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$1 Million Granted by HRSA for DAP Upgra …

Media Contact: Jack Bunting
[email protected]
(760) 323-2118

$1 Million Granted by HRSA for DAP Upgrades

New Generator for Power & HVAC Service in Emergencies

Palm Springs, CA (September 30, 2020) -- Soon, DAP Health Center (DAP) can respond and recover with uninterrupted service to patients in the event of a disaster or other emergency that results in power loss, thanks to a $1 million dollar grant from HRSA’s Capital Assistance for Disaster Response and Recovery Efforts (CADRE).

The medical team at DAP is trained at delivering emergency and disaster-related medical aid to the community, and this award will help ensure it has a backup power source and functioning HVAC it needs in such times.

Over the three-year grant period, DAP will replace eight outdated HVAC units and install a new emergency generator capable of supporting clinic operations. The alternative power source will keep HVAC units running, electronic health records accessible, and will preserve life-saving medications and vaccinations requiring refrigeration.

When the Coachella Valley area experienced power outages from severe flooding in winter 2019, DAP leadership grew concerned about how future outages might affect its ability to deliver needed services during an emergency, especially in its new Blue and Green Clinics.

The new clinics on the DAP campus, opened in March 2020, added an additional 30,000 square feet of clinic space. They alleviated a severe capacity challenge that was limiting DAP’s ability to serve ever increasing numbers of patients needing services.

Riverside County, where DAP delivers HIV testing, linkage to care, and treatment services, has been identified as one of the 48 counties in the United States with the highest burden of HIV infection. No other FQHC in Riverside County has been awarded a grant this size for this purpose by HRSA.

About HRSA

Tens of millions of Americans receive quality, affordable health care and other services through HRSA's 90-plus programs and more than 3,000 grantees.

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable.

HRSA programs help those in need of high-quality primary health care, people with HIV/AIDS, pregnant women, and mothers. HRSA also supports the training of health professionals, the distribution of providers to areas where they are needed most and improvements in health care delivery.

HRSA oversees organ, bone marrow and cord blood donation. It compensates individuals harmed by vaccination, and maintains databases that protect against health care malpractice, waste, fraud and abuse.

About DAP Health Center

DAP Health Center (DAP) in Palm Springs, CA offers medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic, The DOCK, offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

Visit www.daphealth.orgwww.thedockclinic.org, and www.gettestedcoachellavalley.org to learn more.

Seniors Need Protection – Less Isolati …

Seniors Need Protection – Less Isolation

Specialists say social isolation can be as harmful as smoking 15 cigarettes a day, but many people over age 65 in our community are trapped with long-term social seclusion, worsened by this pandemic. We’ve created a medical home for them, with specialized doctors and therapists they can access from home, and a social services team to link them to programs and coverage.  

Seniors make up almost 30 percent of this Valley’s population, about double the national average. Because many already identified as physically vulnerable pre pandemic, seniors are experiencing added isolation from adhering to current social distance rules. 

As the length of this pandemic takes a toll on even the most resilient seniors, advocates like Dr. Jill Gover, our behavioral health manager contributed to a story in The Desert Sun:

"(Older people) are not willing to take the risk and so they are much more isolated — it was a major problem to begin with and COVID has only exacerbated it." (read more here)

Get Access To the Care You Need

One Call is a service that can enroll callers in health insurance or Medi-Cal through Covered California, register them for medical and behavioral healthcare, and schedule their first appointment at DAP — all in approximately 45 minutes. This is a significant reduction in the amount of time this would normally take, thanks to a DAP Healthcare Navigator who will work one-on-one with each caller.

Callers can access One Call service by calling 760-992-0426, Monday – Friday, 9am – 4pm PDT.

PrEP 2-1-1 During COVID

PrEP 2-1-1 During COVID

Weekend Wrap Message – Saturday, September 26, From David Brinkman, Desert AIDS Project CEO 

New HIV infections are continuing in our Valley, and years of our work to reverse this trend are in danger unless we offer the public every prevention method we can.

