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Where Did All This Peanut Allergy Come F …

Where Did All This Peanut Allergy Come From?

Words by Ellen Bluestein

 

According to the American College of Allergy, Asthma & Immunology, as of 2017, 2.5% of children in the United States have peanut allergy. While that percentage may seem small, it translates to more than 1.8 million kids with a potentially fatal condition. 

 

“Probably about 20 years ago, it was clear that this was not only a growing problem, but it had already become a public health problem in the United States and around the world,” says Dr. Andrew Liu, a pediatric allergist at the University of Colorado. “I don’t know that we’re sure why or how peanut allergy has become so prevalent. But I think it’s pretty clear that it’s real.”

 

Researchers have been exploring several possible hypotheses. One — the hygiene theory — explores the idea that with the advent of germ-killing cleaning products, our environments no longer provide the exposure to microbes that the immune system recognizes and learns to fight off.

 

“What is a microbe-rich environment? One where we’re living around a lot of animals,” says Dr. Liu. “There have been a lot of studies where it looks like allergies are less common in kids growing up in farming environments or in developing nations where people live very closely to their animals. Some people think … that the immune system doesn’t see enough of those microbial exposures early because we’ve gone and cleaned up our environment.”

 

Early exposure to peanuts — between four and six months of age — may be one way to reduce the allergy. “The original observation was in Israel, where they had this teething cracker called Bamba which has peanut in it,” says Dr. Liu. “And they observed that within communities where this was a common cultural practice, the prevalence of peanut allergy in the kids was really low compared to what they were seeing in other communities.”

 

This led to more research and ultimately a definitive study on prevention. Children were given Bamba or a derivative, and then followed. Those who received the cracker were unlikely to develop peanut allergy compared to those who didn’t get it. “It looked like early exposure … when our bodies are learning about what is safe … is an essential time period,” says Dr. Liu. “If the immune system learns that the peanut is not something to be concerned about, then that stays.”

 

While there is still much to be discovered, Dr. Liu is optimistic that there will be remedies for those who suffer from the life-threatening condition. “There’s work going on to develop treatments to either reduce or prevent the severe reactions to those who are peanut allergic,” he says. “There continues to be investment in a lot of research … to try to get to that place where there are treatments that can be helpful for people and young kids who are allergic.”

All in the Family

All in the Family

How spouses Andy and Johnny Glorioso found themselves both working in sexual wellness at DAP Health — and loving it.

 

As seen in Issue 4 of DAP Health magazine 

 

Words by Trey Burnette • Photos by David A. Lee

 

Andy Glorioso, who’s been HIV+ since 1986, has worked in HIV/AIDS social services for 23 years. In 2018, he finished his last day of work at San Diego’s largest clinic, jumped in his packed car, and drove out to Palm Springs. The next morning, he was at his new job at DAP Health, where he currently serves as PrEP navigation manager. 

While Andy was settling into Palm Springs, Johnny was relocating from San Francisco — where he’d worked for more than two decades as an E.R./trauma nurse — to similarly create his new desert home. He first discovered the Orange Clinic (as DAP Health’s Palm Springs sexual wellness clinic is known) as a patient. He has been on PrEP for five years, and still uses the clinic for quarterly checkups. From the beginning, he loved the availability of free services and the openness of providers. 

Both men understand stigma and anxiety are intricately linked to sexual behavior and health, and that normalizing frank talk about sex and sexual wellness is the first step in caring for their respective patients. Their mission is to empower through education.

After a patient tests negative for HIV, Andy can get them started on PrEP, the pre-exposure prophylaxis that uses antiviral medications to help prevent the spread of the virus. There are a variety of drugs available — some are daily pills; another is a bimonthly injection. Using a judgment-free attitude, Andy helps patients decide which path is best for theirs needs.

Using the same “come as you are” mindset, Johnny does patients’ PrEP follow-up, testing them for HIV and sexual transmitted infections (STIs). He soothes those who test positive for either, explaining treatment of the former and quick and easy cures for the latter.

“Once they leave the clinic, we don’t know what happens,” says Andy of the patients under the men’s care. “But every once in a while, I get an email that says, ‘Thank you. My experience and the information I received was life-changing.’ Then I know what we did — what we are doing —is working.” 

Though both had a connection to DAP Health, the two first met on a dating app mere weeks after each moved to Palm Springs. Their first chat was a long one. The next night, they saw a movie. Within a few months, they’d moved in together. Marriage happened six months after that, with Andy taking Johnny’s last name.

By 2022, Johnny was working as a sexual health nurse at The Dock, as the Orange Clinic was known when it debuted within the Barbara Keller LOVE Building in 2015. The space opened its rebranded doors in the newly renovated, former county structure christened the Annette Bloch CARE Building across the way in January 2023. The sexual wellness clinic in Indio was unveiled in July 2022. The two present clinics currently serve about 1,075 patients per month. In late 2023, a third DAP Health sexual wellness clinic will open at the Stonewall Medical Center in Cathedral City.

It’s not just within the walls of DAP Health that the Gloriosos are making a difference. Part of the sexual wellness outreach team, they both participate at local events such as Pride, Leather Pride, International Bear Convergence, and White Party Palm Springs. The Orange Clinic has also partnered with several live-in rehabs in the valley, offering education and free testing.

And it’s not just at work that Andy and Johnny are peppered with questions about sexual wellness. They’re social, and people know what they do for a living, so friends and acquaintances aren’t shy about seeking professional advice, either face to face or via Facebook Messenger. The men are more than happy to bring interested parties into the DAP Health family. 

The couple loves living in Palm Springs and working at DAP Health. They were drawn to the city and the organization for their respective progressive attitudes and values. DAP Health, like the men, cares about community. They agree the nonprofit is different from any other place they’ve worked — or visited as patients. “We treat and educate people, at no cost to them, all without an ounce of shame,” says Johnny, adding that birth control, pregnancy testing, and other support services are also available. “It’s work that each of us takes to heart.”

Then there’s the fact that they’re always near each other from nine to five. “The real joy for me is seeing my husband throughout the course of the day,” says Andy. “We generally have a good time together, so we also have fun together at work.”

“Except when the natural way we relate to each other in private spills over,” adds Johnny with a wink and a smile. “To give you an example, when I was gone for a few hours recently, Andy apparently decided to clean out all of my work drawers the way he thought they should be. And when I came back, I couldn’t find anything — just like at home!”

