{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/707wm15p0k/manifest","type":"Manifest","label":{"en":["Dr. Viviana Martinez Bianchi"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003e Statement:This item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eDr. Martinez-Bianchi’s oral history is focused around her impact on diversity and awareness. Her passion has always been for medicine, and helping all communities get the care that they need. As an Argentinian and minority in the U.S., she knew the factors that led to marginalization and she has worked to combat those throughout her career has a physician and her time spent on the bureaucratic side of medicine. It is through her action that we have seen new task forces and committees that have aimed to distribute better care to poor and underserved communities around the country, and indeed, across the globe. \u003c/p\u003e (summary)"]}},{"label":{"en":["Date"]},"value":{"en":["2019-01-18 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Herbert Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","Family Medicine for America's Health","Family Medicine","Family Physician","Medical Research"]}},{"label":{"en":["Subject"]},"value":{"en":["Viviana Bianchi Martinez, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eDr. Martinez-Bianchi\u0026rsquo;s oral history is focused around her impact on diversity and awareness. Her passion has always been for medicine, and helping all communities get the care that they need. As an Argentinian and minority in the U.S., she knew the factors that led to marginalization and she has worked to combat those throughout her career has a physician and her time spent on the bureaucratic side of medicine. It is through her action that we have seen new task forces and committees that have aimed to distribute better care to poor and underserved communities around the country, and indeed, across the globe.\u0026nbsp;\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003e\u0026nbsp;Statement:This item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071","type":"Canvas","label":{"en":["Media File 1 of 1 - Martinez_Bianchi_Viviana_01_Access.mp3"]},"duration":3564.8946,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/071/original/Martinez_Bianchi_Viviana_01_Access.mp3?1760561758","type":"Audio","format":"audio/mpeg","duration":3564.8946,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071/transcript/85365","type":"AnnotationPage","label":{"en":["Dr. Viviana Martinez Bianchi Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071/transcript/85365/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1\n\nDr. Young: This is side 1 of tape of the Oral History of Dr. Viviana Martinez-Bianchi, the leader of the Cross Tactic Team on Disparities for Family Medicine for America’s Health. This is being recorded on January 18, 2019. I’m Dr. Herbert Young, a volunteer at the Center for the History of Family Medicine.\n\nDoctor, do we have your permission to record this interview?  do we have your permission to record this interview? Yes, of course. Yes, of course. Thank you so much.\n\nLet’s start by asking if you would give your full name and your current title and position.\n\nDr. Martinez-Bianchi: I am Viviana Martinez-Bianchi. I am a family doctor. I am an associate professor at Duke University in the Department of Community \u0026 Family Medicine in North Carolina. I have been the tactic team leader for the Health Equity Team for Family Medicine for America’s Health since it started. I am also program director of the Family Medicine Residency Program.\n\nDr. Young: Can you share a little bit about your other professional background?\n\nDr. Martinez-Bianchi: I am a family physician. I trained in family medicine, graduated from the University of Iowa. I’m originally from Argentina. I moved to the United States from Argentina when I learned about family medicine. I wanted to be a family doctor and I wanted to be a family physician that worked with the community, that would be community engaged. So I moved to the U.S. in 1990 to become a family physician here. I graduated in ’96 from the University of Iowa Family Medicine and Residency Program. And I was a rural doctor for five years. Before that started in academia at the Quad-City Genesis Family Medicine Residency Program in Davenport, Iowa. And then went on to the University of Cincinnati to do a faculty development fellowship in caring for minorities and underserved populations. And then went to be associate program director at the Family \u0026 Community In Family Medicine in 2006 and I’ve been here ever since. And I have been the program director for the last five years. I also currently, besides being the Health Equity team leader or team chair for Family Medicine for America’s Health, I am a member of the board of directors of the executive board of the World Organization of Family Doctors. I was elected in 2016 at the Rio Wonca Congress as a member-at-large of the executive and re-elected in Korea, in Seoul, in 2018. And in that role I am the liaison of the World  Organization of Family Doctors to the World Health Organization. So I am representing family medicine to the World Health Organization as well.\n\nDr. Young: Wonderful. How did you get involved in Family Medicine for America’s Health?