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The Thinking Practitioner Episode 18: Ann Blair Kennedy and Kemi Balogun: Project COPE

Whitney Lowe:

Welcome to The Thinking Practitioner podcast.

Til Luchau:

A podcast where we dig into the fascinating issues, conditions, and quandaries in the massage and manual therapy world today.

Whitney Lowe:

I’m Whitney Lowe.

Til Luchau:

And I’m Til Luchau. Welcome to The Thinking Practitioner.

Whitney Lowe:

Welcome to The Thinking Practitioner.

Til Luchau:

Hi. This is Til Luchau. ABMP is a proud sponsor of The Thinking Practitioner podcast. All massage therapists and body workers can access free ABMP resources and information on the coronavirus and the massage profession at abmp.com/covid19, that’s abmp.com/covid19, including sample release forms, PPE guides, and a special issue of Massage & Bodywork magazine.

Til Luchau:

For more, check out the ABMP podcast, available at abmp.com/podcast or wherever you prefer to listen. Recent episodes feature conversations with Ruth Werner as well as Whitney Lowe and myself. Thanks, ABMP.

Til Luchau:

Hey, Whitney.

Whitney Lowe:

Yes. We would like to thank them very much. Til, how are you doing today?

Til Luchau:

Pretty good. How about yourself?

Whitney Lowe:

I’m doing well. Looking forward to our conversation today. We have a couple of very interesting, fascinating guests joining us today. So, would like to take just a brief moment to introduce Dr. Ann Blair Kennedy and one of her students, Kemi Balogun, who are here to join us in our conversation today.

Whitney Lowe:

So, Dr. Kennedy, many people in the profession know you as , ask you just take away and tell us a little bit about yourself. Then, I’ll have Kemi also do the same thing. Let us know a little bit about your background and why are you here with us today?

Ann Blair Kennedy:

Great. Thank you so much. I’m so thankful that asked us to come on the show. It has been great experience to work with Kemi.

Ann Blair Kennedy:

So, a little bit about me. As you said, I am in the profession and I have been in the profession for almost 21 years. I started out, had a great career, had a great practice in a little rural town down here in South Carolina. Then, I got really interested in massage therapy research.

Ann Blair Kennedy:

So, I decided to go back and get my doctorate. I have a doctorate in health promotion education behavior and began working at the University of South Carolina School of Medicine Greenville, where I teach a number of things including social determinates of population health and what some call cultural competence. I look at it more as justice, equity, diversity, and inclusion in health and medicine.

Til Luchau:

Dr. Kennedy, sorry, you teach those to whom?

Ann Blair Kennedy:

Medical students.

Til Luchau:

Medical students. There you go. Okay. Thank you.

Ann Blair Kennedy:

Yes. First and second year medical students is mainly who I teach to. I also teach a fourth year elective, which I will get to in just a moment, which is how I got in touch with Kemi.

Ann Blair Kennedy:

I also am quite active in the profession. I am the chair of governance for the American Massage Therapy Association and I am also the executive editor and editor in chief for the International Journal of Therapeutic Massage and Bodywork, a peer-reviewed scientific journal, open access, totally free for people to get to our research and also free to publish in, which is a little different in an open access model.

Ann Blair Kennedy:

So, like I said, I teach a little bit to the fourth year students. I teach a course on gender and sexuality in a clinical environment. This past spring, our students report out of the clinical environment in March. My dean asked me to take the course that I teach in person and put it online. And lo and behold, Kemi was in my class.

Kemi Balogun:

That’s right.

Ann Blair Kennedy:

That’s how we got to … She’d been in my classes before, but this is a very small class. We only had 10 students, so we really started to build a relationship. And then class is over and I got an email. And I’ll hand it over to you, Kemi, at this point to tell you how it progressed.

Kemi Balogun:

So, I am Kemi Belogun. I am a fourth-year medical student at the University of South Carolina School of Medicine Greenville.

Kemi Balogun:

So, my background, just a little bit. I graduated from Wake Forest University with a degree in biology. I plan on pursuing a career in obstetrics and gynecology and I have some interest in women’s dental health as well as health care disparities.

Kemi Balogun:

So, like Dr. Kennedy mentioned, I enrolled in her gender and sexuality studies virtual elective, because I thought, “You know what? This is going to be very important for my future as an OBGYN.” And I love the course. So, I sent her a bit of a love letter afterwards, just kind of expressing my appreciation for her class.