The Science of Positivity

The Science of Positivity

“Never say never because limits, like fears, are often just an illusion.” — Michael Jordan

Words by Kay Kudukis

 

In the 1990s, a recurring skit on SNL called “Daily Affirmations with Stuart Smalley” had Al Franken portraying an insecure, support group-addicted, self-help schlub in a cardigan. He was the antithesis of the popular, flashy, mindset gurus like Tony Robbins. Stuart would frequently look at himself in the mirror and say, “I’m good enough, I’m smart enough and, doggone it, people like me.”

Although Franken was poking fun at the new fad, it wasn’t very new. Over 3,000 years ago, the Greeks were writing meditations and guidelines touting the best ways to live. The idea is actually 5,000 years old, but back then there was no alphabet, which made writing hard.

By the 1800s, poets and renowned authors were onto it, but scientists didn’t take notice until the 1970s, when they asked, “Is there anything to this?” It took a few decades, and a lot of studies, but the answer is — in wildly unscientific terms — it’s definitely a thing. Turns out, there’s true power in the science of positivity!

Yes, science. The University of Chapel Hill conducts a Positive Emotions and Psychophysiology Laboratory studying “how positive emotions affect people’s thinking patterns, social behavior, health, and physiological reactions.” Johns Hopkins and the Mayo Clinic promote positive thinking to lower blood sugar and high blood pressure, and to reduce the risk of heart attacks and strokes by lowering cortisol.

The human brain is the most complex thing in the known universe, and yours is fueled by your thoughts. Ever heard that if you repeat a lie long enough it becomes the truth? If your brain is filled with negative self-chatter, it will come to believe it. If your inner monologue is positive, the brain responds, and your stress levels decrease along with your blood pressure.

There is another tool called “reframing” that makes you more productive. It’s where “I hate doing the dishes” becomes “I can’t wait to get these dishes done and have a nice clean sink.” Such positivity releases dopamine and serotonin into your system, and if you add a smile? Well, a study at the University of Kansas concluded that smiling is such a powerful source of endorphins that your stress levels go down even when you fake a smile. So now you’ve got a buzzy cocktail of dopamine, serotonin, and endorphins in you, and the dishes are done.

If you need a little extra help, DAP Health is here for you. Its medical professionals won’t do your dishes, but they do have some unique Wellness Services, including a Zoom group based on positivity and related to achieving goals.

Michael Jordan didn’t get to be the GOAT by talent alone. In fact, he attributes his success to positive thinking. He never told himself he couldn’t. “I can accept failure,” he famously said. “Everyone fails at something. But I can’t accept not trying.”

So be like Michael. Flip that switch. It’s not going to make you a great basketball player, but you’ll absolutely, positively, win at this game we call life.

Impactful Planning

Karla Kjellin and Jeff Elder give back
Karla Kjellin and Jeff Elder

Impactful Planning

Karla Kjellin-Elder and Jeff Elder wanted to give back. Then they discovered planned giving at DAP Health and created a bona fide legacy.

 

As seen in Issue 4 of DAP Health magazine 

 

Words by Greg Archer • Photo by Peter Grant

 

The way the light catches on the silver lettering of the Karla Kjellin-Elder & Jeff Elder Social Services Wing signage at DAP Health encourages another look. Maybe it’s the modern design — sleek, long, and lean — or the way the name spreads out so boldly along the wall. Regardless, you’re bound to notice and possibly wonder: Who are the Elders?

It’s fun keeping up with the engaging couple. In conversation, it becomes vividly apparent that Karla Kjellin-Elder and Jeff Elder have long been committed to giving back to their community. This is true as it relates to DAP Health, specifically when the couple began to mindfully plot out their estate plan. They saw all too clearly how a legacy gift assists the nonprofit in continuing to ensure the overall health and well-being of the community. 

The Elders first got involved with HIV/AIDS-related services with AIDS Services Foundation Orange County, which now is under the Radiant Health Centers umbrella. They had lived in Orange County at the time and eventually rooted themselves in the organization — Karla was extensively involved with the food pantry, while Jeff was on the board and became president. When they moved to La Quinta in 2018, they realized it was time to take a tour of DAP Health.

“It was unbelievable and overwhelming what DAP Health was doing,” admits Jeff of discovering the organization’s reach. “AIDS Services Foundation hadn’t been able to do all that yet. You saw what could really happen out here in the desert. So, we got very excited about the organization and wanted to get involved.”

The Elders began attending various galas and Partners for Life events, suddenly finding themselves among people who were passionate about helping. The more involved they became with the nonprofit, they donated their time and resources, and learned more about planned giving — specifically, opportunities for “naming rights.” DAP Health’s social services wing was brought up. 

“‘Social services’ sounded like a motherly thing,” Karla shares. “I think DAP Health strives to be a kind of family for people who may have lost theirs because of ailments or whatever. That’s very sad, to think that somebody is basically homeless, even if they have a home, because they have nobody to nurture and care for them. That’s the good thing DAP Health does — nurture the whole person, not just the ailments, not just a condition. That’s why the term ‘social services,’ to me, sounded like a big hug.”

That department at DAP Health connects clients to social services for which they are eligible. This includes ensuring individuals have access to food, housing, transportation, home health care support, and more.

“We want to give, and be part of the community,” Jeff says. “If you’re part of a community, you help make it a healthy community, a really functioning community.”

They’re both quick to point out that when it came to establishing some kind of legacy gift, they wanted it to benefit DAP Health. To that end, they created their first-ever trust, and divided it into five parts — one each for their four children, and one part for a charity of their choosing. Their intention was clear. Each child would need to donate 10% of whatever they received in the inheritance to a charity of their choice, but to make the donation in the Elders’ name.

“We set up a donor-advised fund, and that fund is how we donate 90% of the money,” notes Jeff. “There are two organizations we give a lot of money to — DAP Health and The Living Desert. And so, when we pass away at some point, our children can give to various charities, and we would expect that a big portion of that will probably go to DAP Health.”

Planning it all in advance brought about a stronger sense of clarity and vision for the Elders. “To me, it’s like having or donating to a utility. It’s just something you do,” Karla says of philanthropy. “So yes, you can take your inheritance and give it to your kids, but it’s also important, I think, to have a portion of your money go to a charity, just like a portion of your income goes to a utility and a portion goes to rent.”