\n\nDr. Martinez-Bianchi: I learned about Family Medicine for America’s Health when it was being announced to the WOFD membership. I saw an invitation for comments and expressed my concerns at that point. So I wasn’t serving as a member of Family Medicine for America’s Health. But it really fit my attention that this actually be a real important step for the Family of Family Medicine to have all of the six (?) organizations work together towards a common goal for ensuing health. However, when I saw the invitation for comments, I expressed my concern that a conversation of the board of directors was too homogenous. That there was no under-represented minority medicine representation. It deeply concerned me that such important voices in the present and the future of our country were not going to be included due to that lack of diversity. So my initial participation was as a concerned member of the American Academy of Family Physicians voicing via the Website my concern about that lack of diversity. When I saw that there was no improvement in the conversation of the board, improvement for me meaning to be more inclusive, and I watched with dismay then that even the conversation of the team was also lacking in diversity, I took it on as a deliberate effort to voice this concern publicly at every meeting where there was a town hall – at the AAFP, at the AFMRD Directors Workshop and STFM and the National Conference of Constituencies. Every time Len Stream or others were given a forum, my concern was that there was really no diversity representation. And the response was always the same, we’re listening to you and your concerns. Not just me. It wasn’t about Viviana. This is about me, representative of the families and the communities that we serve as American family doctors. So the reception was we hear you, we have diversity in thought. I could put this in question marks. But what was much more concerning to me is there was absolute blindness to the importance of diversity and inclusion of minority representation. What I saw about Family Medicine for America’s Health is that there were really, really good people there trying to do good work and at the same time absolutely blind to the life experience of black, Latino and native American colleagues and communities. And there was information and lived experience that those minority representatives could bring to the work of Family Medicine for America’s Health with --. \n\nDr. Young: Over what length of time were you providing this input before you became actually formally part of Family Medicine for America’s Health?\n\nDr. Martinez-Bianchi: I probably should have looked at the exact timeline between … Was it a matter of months or years? Over a year. So the first year when it was being announced and the composition of the members was --. And then the year when it first got started, and then they announced the composition of the member of the team. And I’m seeing there’s only two non-white people in this and there were two wonderful … And again, this is not to say that all of the people that were selected to the teams were not wonderful family doctors, all representatives of different organizations. My concern was that really there were no under-represented minorities in medicine. The two that were non-white were Asians, which are actually over-represented in medicine. Perhaps not in Family of Medicine. And the response was we’re listening to you and your concerns. So what we ended up doing was to actually act through a resolution that was passed at the National Conference of Constituency Leaders, that we were asking that Family Medicine for America’s Health needed to increase its diversity of its board, or at least of its tactic teams. And that was at the National Conference of Constituency Leaders. \n\nDr. Young: Is that the AAFP meeting? Yes, so that’s the AAFP meeting. So they must have done more than listened eventually? \n\nDr. Martinez-Bianchi: Well, yes, because they called for the formation of the Health Equity tactic team. The Health Equity tactic team was not part of the initial teams even though it was one of the core attributes. One of the aspects of Family Medicine for America’s Health was to talk about decreasing health disparities, yet they hadn’t really said … They created an engagement tactic team, a payment team, a practice, research, technology and workforce (?) and education and development team but not a health disparities team, even though it was one of the aims to improve health disparities or work on decreasing health disparities in the U.S. And so it wasn’t until that … There was then a call for people to apply to become a member of what was then called the Health Disparities Team. And that was when I applied to be a member of that. And the initial membership was myself and then one member of each one of the other teams became the Cross-Tactic Health Disparities Team. \n\nDr. Young: You say that there was a change. And, in fact, the sheet that I was looking at when I introduced this on the tape was back when it was called the Cross-Tactic Team on Health Disparities. How did it change then into Equity?\n\nDr. Martinez-Bianchi: When I first started as the Health Disparities Cross-Tactic Team leader, it was myself and then members of all the other teams. My concern initially was that the health disparities, especially in the U.S., were such a tremendous problem and of such depth and breadth that we needed a larger team. And so I asked the board to actually help me increase the number of people, to have at least three more core Cross-Tactic Team members. So myself and there more people would be just members of, at the point, the Health Disparities Team and maintain the Cross-Tactic Team so that every one of the other teams was still represented. Once we formed it, over seventy people applied to the new position of a member of the Society’s Team. And then the selection of three new members, (Inaudible name, ) Jennifer -- and (I’m thinking of her name).            \n\nDr. Young: Looking at the list, I see Laura Gottlieb, Joe … \n\nDr. Martinez-Bianchi: It was -- Brown (?) and Joe Jacob. So there were three members that came in to be members of that team. One was Jennifer, and -- Brown. So we started with that group.  And then as we were working with this group, we did the Starfield Health Equity Summit. As we started planning the Health Equity Summit, we decided that we really were aiming for health equity and we wanted to have a more positive theme to send to the name of our team and started calling it the Health Equity Cross-Tactic Team instead.\n\nDr. Young: So if I’m hearing correctly, your team had representation from the other core teams. So you had a direct link and the ability to understand that they were doing and to deliver also messages to them?\n\nDr. Martinez-Bianchi: Yes. I used to jokingly call myself the Health Equity police (laughter). So in one way what we were trying to do was every one of the other teams … It was very important for us to see that whatever it is that other teams were working, whether it was engagement or payment or practice or research, technology or workforce education and development, whatever product or whatever projects or programmatic changes that we’re working on, that they wouldn’t end up worsening health disparities. So it was a matter of keeping a heightened awareness and making sure that … For example, you’re working for practices or even technology and only those practices are serving people who have more money and more access to technology or those practices that are living in richer communities, there is always a risk as you work and those changes occur only in those practices, then there’s going to be a wider disparity between rich practice and those that are not. So really being mindful and paying attention to not worsening health disparities in whatever programs they are, that they were working with. And at the same time, more of the core team members, each team assigned a person to be part of the Health Equity Tactic Team. Now, as we moved forward and we grew into our work, we first started with just myself and (Inaudible) each one of the tactic teams. Then went on to having three extra core  team members for this Health Equity Team. And then after the Starfield Summit we expanded the work of our team. We started bringing into the team other people who were interested in continuing the work. So Brian Frank, Lloyd Michener (?), (Inaudible name) were the people who ended up being members of the team through the projects that they started working with.\n\nDr. Young: What were the sorts of projects that they were able to get going?\n\nDr. Martinez-Bianchi: Brian Frank, in particular, is working on building the business case for health equity. Lloyd Michener has worked tirelessly in the interactions between family medicine and public health. So primary care and public health, working with state health officers, the Academy, the Practical Playbook, bridging the different areas, the different --  to stakeholders that are interested in working on health equity. Kim Yu (?) started working on the social media strategy for the team. So these were new people that came to this meeting that weren’t there originally. \n\nDr. Young: And, of course, since they were dedicated to your core team, it wasn’t like they were having a representative from another core team actually work double. Right. They were able to focus. \n\nDr. Martinez-Bianchi: I have to say that one thing that we need to remember is that every one of the people involved in this, it was their volunteer experience, including my own. And I was (Inaudible) to my colleagues and my peers because in two years we achieved a lot more. We were supposed to – the initial work was going to be five, or at least four years, for my team. Then we ended up having to do everything in only two years. And I am amazed at the amount of work that our team has produced, all of it on volunteer team. The after hours, the in between patients and early in the morning, late at night, on weekends. People have really devoted a lot of their own personal time. Sometimes funded times through the generous donations coming from their departments. But often their own or their families. \n\nDr. Young: Is the tactic team now finished formally within Family Medicine for America’s Health or is it still operating?\n\nDr. Martinez-Bianchi: All tactic teams finished formally in December of 2018. Our team was one of the last ones to end. But our work continues. I am involved in the creation of a Health Equity Summit Pre-Conference for October of 2019. The whole team, led by Jennifer Edgar (?), is working on a very important Sub-Equity Curricular Target for primary care and there are professional educators that are working for Health Equity. Diane Frank continues to work on the Business Case for Health Equity. So we are continuing to work. One characteristic with all the members of our team is that we are already passionate about health equity work that we can do. So I think our first project was to work with the Starfield Summit on health equity, on primary care’s role in assuming health equity, as we did in 2017. And that really brought us together and connected us with a lot of other organizations in the U.S. who are working on these issues. And it’s something that I think feeds us patience at times (?). It gives us a lot of satisfaction to see that we are able to move forward with something that is so important.