Kori Bridget Flower

Basic Interview Metadata

Interview Text and Audio


In this conversation with Dr. Kori Flower, she discusses her educational history and work at various clinics, and how these experiences have shaped her understanding of the Latino migration trends. She explains how her interactions with patients and their families help her comprehend their lifestyles and thus help her in terms of providing health care. She shares that her ability to speak Spanish have allowed her to grow as an ally for those who live with a language barrier.



[00:00] Akanksha Arora: Ok. [00:06] So my name is Akanksha Arora. It is the fourteenth of April 2016 and I am here with Dr. Kori Flower at her office on UNC Chapel Hill's campus. Dr. Flower, thank you very much for your time today to speak with me.
Kori Flower: You're welcome.
AA: if you could just take a moment and introduce yourself and tell me a little bit about your educational history.
KF: Yes again, [00:24] my name is Dr. Kori Flower and I'm a pediatrician. I started my education-- I went to do my undergraduate work at Cornell University in New York State, where I majored in biology. And then I made a big move to California and went to medical school at the University of California San Francisco, and also did a joint Master's degree program with the University of California Berkeley and that's under a program called the Joint Medical Program. And that was a program that was particularly focused on helping people like me with an interest in public health and social issues that affect health and health care to get some additional education on those issues. And so I received both of my degrees from UC-SF and UC-Berkeley, and developed as I was seeing patients as a medical student great love for families and children, and made the decision to go into pediatrics. And at that point, this would have been 1998, I sought a pediatric residency program and made the decision to move across the country from California to North Carolina, where I started my residency in pediatrics in 1998. And for timing, I then completed my residency in 2002, and began to work part-time at that point at a community health center, which I can say more about, but maybe I'll stop there and see what questions you might have for me about my education background, because that's a lot of information.
AA: No, thank you very much. So you're saying you're pediatrician--
KF: --Yes
AA: -- If you could just go in a little bit more depth of your position at the hospital. How long you've been here, if you've traveled around to different clinics, anything like that.
KF: Yes, yes. Okay, so I.... so as I was starting to mention, when I completed my residency training in pediatrics. It's at that point that one can go on and practice without supervision. [02:40] So I, I initially was doing a fellowship program to gain some research skills, and that was through something called the Robert Wood Johnson Clinical Scholars Program, that was here at UNC but I also took a position at the same time, working part time, in a community health center, in Burlington, NC, and that was with Piedmont Health Services. And, so I initially started providing care to children, sick and well children, two days a week and through Piedmont Health Services in Burlington, at a clinic-- at the Charles Drew Community Health Center. And, so I actually then continued at Charles Drew Community Health Center, though not continuously, but basically from most of 2002 to 2014. In 2014 I had an opportunity to come to UNC as a faculty member, and to do not only direct care with patients but also to use my prior research training and public health skills to address some bigger questions about health care for populations. And so, I made a difficult decision to leave the practice where I had provided care for a long time and to come to UNC. So that was a relatively recent move for me. I began here at UNC in July of 2014, and so since we're in-- I've been here for less than two years.
AA: Okay, thank you very much. And so we were-- I was fortunate to meet you through Claudia Rojas--
KF: Yes.
AA: -- So if you could speak to me a little bit about your experiences with Claudia and with the Center for Latino Health.