There are several kinds of donations accepted by DAP Health. To be sure, individuals can give money. But assets can also be considered. This can be anything from donor-advised funds, life insurance, and real estate to retirement plan assets and appreciated securities.

“There’s an entry point for everyone when it comes to planned giving,” says DAP Health Interim Chief Development Officer Chris Boone. “You can volunteer at one of our four Revivals store, you can give money, you can participate in our annual Health Equity Walk, go to a gala. There’s something for everyone.”

End-of-life conversations, however, may not always feel comfortable. “Sometimes, having those kinds of conversations can be difficult, because you’re talking about end of life and the decisions you’re trying to make,” Boone says. “But at the end of the day, the conversation is always centered around, ‘What do you want to leave, and what do you want to be remembered for doing in this world?’ Planned giving is all about impact, and helping others in your community.”

Moving forward and into 2024, Boone says he and the DAP Health team are excited about new possibilities that have emerged. In addition to sharp attention on planned giving, the goal is to have the organization’s Vision Forward capital campaign wrapped up in the next year, which, he says, “is a fantastic milestone. We can’t wait to celebrate our success thanks to donors like the Elders.”

Another significant opportunity to expand DAP Health’s impact is the recent acquisition of the Borrego Health system, which saw the nonprofit go from serving 10,000 patients a year at two locations in the Coachella Valley to more than 100,000 patients a year at 25 clinics located throughout 240 rural and urban zip codes from the Salton Sea to San Diego. The list of services offered now includes OB-GYN, pediatrics, urgent care, pharmacy, and veterans’ health — all of which will be covered under DAP Health. “We’re really excited about it because it really opens the door to a whole new community of folks to help. And that’s going to be huge. It’s a big thing to chew on,” Boone notes.

The Elders admit they were nicely taken aback when they first saw their names on the wall at DAP Health. Deep down, it felt like a full-circle moment for the couple, who have long been donating their time and resources to charitable organizations, and, in turn, making an impact.

“We tell people, ‘If you have money, give money. If you have time, give time. And if you have both, give both,’” states Jeff. “We’ve been fortunate. Some people hoard their money, so that when they die, their kids have this giant inheritance. We gave our kids a good education and raised them well. And they seem like they’re OK. Our plan really is about getting as much as we can out of life while we’re still alive, but whatever is left, a big piece of that should still go to charity because we really should be helping.”

Learn more about planned giving at PlannedGiving.DAPHealth.org.

Breaking Down Barriers

Breaking down barriers

Breaking Down Barriers 

By addressing social determinants of health — those nonmedical factors that influence patient outcomes —DAP Health is creating equity.

 

As seen in Issue 4 of DAP Health magazine

 

Words by Ellen Bluestein 

 

In its efforts to deliver care based on the needs of the individual, DAP Health’s innovative, whole-person approach continues to extend beyond the medical to address the systemic and societal forces that often prevent patients from receiving that care.

Known as social determinants of health (SDOH), these factors are the outside influences that impact a patient’s ability to seek or maintain health care. “They’re the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks,” says DAP Health Chief of Community Health C.J. Tobe. “Typically, there are five different categories that social determinants of health are broken into: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and then social and community context.” Each can have a profound effect on health outcomes. 

Now that DAP Health oversees a total of 25 clinics in Riverside and San Diego counties, this broadened area of service brings increased challenges to care. “We recognize that addressing social determinants of health is important to improve patient outcomes,” says Enhanced Care Management Operations Supervisor Claudia Barron. “First and most importantly, we conduct patient assessments, and we go beyond medical conditions. Our case management teams are trained to address social determinants of health, like housing insecurity, transportation barriers, financial challenges. And we also understand that every patient is unique and has their unique challenges. So, we focus on creating personal care plans. We also get trained by our health plans so that we can connect patients with resources.”

“We early on learned that having a great doctor and fabulous medicine is not enough,” says Senior Director of Social Services Zayda Welden, who oversees the nonmedical programs and services for HIV clients. “All these other factors are so important, or as important, as having the best infection specialist.”

Welden continues: “Clients have the best intentions, but if they cannot get here because they are living in the back dumpster of some building that offers shade — and if they leave, someone else will come in and take the place — they’re not going to leave,” she says. “If someone is not able to walk to the bus stop two miles to get on the bus and come in for the appointment, they’re not going to come in. If they don’t have money to buy gas, they’re not going to come in. So, we can have the best clinic and the best treatment available. If they are not coming in, then our work is not done.” 

To address this barrier, DAP Health has instituted transportation programs. “We have the ability to give clients bus passes and gas cards,” says Welden. “Now, not everybody has a car, so 

we have bus passes available for them. We have two kinds: one that is for seniors and disabled individuals, and one that is a regular monthly bus pass.”

It should be noted that, at this time, the medical transportation benefit is funded through grant programs limiting access to HIV-positive clients living in specific geographic areas who qualify. 

Welden also cites food insecurity as a negative social determinant of health. “Every patient who comes into the clinic gets asked a few questions in regard to food insecurity,” she says. “If they say, ‘Yes, I need a bag of food for the next two or three days,’ then we will provide that bag of food, no questions asked.” DAP Health’s nutritionist carefully chooses the nonperishable items that go into the bags, ensuring that they are both shelf stable and nutritionally substantive. 

“A lot of people downplay the importance of access to good, nutritious food,” says Tobe. “That’s going to be a social determinant of health — making sure people are able to eat several balanced meals per day. There’s fresh water. We found out that in our Oasis clinic, there’s not fresh water. That’s another social determinant of health.”

At said Oasis clinic (also known as Centro Medico Oasis, located in the town of Thermal), most clients work in agriculture, an often-grueling business with long hours and low pay that can profoundly affect health and well-being. “What we’ve gathered from talking to patients is that not all of them have or work for a company full-time where they get vacation, benefits, and all that,” says Oasis Clinic Manager Israel Ochoa. “The majority of them get three sick days, so once they’re gone, they don’t get paid. A lot of them would rather work unless it’s really, really necessary, or they’re really sick. They don’t have the luxury of benefits.”

Some clients also don’t have the luxury of literacy. “Centro Medico Oasis is 95% Spanish-speaking,” says Ochoa. However, for roughly 60% of the community, the first language is Purépecha, a Spanish dialect from Central Mexico. While these clients speak Spanish, there are some differences that prevent them from fully understanding it. When it comes to reading and writing, it’s Purépecha, not Spanish, that’s used. Most of the staff at the clinic speak English and Spanish, but there are times — during mental health appointments, for example — when clients and providers need interpretation assistance. For that, an online translation service is employed. 