Most of our clients who are using PrEP to prevent HIV are on the daily dose, and this remains the most effective regiment. For a few, daily dosing is not an option, and we believe in making this lifesaving therapy available to them.

Clinical data indicates that while daily PrEP has shown to be 99% effective in preventing HIV, PrEP 2-1-1 has been shown to be up to 86% effective. 

With medication delivery, telephone consults, and sanitized stations for periodic STI testing, clients are preventing HIV while being safely served. You can learn more here.

Seniors Need Protection--Less Isolation

Specialists say social isolation can be as harmful as smoking 15 cigarettes a day, but many people over age 65 in our community are trapped with long-term social seclusion, worsened by this pandemic. We’ve created a medical home for them, with specialized doctors and therapists they can access from home, and a social services team to link them to programs and coverage.  

Seniors make up almost 30 percent of this Valley’s population, about double the national average. Because many already identified as physically vulnerable pre pandemic, seniors are experiencing added isolation from adhering to current social distance rules. 

As the length of this pandemic takes a toll on even the most resilient seniors, advocates like Dr. Jill Gover, our behavioral health manager contributed to a story in The Desert Sun:

"(Older people) are not willing to take the risk and so they are much more isolated — it was a major problem to begin with and COVID has only exacerbated it." (read more here)

Untreated HIV Still A Threat

We hope these numbers do not increase as the economy suffers, but people are still developing and dying from AIDS in 2020, right here in the Coachella Valley. Staying in treatment for HIV is not easy for many, but our medical team has the expertise and heart to help anyone re-enter care without judging them.

Our early intervention program had 160 referrals for attempts to find patients who had stopped filling their ART prescriptions, ceasing their HIV treatment without explanation. (Based on calendar year 2019) You can read more here about our work to make sure anyone needing HIV treatment can get it quickly.

Accessing PrEP During COVID-19

Accessing PrEP During COVID-19 

Getting on PrEP at DAP is easy. We offer help with insurance and discount programs, and our navigators and doctors give you specialized attention to find out what works best for you as an individual. 

Most of our clients who are using PrEP to prevent HIV are on the daily dose, and this remains the most effective regiment. Clinical data indicates that while daily PrEP has shown to be 99% effective in preventing HIV, PrEP 2-1-1 has been shown to be up to 86% effective. 

For a few, daily PrEP is not an option, and we believe in making this lifesaving therapy available to everyone. Your DAP doctor can tell you more. 

Under certain circumstances, PrEP 2-1-1, or PrEP-on-demand, is available at DAP. While we fight COVID-19, our doctors are also keeping their patients safer from HIV by finding new ways to protect their sexual health. 

During this period of lockdown, we make daily dosing easy for you. With medication delivery, telephone consults, and sanitized stations for periodic STI testing, clients are preventing HIV while being safely served. 

If you or someone you know wants to talk about PrEP, please call (760) 323-1999 to talk to a member of our team who’s ready to tell you more. You can also learn more here. 

Community Impact Newsletter September/Oc …

Community Impact Newsletter September/October 2020

Lifesaving HIV Meds Quicker Under New Rapid ART Program

DAP programs for promptly treating patients with HIV are being recognized again at the national level, and the result will save even more lives and prevent new cases. It also says a lot about our community, because without donor support, these programs are not possible.

Winning designation as a Rapid ART Implementation Site is an important milestone in the fight to end HIV. DAP stands with just 10 other healthcare organizations in the U.S. The Award for Special Projects Of National Significance was won in a competitive grant process and is bestowed by the Health Resources and Services Administration (HRSA).

By joining this national demonstration project and collaboration with HRSA, DAP will share its 36 years of experience in the fight to end HIV, and it will boost resources for its HIV testing and treatment programs for people in the Coachella Valley.

For a three-year period, DAP will continue to build and share its best practices for making sure PLWHA receive antiretroviral therapy (ART) quickly after receiving an initial HIV diagnosis, or immediately after requesting it if they had stopped ART for any reason.