KF: I'd be happy to, yes. So the-- right. And I'm just pausing to reflect on what really is the beginning of that story. [04:36] And I think that that story begins really back with my work at the Health Center. I had been taking care of children of families, you know roughly 50% Latino families in that setting, very approximately. And had been doing that for a long time, and was really really interested in serving them the best I could, which is why I was there for a long time. And so I had just made the challenging decision to take a new position with new challenges. One of the things I had done just before coming to UNC was to spend some time in Nicaragua. And was a volunteer there in a remote, rural health center. And I had gotten off the plane from Nicaragua the day before, I started my faculty position. When I came to UNC, I did so with the eyes of someone who was new here. And I think that that is how many of our patients feel, is new. So I pulled my car into the parking lot, and I had my books and my bags and things. And I sat on the cart, and I sat on the transportation cart that bring people from the parking lot to the hospital. And I just want to explain to people that it is kind of a long way to get from the parking lot to the hospital. And both areas are big; the parking lot is big. The hospital is huge. I really didn't know that well where I was going. [06:13] A family approached the parking and transportation people to get some help. They spoke Spanish. And I just kind of observed how very difficult it was for them to figure out where they were going. It was hard for me, it was even harder for them. They had difficulty explaining where they needed to go. Ultimately, we all got on the cart together and came to UNC. But I-- that was my first experience coming here and it was obvious to me how hard it was not only for me, but also certainly people who speaking Spanish. So that challenge that families were facing was something that I really noticed when I came to UNC, and was thrilled to see that we have a wonderful and committed group of professional medical interpreters who assist families once they are in the rooms, but I noticed that there were a lot of families who had a lot of difficulty figuring out where they were going or really understanding what would happen after their appointments. [07:31] So I was really lucky to meet Claudia Rojas at that point who was the Center for-- Program Manager for the Center for Latino Health here at UNC, and she had been working on and concerned about similar barriers to care for many years, much longer than I had been here. But she and I started working together to try and close some of those gaps. And I really had the privilege of working with Claudia Rojas and other people at UNC on helping to develop a patient navigation service this year. For Spanish-speaking families. And that it's really aimed at helping them find places, know who they are seeing, and really break down those communication barriers. So that's the longer story of how I got to UNC, and how I met Claudia, and how I had the privilege of starting to work with her.
AA: So wonderful to hear the work and projects that you and Claudia are doing together. It's wonderful-- I think it's wonderful for the patients. So you were mentioning a little bit about the language barrier and I do know that you speak Spanish fluently. So how has that helped when you're providing care to patients or families who have that language barrier and maybe cannot speak English?
KF: Right, [08:49] so I did not learn as a younger person and I really appreciated once I was in medical school that this is something I absolutely had to work on in order to be effective with the families I was going to see. So I came to learning Spanish late, and I think that gives me huge empathy for the fact that many of my families also come to speak Spanish-- uh, English late. I empathize greatly with the challenges that they go through to learn another language, because I've had to do it. So-- though I've had more resources and more support to do it than many of them experience in their struggle to learn English. But, it's a wonderful language, and once I realized how important for me to learn to speak, I have dedicated a lot of time since coming to-- I'll call it continuous improvement, to better serve my patients every day. It's been really important, just because of again about half of the families in the Community Health Center where I worked spoke Spanish, and it continues to be important here at UNC. I will say that in the time period we have been discussing from when I came to North Carolina to being here with you today that coincided with a big demographic transition for North Carolina. And so, it just turned out that I came to North Carolina myself at exactly the time when there was a pretty big change in migration and there, you know, I think-- I think it is well-known now that there have been many, many families who did come from Mexico and Central America looking for work and the same time that I came. So my-- I was really trying to build my skills to better serve their needs at the same time children were coming with their families at greater numbers.
AA: Sure sure. And so when you're talking about these trends of migration coming in and you working with the community care center-- community care clinic, I apologize-- and you going to Nicaragua, as well. So if you could speak to me a little bit about your experiences with immigrants, little bit more in detail, whether they be undocumented or documented.
KF: Right, okay. [11:03] And so, in doing so, I'll of course be careful to mention these circumstances in a really general way, because I think the theme for families are often fear, because they're in the United States and they're not documented, and they're health care and healthcare experiences are affected by the very real fears that they face every day. The-- so-- I have seen quite a bit of change in the Latino families that I have served over the years in a number of respects. So when I first started this work in about 2002, I was seeing children who had-- children who had recently come to the US with their families. And that was pretty frequent, so I had to learn to read-- one my most outstanding memories from, you know, around 2002, was that I would regularly see children who had just arrived to the US with their families, and I would look at their immunization cards, so I would pretty-- I would pretty quickly had to learn to decipher the immigration cards from different countries, countries that had their immunizations on them. So those are different for different countries, and I had to learn to read them and I had to learn to recognize when children were up to date. So, I went through some years of reviewing children's immunization records and then at some point in the last 5-10 years that really slowed down to stopped, and I was no longer seeing actively children who had just arrived. So it seemed pretty obvious to me that at least in the particular location where I was, in that city, that there was a pretty big wave of families who were new to the US, who were telling me that they had, you know, just arrived. And that was no longer the case. In recent years, it's typically a very long time between when I see a new immunization card for a child.