From environment to education, work to worship, many factors influence health outcomes. “Negative social determinants of health…don’t discriminate. Anybody can face them,” concludes Tobe. Identifying and implementing programs to address them is the key to combatting them. “It’s really all about creating different access points or ways for people to obtain different services,” he continues. “It’s coming up with innovative ways to be able to eliminate that red tape, reduce those barriers, and meet people where they are that’s going to help support people living their healthiest and best life.

“With this marriage between DAP Health and Borrego Health, I think we’ll be able to take a lot of the foundational work that we’ve done…[and] then build on that infrastructure and replicate different programs — or even create new programs to address different social determinants of health for our complex patient population.”

social determinants of health

Against All Odds

Corina Velazquez

Against All Odds

 

The average age of a chief operating officer is 51. Corina Velasquez had earned that esteemed title by 36.

 

As seen in Issue 4 of DAP Health magazine

 

Words by Kay Kudukis • Photo by Zach Ivey

 

Being a medical assistant (MA) wasn’t the dream of Corina Velasquez in grade school. She was into poetry and prose. She was good at it too. Won an award and everything. In high school, that dream morphed into one of law school and a seat on the bench. All that changed with one test.

“I dropped out of high school midway through because I got pregnant with my daughter,” Velasquez says. She was 17 when she gave birth. It didn’t take long for her to realize that, domestically, she was in a bad situation. She left the father within two years.

“Statistics say I’d still be at my house on government assistance, but I didn’t let my fear of not being good enough stop me,” she says. She returned to her studies, became a certified phlebotomist, and took a job working in-patient at Eisenhower Health.

But Velasquez had her sights set on becoming an MA, so it was back to school. After a few internships, she got her first paid MA position at Borrego Health’s Centro Medico Cathedral City, which had previously been a private practice. Velasquez was also able to draw blood in the small, one-doctor clinic, where it was hard enough to get a patient through the door, much less go elsewhere for blood tests.

It was a great time in Velasquez’s life. She was 24, had a full-time job in an exciting field, and she’d found love again. They had two daughters, but after 10 years together (three of them married), they divorced. They’re such good co-parents, people think they’re still a couple.

Born in Ventura County, Velasquez completed kindergarten in Coachella after her single mom moved the family of four there, courtesy of a new job. A middle child, she was sandwiched between an older brother and younger sister. Eventually, her mom purchased a mini-mart where Velasquez worked after school and on weekends. That came in handy when she was transferred back to her old stomping grounds, subbing for the Coachella clinic’s MA, Carmen Ruiz, who now pulls double duty as the clinic manager at both Palm Springs Family Health and Desert Hot Springs Specialty Care. Both are Borrego Health centers now under DAP Health’s auspices. 

As Velasquez learned more about federally qualified healthcare centers (FQHCs), she asked her mom to refer mini-mart customers to their clinic, emphasizing their zero-discrimination policy, discounted medications, and sliding scale fees. When Ruiz returned from maternity leave, she discovered that, due to Velasquez’s expert outreach, Coachella had gone from treating six patients a day to routinely more than 30.

“I had worked with the company for a couple of years, and it was very different working with Corina,” Ruiz emphasizes. “Very different than working with anyone else. We would just look at each other and I’d say, ‘Did you see what’s going on in the lobby?’ And she’d say, ‘Yeah, I got it.’” Ruiz is referring to drop-in patients and the workload ahead. “Corina knew exactly what I was talking about. She was always going the extra mile, and I was the same way. We made a really good team.”

Velasquez agrees. “Carmen and I had this amazing working relationship where we could communicate without even talking. Just boom, boom! It was awesome.” 

When Borrego Health graduated from paper to electronic health records (EHR), it chose to conduct training at the small Coachella facility. Trainers came in but didn’t bring step-by-step learning tools. 

“I created screenshots at the nurses’ station so I could remember, because I knew the instructors weren’t going to be there forever,” Velasquez recalls. Shortly thereafter, she happily accepted a promotion to become the trainer of the new system — for all Borrego Health MAs. 

Velasquez also began learning about quality and compliance. Soon she was auditing charts, helping with audit tools, and in 2011, was asked to manage a brand-new clinic. She would be stocking, staffing, and problem-solving.

She did so well that it was requested that she find her replacement, and do it all over again. Wet, lather, rinse, repeat. Every clinic, from soup to nuts.

At the same time, changes were going on at the upper levels of the organization. The VP of operations was promoted to COO, the regional director of operations became VP, and Velasquez applied to be — and was appointed — regional director in 2012, where she stayed until her 2015 promotion to VP of patient access.

Her rise to the C suite came in 2021. With Borrego Health then serving more than 120,500 patients (roughly 463,000 annual visits) throughout Riverside and San Diego counties, being chief operating officer was a big job. It’s an even bigger job now that she serves in that capacity at DAP Health. It’s a role that was previously absent at the organization — one created just for her.

“Corina is simply a force to be reckoned with,” says DAP Health CEO David Brinkman. “Her journey is such an inspiring one. She’s a doer whose presence is nonetheless so warm and welcoming. I’m tremendously excited to have her keep doing what she does best for us now that we are one, integrated health care agency.”

Here’s an anecdote from her early years, which shows why Velasquez has been so successful: She was working with a provider who had a reputation for being “a little too direct” (as she gently puts it), when he snapped at her in front of a patient. 

“I went into his office when we were done, shut the door, and said, ‘Let that be the last time that happens. I’m here to work with you. So, let’s make this a good day.’ He just looked at me, then smiled and said, ‘We’re gonna do just fine.’ After that, it was a really good relationship. At the end of the day, everybody wants the same thing. Sometimes, they just need a different map on how to get there.”

Now 39, Velasquez can look back and offer advice to other young adults, no matter their situation. “Even when you don’t believe in yourself, be curious enough to ask the questions because that can open so many doors to things that you never thought you’d even be in the right vicinity of.”

Before DAP Health’s acquisition of Borrego Health, when things were up in the air, Ruiz one day felt inspired to call Velasquez to say, “I just want to thank you. I know what you’ve done, and what you’re capable of doing. We don’t know exactly what you do for us behind the scenes, but things happen because of you. Good things.” 

