Episode Transcript
[00:00:18] Speaker A: Hi, everybody, and welcome to another edition of the Southern Fried Podcast, a production of the Arkansas Democrat Gazette. I'm Democrat Gazette Senior editor Rex Nelson and we're going to be talking healthcare today. And I need to start doing more of this. I mean, the University of Arkansas for Medical Sciences is not only such a great economic engine for our state, but the world renowned specialists that are there. I don't think enough Arkansans have an idea. So hopefully this is the first of, I would hope, a number of podcasts where we have specialists from UAMS.
So glad to welcome Dr. Susan Emmett. She is with Nose and Throat Clinic at the UMS Medical center.
And we're going to talk a lot about rural health care, but maybe about Arkansas and the situation as a whole. Dr. Emmett, thank you so much for joining me today. I'm looking forward to it.
[00:01:19] Speaker B: Thanks for having me today. Appreciate it.
[00:01:20] Speaker A: Now, we were talking before we began taping.
You grew up in Memphis, but literally have lived around the world. Came to Arkansas about three and a half years ago, I believe you told me. But just a. To get started about your journey and what led you into healthcare as a profession.
[00:01:42] Speaker B: Sure. So in addition to leading the center for Hearing Health Access at uams, I'm also a practicing ear surgeon. And in my clinical practice, I do cochlear implants to restore hearing for patients with severe hearing loss around the state.
And my journey to healthcare actually started in health policy. I worked on Capitol Hill before I went to medical school, and I knew from the very beginning that I wanted to be a physician and a scientist who helped improve healthcare in rural communities.
Interestingly, I actually fell into the topic of hearing loss because I spent a year of medical school in East Africa, in Tanzania.
[00:02:20] Speaker A: Wow.
[00:02:21] Speaker B: And I was doing pediatric HIV research there. And many of the children we took care of had hearing loss. And it was affecting their ability to do well in school. But there were so many other pressing issues that it really wasn't paid attention to at that time.
And that's when I decided that I really wanted to dedicate my career to making sure that everyone has access to hearing care.
[00:02:43] Speaker A: Gotcha. When you were on the Hill, were you working for a member of Congress at the time?
[00:02:47] Speaker B: I was. I was working for Senator Frist.
[00:02:49] Speaker A: Oh, okay, wonderful.
[00:02:51] Speaker B: I grew up in Tennessee.
[00:02:52] Speaker A: Right.
[00:02:53] Speaker B: And I was a part of his healthcare team. And it was really quite a transformative experience. I learned so much.
[00:02:59] Speaker C: Yeah.
[00:02:59] Speaker A: Well, I lived on Capitol hill in the 1980s, so I was the correspondent for the then Arkansas Democrat. We had a Democrat and A gazette before we combined. And I was the Arkansas Democrat Washington correspondent and covered the Arkansas congressional delegation and other things going with Congress. So just out of curiosity, I had to ask. You haven't spent the 80s in D.C.
yeah. Well, it is so good to have you here in Arkansas. Now, obviously, you know, being from Memphis, you're very familiar with Arkansas, but becoming increasingly urbanized, but still classified as a rural state.
What I'm wondering is, how common is hearing loss in Arkansas? Especially out there in the rural areas.
[00:03:50] Speaker B: Of our state, hearing loss is like death in taxes. It will happen to all of us.
Basically, we all develop some amount of hearing loss as we age. For instance, if you're over 70, your chances of having hearing loss are more than 75%.
So here in Arkansas, that means that hearing loss at all levels affects about 684,000 Arkansans today. Wow.
[00:04:18] Speaker A: 1L.
[00:04:19] Speaker B: It is a lot of people. It's just shy of one in four people in our state.
[00:04:25] Speaker C: Yeah.
[00:04:26] Speaker A: And it's a huge problem. Not to make light of it, but I always tell people, I do a lot of public speaking, a lot of broadcasting, and I'm loud, as you can tell, and I tell people, well, I grew up that way because my dad was hard of hearing my whole life. So we all screamed at each other in our family, but my dad was a Bombardier on a B17 during World War II.