Untreated HIV Threatens Coachella Valley

It’s a surprise to many, but people are still developing and even dying from AIDS in 2020, right here in the Coachella Valley. Our early intervention program had 160 referrals for attempts to find patients who had stopped filling their ART prescriptions, ceasing their HIV treatment without explanation. (Based on calendar year 2019)

Falling through the cracks means that some patients whose bodies had stabilized with life-saving HIV meds have stopped taking them, sometimes for five years or more. And for others, it means not starting therapy at all after receiving an HIV diagnosis.

Without accessing care, they are waiting until they are sick from HIV-related illnesses before attempting to resume ART and primary care.

Waiting to begin or resume ART always leaves a dangerous gap of time that could result in catastrophe, such as failing to ever adhere to medication therapy, or even death. Another consequence is the effect on others as sex partners are put at risk for HIV.

This collaboration with HRSA seeks to remedy the problem with a protocol that provides ART ASAP:

  • Same day as HIV diagnosis (some exceptions)
  • Quickly after request is made to resume therapy

The vast majority (about 80 percent) of new HIV infections in the U.S. in 2016 were transmitted from the nearly 40 percent of people with HIV who either did not know they had HIV, or who received a diagnosis but were not receiving HIV care. (CDC)

According to Dr. Tulika Singh, DAP Associate Chief Medical Officer, not all physicians are permitted to treat their patients without administrative obstructions that derail health outcomes.

“Despite having extensive experience in HIV treatment and care, caregivers struggle to reduce high HIV prevalence and rising HIV incidence rates, due to delays in starting ART,” she says. “This is due to previous protocols and practicing traditional HIV medicine,” like having to do unnecessary lab work or jumping through hoops with insurance.

“No more!” says Dr. Singh.

Greater access for ART through this project will be enabled by DAP’s referral and linkage networks, with extensive arrangements with regional medical centers, community clinics and individual providers, in addition to this grant.

“We are able to provide rapid start ART for newly diagnosed persons living with HIV as early as the same day of diagnosis,” she says. “This will help us get to UN 90-90-90 goal sooner than anticipated and help our patients age in a healthy way.”

Getting Back On ART -- Helping Someone Find The Courage

Given what we know about the health consequences of stopping ART, the public health argument is strong for offering the resources to resume therapy quickly and without delay. This includes taking the time to make a personal connection, so that people can feel safe.

When it comes to why people fall out of care, “Every situation is so different,” says C.J. Tobe, Director of Community Health at DAP.

Poverty affects most DAP clients, but it affects PLWHA uniquely. They might cope with denial, depression, and suicidal ideation. Stigma is often made worse by rejection from loved ones, and drug and alcohol abuse are more likely to increase.

But other factors may include housing insecurity, unemployment, lack of transportation, and fear of government due to immigration status. Being a recent transplant to the Palm Springs area from other parts of the U.S. also can also be a reason.

“People are also dying by not accessing all the things you need to make the medication keep working,” says Tobe.  “There’s a lot that goes into getting that treatment, starting with walking through those doors.”

In addition to ART, DAP helps patients thrive with HIV with access to social services they are eligible for, ensuring they receive needed food, housing, transportation, and home health care support if they need it.

U=U Helping End The Epidemic

The more people who are on treatment and undetectable, the fewer new transmissions there will be. According to Prevention Access founder Bruce Richman,

“We need access to treatment and removing barriers, not just for the wellbeing of people living with HIV,” he says. “But also, to prevent new transmissions.”

About U=U & Prevention Access Campaign

Prevention Access Campaign is a health equity initiative to end the dual epidemics of HIV and HIV-related stigma by empowering people with and vulnerable to HIV with accurate and meaningful information about their social, sexual, and reproductive health. Find out more here.

Undetectable = Untransmittable (U=U) is a growing global community of HIV advocates, activists, researchers, and over 990 Community Partners from 102 countries uniting to clarify and disseminate the revolutionary but largely unknown fact that people living with HIV who are on treatment and have an undetectable viral load cannot sexually transmit HIV.  

About UNAIDS 90-90-90

 Removing barriers to ART is in support of UNAIDS 90-90-90, the global plan to end AIDS as a public health threat by 2030.