As it turns out, Velasquez has core values — strength, truth, justice, optimism—that she shares with Wonder Woman. Like Velasquez, Wonder Woman has profound healing, telepathy, and supernatural leadership powers. 

Isn’t it interesting that Wonder Woman and Velasquez have never been seen in the same place at the same time. Make of that what you will

Where Barbie Fears To Tread

Women of Impact

Where Barbie Fears To Tread

With “Barbie” being the biggest movie of 2023, it’s a perfect time to not only raise awareness, but to actually do something about the state of women’s care. It may surprise you to know that DAP Health is already the projected leader.

 

As seen in Issue 4 of DAP Health magazine

 

Words by Kay Kudukis • Photos by Zach Ivey

Whether or not you liked the movie “Barbie,” you have to admit it’s causing … feelings. But since neither Barbie nor Ken have genitalia, or any internal organs, it has kept some salient points, like women’s health care, from being explored on screen. 

Still, they could have thrown in a scene where America Ferrera’s character chooses a blue razor over a pink one while explaining that the latter is, save for color, exactly the same as the former but that, since it’s marketed “for women,” it’s available at a 13% price hike. Or that in 21 states, feminine hygiene products are still taxed as luxury items — which is some very dark state humor. Both are victims of the unwritten “pink tax” that requires women to pay more for bare necessities.

The film’s all-girl Supreme Court screamed “goals” and, independently of “Barbie,” DAP Health thought that was a good idea too. There are now six women on the nonprofit’s board of directors, and we’ve “poked the bear,” so to speak, and asked them to weigh in with their experiences and concerns. 

“You can find numerous stories where women ‘know’ there is an issue and they are ignored by their doctor,” says DAP Health Board of Directors Vice Chair Lauri Kibby, an investor and entrepreneur in Palm Springs. “As if the ‘hysteria’ label continues to exist — though much more subtle.”

If you’re late to the game, in the mid-20th century, women with “unexplained malaise” were diagnosed with hysteria.

Bottom line? We need a big wake-up call in the medical community, which even today has an astoundingly limited understanding of the intricacies of a woman’s body and how it relates to her well-being. “The medical profession has has been bound by the assumption that women’s health management and issues are similar to male health management and issues,” Kibby continues. “This could not be further from the truth. As a consequence, research methodologies, and even provision of care, has mimicked male health care, resulting in insufficient — and often delayed — diagnosis, and in many cases, the cause of serious prognosis or early death.”

Dignity Health St. Mary Medical Center Hospital President and CEO Carolyn Caldwell of Long Beach, also a DAP Health board member, calls attention to something of which many women are guilty. “They are often so busy taking care of their families, they forget to take care of themselves,” she says. “It is critical that the health care powers that be educate women on the importance of self-care.” 

But many women are single parents who work, and seeing a doctor or having tests requires time off, not to mention the cost of childcare, so they skip it. That only compounds whatever ill might be silently brewing. 

“Due to a historically patriarchal health care system, women are prone to increased and often untreated forms of heart disease, mental illness, cancers, and other complex medical issues unique to women,” adds Palm Springs’ Eve E. Fromberg-Edelstein, an attorney and partner at Fromberg Edelstein Fromberg who also sits on the nonprofit’s board. 

NPR cites a study showing middle-aged women with chest pain are twice as likely to be diagnosed with a mental illness (instead of a heart condition) than their male counterparts, indicating women’s medical concerns are often dismissed at higher rates than those of men.

“Listening to women and responding to their concerns is a step in the right direction,” suggests Kibby, who also spearheaded DAP Health’s new Women of Impact initiative (see sidebar). “Training doctors and medical students that there are differences, and changing methods of research to include the biology of women, are all preliminary steps to changing the culture of women’s health care.”

“I will say this,” adds board member and Palm Springs business owner Athalie LaPamuk of her involvement in Women of Impact. “I was initially drawn to serving on this particular committee because, for the last eight years I have lived in the desert, I have continued to see my gynecologist in New York City once a year. That just seemed normal given the lack of women’s care options here. Hopefully, our women’s health initiative at DAP Health can change that. I think it’s been proven that a community is only as healthy as its women, so this is very important.”

DAP Health Associate Chief of Operations Nereida (Nedy) Terrazas served at Borrego Health for over 20 years, and has been involved in women’s health care since 2014. She comes into her new role within the integrated system with experience, ideas, and big plans, including practical ones such as moving from paper medical records to the much more efficient electronic ones. She also wants to address the issue of women missing appointments. “We are looking into an Uber health account so we can begin offering transportation services to our patients,” she says. Many families have only one car, and during clinic hours, the husband often uses it for work.

Terrazas seconds Caldwell’s concerns that lacking self-care is a major issue. “Your health should always be a priority,” she says. “Women tend to be the caregivers and make the health care decisions for our families. If we’re not well, who will replace us? Preventative care keeps us healthy so we can take care of our families. We cannot afford to skip it.”

Professor Karyl E. Ketchum, Ph.D. — who also serves on DAP Health’s board — is the department chair of women, gender, and queer studies at California State University, Fullerton. She brings good tidings: “Healthy women are better able to engage in economic activities, both within and outside the home, contributing to increased household income, economic growth at the community level, and improved living standards.”

With such strong and strongly empowered women in place within its leadership and workforce, DAP Health (which estimates that more than half of its patient population is female) is set to galvanize women throughout Southern California thanks to much-needed improvements in female-specific health care. What a perfect premise for a … “Barbie” sequel!

Fade in: 

Palm Springs Barbie, in vintage Bob Mackie, sips a chilled beverage in her immaculately appointed Midcentury Modern doll house as Pregnant Midge gushes over the award-winning, holistic, patient-centric care she is receiving at DAP Health.

Barbie is inspired to create an “In the Pink” world tour, and to kick off her opening speech, she uses the words of yet another member of DAP Health’s governing body in Palm Springs, U.S. Soccer Foundation Chief Revenue Officer Ginny Ehrlich: “So many are headed in the wrong direction when it comes to women’s health. But not DAP Health. Instead of stripping women of their ability to determine what’s right for their own bodies and well-being, we are offering them the respectful and comprehensive health services they need … and deserve!” 

Greta Gerwig, call me.

Sidebar:
Women of Impact, the newest initiative for DAP Health, came together through the passion of a powerful group of community, board of directors, and staff members dedicated to setting the “gold standard” of health care for women and children in our community.