Never thought of wearing earplugs in those days. You were just trying to stay alive.
And then on top of that, believe it or not, for decades, he was the top track starter in the state. So he was shooting a gun in his right ear all spring, every spring, as he started track meet. So you can see that. But, I mean, that number you gave is incredible. And it's got to have a huge impact on lives that people like me just never, never think of. Never think about.
[00:05:24] Speaker B: It's so true. I mean, we all know people who have hearing loss. I mean, you're talking about your dad. It affects all of us. It either affects us personally or we know someone. But interestingly, hearing loss is invisible.
So sometimes it can affect us, and we don't even realize that we have it. Like, if you've ever struggled to hear in a noisy restaurant or when somebody's talking to you in another room, that can be mild hearing loss.
[00:05:49] Speaker C: Yeah. Yeah.
[00:05:50] Speaker A: And after I started in radio with headsets on like these at age 13, so I'm probably getting there.
Why, though? I mean, there are not that many of us that work in radio. Why is hearing loss so Common in Arkansas.
[00:06:06] Speaker B: Well, noise exposure is one of the really big contributors to hearing loss. And, you know, a safe level of noise is 70 decibels. It's what we hear when we're riding in a car or sitting in an office building, which is actually pretty quiet.
[00:06:20] Speaker A: Very much so.
[00:06:21] Speaker B: But hunting, I mean, you talked about, you know, shotguns going off at track meets. It's the same idea. Hunting is a huge source of hearing loss here in Arkansas. And just a single gunshot can be 160-170db.
All it takes is one gunshot to permanently, irreversibly damage hearing.
And that's why hearing protection is so important.
[00:06:45] Speaker C: Yeah. Yeah.
[00:06:46] Speaker A: Well, guilty. I'm a. I'm a duck hunter, and I've never, never worn earplugs in my life on any hunt I've ever gone on.
[00:06:53] Speaker B: Yeah. I mean, agriculture is another example. Right. It's absolutely critical.
[00:06:58] Speaker A: Loud. Agricultural equipment, the equipment is so loud. Construction, the same thing.
[00:07:03] Speaker B: Yeah, exactly, exactly. You know, if you're around a tractor or, as my toddlers like to say, a digger, that sound is about 90 decibels. You can only be around that for a maximum of two hours without hearing protection before you have irreversible damage. Two hours is not a work day.
[00:07:23] Speaker A: It's really not. It's really not 80s. Four times that.
[00:07:26] Speaker C: Yeah. Yeah. Wow.
[00:07:28] Speaker A: So we've established the problem. We've established the numbers there. Talk about your center and the work that you're doing around the state.
What is feet on the ground action, so to speak, that we're seeing around Arkansas right now?
[00:07:45] Speaker B: Yeah.
Well, to start with, let's talk more about impact, because I think it's so important to talk through and think about the fact that hearing loss happens at every age, and the impact is huge at every age, even with mild hearing loss.
We know that young children with just mild hearing loss have speech and language delays. This affects kids in school a lot because they can't hear their teachers. So they get labeled as behavior problems when really they just can't hear. Their math and reading scores are lower. They're three times more likely to repeat a grade. They're three times more likely to not graduate from high school. That has huge economic ramifications. Right, because it limits job opportunities.
[00:08:32] Speaker C: Oh, yeah.
[00:08:33] Speaker B: I mean, it affects a kid's entire life. So it affects our future workforce in this state.
And that's true in adults, too, because even mild hearing loss doubles the risk of unemployment.
So it has an impact in kids. It has an age, doubles the risk of unemployment.
[00:08:50] Speaker C: Wow.
[00:08:50] Speaker B: And that's mild hearing loss. We're not even talking about severe hearing loss.