Til Luchau:

This is before your grades were sent out?

Kemi Balogun:

This was before. It was a pass/fail class so, but this was a genuine, I really enjoyed the topic and I enjoyed the way she moderated those very sensitive discussions. I said, “I’m really interested in the work that you do. Is there any opportunity for me to join in on any current research projects?” That’s how we started talking about Project COPE.

Til Luchau:

Tell us about Project COPE. What is that?

Ann Blair Kennedy:

Well, so right at the start of the pandemic, I had actually come back from an AMTA board meeting when things were starting to move very quickly here in the US. I started to see the massage profession get very isolated and upset and panicky, this is all through social media and through my friends and profession, but also because I worked in a health system, we had other things going on.

Ann Blair Kennedy:

So, one of my very good friends and my co-primary investor on the study on Project COPE, his name is Smitty Heavner-Sullivan. He is an RN who’s been working in ERs and critical care, but he’s also working on his PhD. So, he’s actually a research manager for one of the programs in the health system. We’ve been talking about this from an evaluation standpoint about how in the past, when there have been tragic events of any type. Health care workers are not usually talked to during the event. They’re usually talked to after, and we were seeing that we could potently start gathering data from all types of health care workers. We were thinking early just starting in the US, but we ended up going global.

Ann Blair Kennedy:

It started because there was a study that was already going on in our emergency department. We really wanted to put a little bit of a qualitative mixed methods spin on it, but we ended up not being able to do that in our local level.

Ann Blair Kennedy:

So, we decided to take their methods and expand the study and really look at all health care professions from those who were locked out of the health care system, oftentimes called non-essential and those who were the front-line workers. We really wanted to see what the differences that were going on and maybe follow these different individuals over a time.

Ann Blair Kennedy:

So, we launched Project COPE. With that, we also asked for video diaries. So, we have a set of surveys that go out, that people can sign up for and this is a longitudinal study, meaning we’re following people over time so they take an initial survey and then they can say that they want to be part of this study. We send them out. We started out at weekly survey, but now we’re going to maybe once every other week or once a month with some different measures that we’re looking at.

Ann Blair Kennedy:

And study-

Til Luchau:

Is that like a …

Ann Blair Kennedy:

Go ahead.

Whitney Lowe:

Til, go ahead. What does COPE stand for?

Ann Blair Kennedy:

Ah. Chronicling healthcare prOviders’ Pandemic Experiences. We scientists really like our acronyms.

Til Luchau:

Oh, yeah. There you are. Chronicling healthcare prOviders’ Pandemic Experiences. Okay. So, it’s a qualitative study. You’re gathering data.

Ann Blair Kennedy:

It’s mixed method.

Til Luchau:

Mixed method.

Ann Blair Kennedy:

Mixed method.

Til Luchau:

Tell us what that means, if you don’t mind.

Ann Blair Kennedy:

So, that means we’re getting quantitative or numerical data from some validated survey items, scale items. We’re looking at burnout and moral distress and coping mechanisms. Then, we’re also getting some qualitative data or usually thinking up words and pictures. In this, we’re asking for a video journal. Not everybody who is in the study gives us those video journals and we’ll talk about that I’m sure in a little bit because that’s exactly what Kemi’s doing for us. She’s helping us review those pieces of that part of the study.

Kemi Balogun:

Exactly.

Whitney Lowe:

Maybe a little early to kind of extrapolate some of those things, but what’s your sensation of some of the kinds of things that you’re likely to be finding by looking at this in the midst of the activity as opposed to retroactively looking at it after it’s over? It seems like a lot of times, people’s perceptions may be a little bit colored by looking backwards as opposed to what I’m really feeling right now. So anything in particular you think that you’re likely to find with this approach?

Ann Blair Kennedy:

Well, that’s a really interesting question and so what we can really see where we can see that the most are in those people that do stay with us throughout the study and fill out information over time. Probably the one who can answer that best is actually Kemi, because she’s the one who’s watching all of our videos.

Ann Blair Kennedy:

But I want to tell you a little bit about how we brought her in and why. That’s kind of why we’re here, too. Is that okay?

Whitney Lowe:

All right. Good. Yeah.

