On Tuesday, my mom testified in Congress about the impact climate change is having on our public health. She is extremely accomplished as a physician, academic, and community leader and so, I have to confess, this is the first time in a few years that I’ve really been surprised by something she has done, or was invited to do! (The last time was when she was inducted as a fellow of the American College of Physicians, which is an honor reserved for only the most accomplished internists in America.)
I posted a short clip of Representative Ocasio-Cortez (yes, the AOC) asking my mom a question. And it went viral in my social media universe. The video has been viewed more than 2,000 times just on Facebook and a thousand more on Instagram! Dozens of you have been asking to meet or to learn more about my mom.
Well, since this is the first time I’ve ever had direct requests to feature someone on the blog, I figured I’d try to make it happen! So here we go! Please enjoy this special edition of Jaja In featuring my Mama, Dr. Cheryl Holder, MD.
”May the Fourth be with you” — My mom
Los Angeles, CA, USA
Highlights From the Conversation
My mom says she is an “accidental climate advocate.” How did she realize that climate change was already impacting people’s health?
I had a patient who had COPD and generally had been well controlled, but this was 2016 and it was hotter than usual. I didn’t think about it being one of the hottest years, but I just saw my patients coming in more frequently for asthma inhalers and I saw they were using more nasal inhalers for their allergic rhinitis. There was a lot more discomfort.
I work with a poor population that tends not to have air conditioning, or if they have it they really can’t afford to use it, and so they only really use it when it’s really necessary. And my patient needed more inhalers, and she asked me at the end of the visit if I could fill out this form for her? And it was a form from the electric company. They have a program where if you can’t pay your bills, you can apply for relief, but you need to have a life threatening medical condition and need special equipment. And according to the form, I wasn’t sure if I could legally sign because I didn’t think she met all of the criteria. But on the other hand, this lady really couldn’t breath, and even though she wasn’t at the point where she needed to be hospitalized she really needed some help in using her air conditioner most of the nights, because it was so hot. This is how she could avoid the hospitalization.
So I was stuck with a form that she didn’t quite meet the criteria for, and not knowing the best next step for this patient. I connected her with the social worker to figure out the best solution. But for many patients like her, they’ll lose their electricity because they don’t meet the strict criteria. And from there I heard more problems, and every year it just got worse. And then we got Zika.
So I told that story at a presentation, and it got people thinking that it’s not just the polar bears and what we see on TV, but it’s people like my patient who basically can’t breath at night, and can’t sleep, and can’t afford to pay all their bills.
Where in the past have you seen something start small and get big?
I trained during the early years of HIV, when we didn’t know what HIV was. And in the US, we thought it was just a few people in a certain segment of the population-- they thought it was just a gay person’s disease.
I was still a medical student and training at St. Vincent’s Hospital in Greenwich Village in 1983, and it was just rooms full of these men who were gasping for air, and they had purple patches, were emaciated and nobody really knew what was going on. We had heard about the virus, but everything was still in research and everyone was pretty scared. And I was a medical student, and I tend to be “I’ll help you, help you, help you” and I don’t mind going into situations. And the residents would send me in to different patients, and especially patients who were by themselves. And one day they sent me into this room with this man who was a white male. He looked like those Holocaust victims that you saw in pictures, and he had on a non-rebreather mask (type of oxygen mask), and he gasped and gasped and I’d go in the mornings to try to talk to him and help him a little bit. And he could barely talk, but he would give me a smile. And I just remember the purple patches all over his skin. I’ll never forget his face because he just looked like those Holocaust victims you see in pictures, and there was nobody else with him; and in many of these room there was nobody else. The residents never really went in, nobody really went in to see them too much except I would go in and see him. And then one day he was gone. And that’s how it was for many of our patients at that time. But what was striking is that they were always alone and dying.
And then from that I went up to Harlem and met even more patients. And then we started seeing women, and drug users, and they all weren’t gay. And many Black people and Hispanics and women-- because before you thought it was going to be a male disease-- but we started seeing Black women with this. And coming to Miami, we started seeing more and more women, and women from all walks of life, not all prostitutes: there were mothers, there were grandmothers, all ages. And this is what we saw until we could get the treatment and the diagnosis and really get people into care. But before that, we saw the people coming and we knew this was not just a gay person’s disease. We knew this was not just a male disease, cause that’s what we saw in our clinic before the researchers caught up to it.
A happy story
One of my most memorable moments is of a young mother. Her daughter was about 3 or 4 at the time, and our goal was to try to keep her alive until her daughter graduated from high school. And so the minute the research came up, and one of the first trials opened for AZT, we got her on it. And she’s still alive today. Her daughter is a grown up. She’s now a grandmother. And that’s when you see that we can make a difference with action, but we’ve got to do it together. We’ve got to get the whole world working together. And you need some voices.
Why are you speaking up with climate change?