And then you get into the senior age group and just a mild hearing loss doubles the risk of dementia. It has an impact on loneliness and social isolation. I mean, these are very real things. We've all been around a grandparent that withdraws from family and community gatherings because they can't hear.
There's a really interesting connection that we're working on now between hearing loss and falls, which is a really big deal when it comes to hip fractures and hospitalizations and extended rehab stays. So basically, the reason that we are doing the work that we're doing is because hearing loss has such serious social and economic consequences. That's just too big for any of us to ignore.
[00:09:38] Speaker C: Yeah, yeah.
[00:09:39] Speaker A: And I'm so glad you joined us today because, you know, obviously we have a lot of healthcare needs in Arkansas, but we tend to talk about cancer and about dental needs and so forth. And hearing. Hearing losses is, again, not something, frankly, that I've written about, talked about a lot. And obviously with the number you've given us, it needs to be something we're all aware of. So, again, let's get back to your center and what you're actually doing to try to address these problems that we have.
[00:10:15] Speaker B: Absolutely. So I was recruited three years ago from Duke University to start a new center for hearing health access.
And it's the first of its kind in the country where we are focused specifically, specifically on expanding access to hearing care to make sure everyone has access to the care that they need, no matter who you are or where you live.
This has been so exciting because it really is a chance for UAMS to lead nationally in this area. We're creating a model for the entire country. Right here in Arkansas, our center is a home of surgeons and audiologists and scientists where we're all.
We have the expertise in hearing loss and tech development and public health. And we work with collaborators across the country. We even have collaborators internationally. And all of our science is informed and inspired by patients and by communities.
And what we do is we lead large projects. They're mainly funded by the nih, the National Institutes of Health and Foundations, to develop new ways to reach the most rural and remote communities with cutting edge care. At uams, we've developed new telehealth care models, and I'll talk more about that in a minute. We've developed new software platforms, we've even developed new medical devices.
Basically whatever technology is needed to make sure that everyone can have access to hearing Care.
We do that and we build it, and we're constantly innovating and changing and improving things to make sure that we can reach everybody.
[00:11:47] Speaker A: Yeah, that's very exciting to me that we've got a first in the nation, always, like when we're using the old saying, punching above our weight in Arkansas. And here we are, first in the nation.
So let's go. You mentioned those tech innovations.
Let's hear about a few of them. Interested in hearing what is happening? Because I know you and a number of other people who are experts in this field are all working together as a team right now.
[00:12:21] Speaker B: Yeah, Well, a lot of our work has been really focused on improving access to hearing care for children, because one of the things that we know is in rural areas, and this is true in rural Arkansas as well, is that the most common source of hearing loss in kids is ear infections, and it's all preventable.
And a lot of the work that we've been doing over the last decade is developing new models of care to make sure that we're identifying kids that have hearing loss and ear infections. We're making sure that they get the care that they need. We've done some really exciting work in rural schools to develop a new telehealth model that works with schools doing school hearing screening programs to make sure that kids who are identified in those programs then immediately get connected to specialty hearing care right there in the school setting. And I remember a conversation you had with Skip Rutherford several years ago about building rural Arkansas and just how important it is to have really strong schools and to have good broadband in rural communities, and that there is potential for us to bring specialty care from children right there into the school setting. If you've got those two things in place, that's exactly what we're working on.
We've done some really innovative projects, actually, that started in rural Alaska, place that I used to live, where we've shown that using this new telehealth model, kids are more than twice as likely to get hearing care, and it happens over 17 times faster than with traditional health care delivery. And so we've really built on that. And we have two huge projects going on right now in rural Alaska and Appalachia that have reached 20,000 children across 100 schools in those two states.
And our next goal is to bring all these innovations home to the children in Arkansas.
[00:14:14] Speaker A: I've got to tell you, you have just hit home with me again. I talked about my father earlier. My youngest son, who was born in 1997, was slow to Start talking.
He was constantly banging his head on the crib to the point that he would bruise himself, his pediatrician and us, I've got to tell you, were really slow to diagnose.