“We all know there are severe gaps and barriers to good quality care for the women in our community and the families they care for,” says WOI Chair and DAP Health Board of Directors Vice Chair Lauri Kibby. “Our goal with Women of Impact is to fund programs that will address those gaps and educate the public about how they can be part of this movement.”

You can join Women of Impact — or get more information about the WOI tours that began this fall at Centro Medico Cathedral City — by contacting Chas Kidder at ckidder@daphealth.org.

Caption: DAP Health PrEP Navigator Livi Moreno photographed by Zach Ivey in a dress by Peepa’s Palm Springs from Revivals

Caption:  DAP Health's Women of Impact Committee members photographed by Zach Ivey.

Imagine

Imagine 

Lift to Rise is partnering with DAP Health and others to erase desert homelessness.

 

As seen in Issue 4 of DAP Health magazine

 

Words by Kay Kudukis • Photos by Noé Montes for Lift to Rise

 

Collective impact: a network of community members, organizations, and institutions advancing equity by learning, aligning, and integrating actions to achieve systems-level change.

Even before 2011, when the term was first coined in a paper published in the Stanford Social Innovation, Heather Vaikona had been putting “collective impact” into practice in England, networking organizations to get behind a common cause to drive toward something.

In 2014, having returned from overseas and serving as the resource development director for United Way of the Desert, Vaikona was invited to an investor meeting. “The significant amount that all local funders were investing in was FIND Food Bank,” Vaikona says, which sounded fantastic until data showed food insecurity was still a thing. It was a symptom of something bigger. “Folks said, ‘What would it mean if we formed a coalition to try to tackle the root cause issues?’ Everyone in the room said, ‘Yeah, you figure it out, and come back and tell us.’”

Vaikona hit the road, lifted the hood at all the existing coalitions, and listened. “I heard loud and clear the importance of having an academic data partner using a results framework.”

Enter USC Professor Gary Painter, a leading economist who prompted Vaikona and FIND Food Bank to successfully apply for a $500,000 grant from Feeding America on behalf of FIND. “We did a valley-wide needs assessment between 2015 and 2016,” she says. “Gary did quantitative data analysis: If we were to move one or two or three indicators, what would radically shift conditions for all residents? And then qualitatively, we asked 1,500 residents to identify their biggest obstacle to economic stability and it was overwhelming. Everyone said ‘housing.’” The data matched. 

The Coachella Valley’s number one industry, with a whopping $7.1 billion dollars (2022) is, not surprisingly, tourism. The number-two industry surprises some: Agriculture brings in $600 million annually. That means the valley is home to thousands of hospitality and farmworkers, many undocumented. 

Statistics show that 40% of the Coachella Valley’s workforce is employed in hospitality and service sector jobs that pay between $15,000 and $33,000 annually. The average one-bedroom apartment in Palm Springs currently averages $1,822. That’s $21,864 per year. On the lower income end, it’s a non-starter; on the high end, factor in utilities, food and household goods, car, phone, and gas expenses, and you’re in the red.

Affordability is an extraordinarily civilized word used to define a crisis in America resulting in 600,000 homeless Americans, which increased since 2022 by 11%. 

It was already a problem in 2018 when Lift to Rise, the low-income investment fund founded by now CEO Heather Vaikona, was born. Its mission? To build 10,000 affordable homes in the Coachella Valley by 2028. 

And then, COVID-19 hit.

DAP Health Care Coordinator Specialist Regional Coordinator Veronica Garcia grew up in Coachella as one of six kids raised by a single mom who worked as a farmworker and at a citrus-packing plant. Weeks into the pandemic, people she knew socially were coming in, scared of facing homelessness. “In the beginning, there was no work, and if there was, they didn’t hire as many farmworkers,” she says. “It was really hard on the East Valley.” 

Garcia gets emotional describing the impact Lift to Rise had on her community after the org showed up at one of her staff meetings to share details about its United Lift Rental Assistance Program.

Vaikona explains why: “We deployed emergency cash assistance to 5,000 folks and beyond, and the great thing about that is we got to see everyone’s applications and analyze the data. More than half said they weren’t going to be able to pay their rent. We already had this rock-solid partnership with Riverside County, and honestly, the Riverside County Board of Supervisors does not get enough credit. They made the largest allocation of Cares Act funding in the country to build what became our United Lift Rental Assistance Program.”

The balance in Lift to Rise’s PayPal account — linked to a donation button on the org’s website, which rarely got any action — suddenly ballooned by $100,000 in two hours. Vaikona and her team had no idea what was going on until an excited phone call from a colleague announced that Lift to Rise had just been featured on PBS Newshour. At the end of the day, a small army of like-minded Americans had independently donated $600,000.

Last year, Lift to Rise received the California Nonprofit of the Year Award and, along with other organizations, partnered with DAP Health and Coachella Valley Housing Coalition to fund a 61-unit affordable complex called Vista Sunrise II, currently being built on DAP Health’s Sunrise campus in Palm Springs. It will house those with chronic illnesses who are facing homelessness, and residency will include health care services provided by DAP Health. 

By its fifth birthday, Lift to Rise had plenty to celebrate. Here’s its highlight reel: 

Due to its advocacy, Governor Newsom created a $600 million kitty, made catalyst funds eligible, and Vaikona expects they’ll be capitalized with at least $40 million by 2024.

We Lift — its housing catalyst fund in partnership with Riverside County, Rural Community Assistance Program, Low Income Investment Fund (LiiF), and 70 community partners — has funded seven projects totaling 500+ affordable housing units, and has deployed $3.5 million in loans, with 1,600 units under construction.

Its Resident Leadership Table, comprised of 14 community leaders, is dedicated to Lift to Rise’s mission.

Its Collaborative Action Network, made up of more than 60 partners, sets strategic pathways to housing security through economic mobility.

As impressive as that is, Vaikona will not go gently into that good night, resting on laurels. She expresses a viewpoint that leaves those conflating altruism with economic challenges rather … uncomfortable. 

“We don’t have a resource problem when it comes to homelessness. We have a value problem [relating to] how we view those who are unhoused,” she says. “Our economy is based on significantly underpaid labor. In that way, the economy is exploitative. It is not Mother Nature, something we have no control over; it’s a complex set of individual behaviors and choices and transactions.” If someone told them to build three million houses right now, Vaikona says they could do it if it weren’t for all of the barriers imposed by people. 

