the national level.

It was this very, very overwhelming. We also had patients just wanting to try to wrap their head around it. And it was almost, in a sense, too much information early on. That was just very overwhelming. And people were having a hard time figuring out how it related to them individually. We were having so much ⁓ kind of media questions, people trying to come around to the testing site and find out about what we were learning and what was going on. And so...

we kind of realized like we need something locally where folks can get information that is digestible and relatable and is sort of can be put into some practical steps.

And so at some point we said, well, maybe if we can just put out, you know, update, kind of a quick update, because we were seeing press releases and news conferences and things like that happening again at the national level, but maybe we could do one that's sort of like really tailored to what is happening in Oakland and just, you know, give succinct information to share what it is that we're learning and then what it is that we're hearing. And so I...

I really didn't think it was gonna be something that would last more than six months or something like that ⁓ because of the newness of it all. So we started in about June or July of 2020 and it turned out to be a resource that folks who were just any everyday person to people who were working on the front lines.

colleagues in city government or other areas who just wanted sort of that quick, concise update about what was going on. And we will really look at all of the data that we can get our hands on. Initially, it was very local because that was really the main focus. And then over time, as we lost local data sources, I think things...

had to keep evolving, had to keep evolving. But there's never been sort of a shortage of something to talk about, especially as it relates to COVID. But I think for us, the reason why we were so kind of ready, I think, to spring into action to respond to the COVID pandemic is because I think we already kind of saw ourselves in this role in community health where it wasn't just about the patients that were coming in the door. It was really also about us going out and trying to find the people that we're most concerned about.

and bring them in or at least build that bridge over time for them to know that we're a resource. And so that could have been with any number of things, you know, within the community that we were, you know, that we're educating about and talking about. Any other, many of them are certainly contagious diseases, HIV and hepatitis C and other things that we would go out and test and educate around.

And so this kind of just, this really amplified it obviously, and it was a huge increase in terms of the, just the sheer volume and numbers of people. But I think it's really along those same lines of what is the information the community absolutely needs to know in order to be informed and to protect themselves and their loved ones and their community. And so, like I said, there's been no shortage of COVID topics to keep discussing, believe it or not. You know, it was just like every week there's still something new.

Well, you know, ⁓ but I think also thinking about what else are our threats to the public's health and how can we be talking about those things and how can we be very honest and transparent about not just what we know, but what we don't know and how we're kind of navigating uncertainty. And so the format has very much been, I think from the beginning, it kind of still is like, this is what we know, this is what we don't know.

And this is our best advice. And so in addition to COVID, we're often talking about at this time, you know, some of the concerns that we have around disinformation and misinformation and how that's translating into lower vaccination rates for regular childhood illnesses, but also other emerging infectious disease threats. And, you know, even some of the issues around our mental health as well.

⁓ because that I think we are increasingly recognizing as a community health issue. And it was probably along with homelessness, our top issue that we were focusing on before the pandemic hit in terms of how do we really talk about mental health as a community because it was really already reaching crisis proportions before the pandemic and has only continued to do so. So those are some of the things that we talk about and kind of how we think about.

our role in terms of talking directly to the community and not ⁓ dumbing it down and oversimplifying it to the point that was a lot of the critique that we were hearing from folks. It's like either too complicated and overwhelming, or it's so oversimplified. I know there's more to it than that. And so really trying to strike that balance of delivering some nuanced information, but in a way that is accessible.

Dr Zeest Khan (40:35)
As the COVID-19 pandemic has shifted phases, the People's Health Briefing continues to cover COVID-19 levels and advises on precautions. You're also going to hear about measles rates, RSV, other viral illnesses like bird flu, and she even covered the raw milk news as it was developing. There seems to always be something in public health.

that is concerning these days and the People's Health Briefing is something I really recommend following. As our conversation winded down, I was really interested to hear what Dr. Noha felt about healthcare more broadly. What could we learn from Roots Community Health? What could be applied at scale? And what obstacles are in our way?

Dr Noha Aboelata (41:27)
It's a really, really good question and a difficult question. I think we have to start with access for everyone. I can talk about what we face in Oakland, but the truth is we are very blessed to be in a state that has expanded Medi-Cal, ⁓ our version of Medicaid, for everyone essentially. so

There's a lot of work to be done to make sure that there are points of access that are culturally responsive and that can really meet people where they are. And that is my hope, I think, more broadly for everyone is that everyone be able to have a primary care medical home where they are ⁓ taken care of and where that they can feel that they have a choice and that they are not judged and that they get access to what I believe should be

really a fundamental right, particularly a country this wealthy. And I think we need to really ⁓ shift the way that we think about ⁓ what's important in medicine and in healthcare and bridge the gap that I hoped would be bridged during the pandemic, but unfortunately has not been bridged between public health and healthcare delivery. I think that that

that we have sort of created and seem to be maintaining is really at the heart of a lot of our challenges because I think the healthcare delivery system doesn't necessarily have a responsibility for the health of the population and our public health system is so underfunded and under supported that we inevitably end up leaning so heavily on this complicated healthcare delivery system.

when I think a much more effective use of our resources would be to bridge that gap, make sure that we have a well-resourced safety net and primary care ⁓ sort of access for everyone and that we think of it more as a continuum that everyone can access. That would be my big hope.

Dr Zeest Khan (43:43)
I share that hope ⁓ and I see Roots as a model for that that I hope is replicated on a broader scale. Dr. Noha, thank you so much for joining me. Thank you for sharing your voice with us. Thank you for sharing your thoughts. ⁓ Thank you for serving the community. I hope I get to meet you in person soon and come visit Roots myself.

Dr Noha Aboelata (44:06)
I would love that. Thank you so much. It's been a great conversation.

Dr Zeest Khan (44:11)
You know, I interviewed Dr. Noha several months ago and I sat with this interview because I wanted to make sure I presented it in a way that really contextualized the importance and the connection between the community of long COVID, ME-CFS, chronic illnesses that have been minimized and under research and under supported to this greater struggle of

racial disparity in healthcare, ⁓ marginalization of communities, and the obstacles that we all face trying to do right by ourselves, our families, and our communities. I hope I was able to do that today, and I hope that as you improve and recover, you can ally with groups like Roots Community Health.

and recognize yourself in a group of people you did not before. Thank you once again to Dr. Noha Aboelata. You can learn more about Roots Community Health and subscribe to the People's Health Briefing on YouTube in the show notes below. As for me, as we wind down this season of Long COVID MD, you can keep in touch with me online.

check out my website, longcovidmd.com, sign up for the newsletter that goes through Substack. A paid subscription or a donation through Buy Me a Coffee supports this platform and allows me and my little family ⁓ the ability to upgrade what we can offer.

to spread the word about long COVID and offer resources for patients to meet needs where the healthcare system is still lacking. I know struggling with this disease can be discouraging and daunting. I want to celebrate and acknowledge your efforts thus far. ⁓ Keep going. I really hope you're feeling well in this moment. And if not, I hope you feel a little bit better in the next. Take good care and bye for now.