Ann Blair Kennedy:

So, my great team that I’m working with, it’s a multi-institutional, a very multidisciplinary team. As I mentioned, my colleague Smitty. We also have Niki Munk, which some of you may know. She’s also a massage therapy researcher at Indiana University. I have a couple of colleagues from Clemson, Tom Britt and Marissa Shuffler Porter, as well as Chloe Wilson is our fantastic project coordiator. She’s a graduate student. We have Shannon Stark Taylor, who is a clinical psychologist within family medicine at Prisma. We have Molly Benedum, who is from Appalachian Regional Healthcare System.

Ann Blair Kennedy:

So, it’s this big team working together. We also have Kendall Dean, who’s a medical student with us as well and , who is a recent graduate from University.

Ann Blair Kennedy:

So, we have this big, broad team and Hanna just joined us, but one thing that we noticed as our team, as Smitty and I do this work quite a bit, we realize we’re all white, a bunch of white people, multidisciplinary, bunch of different fields, but we were all white. We were like, “Hmm. This really isn’t great. This is not the way we should do research. This is not the way we want to do research.” And then Kemi sent me the email.

Whitney Lowe:

So, what did you say, Kemi?

Kemi Balogun:

So, she told me about Project COPE and I said, “Well, this sounds very interesting.” And she was very transparent and she said exactly what she said to you all. We are an all-white team and we recognize that that is an issue. Would you be interested in joining this study? I said, “Of course.”

Ann Blair Kennedy:

Kemi’s not white.

Kemi Balogun:

I am Black. And I said, “Yes,” with the idea of bringing a different perspective to the table. I will have the ability to tap into my networks, my communities and hopefully uplift and highlight minority voices to ensure that everyone’s voice is heard in this project. So, I was very glad that she brought that up because that was going to be my mission anyway.

Kemi Balogun:

I would like to bring up one thing here. So, it’s really important to diversify your team, but it’s also important not to tokenize your minority team members. What I mean by that is that yes, you have a diverse team and you’ve included a non-white participant or person, but it is not that person’s sole responsibility to bring forth ideas of inclusivity. It is a collective effort. That’s just one step to ensuring that everyone’s voice is heard.

Kemi Balogun:

So, I would just like to bring that up. I don’t speak for all Black people and it’s not solely my responsibility. I’m just here to bring a different perspective and hopefully encourage everyone to consider experiences outside of themselves.

Til Luchau:

I think that’s great. This is interesting and all. Kemi, I’m curious to hear from your experience as a student, too. We speak about under-representation in certain areas. I don’t know the statistics on representation of people of color in medical school programs, but I would imagine it probably isn’t reflective of the overall population and just curious to hear how you feel that perspective since Project COPE is looking at how health care providers are responding here. What else is being brought up about, well, maybe it’s just delving into some of these bigger questions about the representation and diversity within our health care teams.

Kemi Balogun:

Yeah. I’m so glad that you brought that up. So, according to the AAMC, about 5% of active physicians in the United States identify as Black or African American. In my class, the class of 2021, Black students made up about 10% of the class. So, there is an issue of representation of Black people in medicine.

Kemi Balogun:

And that’s an issue because studies show that when patients see physicians who are similar to themselves, they’re more likely to seek out preventative care, they spend longer time with their doctors, and they report higher satisfaction of care received. There are also studies that show that there are better outcomes when you have increased representation of Black physicians in medicine.

Til Luchau:

I just want to jump in there because those are important things to really underline or take a moment for because many of us have inclusivity and inclusion representation as values in and of themselves, but then I know there are a lot of different views on the subject, but when you start to talk about what are the other, how does that trickle out into the larger effect or the effectiveness of the health care system, that turns the conversation around and makes it a different conversation.

Kemi Balogun:

It really does, especially when you-

Whitney Lowe:

Yeah, it’s really underreported and underdiscussed is the impact that that has on health care practice and delivery of health care in these communities.

Til Luchau:

Kemi, so sorry for jumping in, but as I understood, you were saying a more inclusive representation of practitioners has different health effects in the population it serves.

Kemi Balogun:

Right. It improves health outcomes for minority populations. So, that has been supported in the literature and that just indicates that we have more work to do to increase representation.

Kemi Balogun:

Unfortunately, this is not an issue that’s unique to just medicine. Dr. Kennedy and I were investigating the lack of representation of Black massage therapists in the field. We see similar patterns there.

Til Luchau:

Do you have numbers for us at all?