\n\nDr. Young: Some of the core teams, as they have ended, have had definite projects that have been taken on by some of the organizations within Family Medicine for America’s Health. Is that something that I’m hearing may be occurring in some cases here or there’s a platform or resources in one of the organizations to take advantage of?\n\nDr. Martinez-Bianchi: Yes, absolutely. So the American Academy of Family Physicians through the Center for Diversity \u0026 Health Equity. -- Jones was another person that came in as a special member of our team. She’s a manager for the CVHE (?). And our team helped to co-create a Health Equity Fellowship that continues on with family medicine through the American Academy of Family Physicians Center for Diversity \u0026 Health Equity. It was wonderful to really be able to see. This Health Equity Fellowship was one of the dreams of our team and it was wonderful to see AAFP taking it on as its own project. We have been extremely happy to see that back and forth interaction with AAFP, especially with the Everyone Project and with this Health Equity Fellowship. STFM is also very involved working with the Health Equity Toolkit. We will be launching the Health Equity Toolkit in the spring conference of the Society of Teachers of Family Medicine. And then the Health Equity Toolkit will actually live within the AAFP Center for Diversity \u0026 Health Equity. \n\nWhat we are seeing, which is really satisfying for me, at least, has been to see organizations work together and connect. Another thing that happened, that I forgot to mention, was the Health Equity Fellowship. We started with two members selected by the AAFP. And the AFMRD selected one more fellow, a representative of the -- Family Medicine Residency Director. So that will be another interconnection. And it was great to have the participation of all of the … Sorry, I’m going on. I hope it’s okay. This is wonderful, please do. Actually it was decided to bring together all of the family medicine organizations and also bringing to the organizations an administrative staff. One of the issues that I see as a concern for how do we move these things forward is that all of our organizations have board of directors that are formed by volunteer physicians, right? We become members of the board, then we go with the board, then we go on. And so I thought it was very important to bring in to the Health Equity Summit the members of the administrative staff, the people who are the ones who are going to make it happen. The very important people that work within every one of those organizations to hear the issues of health equity. We in clinical work see the inequities that are patients are suffering every day. But I think it becomes very different if you’re sitting in an office and working to support the work of the boards, whether it is the AAFP, ACRC (?), STFM or any one of the organizations. So we really thought it was very important to bring the staff also to, especially the -- staff, to the Health Equity Summit and see them going from … I’m not really sure if (Inaudible), that, oh, my goodness, yes, it does. And so then seeing that the issues of health equity are living on through the support that the executives of these organizations are giving to the boards in regards to health equity. So ABFM, department chairs, I’ve seen them really engage through their work there. I’ve seen AFMRD be common-minded. I’ve seen ACRFP also have in their composition, there are different priorities – and where do you put the -- for the family physicians. And that has also been an area of health equity that we need to continue to visit and review and make sure that we support the work of rural doctors. There is often a large membership of ACOFP, DO’s. So it has been wonderful for me to see that. I\n\nam hopeful that a lot of these projects and the language that we have started with the Health Equity Tactic Team will continue to live on through the organizations.\n\nDr. Young: Do you have a feeling that because of this training exposure of the staffs of the various organizations as well as the members with their incredible contributions, will each of the family medicine organizations continue to pay attention to this issue and generate new ideas that go beyond what your core team has had the opportunity to do?\n\n\nDr. Martinez-Bianchi: I truly hope that that’s the case. I think if we really want to address family medicine’s capacity to improve health equity, we need to collaborate, we need to become accountable. We need to build coalition with others. We need to create coalitions with communities. But we definitely need to create coalitions to improve health equity among our sister organizations. This cannot be just one organization’s project, although the material can be held in one place or the other. But I hope that throughout the future every working party of all the organization, that health equity becomes center. And we’re not going to improve health unless we look at these terrible disparities that abound in our country. Especially when we are really now having the concern … Issues of racism and inequities come directly from the political level. Unfortunately … I don’t want to politicize my conversation with you today, but when we’re seeing policies that are worsening access to care and access to health for all in our country coming down from the government level down, it really is our role as family doctors to really rise up, depoliticize this problem and touch members of both sides of the political spectrum to really work on improvement our health for all.