And here’s the most difficult pill to swallow, according to Vaikona: “It’s really ‘Who do we love?’ and frankly, ‘Who don’t we love, and why?’ If we love people, we will go to the wall to ensure their care. It’s a real existential question: What does it mean to be alive on planet Earth? Why am I here? And what do I owe my fellow human? We’re holding structures and mental models about who is deserving and not deserving of support and care. We could solve all of our problems very quickly if we operated from a different value system. I think we have to step back and look at our obligation to each other. We can choose to build a radically different future than the one that we live in.”

Imagine all the people, living life in peace. 

~ John Lennon & Yoko Ono.

Caption: Above: Lift to Rise received a $15 million allocation from the state budget to go into We Lift: The Coachella Valley’s Housing Catalyst Fund to encourage affordable housing development. Pictured from left to right are Lift to Rise board member Matt Horton, Lift to Rise President and CEO Heather Vaikona, Lift to Rise board member Nadia Villagrán, Assemblymember Eduardo Garcia, and Lift to Rise board member Bea Gonzalez. Right: Lift to Rise celebrated its firth birthday in July.

A Tale of Two Cultures

DAP Health and Borrego Health

A Tale of Two Cultures

How DAP Health and Borrego Health married their expertise into one unified vision

 

As seen in Issue 4 of DAP Health magazine

 

Words by Barbara Kerr

 

At DAP Health’s Sunrise campus in Palm Springs, one client is receiving HIV specialty care and a connection to social services, including food and housing, as another receives gender-affirming care. 

At Borrego Health’s Coachella Valley Community Health Center in Coachella, physicians are providing obstetrics, pediatric, and dental care for a migrant family, plus specialized care for a veteran’s family.

These stories reflect just a few of the comprehensive services provided by DAP Health, serving the Coachella Valley since 1984, and Borrego Health, serving Riverside and San Diego counties since the 1980s. 

Now, the two organizations have become one, offering compassionate health care with dignity and respect across Southern California. Looking to the future, leaders of both organizations are committed to nurturing a true partnership.

Corina Velasquez has a unique understanding of the mission and culture of Borrego Health. Sixteen years ago, she joined the organization as a medical assistant. In 2021, she became its chief operating officer, a role she now fills at DAP Health. “I think the culture is in the need to deliver care to the underserved, making sure that you’re here for your neighbors, your friends, your family,” she says. “Because that’s who they are to our employees.

“This organization has been through a lot over the past couple of years, much like many other organizations in terms of COVID-19 and how that’s changed things. But with Borrego, it goes a step further with all the things we’ve had to deal with.” 

Velasquez credits the staff for their dedication. “So many of them could have left. But when you look at the staff that are still here — and you ask about their tenure — it’s anywhere from five, 10, 15 years and climbing.”

To answer questions and ease concerns, Velasquez, Borrego Health Vice President of Clinic Operations Nereida “Nedy” Terrazas, and DAP Health CEO David Brinkman took part in an extensive listening tour prior to the official start of the two organizations joining forces. “We went to every single one of our brick-and-mortar clinics over the course of about five to six weeks,” Velasquez reveals. The goal was not only for Velasquez, Terrazas, and Brinkman to answer tough questions, but for the latter to start to get to know Borrego Health employees, and vice versa.

“It was very important to me to travel near and far, accompanied by Corina and Nedy, to visit the many people with whom we would soon be working so closely, in their own workplaces,” says Brinkman. “What was most moving to me was not only to see how long most have been in health care, but to witness firsthand the love and passion they have for the work; the dedication they have to the patients they feel it’s their duty and honor to serve. All of that was immediately apparent from our very first conversations.” 

Velasquez believes DAP Health is a perfect partner in terms of patient care. “It is such an alignment of DAP Health’s ability to do the wraparound services — all of the things that are not direct patient care, from housing to food insecurity — and marrying that with Borrego’s ability to deliver complex care, from women’s health to pediatrics, adults, and specialty. I’m really excited for the future and what’s to come.”

Deanna Drake — who earned a master’s in public health from the University of Minnesota, Twin Cities — is a senior manager at Facktor Health, a nationally recognized consulting firm with expertise in development, innovation, and integration for federally qualified health center (FQHC) health plans and hospitals. The company has been supporting DAP Health and Borrego Health throughout this integration, and will continue for the foreseeable future. 

Drake notes that both organizations were established to meet an unmet need for a population that didn’t have access to care. “I think what’s really similar is how they started — their motivations for caring for people,” she says. “And what’s changed, over time, is who those populations are.

“Many people choose to continue working at these two organizations for the exact same reason. They’re passionate about caring for their patients. And those are patients who are typically quite underserved, vulnerable, and subjected to marginalization or discrimination.”

What does that mean to those who turn to the new, blended organization for care and support? “Say you’re a busy mom and you’ve got three kids,” Drake suggests. “You want to know: When I call to make an appointment for my child, is it the same phone number? Can I use my same insurance? Will my doctor or my nurse practitioner be there?

“They want that stability — that reassurance that the care they’ve been receiving will continue and it’s as accessible as it always has been. They want to hear, ‘I’ll be here for you. Yes, it’s the same phone number. Yes, you can use your same insurance.’ It’s really important to get that information to those patients directly through their providers.” 

What could the health care partnership look like within the two years? Drake has a powerful and inspiring vision. “It’s an organization filled with very talented leaders — and very mission-driven staff — who have learned from each other to create a system that is truly exemplary,” she said. 

Looking to the future, Drake says, “In terms of the quality of the care they’re providing, the quality of their facilities, the excellence in their approach to social determinants of health, they’ve taken the best of both entities and blended that into a strong, unified vision and a mission-driven organization.”

Timeline

September 12, 2022

Borrego Health files for bankruptcy and solicits potential acquisitors to assimilate its assets, and to serve its more than 100,000 patients (which include people of all genders, as well as children — individuals as diverse as migrant farmworkers in rural areas to refugees and recent immigrants in urban settings).

February 5, 2023

DAP Health makes public the fact that — having retained Facktor Health (a firm with expertise in FQHC acquisitions) and having formed an alliance with fellow regional FQHCs Neighborhood Healthcare and Innercare — it has made a bid to absorb Borrego Health in order to advance DAP Health’s nearly 40-year-old mission of protecting and expanding health care access, especially for marginalized populations.