Ann Blair Kennedy:

We do, actually. So, these come from the US Labor Department, I believe. It seems that about 8.8% are Black or African American, 13.1% are Asian, 11.1% are Hispanic or Latino, and 72.3% are white. When we look at the gender differences as well, from this bit of data, it’s indicating 83.6% are women, where when we look at, I’ve seen anywhere from 80 to 88% of the profession are women in massage therapy.

Til Luchau:

That’s in massage therapy?

Ann Blair Kennedy:

Massage therapy, mm-hmm (affirmative).

Til Luchau:

Okay.

Ann Blair Kennedy:

So, we definitely see a disparity in who is there and who’s represented. Also, if you look at who receives massage therapy, there’s data from 2012. That’s the most recent data that we have, but there is a clear disparity in who receives massage therapy and those who receive massage therapy are mostly white women somewhere between 35 and 50. You see that in Google images, right?

Til Luchau:

Oh, yeah.

Ann Blair Kennedy:

You go search massage therapy and you are going to see luxurious settings with white women giving and receiving massage therapy. It takes a scroll or two to find either a man or a person of color either giving or receiving and-

Til Luchau:

I would probably argue, that’s more than a scroll or two probably, because I’ve looked in trying to do graphic things for some of our courses or promotion materials. You got to really dig. You really got to dig to find other things like that.

Til Luchau:

So, I’m curious how this sort of the picture in the representation that comes out about what massage therapy or, in this instance, we’re talking mainly about massage therapy and soft tissue manual therapy approach is the way it is represented, how that impacts somebody’s desire and willingness to want to receive that.

Til Luchau:

Kemi, I believe you mentioned you’ve received massage before. Did you have any of those kind of perceptions initially when you first got exposed to it?

Kemi Balogun:

Yes. In that meeting that Dr. Kennedy and I had back a couple of months ago, she brought up Project COPE. She mentioned that we do have a large number of participants who are in the massage therapy field. I said, “Well, I’ve received massage regularly.” And I kind of said it sheepishly.

Ann Blair Kennedy:

She did. She did.

Kemi Balogun:

And she probed me a little and she said, “Well, why do you say it like that?” That’s where the discussion began. I basically explained to her that it’s seen as a luxury in the Black community. Unfortunately, as you mention, Whitney, the media does not reflect us in any way.

Kemi Balogun:

So, I think that the lack of representation of Black folks in massage therapy is probably due to a lack of personal experience in the field itself.

Kemi Balogun:

So, if you haven’t received a massage, you are largely unaware of the health benefits. You probably aren’t privy to the career opportunities available in the field.

Kemi Balogun:

So, I think that to examine why there is a lack of Black therapists, you need to start thinking about why there is a lack of Black clients or patients. So, I think it’s a threefold issue. So, economics, education, access.

Kemi Balogun:

So, economics, like I mentioned before, and I don’t speak for all Black people, but I suspect that many view massage as a luxury, one that they probably cannot afford. Another is they’re probably not aware of the health benefits. I think that’s probably initial across the board, but probably more so within the Black community considering the lower health literacy levels plaguing the community. Then, you also have to think about access.

Kemi Balogun:

So, my introduction to massage was via a franchise. I think about, well, where are those stores located? Are they located in lower income communities which are largely occupied by minority and Black populations, and if they’re not, well, then how would you expect someone who maybe is aware of the health benefits to access those services?

Kemi Balogun:

So, if we can tackle those issues, increase the number of Black people getting massage, it may have a trickle down effect on the number of Black people who may say, “Hey, this is a great service. I want to pursue a career in it.”

Ann Blair Kennedy:

Potentially.

Til Luchau:

Kemi, I’m curious about your early and very first experience with receiving massage. Can you tell me a little bit about what it felt like when you were making the decision to make that appointment and to go in there? What was the driving factor that made you think, “Oh, I think I want to try this. I think I want to check this out,” or were you going because you needed to for a health reason or what kind of drove you there to begin with?

Kemi Balogun:

Again, it links back to my idea or my perception of it being a luxury. So, I actually for as a birthday present for myself.

Til Luchau:

Uh-huh (affirmative). Good for you.

Kemi Balogun:

And I loved it. I said, “Well, I’m going to go again.” I just found myself going more and more often. Eventually, it just became a part of my wellness routine.