\n\nDr. Young: That has been something, that is to say the change in the political scene that I think had impact on Family Medicine for America’s Health because it started before we had the current administration. And I believe there were changes in resources and strategies that have been shared in some of the other Oral History interviews. I’m curious if … You mentioned working with state health departments and other levels more local than state. Is that being continued as such? I think you called it the bridging activity. \n\nDr. Martinez-Bianchi: I -- collaboration is extremely important – and it continues. What I see happening is that regardless of … What I see happening is that maybe certain policies have taken many people out of complacency. That there is a really heightened awareness of the … (Inaudible), a group of people first, -- access care and then it’s about the risk of taking it away.   \n\nAny physician working on the frontline of family medicine and primary care, so many people that fell in the (?) access care. And we saw people with really severe chronic medical conditions that could have been prevented had they had access to healthcare early on. So I see that. I see the dismounting of some of the health departments opportunities or state offices as something that has brought perhaps a significant awareness of family physicians to starting to talk about conversations that perhaps weren’t happening. I think through Michigan, for example, the work that pediatrician (Inaudible) and really putting awareness to the severe problem of less contamination in the water supply was a wakeup call. But I argue that there are Michigan’s in every state in this country. There are multiple places where if we were to become larger advocates, we could actually start showing how our communities are suffering due to different issues. Is it because of poor education? Is it because of dilapidated, low income housing? We all are measuring things – you know, heat is measured, we are all measuring our prices (?). But there are things we’re not measuring. We’re not measuring health and code violations and how they affect children’s health. For example, how do they affect --? Without measuring how poor performance is school is affecting … Because we know that this is affecting children. That the long term effects of poor education, it’s long-lasting for our country. And then if we go to policies in the environment, are we really ready to see that in ten or twenty years we may need to walk around with masks in our big cities, like they’re already doing in Beijing or other large places in the world because they haven’t had regulations with regards to fumes in the environment? Perhaps seeing the changes in policies that were coming our way, it really got us thinking more about what we need to do outside of politics to impart and improve policymakers’ awareness of how important this is. \n\nDr. Young: Are any of the organizations doing programming, educational, or sharing success stories across state lines or across residency programs or across departments?\n\nDr. Martinez-Bianchi: So I would say that Society of Teachers of Family Medicine, AAFP, the Everyone Project, the Practical Playbook, in particular, which involves several organizations. The material on the Starfield II Health Equity Summit, which lives on the Website. There has always been sharing of collaboration. I’m not sure that we need a better place to really look at how this impacts. We’ve probably seen enough. I think there are so many efforts not just in the U.S. but all around the world to improve health. I think sharing some, perhaps not enough. I think we are learning how to navigate this because this is not a paid part of our work every day. We are talking about value-based care but we are still trying to understand what does that mean and how do we fund it. \n\nDr. Young: Let’s take a couple of steps backward to get a larger view of Family Medicine for America’s Health but keeping in mind the work of your colleagues. As you look at the healthcare system in the United States, what’s needing to be done to give us better health? And think of government, think of managed healthcare, think of payers. Just whatever parts of the overall American society you would want to address. What have we got to do better to give us health equity?\n\nDr. Martinez-Bianchi: I think we need to work together. We need to address this challenge of how do we increase the accountability of our organizations, our insurance plans, our hospitals, our health systems, our government into understanding that we need to improve health for all of the country. That it cannot be that there is a discrepancy in the system between what my patients who have private insurance versus public insurance. But worse than that is all those people who are hard-working people but don’t have access to either one of them. And we have to figure out a way to have access to the healthcare they need and at the same time have access to the social determinants that would improve what they do or will improve their health outcomes.\n\nDr. Young: Do you think that, from what you’ve been saying, family medicine is still needing to understand these other factors that impact health? And I raise that because I know that many of them are struggling to try and do all the paperwork they have to do to get paid for the work they do. But they also live in communities and have patients, many of whom are impacted by these other factors – like you mentioned, the housing or issues of education, transportation, access to fresh food, not having food deserts, et cetera. What are your thoughts in terms of what activates the physician to act?