Again, back to chronic ear infections and back to getting ear tubes when I think he was two and a half. Then got him into some speech therapy. At that point, by the way, everything turned out very well. He has both a law degree and an MBA from Emory University in Atlanta.
[00:15:09] Speaker B: Now, so I'd say he's doing just fine.
[00:15:11] Speaker C: Yeah, yeah.
[00:15:12] Speaker A: But you've struck home again and about how common this kind of thing is.
[00:15:18] Speaker B: This happens all the time. My youngest son needed tubes and he said his first word five days. Days after he got two. Yeah, I mean, it's. There are so many children in this state that need this care, and it.
[00:15:30] Speaker A: Well, you really hit home with that.
[00:15:31] Speaker B: On children our entire lives, unless we get it to them right away.
[00:15:35] Speaker C: Yeah, yeah.
[00:15:35] Speaker A: And I, you know, we were supposedly educated family. I mean, we were just. We were very slow. Very slow to figure out what was going on, though. Very slow.
So what, what. Great work. And especially for children across Arkansas that we're seeing right now, because you gave those stats a while ago, if we don't address those hearing problems, we're consigning them to a really, really tough life. And I can only imagine the teachers who are out there thinking that certain children are slow learners when they simply can't hear in the classroom. There has to be a lot of that going on.
[00:16:22] Speaker B: There is a ton of it. And we can prevent this.
We can make sure that every child has the care that they need.
[00:16:28] Speaker C: Yeah, yeah.
[00:16:29] Speaker B: We've actually taken this model that we developed in rural schools, and we're starting to build on it and expand on it for something that's really exciting, wonderful.
[00:16:39] Speaker A: Let's hear more about that.
[00:16:41] Speaker B: Our goal is to make sure that every Arkansan, from newborns to seniors, has access to hearing care right there in their home communities. This is all about how do we bring specialty hearing care to the places where people live, work, and gather. Right.
And it means that we've got to think outside the box. This isn't about traditional brick and mortar healthcare. This is about how do we provide cutting edge specialty care in.
In less traditional locations and using lay facilitators, community health workers, pharmacy techs, school nurses, really making sure that members of rural communities have an opportunity to learn new skills and really contribute in a very unique way.
So this new model, for example, today, I told you, I'm an Ear surgeon and I see patients at uams. My patients usually drive a couple of hours to come see me.
[00:17:44] Speaker A: Obviously, UAMS serves people from all 75 counties and parts of surrounding states. I mean, it's a regional powerhouse.
[00:17:51] Speaker B: Absolutely, absolutely. So people are driving a couple of hours, they have to take a whole day off of work. They come get tested by the audiologist in our clinic, and then I see them in a consultation to develop a treatment plan. Well, with this new model, you don't ever have to leave your hometown.
[00:18:08] Speaker C: Wow.
[00:18:09] Speaker B: You could go to a community pharmacy and a pharmacy tech who we've trained to use mobile equipment that fits in a suitcase and can move around, can work with an audiologist to do that hearing test remotely. And then all that information can get transmitted to me or another surgeon and pictures of the eardrums get transmitted. We review it all and we can do that consultation right there in the comfort of your home community.
[00:18:35] Speaker C: Yeah.
[00:18:36] Speaker A: You know, and I want to expand this for just a second. I know you don't speak for all of uams, but I have written a lot, not about, as I told you, hearing loss specifically, but about rural healthcare and the challenges we face in Arkansas. You and I were talking before we began taping about doing a podcast and how a newspaper, most people don't read it on paper anymore, they're reading it online. And what we really are here is a 247 digital operation in a rural state like Arkansas. Not only for the hearing work that you do, but every aspect of health care.
I would think that taking telehealth to people, other innovations to people especially, unfortunately. And I'm going to get off, I'm not going to digress on this, but especially in a budget atmosphere where we could easily lose half of our rural hospitals in this state over the next decade.