The goal is that globally,

90% of all people living with HIV will know their HIV status, and  

90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and

90% of all people receiving antiretroviral therapy will have viral suppression.

According to its 2020 update, “The response could be set back further, by 10 years or more, if the COVID-19 pandemic results in severe disruptions to HIV services.”

Using Tools That We Trust

Using Tools That We Trust 

Weekend Wrap Message – Saturday, September 19, From David Brinkman, Desert AIDS Project CEO 

Committed to Preventing Flu  

By missing a flu shot, as many as 50 million Americans may catch influenza this year, but now it can be much deadlier. 

Experts warn that it is possible to catch the flu on top of a COVID, but there is something everyone can do now to make a huge difference. Flu season starts in late fall, and getting your vaccination is recommended by October 1, 2020. 

Now is the time to schedule your flu shot with your DAP doctor by logging onto MyChart, or by calling (760) 323-2118. Please read more here

Flu season often is delayed in Southern California, meaning we see cases peak in January through February. DAP is timing its flu shots so that patients retain immunity during peak months. 

If you have HIV, you are at high risk of developing serious flu-related complications. In addition to taking antiretroviral therapy (ART), the best way to prevent flu is by getting a flu shot.  

Questions About Flu? Call Us! 

Our COVID Clinic also specializes in multiple upper and lower respiratory diseases, including flu. Anyone interested in talking about the flu should call 760-992-0407 to talk to a clinician.  

Desert AIDS Walk Paved Way for COVID Response 

36 years of walking created the roadmap DAP used to quickly open a COVID Clinic, which has provided testing and respiratory treatment to almost 3,500 residents since the pandemic began. Together we are boldly applying lessons from our past to today's crisis.  

Because of community support, DAP developed the services needed to respond to the AIDS epidemic while creating a patient-centered model of care that today helps more than 7,000 patients, regardless of HIV status. 

The AIDS crisis left unhealed wounds and it is understandable that we may resist leaving our comfort zone.  But AIDS taught us a community response is the most effective response.  It taught us that we cannot turn our backs when communities are in need and in fear, that we must remember our humanity and the gift of giving back and be there to help. Read more here

Flu Vaccination at DAP Suggested by Octo …

Flu Vaccination at DAP Suggested by October 1, 2020

Media Contact:
Jack Bunting
[email protected]
(760) 323-2118

Easy Flu Shots Protect All Season Long

Now is the time to schedule a flu shot with your DAP doctor by logging onto MyChart, or by calling (760) 323-2118.

Flu season starts in late fall, and getting your vaccination is recommended by October 1, 2020.

Why Is A Flu Shot So Important?

By missing a flu shot, as many as 50 million Americans may catch influenza this year, but now it can be much deadlier. Serious complications from the flu are deadly enough to kill over 34,000 people in the U.S. every year. (CDC)

Experts warn that it is possible to catch the flu on top of a COVID, but a flu shot makes a huge difference.

Everyone should get a flu shot, but especially if they are 65 years and older or living with:

    • HIV/AIDS
    • diabetes
    • heart disease
    • serious overweight issue (40 BMI)
    • HCV
    • cancer

Flu season often is delayed in Southern California, meaning we see cases peak in January through February. DAP is timing its flu shots so that patients retain immunity during peak months.

Questions About Flu? Call Us!

Our COVID Clinic also specializes in multiple upper and lower respiratory diseases, including flu. Anyone interested in talking about the flu should call 760-992-0407 to talk to a clinician.

If you have the flu

It is important to seek immediate care from your DAP doctor for flu-like symptoms by logging onto MyChart, or by calling (760) 323-2118.

You can also call our COVID Clinic to discuss your symptoms and find out if our respiratory treatment options are right for you.