\n\nDr. Martinez-Bianchi: I think there are different levels of activation. I think in the individual care, we all understand advocacy. We constantly advocate for our patients to have better access to what our health systems can offer to them. I think we are often mindful of especially lack of access, right? I know what would work best for this person yet their insurance is not allowing certain tests or certain medications, is something that we navigate and negotiate to the point of burnout, right? At the same time, we also sometimes are forgetful or are not really aware of (Inaudible) between health disparities such as sexism, racism, the inequitable distribution of power that is permeating in all of society and how important it is to understand what’s going on in our communities and what is our role as members of the health system to address those issues. I often think that family doctors are those who are most likely to take care of the holes of our community. And yet, at the same time, we are missing certain cues. For example, we got trained in the intensive care unit. We were doing the unit. You are constantly monitoring pulse and vitals, right? I really think we need to learn to constantly monitor the pulse of our community and how to see when people are really suffering in ways that our privileged lives are not allowing us to see. Sorry, I get choked up with a lot of these things because I see it all the time. I see the kids that come in suffering because he is afraid his or her parents are going to be deported. I see it in the mother who’s afraid because her young black son may be killed by the police. I see it in the frustration that I have when I go to school in my son’s public education. In a minority school there’s really no participation or engagement of African-American parents. \n\nDr. Young: So obviously the issues can be overwhelming. Yes. And what I’m trying to understand on a big-pictured level, I guess, is as Family Medicine for America’s Health goes through its sort of shutdown but the work of the core teams are being taken up by individuals but also particularly maybe individuals working within STFM, AAFP, the Department Chairs Group, etc., how can those organizations continue the learning that I think you’re pointing out, but also the activation. What does one practically do? Because there are a lot of family physicians in the United States and that can be a very powerful group. \n\nDr. Martinez-Bianchi: I think, at least for me, Family Medicine for America’s Health, in the forming of the Health Equity team did for me and I think for the members of my team was to find among us a group of peers who were really ready to invest time and effort into making a difference. And it was so rewarding to find others that were likeminded and had really this type of interest. And the AAFP National Conference of Constituency Leaders was the place where I grew up in family medicine where I was able to find other interests, these types of interests, this real desire to make a difference at the health equity level. And what I think is necessary to be able to continue to grow in this is to create those spaces that are safe for members of our organization that want to have this conversation. And what I think is necessary to be able to continue to grow is to create those spaces that are safe for members of our organization that want to have this conversation, to be able to get each other’s energy and learn from each other’s experiences to continue to do the work that we do every day. Because if I, who has been doing this for … You know, I’ve been a family doctor for the last twenty-six years and I still continue to get choked up because of the inequities I see coming into my office. I see this happening all around the country. So having a place where we can continue to have this conversation and then training, forming leadership in a way that really helps us to be accountable to those communities and be able to understand how can we become advocates not just for the specialty of family medicine but for the members, for the families that we represent in our specialty – and we represent our patients through the work we do.\n\nDr. Young: As you think of the practice, what’s the role of others in the practice – nurses, nursing assistants, PAs, et cetera? And are they interested? Are their organizations, do you know, paying attention to this and offering their members education resources?\n\nDr. Martinez-Bianchi: I think if I feel that we missed out - because our time with FMAH got shortened, right? We were going to have two more years and we had to finish now. The next two years where the important time to engage many other organizations, we’re doing it but not to the level ... I really felt that with Family Medical for America’s Health, we organized what was happening in the health of family medicine. We pay attention to how do we work together. And then this would have been the perfect time to go and align our efforts with so many other organizations. So we, Family Medicine for America’s Health, couldn’t quite do it to the level where I think we could have. So it is my hope that the AAFP is going to work with the different health professional services organizations. In my work with interdisciplinary teams here at Duke, it’s a reality that nurses get it. Medical assistants are actually some of the lowest paid people in our society. And when we talk about social determinants of health, they