I would think that is the future. And that's what people, across all areas of UAMs, a lot of smart people are working on. Now. Just what you're talking about. How do we get to them without them having to drive to us?
[00:20:00] Speaker B: Absolutely. I mean, you've really hit the nail on the head. This is, you know, what we're talking about and the models we're developing could be used for any type of specialty care. It's about bringing high quality, cutting edge care to people and providing it right care, right place, right time, how do we bring it to people where they are and we can do this.
You know, it just, it requires creativity, thinking outside the box and really filling technology gaps. You know, we've, we've Run in. I've got two examples of that that, that we've run into in our own work where we found that we were really missing something that we needed to be able to provide care, but specifically for kids in schools. And one of those is that we needed a technology platform that interacted with medical devices so you could actually collect the data that you needed, but that you could do communication between education and healthcare entities. It had to be HIPAA and FERPA compliant, all the privacy regulations, to have that seamless communication. And that type of platform literally did not exist. And so we built it.
It's called Trio Connect. And it's the basis of how we're doing hearing care for 20,000 children right now.
And it's things like that that are really exciting because if you find that we're missing a piece of technology to be able to provide health care in a new and innovative way, you just got to go out and build it.
We did this similarly around how we screen children for hearing loss, how we actually identify them. Because you think of hearing screening as somebody says, raise your hand when you hear the beep.
We still do that to this day. But what we've learned in our work is that that doesn't catch every child with hearing loss because it misses the kids with ear infections. And you actually need a different tool to identify those kids. It's called a tympanometer. It's a special test that looks at the health of the middle ear. Well, there's a big problem there because tympanometers cost between three and $10,000 each and they're meant to be used by an audiologist. And a rural school simply can't do that. Right. Even if that's what's needed, they can't do it.
So we fixed the problem. We partnered with a really incredible biomedical engineer at Duke and we've built a low cost cell phone based tympanometer that's affordable and it can be used by a layperson, by a teacher or a community health worker. And we've done the first in human studies with this right here in Arkansas at UAMS in Arkansas Children's.
[00:22:36] Speaker A: Wow, that's exciting.
[00:22:37] Speaker B: It's very cool.
[00:22:38] Speaker A: That is cool to hear. Now we're talking now about the children, but we were talking earlier and I want to hit on this partially given my background, but again, adults too, and workforce. You were talking about the much higher unemployment rates among those who have hearing problems.
I was appointed as one of the presidential appointees to something called the Delta Regional Authority.
It Was full time gig for four years. I did it from 2005 to 2009.
We did economic community development mainly in rural areas of an eight state region in this part of the country.
And when I got over there, I quickly determined we did your traditional water grants, sewer grants, industrial development, but that our biggest problem was we had an unhealthy workforce in the rural south, probably rural America as a whole. And we began to focus more and more on health care.
For instance, we went to the state department and got approval that our organization could be an issuing organization for what's called J1 visas. Because a lot of time the only physicians we could get into rural areas were Pakistani or Indian.
But it goes back to that.
Let's focus on our children. But also it's a workforce issue.
[00:24:14] Speaker B: It's a huge workforce issue.
It's something that if we're thinking about how to advance economic development in the state, particularly in rural communities, we can't ignore this.
We've got to find a way to get good hearing care and good healthcare in general into rural areas.
And so we've started to do pilot projects for adults as well. So we do a lot of work with kids, but there are so many adults in this state with hearing loss.
And one of the pilot projects we're doing right now is actually with churches in Brinkley and Clarendon and the Tri County Rural Health Network. We're thinking about how do you reach people where they are?
[00:24:56] Speaker A: Through church.
[00:24:57] Speaker B: Exactly, exactly. This is not about brick and mortar healthcare. This is about reaching people in the places where they are. Where we live, work and gather.
[00:25:07] Speaker A: Yeah, absolutely. It's so important.
So let's say that somebody's listening to the podcast and they say my mother, father, just pulling something out there, Liv at McGee and boy, they could really use some help.
Where are your services available?