AA: Wow, that's so interesting. So while you were seeing these patients, did you see any trends of the illness, or the diseases, or any conditions that they were coming in being an immigrant? Did you see anything that was specific to them or any lack of immunization, maybe, for example?
KF: Yeah, that's a great question. [13:42] I think most of the changes that I have seen over time-- well actually, hepatitis A is one example that I used to see hepatitis A occasionally, which is much more common in Mexico and Central America, and really not common here. And we have an immunization for it here in the US now, so it's become quite unusual. So that was something I definitely was seeing for-- from time to time. I would say that the-- it's much more common as, you know, now the-- I had been in practice for long enough that some of the young people I took care of when they were perhaps 10, were then 15 or 20 years old. And so they then made the transition into adolescence and adulthood under my observation, and themselves had often been enrolled in school and been through a-- years of living in the United States, and the-- so their needs became very different from the needs of a 5-year-old who had just come with his or her family and did not speak English. So I think over time, certainly, more of the families and particularly the younger people or people who were raised here, I was finding were speaking more English. [15:04] One particular problem that I had seen emerge was that the families face a lot of pressure, you know, want their children to succeed and children are exposed to English through television, through classrooms. But sometimes I fell away from speaking Spanish with their families. And actually, I started in recent years to see situations in which parents and children really couldn't communicate effectively because the parents still only spoke Spanish and the children sometimes don't understand the Spanish of their parents very well. And so you have sometimes a communication gap that happens in adolescence anyways, and it gets magnified if they're really not able to understand each other well. So sometimes I'm finding that adolescents in a family will speak English together and the parents are completely out of that conversation if they're speaking Spanish, and there's not as much crossover. So one of the things I do talk with families about is the value of being able to share that Spanish with their children and have that be something that the family does retain well. Well, of course, you know learning English well here in school and things like that.
AA: That's such a beautiful sentiment, continuing their culture and traditions even though they are here--
KF: I do try to convey that in a way that is not imposed by me, but allows them to retain value for what they have brought with them and communicate that I value that for them too.
AA: Very true. That's wonderful. And so when we're talking about children and patients that you see as a pediatrician, what have been your experiences with DACA or rather your understanding of the role of DACA in the health care and treatment that patients receive if they are under that program.
KF: Yeah, again, [16:55] I'll speak a little more generally and I have to say that one of my shortcomings as a pediatrician is that by the time that children get to me really the information I have is "do they have any type of insurance or not?". Then typically if they do not have insurance-- if they do have it, I am not generally aware of the reason for that as a pediatrician. I don't always know the route that they took. And then the second part is that if they don't have insurance then I'm typically needing to work with one of my office staff members who is more knowledgeable than me about how they might apply for insurance. I'll just have to speak in a general way--
AA: Sure.
KF: -- but I have taken care of many families who are not documented and as you know they are typically-- by not documented, I mean not having legal status here in the US, and so not eligible-- generally speaking-- for Medicaid or federally-support forms of healthcare coverage. [18:03] The--federally-qualified community health center in which I worked, part of the mission of that type of organization is to provide safety net care and very specifically to provide care for uninsured persons. And so our system is-- was like any FQAC across the country, in that we provided low-cost sliding scale treatment for uninsured people. Typically a visit cost approximately $20 and we provided comprehensive healthcare for $20 and low-cost prescriptions. So for uninsured people, that has been my primary way of providing care. And then children who are born in the United States have the good fortune of being able to receive Medicaid and get their healthcare provided through that. So those are the two main forms of-- those are the two main situations that I have personally seen in regards to kids’ healthcare coverage.