are leading in that area. They are the closest members of the team to our patients and those who live in much lower income situations, right? Often our teams are diverse mostly because our NAs represent the communities that we serve much more likely than our medical society members. The number of minorities in medicine, the number of black doctors and Latino doctors and Native American doctors is very low but our medical assistants staff can still be representative of the community that we’re serving. So definitely we have to work together and listen to their expertise and experience in knowing what’s going on in their own communities. And we need to engage them and their organization. And the same happens with nursing. Our health equity purpose is really more interdisciplinary and we have worked with different organizations to create them, to know what would be useful for all of them. But I definitely think because we didn’t have enough … I had envisioned another two years of really working to really reach across all health professions and all teams.\n\nDr. Young: Can we talk a bit more about the Toolkit?\n\nDr. Martinez-Bianchi: Yes. So the Toolkit - In primary care and inter-professional care educators that are striving for health equity, we would like to use the Toolkit made to (?) hands-on practice and we want people to be able to identify opportunities to implement the Toolkit as they participate in institutions. We would really like the Toolkit to be useful to work together to increase social accountability within primary care organizations across the U.S. And that includes the work we do both in our own clinics and in our health system and in the academies and societies that represent our specialty. So the Toolkit was based on different team themes (?) that we used in the Health Equity Summit for social determinants of health that included understanding health experiences, identifying and addressing patients social and economies to actually learning approaches, to how to teach it. It includes how to address underserved populations in rural settings, people with disabilities, respects (?) of racism, sexism and conscious values in the care that we provide, the care for -- populations. And then how do we work when patients are suffering the consequences of what is called inter-sectionality (?), the interconnection, interclass, gender, race and other types of vulnerabilities. And then how do we address economics and policy both in the local access to primary care, creating health equity roadmaps, to -- on the ACA. How kind of payment reform we need to really address the issues of inequities to international efforts. So the Toolkit tried to use the material that we created at their Starfield Summit to then use modules that help people teach this, creates moments for discussion and management of conversations within a practice or a teaching with any type of health professional. And then they did apply an inequity and empowerment lens which we learned from -- County, Office of Diversity and Equity in -- County Health Department in Oregon, paying attention to issues of people’s faith, trust and power when we are making decisions in our health system. Really understanding who is positively and negatively affected by this issue, how are the issues or decisions accounting for people’s emotional and physical safety, for example. Where are the processes and power issues that we need to address. So this Health Equity Toolkit will be represented at the STFM Annual Spring Meeting, tries to address how to teach this, how to work with it. And this is not easy. It triggers a lot of conversations that people haven’t navigated. And at the same time, our hope is that we will all understand that we need to be humble, that we need to learn how to listen and how to learn from our experience if we want to address improving health.\n\nDr. Young: And that Toolkit is going to be presented at that STFM Spring Conference. How will it then be accessed?\n\nDr. Martinez-Bianchi: It will be accessed through the Center for Diversity and Health Equity, through the AAFP Website.\n\nDr. Young: And is it Web-based materials?\n\nDr. Martinez-Bianchi: Yes, it’s going to be Web-based material. There are videos to watch to guide people through the modules. And then guided materials to teach and learn.\n\nDr. Young: Will there be faculty that can help facilitate or is this something that a practice, a residency would simply access and then run themselves?  \n\nDr. Martinez-Bianchi: That’s a good question. We hope that they will run it themselves. But also the people who have been involved with this will continue to be involved with STFM. Several are members of STFM. Jennifer Eckles is the person who led this project, continues to be extremely with the Teachers of Family Medicine and the foundation. I’m sure we will be able to continue to be involved in helping those who are initiating this process.\n\nDr. Young: Are there any other things that you would like to share?