February 15, 2023

The Borrego Health board of trustees selects DAP Health to absorb the Borrego Health system based on a process conducted through Borrego Health’s Bankruptcy Court proceedings. The final sale is still subject to the approval of both the Bankruptcy Court and the Health Resources & Services Administration (HRSA).

March 1, 2023

The Bankruptcy Court approves DAP Health’s bid to acquire all assets of Borrego Health, launching a regulatory transition process involving the California Department of Health Care Services (DHCS) and HRSA.

Working with the consultants at Facktor — and having created various committees devoted to human resources, communications, IT, operations, etc. — DAP Health works through not only its DHCS and HRSA requirements, but the logistics involved in hiring Borrego Health’s 600 employees, all of whom are offered positions at DAP Health.

DAP Health and Borrego Health leaders — in addition to that at Innercare and Neighborhood Healthcare, plus Facktor consultants — focus on implementing a well-thought-out plan that will lead to the smoothest transition for all involved.

July 31, 2023

HRSA officially approves the absorption of all Borrego Health assets by DAP Health.

August 1, 2023

DAP Health and Borrego Health begin operating as one integrated health system. 

Information for Patients

Does DAP Health own Borrego Health? 

Yes. DAP Health purchased Borrego Health and is responsible for managing all Borrego Health employees and for operating all Borrego Health clinics. 

Why did DAP Health choose to acquire 

Borrego Health? 

DAP Health chose to acquire Borrego Health to protect and expand care for Borrego Health patients, and to increase its footprint so it can bring its award-winning, holistic, patient-centric model of care to more communities throughout Southern California. 

Is the name of any DAP Health and/or Borrego Health clinic/center changing? 

No. For at least the next 12 months, each clinic/center will retain its original name, branding, and signage. 

How will this acquisition affect patient care? 

Programs and services for all DAP Health and Borrego Health patients will remain the same everywhere, and in many cases will be improved as DAP Health adds more providers and support staff. There will be no interruption in care, which patients can access as they normally have. 

Will patient care teams remain the same, and will patients retain their same provider/doctor? 

Yes. All providers and care teams are now employees of DAP Health. However, most will continue to serve at the clinics where they have been working and caring for patients. 

Will all Borrego Health and DAP Health clinics/centers have access to all patients’ medical records? 

Yes. Once you are registered as a patient at the clinic, you can authorize staff to request your records. 

Can a patient transfer their care between Borrego Health and DAP Health? 

Now that DAP Health and Borrego Health are one system, any patient who wishes to visit another clinic location should call to speak to a representative about registering at that clinic as a patient. 

Will there be changes in insurance requirements? 

No. All insurance requirements remain the same. 

Do existing Borrego Health patients need to change the facility name on their insurance card if they want to be seen at DAP Health? 

No. Existing patients can continue to use their current insurance cards. Only new enrollees will be issued a new card that indicates that DAP Health is their medical home.

Together For Better Health

DAP Health and Borrego Health

Together for Better Health

DAP Health and Borrego Health become one integrated health care system with a singular goal — to protect and expand local access to culturally competent care for more than 100,000 patients.

 

As seen in Issue 4 of DAP Health magazine

 

Words by Daniel Vaillancourt

 

On August 1, 2023, DAP Health and Borrego Health became one in a union sanctioned by both the Bankruptcy Court and the Health Resources & Services Administration (HRSA). Since then, the integrated health care system has operated with some 850 employees serving more than 100,000 patients of all ages, genders, ethnicities, orientations, and socioeconomic status at a total of 25 Southern California clinics located within 240 rural and urban zip codes from the Salton Sea to San Diego.

Prior to the two federally qualified health centers (FQHCs) joining forces, DAP Health’s programs and services included primary care, infectious diseases, gender-affirming care, LGBTQ+ care, mental health, dentistry, harm reduction, recovery services, affordable housing, and social services. The Borrego Health disciplines now under DAP Health’s vast umbrella include family medicine, women’s health (including OB-GYN), pediatrics, veterans’ health, geriatrics, urgent care, and pharmacy services.

“It’s an honor to unite Borrego Health and DAP Health’s missions, as well as our region’s most exceptional, dedicated, and passionate health care professionals,” says DAP Health CEO David Brinkman. “Together, we will build a brighter future where every individual — regardless of who or where they are — has equal opportunity to live a healthy and fulfilling life.

“We will achieve this by replicating our time-tested, holistic, patient-centered care model, which addresses all applicable social determinants of health (SDOH) negatively affecting the patient population at each of our clinics. By addressing these SDOH — whether they pertain to language and literacy, housing, nutrition, transportation, education, employment and income, addiction, violence, and/or racism and other discrimination — we remove barriers to care, increase our patients’ quality and length of life, and create true health equity.”

“When all of us at Borrego Health were looking for a like-minded FQHC to take us under its wing, three things mattered most,” says DAP Health Chief Operating Officer Corina Velasquez, who served in the same capacity at Borrego Health. “Continued access to health care for our more than 100,000 patients. Continued employment for our more than 600 employees. And mission match — an organization that would share our values and our vision for continually creating more health equity in this region. In DAP Health, we hit the proverbial trifecta … and then some!”

Of note:

Every DAP Health and Borrego Health location will remain open, retaining its original name, branding, and signage for the time being.

Some 99% of Borrego Health employees accepted DAP Health’s invitation to join the combined entity. There were no layoffs or forced relocations among existing DAP Health employees.

Fellow FQHCs Innercare and Neighborhood Healthcare — allies of DAP Health who have regional and cultural expertise in Riverside and San Diego Counties, respectively — will offer guidance, support, and community connections on an as-needed basis.

DAP Health’s mission — including its commitment to LGBTQ+ health care, HIV care, gender-affirming care, and the Coachella Valley community — will expand as a result of its absorption of Borrego Health.

Over the next 12 months, DAP Health’s fortified executive leadership team — consisting of individuals from both organizations — will analyze all social determinants of health (those non-medical factors that negatively impact patients’ health outcomes) at all the clinics served. It will actively engage fellow community organizations, government agencies, educational institutions, and businesses to improve health outcomes for all, whether that be by adding programs and services or improving physical facilities. By combining a plethora of strengths, DAP Health will achieve new levels of excellence in delivering comprehensive, accessible, and culturally sensitive care to its diverse patient populations.