AA: And so focusing a little bit more on your work at the community care center, those who don't have a federally approved insurance program or Medicaid or anything of the sorts, and they are undocumented. Have you seen any restrictions as a doctor on the medications that you would maybe want to give, but because of the program that they are put under, you may have to give something else or you're kind of limited to the treatments you could provide them?
KF: Right. That's a really good question. [19:38] I truly think that this system of federally-qualified community health centers has some really-- real strengths in that multiple services are present on-site. And so we actually had an on-site pharmacy. And that on-site pharmacy had a formulary. And so we did have specific medications that were available. But I truly felt as a pediatrician that everything that I needed with very few exceptions, was generally available on the formulary. So I did not major concerns about medicines that I was not able to get. I would say that the hardest area historically has been insuring when a child needs a specialist, that the visit for the specialist is possible for the family. And so, I think we were lucky to be able to send children needing-- and adolescents-- who were uninsured and needed specialty consultation, we did send them to UNC. And UNC does have a program by which families can do sliding scale payments for-- and the payment is reduced for a specialty visit. So that's-- I think that the cost of that sometimes has been a barrier to families, but I would say that for the most part we were able to get the children resources that they needed.
AA: That's wonderful to hear that even though there are some limitations that you're able to overcome them as their physician [Laughter]. So you're speaking about the health care system and how you've played a role in it, or have had to work with it. So what your opinions on the state of healthcare for those who are undocumented? I know there are strengths, but there are weaknesses. So--
KF: Yes. Yeah, yeah. No, I've had an opportunity to say what we're able to do from the perspective of working in a community health center where the mission is to find ways to provide that care. But no, it's very difficult. I think that-- [21:47] you know, as a pediatrician, the biggest gaps that I have seen are for adults. And so, the-- I think that the-- often the adults in a family are in a situation where either they have children who are uninsured, and they prioritize the needs and expenses of the children, as parents often will. Or we have a lot of mixed situations in which families have children who were born here, and so the children may have Medicaid coverage, and so the children’s' medical needs can get covered, but the parents have nothing for their serious health conditions. So those are really the situations in which I've felt really bad that there's not more that can be done for the adults.
AA: And so with your work, have you seen any changes in that there may be less restrictions on you, there are more doors opening for these patients that are coming in undocumented or under DACA?
KF: Right. Honestly, again, with the-- I think that children are-- young children in the age range that I work with, tend to be a little bit, have a little more available to them. Sometimes, again, by Medicaid if they are eligible or me going to bat for what they need if they're not. I do not think I have personally been able to witness a shift that I would say is specifically due to DACA. But then again, I don't think I see as patients most of those people who are probably affected.
AA: Sure. Dr. Flower, do you have anything else you would like to add on this matter? I know there's a lot to say--
KF: Yes. [Laughter]
AA: But--
KF: I think these are great questions. Thanks very much for your work on this interesting project.
AA: Thank you. Thank you for your time.
KF: Absolutely!
[00:00] Kori Flower: I just—[00:02] this is Kori Flower speaking again. And I thought I would add that-- I think that we've talked about some of the situations that of insured children and children who don't have insurance. One of the things that I haven't spoken about, but I think is a very real part of the lives of the families that I have cared for is fear. And their fear does affect their health and their healthcare in very specific ways that are very hard for me as a pediatrician to address. So this has to do with the social context in which they are receiving their care, so that when families are afraid to drive because they are afraid they will be pulled over and reported to immigration, this very much affects the health care of themselves and their children. So-- and unfortunately that is a very real limitation to their healthcare. And I have heard about that from families who I have cared for that they either-- that they're afraid to drive because they're afraid they'll be pulled over and turned into to immigration. And so sometimes I have not been able to do as much for children as I would like because they are afraid to drive. And then other, you know, social barriers that relate to families’ needs are just transportation. We do live in a state that's without a-- without public transportation. I practiced in North Carolina's largest community that does not have public transportation, and so families were very much dependent upon rides, or I had families that would walk to see us. And so I think that-- I feel like I have to acknowledge that there are factors really beyond the healthcare coverage that have a big impact on whether-- the extent to which families can fill that prescription that I just wrote or families can follow on the recommendation to go a community away to specialist. So I just wanted to add that.
AA: Thank you.