Kemi Balogun:

So, my initial introduction was just this is a gift. This is a luxury, rather than this is a legitimate or could be a legitimate part of my wellness.

Til Luchau:

Mm-hmm (affirmative). Yeah.

Ann Blair Kennedy:

Yeah. We had a long talk about that.

Kemi Balogun:

We sure did.

Whitney Lowe:

Right. Good. Well, I think you’ve hit on something that I think is so valuable about messaging, that we as a profession really need to do some work on to get out there. This is something that Benny Vaughn bought up in his discussion when we were talking about this with him about how do we reach out to those communities of African American communities and places where people are in minorities that school seem to be struggling to get new students in there. Let’s put out some effort to go find where some of these people are and these people in the communities that are underrepresented in our profession. I think we all could be doing a little bit more work in that area.

Til Luchau:

And your story, Kemi, makes me think that maybe we don’t have to worry about even selling it really hard as much as introducing it, because-

Kemi Balogun:

Exactly.

Til Luchau:

Yeah, because it almost, once you experience it, once you’re involved, you know. You know the value of it once you receive a decent massage.

Kemi Balogun:

Absolutely.

Til Luchau:

And I’m glad your experience at the franchise was decent enough for you want to go back. That’s saying a lot. It’s fantastic. Yeah.

Ann Blair Kennedy:

And I actually really like the franchises. I have since the beginning because of their price point. When you look at the national average, which is now reaching into $75 or something, it’s getting close to $75 for a one-hour session, the franchises are generally a little bit lower than that. So, I think of that for those who maybe are school teachers. They can’t necessarily afford to go to a high-end spa where it cost $200 to get a session, but you can still get great sessions at the franchises, but it all comes down to management. That’s a whole nother discussion that I don’t want a whole .

Whitney Lowe:

Yes.

Ann Blair Kennedy:

Send this down the line to-

Whitney Lowe:

It certainly is a big wormhole, but I will-

Ann Blair Kennedy:

It is.

Whitney Lowe:

… tag one thing onto that because I think you are hitting an interesting point. We hear a lot of franchise bashing in our profession because of some of the economic models for the practitioners that are, let’s say, less than ideal in a number of situations, but people will oftentimes bash the franchises as getting a poor massage experience in the franchise.

Whitney Lowe:

People need to remember, the franchise doesn’t deliver the massage. It’s a person who’s a massage therapist there who’s delivering that. If you had a bad experience, it’s probably because the practitioner didn’t give you a really good experience. It’s not because of the place where they worked, has a lot less to do with getting a good experience there and there’s some really very fine therapists working in franchise situations. So, it’s a lot more to do with the individuals themselves.

Whitney Lowe:

Kemi, likely, it sounds like you had a good person that you interacted with that first time, otherwise, you might have thought, “Eh, this is not for me. I’m not …”

Kemi Balogun:

Right.

Whitney Lowe:

That’s happens to a lot of people, you know?

Kemi Balogun:

Mm-hmm (affirmative).

Til Luchau:

And I thank you, Whitney. I think maybe some of my bias was showing through. First thing I thought when I heard a franchise, like, “Oh, boy. I hope it was good,” but, yeah, you bring that point up that it is the person. I’m just thinking of all the students I know that skilled practitioners that come to my class who I would get sessions from them anytime. So, I got to work on my own attitude about that franchise thing, I think.

Ann Blair Kennedy:

For me, it usually comes down to the franchise owner because if you keep therapists there for a longer period of time and you’re treating them well, then that’s great. If you have a lot of turnover in any business, any business that has a lot of turnover, that’s where the issue comes in.

Ann Blair Kennedy:

So, yeah, we can go on and on about the ethics and different pieces around franchises for hours, I’m sure.

Whitney Lowe:

Yeah. Right. So, yeah, I’ve got another question I want to bring up here, kind of getting back to Project COPE and also some other things that we’re talking about here with some of the diversity issues, but we’re going to take a brief moment here just for our half-time sponsor. We’re going to hear a brief message from Andrew Biel, author of Trail Guide to the Body from our sponsor, Books of Discovery.

Andrew Biel:

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Whitney Lowe:

And thanks to Andrew Biel and Books of Discovery for their support. Please do be sure to check out their great offer and thank you again for supporting The Thinking Practitioner podcast.

Whitney Lowe:

So, I want to pose a question really to both of you about something I heard just recently. This was on the Massage Therapy without Borders podcast and believe AK, you’ve been on that podcast once before. This is something we were talking about just the other day. Yup.