Treatment provided for upper and lower respiratory infections at DAP’s COVID Clinic includes:

    • Oxygen Therapy for patients who have lower than normal levels
    • Nebulizer treatments to open airways and address shortness of breath
    • IV Fluids for dehydration
    • Fever control with medication
    • Community Acquired Pneumonia Treatment – Injection of antibiotics and ability to prescribe medications to our DAP Walgreens (overnight home delivery available)
    • Influenza A & B testing and treatment
    • Strep Throat testing and treatment

If you have HIV, you are at high risk of developing serious flu-related complications. In addition to taking antiretroviral therapy (ART), the best way to prevent flu is by getting a flu shot. 

Check-in with your doctor about other shots you might need

Depending on your age and certain risk factors, other immunizations may be needed. This is a good time to make sure you are current on immunizations by discussing it with your doctor (examples include bacterial Pneumonia and Hepatitis vaccines).

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About Desert AIDS Project

Desert AIDS Project (DAP) is a humanitarian healthcare organization in Palm Springs, CA offering DAP Total Care – a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic, The DOCK, offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

Visit www.desertaidsproject.orgwww.thedockclinic.org, and www.gettestedcoachellavalley.org to learn more.

Get Access To the Care You Need

One Call is a service that can enroll callers in health insurance or Medi-Cal through Covered California, register them for medical and behavioral healthcare, and schedule their first appointment at DAP — all in approximately 45 minutes. This is a significant reduction in the amount of time this would normally take, thanks to a DAP Healthcare Navigator who will work one-on-one with each caller.

Callers can access One Call service by calling 760-992-0426, Monday – Friday, 9am – 4pm PDT.

Sexual Health Clinic - Palm Springs

1695 N. Sunrise Way Palm Springs, CA 92262

Monday - Friday 8:30 AM - 4:30 AM (Closed for lunch from noon-1:00 PM)

Call 760-992-0492 to schedule an appointment.

To reach our after-hours answering service, please call (760) 323-2118.

Hope is Theme of Desert AIDS Walk 2020

Hope is Theme of Desert AIDS Walk 2020  

Weekend Wrap Message – Saturday, September 12, From David Brinkman, Desert AIDS Project CEO 

HIV remains a substantial threat to public health in the Coachella Valley, and we are not letting COVID distract us from vigorously fighting it 

As we test more new positive cases, we are stepping forward and evolving our programs to test, treat, and prevent HIV in the age of COVID. 

Desert AIDS Walk 2020 is more important now than ever. You can find out more at  www.DesertAIDSWalk.org.  

The reason for the Walk has never really been about balloon arches or walker t-shirts. It’s always been about the collective power of community and our shared vision of a future where everyone has the comprehensive care that they need to live their best lives. 

Desert AIDS Walk 2020 is an important funding source for programs and services that help people thrive with HIV, while preventing new cases in our valley. It also supports Hepatitis C cures, behavioral health services, dentistry, food, housing, and other vital services. 

This year we are making it easy and fun for Valley residents to participate with downloadable walk routes, specialized for safe walking in their cities. We’re also including an online wellness forum that will provide entertainment and more about DAP’s programs and services, dedicated community sponsors, and the extended work of its partners. Registration and more information is available at www.DesertAIDSWalk.org.  

DAP Talks  

Suicide Prevention 

Preventing suicide during the COVID-19 pandemic is a major concern for mental health advocates everywhere. DAP’s Dr. Jill GoverBehavioral Health Manageraddressed the warning signs and other important information we all should be aware of in her latest DAP Talks. You can listen here.  

If you or someone you know needs to talk to a specialist about suicide, please don’t wait. The following services are availableday and night: 

The National Suicide Prevention Lifeline 800-273-8255.  

Riverside County HELPline, a free confidential crisis suicide intervention service (951) 686-HELP (4357). 

DAP In The News 

No matter what health profile we fit, it’s important to stay engaged in our healthcare during this crisis. Dr. Tulika Singh talked to The Standard about the top four neglected health habits she notices in her patients, plus realistic fixes for better outcomes. You can read more here. 

DAP Talks: Restoring Hope – Nation …

During the COVID-19 pandemic, many people have been experiencing anxiety, fear, frustration, sadness, and loneliness. And some, to the point that those feelings have become unbearable. If you’re feeling hopeless and having thoughts about suicide or you’re concerned about someone else, listen to Dr. Gover, Clinical Psychologist, talk about some ways to find help, and restore hope.