\n\nDr. Martinez-Bianchi: We are going to place an article in Family Medicine that’s coming up in a few months about the work of the team and some of our cause and what we think we can do to look ahead. We really sometimes are left with more questions than answers when we are doing this type of work. And I think some of our questions are questions we need to ask ourselves in our practices such as how are current practices contributing to disparities, what health barriers to health equity currently exist within our institutions, how can we improve diversity. I think that this is not easy work, but we need to do it, right? I also think it’s important that we … We created some ground rules for the Health Equity tactic team that we had to do because we weren’t sometimes ready to be able to listen to what others had to say. So it was very important to create some ground rules such as creating a safe and respectful environment for our members to contribute their feelings, their stories and perspectives in their own style and approach and a confidentiality for personal narratives. That was probably one of the most important things that we needed to do. We have a six point ground rules that we used for our team that were very important. \n\nDr. Young: Is that going to be covered in the article?\n\nDr. Martinez-Bianchi: Yes. I can read them to you right now, if you want. Or we can … \n\nSure. I’m going to go through the six ground rules: No 1. We will create a safe and respectful environment for all members to continue their feelings, stories and perspectives in their own style and approach and uphold confidentiality for personal narratives. No. 2. We will leverage and build on the contributions of each member to create better outcomes. No. 3. We will settle into becoming comfortable with the uncomfortable by really leaning into the discomfort to provoke activity -- patients and discussions. No. 4. We will address our differences intentionally. We will work to understand intentions and their impacts and model behaviors and respond effectively to micro aggressions and --. No. 5. We will respect each other’s time, honor our commitments and come prepared to meetings. No. 6. We will make the process of agenda setting and development more explicit and transparent and one that empowers and elevates voices of all participants. \n\nDr. Young: Sounds well thought out. \n\nDr. Martinez-Bianchi: Yes. It was very important ground rules to put together as members of the team and they really helped us in our work. \n\nDr. Young: We’re coming to the end of this side of the cassette. Is there anything else that you would like to say at this point or do we wish to continue recording on the other side?\n\nI don’t know. What do you think? This is really up to you. It’s your chance to share. If you think that you’ve covered all the points that you wanted to make, fine. If there’s more that you’d like to share, that’s fine also. It seems to me that we got quite a bit of it. You’ve done this and you have more experience than me in figuring out if this one hour … It’s been one hour and you’ve covered a great deal of ground. Yeah, so I think it’s probably enough unless there is something else that you think about or maybe when I read about, we do our last half hour of the recording perhaps. I’m not sure that we’re going to be allowed to do an additional recording at this time just because of the plan. So we probably have about one minute left, if there’s any last thing you would like to share. No, I think this is good. I just hope that we can continue this work in every corner of everyplace in this country because our patients and our communities need this work done. Wonderful. Thank you so much. Thank you.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071#t=0.0,3564.8946"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071/transcript/85366","type":"AnnotationPage","label":{"en":["Dr. Martinez Bianchi Interview Summary and Biography [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071/transcript/85366/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Bianchi-Martinez, Viviana\n\nInterviewer: Dr. Herbert Young\n\nInterview Date: January 18th, 2019\n\nBiography\n\nViviana Martinez-Bianchi is originally from Argentina but moved to the U.S in 1990. By 1996 she had graduated from the University of Iowa Family Medicine and Residency Program. Upon graduation, she was a rural doctor for five years. She then worked at Quad-City Genesis Family Medicine Residency Program in Davenport, Iowa. Then went on to the University of Cincinnati to do a faculty development fellowship in caring for minorities and underserved populations. Finally, she went to be associate program director at the Family \u0026 Community in Family Medicine in 2006 and she’s been here ever since. She has been the program director for the last five years. Regarding FMAH, she is the Health Equity Team Leader and team chair. From the beginning of FMAH she expressed her concerns on the diversity of the board and its inclusiveness. As a minority herself, she felt that it was necessary to be more inclusive in the FMAH staff and leadership. Her concern with the lack of representation was the spurring factor for the Health Equity tactic team which helps to improve health disparities in communities. Through her outspoken voice, she has helped with awareness and representation for minority communities in health, medicine, and the across the U.S. \n\nOral History Summary\n\nDr. Martinez-Bianchi’s oral history is focused around her impact on diversity and awareness. Her passion has always been for medicine, and helping all communities get the care that they need. As an Argentinian and minority in the U.S., she knew the factors that led to marginalization and she has worked to combat those throughout her career has a physician and her time spent on the bureaucratic side of medicine. It is through her action that we have seen new task forces and committees that have aimed to distribute better care to poor and underserved communities around the country, and indeed, across the globe.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162280/file/295071#t=0.0,3564.8946"}]}]}]}