Ann Blair Kennedy:

Mm-hmm (affirmative).

Til Luchau:

Cal Cates and Cathy Ryan.

Whitney Lowe:

Yeah. Cal Cates and Cathy Ryan from BC and Virginia area. So, they were talking about this concept. I had never heard this term before and I thought this was really a fascinating perspective. They were talking about the disparity or the incidence, let’s say, the high incidence of a number of major health problems that seemed to be more prevalent in the Black community than they are for white people, for example. You got high rates of diabetes, high rates of many lifestyle illnesses. There’s been this sort of running dialog for many years that this was the result of genetic differences that made them more susceptible to these kind of diseases. They were talking about this concept called weathering, which I had never heard before.

Ann Blair Kennedy:

Weathering hypothesis, yeah. Mm-hmm (affirmative).

Whitney Lowe:

Yeah. So, can you talk a little bit about that because I thought it was really fascinating, the idea of really maybe some of the more socioeconomic factors around racial prejudice and some of the systemic racism in our culture are actually playing a bigger part in that whole health care perspective. So, can you talk about that for just a moment?

Ann Blair Kennedy:

I’m going to see what Kemi has to say first before I dive in because I could dive in for a long period of time.

Kemi Balogun:

Yeah. So, some of my thoughts are the whole genetic argument is bogus, quite frankly. So, we have to recognize and acknowledge that a lot of minority population, specifically Black people are disadvantaged historically. So, again, thinking economically, we earn much less, so we may not have the means to go and see a physician regularly.

Kemi Balogun:

So, that can lead to uncontrolled diabetes or uncontrolled hypertension, therefore leading to poor outcomes. Also, it would be remiss of me not to mention the historical relationship between physicians and Black people. There is a mistrust within the Black community of physicians. The Tuskegee experiments amongst many other examples contribute to that.

Kemi Balogun:

So, even if you do have the means, you might not trust your physician or you might not go regularly. And then, that could also lead to poor outcomes. Some Black people live in food deserts, so you don’t have access to good quality, healthy food or your neighborhoods aren’t sourced with parks so you don’t have a cheap and accessible means of getting regular, routine exercise.

Kemi Balogun:

So, those are just a few examples of why we may be seeing some of these trends or health care disparities.

Whitney Lowe:

Yeah. Interesting. And also, they were mentioning the potential impact on the suppression of the immune system from a constant life of being in fear or apprehension for many people about the social instances in which they’re going to live and the encounters that they may have in a society.

Ann Blair Kennedy:

And what some of the literature in this area of the weathering hypothesis has been looking at for a long period of time is we know across the board that there is a grater morbidity or mortality and people get an illness or die quicker in the African American or Black community.

Ann Blair Kennedy:

So, as Kemi was saying, some of it is thought of maybe it’s the socioeconomic status. Well, when you compare people of the same socioeconomic status, Black people and white people, the Black people are still dying quicker and at a younger age than the white people.

Ann Blair Kennedy:

So, then, dear lord, what is it? What is it that’s getting to them that is making them die quicker than white people. That’s where the people were starting to think about that biological differences between the two. It’s actually what they’re starting to see is that it’s the systemic racism. So, that constant microaggression and that constant wearing down on them, that constant stress and inflammation makes them die quicker and get more diseases.

Ann Blair Kennedy:

So, this constant racism that they’re facing in the United States, let alone having issues with, oh, police forces, it just impacts them much differently than other populations. And they’ve showing similar things of how racism, the science has, when I say, “They.”

Ann Blair Kennedy:

There was a really interesting study and I don’t have it pulled up here right now that was done right around 9/11, within a couple of years of 9/11. I was talking about it with Hannah on our team not too long ago where they were looking at birth outcomes for Arabic women in the US before and after 9/11, thinking that this could be a natural experiment to see what racism does to individuals. If you ever look at how we ask people about race and ethnicity, we don’t ask people to identify if they’re of Arabic heritage or Arab-American in any way.

Ann Blair Kennedy:

So, this group had to pick a proxy so they looked at names, last names more than anything. I believe this was done in California and they were looking at birth outcomes for the nine months before 9/11 and then the nine months to a year after. I can’t remember all of it right here in my head, but it was something about it that … We went to the birth outcomes after 9/11, the women had worse birth outcomes across the board. Lower birth weight babies-

Whitney Lowe:

If you have Arabic last name, then you’re more likely to have a worse birth outcome after 9/11 than before.