Suicide Prevention Resources:

If emergency medical care is needed, call 9-1-1 or go to the emergency room of the nearest hospital.

National Suicide Prevention Lifeline at (800) 273-8255. The phone lines are answered by trained professionals; the call is free and confidential.

Riverside County

If you need to be connected to mental health services in Riverside County, call the CARES Line at (800) 706-7500. You may also call or walk into a Riverside County 24/7 Mental Health Urgent Care location. Whether you are in crisis or just need someone to talk to, all services are voluntary. Counseling and nursing, as well as, psychiatric medications are available. All locations are open 24/7 and everyone is welcome regardless of insurance type or ability to pay.

The Trevor Project

The Trevor Project is a national organization providing crisis intervention and suicide prevention services to LGBTQ youth and young adults, ages 13–24, over the phone, online and via text. Trevor Lifeline (24/7): (866) 488-7386, TrevorText: Text the word “Trevor” to (202) 304-1200 to text with a trained counselor on Fridays from 1–5 p.m., TrevorChat: Confidential chat service with a trained volunteer counselor available 7 days a week, from 12 noon –6 p.m. Learn more at https://www.thetrevorproject.org/

It Gets Better Project

This website is a place where young people who are lesbian, gay, bisexual or transgender can see how love and happiness can be a reality in their future. It’s a place where people can share their stories, take the It Gets Better Project pledge, watch videos of love and support and learn about resources. Visit https://itgetsbetter.org/ to learn more. What’s Up Safehouse What’s Up Safehouse is a 24/7, free, anonymous mental health crisis texting line. Get immediate support from a licensed mental health professional. Dedicated to helping support the residents of Riverside County through issues surrounding anxiety, substance abuse, depression, school pressure, peer pressure, LGBTQ struggles, relational issues, suicidal thoughts, bullying, and any other issue that is causing trouble. Text SHHELP to 844.204.0880 24/7 for immediate support and resources. Learn more at https://safehouseofthedesert.com/what…

Sharing what we know to help others grow

Sharing what we know to help others grow

Weekend Wrap Message – Saturday, September 5, From David Brinkman, Desert AIDS Project CEO

We Won Rapid ART Implementation Site Status By HRSA

Significant numbers of PLWHA here and across the U.S. live without taking medication to treat their HIV. This threatens their own lives, as well as public health, because being virally suppressed means stopping new transmissions of HIV.

Not having access to antiretroviral therapy (ART) shows us one of the most painful examples of healthcare disparities today, and we have worked hard to make sure patients at DAP don’t wait for ART, plus other important life necessities for thriving with HIV. 

After hard work by our team, DAP has been designated as a Rapid ART Implementation Site, standing with just 10 other healthcare organizations in the U.S. who also competed.

This national demonstration project and collaboration with HRSA will help us share our 36 years of experience, as well as boost resources for our HIV testing and treatment programs for people in the Coachella Valley.

For a three-year period, DAP will continue to build and share its best practices for making sure PLWHA receive antiretroviral therapy (ART) quickly after receiving an initial HIV diagnosis, or immediately after requesting it if they stopped ART for any reason. To learn more, click here.

Affirmation From HRC

When we started 36 years ago, HIV rights and the fight for medical access were synonymous with LGBTQ rights. Opening our doors wider requires doing the work to always ensure that we hold ourselves accountable when it comes to honoring every letter in the acronym LGBTQ. 

We are proud to receive the status of Top Performer in the annual Healthcare Equality Index (HEI) 2020, administered by the Human Rights Campaign (HRC). You can read more here.

Saying I Love You To Palm Springs

Dr. Shubha Kerkar modeled some healthy behavior for us all when she helped unveil the new PS I Love You public art sculpture, getting plenty of fresh morning air while also wearing a face mask. The unveiling was dedicated to healthcare workers on the front lines during the COVID heath crisis and included representatives from Eisenhower and Desert Health.