How do people take advantage of those services?
[00:25:32] Speaker B: Well, right now we've got, we've got services in place for about 20,000 children in 100 schools. And I mentioned that earlier. And then we've got this pilot program going and Brinkley and Clarence, I duck.
[00:25:45] Speaker A: Hunt in that area.
[00:25:46] Speaker B: I love it.
[00:25:47] Speaker A: I'll be in that area. Not duck hunting, obviously, it's the wrong time of year. But I'll be in that area Friday.
I do Delta tours on the side too. So anyway, go ahead, go ahead. A lot of friends over there.
[00:25:59] Speaker B: We also have a pilot project running for newborns that's all about bringing screening and diagnostic services to families, actually bringing it into their home homes so that they don't have to drive and wait with a crying, hungry baby in a doctor's office for several hours, which is a really big deal because often babies in Arkansas don't get the follow up after newborn hearing screening after they leave the hospital because it's too hard for families to do. But we can bring that service to them. And it's actually the same audiologist that would be doing those in person visits. They're doing them virtually, you know, those audiologists at children's and UAMs. So we have that pilot project running as well. And honestly, we're really, we're excited and ready to expand and implement this program literally wherever people want it.
[00:26:50] Speaker A: Wonderful.
[00:26:51] Speaker B: We're building partnerships and we're really looking to make healthcare accessible across the state and build this in the way that people are most excited about it.
[00:27:02] Speaker A: Yeah. So what excites you most about the future?
What do you see over the next five years, the next 10 years for this program?
[00:27:10] Speaker B: I am really excited that we have the potential to bring hearing care to every Arkansan. I mean, this is unique. This has never been done in any other state. We have the chance to do something in Arkansas where we will be the leader nationally in how to improve access to care for rural communities.
And so we're starting to build out the plans for how do you really make this vision a reality? Right. Like, we've got the tech to do it. We know what to do. So what's next? And so we're starting to think about how do we specifically adapt this program to support the agricultural communities here, to support industry here, and the occupational screenings that have to happen. We want to adapt our technology so that this can be expanded across community pharmacies throughout the state, since there's so many pharmacies in rural communities.
And we really, we're expanding into newborn hearing screening. We really want to bring this into schools in Arkansas because it can make such a difference.
[00:28:10] Speaker C: Yeah.
[00:28:11] Speaker A: Well, as somebody who writes a lot about and spends a lot of time in rural Arkansas, this really excites me greatly. And as somebody, you know, who has dealt with hearing issues in my own family, as I told you before, father and then my youngest son, it excites me greatly.
I knew the 30 minutes would go very fast. Any final thing you wanted to add that I may not have asked before we wrap up?
[00:28:41] Speaker B: Well, I think at the end of the day, we all know that we live in a state that has poor health outcomes, and we're talking about something that affects so many people in Arkansas and throughout their entire lives.
And UAMS has the center in the country with a potential solution to solve this problem for our state and ultimately have our state lead the nation in this area. I mean, this is really exciting stuff.
And what we need at the end of the day to move this forward is the money to build and implement it across the state, because we can make Arkansas lead the country.
We can truly change our state, our nation, and our world with this work.
[00:29:24] Speaker C: Yeah.
[00:29:25] Speaker A: Yet another area where Arkansas, Arkansas is leading the nation. My favorite compliments I get on this podcast is if somebody says to me, you know, I learned something. And Dr. Emmett, I can tell you I learned a lot in the last 30 minutes. Thank you so much for joining us. And I promise you we'll, we'll get you back for an update at some point.
[00:29:49] Speaker B: Sounds great. Thanks again.
[00:29:50] Speaker A: We appreciate the work you're doing for our state. Our guest was Dr. Susan Emmett from the University of Arkansas for Medical Sciences. I'm Rex Nelson. Thank you for joining us for another edition of the Southern Fried Podcast, a production of the Arkansas Democrat Gazet.
[00:30:14] Speaker C: Sat.