In the HIV epidemic, besides being a treater and going to the conferences and calling congresspeople, I wasn’t out there very much with it. I just really worked in the grassroots and tried to do the programs, and get the condoms, and try to educate. But I wasn’t out with the policy and being loud. But if it weren’t for groups like Act Up and all the brave gay men who spoke out loudly, we wouldn’t be where we are now with HIV. Where we’re getting closer and closer to a cure. And if we don’t get to a cure, we can get to un-transmittable. Where we can get to the point where this is something that folks don’t have to get. And that’s after only 30 years. But that’s because folks spoke up.
So when things started with climate change, and I started seeing more of my patients with what seems like minor complaints-- can’t pay the light bill, needing extra asthma medicine, their kids suffering, the mold-- so learning from what I saw in the past, I saw that I can’t just treat. I wanted to do more this time.
What happened in HIV I don’t want repeated. When the most vulnerable populations were affected it was the silence that returned, and folks are not being aware and being able to put the resources toward the vulnerable populations, because it’s no longer just rich gay men, it’s no longer Elizabeth Taylor-type friends that are out there. It’s the poor Hispanics, the poor Blacks, especially the young poor Black men who have sex with men who are most impacted by HIV, and we don’t see the support like we should.
And with climate change, the group that will be most impacted are going to be the most vulnerable in our population: the elderly, the poor, the children. So I don’t want what happened with HIV repeated in this population. So I don’t want just my voice, I want more and more people involved.
List of current jobs and how she does it all.
Medical school professor
Internist and HIV specialist
Mentoring next generation of doctors and increasing number of underrepresented people in the sciences
STEM Saturday pipeline program
Research as education as a social determinant of health
Research in transgender women and HIV prevention
Research in childhood obesity
President of Florida State Medical Association
You’ve got to focus. I get into my flow. There are 24 hours in a day. You need to get enough sleep, at least 7 hours, and then an hour for exercise. So now you’re left with 16 hours. What are you going to do?
The key to getting anything done is communicating and harnessing other resources. And you can do that through writing. I can write quickly, not stylishly, but like medical textbook writing. And then execute. I can execute because I’ll follow through, and I will call and I’ll get people, and I’ll stay on top of things. And I’ll file things mentally, or on the cellphone, or on the computer. And I find these apps have made things much easier. I can now communicate with a hundred people with just one little text message. So some of the work that I do in organizing and communicating with the doctors is done very efficiently through email and text groups.
And the other research is leveraging my community network. Because I’ve been in the community forever, I’ve built on what I’ve already established so I’m not doing a lot of new work. So to communicate on climate change in the same vulnerable population that I’ve always worked is just connecting in that network, is just setting up and communicating about climate change in that network.
It’s to see what you have, and to build on your strengths. My strengths are in connecting and coordinating efforts and resources and doing public speaking or writing. So whatever I do within the different areas that I work, it’s pretty much building on those core strength areas. I don’t take on a lot of new things that I’m not really good at, because that takes time to really develop those skills and go toward it. So I build on the skills and networks I already have and then efficiently communicate my needs and what I want to teach to that community, and leverage the resources.
So with that, you can do a lot in the 16 hours you have. And I try to have specific goals in mind and not go way beyond my ability, or beyond the ability of the group that I work with. Resources matter and you have to be aware of the resources you have, and time is one of the resources. I’m not going to take on projects that are going to be three years long unless I anticipate there’ll be some incremental changes over the three years and those I am able to predict and have those small milestones and that’s part of the plan.
I do lay out the plan and get the strategy.
And for the areas that I’m not strong it, which is the clerical type work, I’ll find someone else who can do that and stay on top of things.
For example, there was a conference on Friday. There were four lectures, and I can’t do any of those because I couldn't even attend the conference! But I was able to find the people, set up the topics, explain the goals of each presentation, and implement. So my strength is in coordinating, managing the program, the ideas-- I like a lot of collaborative work. So if I have one big idea, then use all of the folks that are working with me to help tweak it, and allow them to implement some of the ideas in the tweak, which then makes them much more involved in the process. Oftentimes folks want to micromanage, I never micromanage because then I have to do all the work. So that’s how I do it pretty much.
But you’ve got to be willing to do the work. I’m on the ground because I love people and I love being with them and seeing the improvement. And to be successful and to keep doing it for 30 years, you’ve got to see the incremental successes-- the small ones, and the small improvements.
I tell folks about my patient who has substance abuse. I’ve had her for three years, and we’ve been working with her to stop drinking and getting high and the way she’s going to prove it is to not come to clinic drunk or high. So three years I’ve been working with mer, and on the last visit she came in, and she was sober! And we celebrated! Most folks would have been frustrated, would have written her off, but it took three years and she came to clinic sober, and she said “I am a woman of my word.” And I said “I always knew it.” And that’s what it takes to keep going, you’ve just got to believe in them and it will happen.
Her basic message and main takeaway
Everyone can take action when it comes to climate change: Whether it’s something small and you get rid of your plastic or cut down on your electricity, or you join a group and get the word out and vote. Because we have got to do it, we have about 30 years to make that change and we can do it. We did it with HIV, my patient who’s a grandmother is alive and about to be a great grandmother, and we can accomplish so much in 30 years. So we’ve go to start now.