Ann Blair Kennedy:

Shortly in this brief time period so it was, I can’t say that that is true now, but in this time period that they were looking at, that’s what they were saying. They were worse birth outcomes for people with appeared to be from an Arabic heritage.

Kemi Balogun:

Dr. Kennedy, thanks for bringing that up. This brings to mind the fact that Black women here in the United States are actually five times more likely to die from birth, even when you control for income, level of education, and all of that.

Kemi Balogun:

So, it just makes you wonder, like you mentioned earlier, well, what is it? And studies are pointing to systemic racism. So, thank you for bringing that up. This sort of trend is also seen in the Black community in terms of maternal mortality.

Whitney Lowe:

And we were talking about this, some of this might be just because of challenges that some of these individuals are having in their own individual sort of health world that they’re in, but it also seems like at least in some of the things that I have read about the statistics that you bring up there, Kemi, that a lot of this can also be traced sometimes to perceptions by the health care providers about the quality of care that they’re delivering to people of color, that that’s not the same quality of care and, in one case, that a white women who had this group of symptoms would be bumped up the triage level into more important or more serious investigation whereas the black money was not left down on the war to not look into when something serious was going on or something like that, so it seems like those are factors that still play into different parts of our health care system.

Whitney Lowe:

It makes me wonder, too, with this very disproportionate degree of impacts that we’re seeing from COVID-19 in the Black community, how much of that is happening now in relation to some of these same things and very interesting that we’re seeing this sort of intersecting with this big kind of reckoning of a lot of people finally coming to say like, “All right. I think we actually still, we really do need to start looking at some of these issues of systemic racism throughout our culture.”

Til Luchau:

And if you think about, you mentioned inflammation and you think about inflammation as an internal, physiological protective response that’s a reaction, it’s a biological reaction to a perceived threat or damage.

Til Luchau:

Then, if we extrapolate that out into the context in which we live or the interactions we have or the physiological or behavioral or bio-psychological states that we end up in, it’s pretty easy to connect the dots and do an inflammatory state, saying, “If you’re not perceiving yourself as being safe, you’re probably more likely to have an inflammatory milieu or reactive milieu,” and, as we know, that has all sorts of trickle down effects.

Til Luchau:

The good news is we know a thing or two about what helps reduce threat levels. We know a thing or two about health and we know a thing or two about what actually makes a difference for people.

Kemi Balogun:

Yeah, it seems like, one would argue that the community that may need it the most may need massage therapy or body work the most, just considering the generational trauma, the chronic microaggressions, and the toll it takes on the body. It seems like we would need it the most, but yet, we are receiving it the least. So, that’s an interesting takeaway there.

Til Luchau:

So, that brings us back to, what were some of those questions we were asking earlier about how do we get it there better? I think you all have hit on some very important things about we’ve got to start at a grass roots of making many of these approaches a lot more enticing to these different communities, the emphasis of wellness and health enrichment and health enhancement and whole life scale health approaches and that kind of stuff. It’s got to become more prevalent in many of these different communities.

Til Luchau:

I would like to think, hopefully, if one of the potential silver linings might be coming out of this tremendous time of social unrest that we’re seeing in our country is a greater perspective of outreach into some of these communities for greater inclusiveness to bring practitioners into these fields in much greater representation.

Whitney Lowe:

And you’ve given me three levers at least, many, which you’ve gotten me thinking of three ways. Economics, sure, there’s thing’s that I can do that’ll help make what I do more available to people economically. Education, that’s what I do. I can think about more of how that penetrates into places where it’s most needed. Then access. What can I do to make it possible, convenient, and realistic for people to actually have access to the kind of things they do? I think that’s a great way to map out each of the possibilities to each of us. Mm-hmm (affirmative).

Ann Blair Kennedy:

And that really goes across the lines of not only for clients, and so bringing in more clients and more patients in those areas, but it’s also going to the therapists, too.

Ann Blair Kennedy:

So, it’s really this iterative process that are building upon each other, but I think we can get more black people into become patients and clients. Once we start getting in more therapists, and once we start getting more therapists, we can start getting more clients. It’s just going to start building and building upon itself. And it’s just when we look at who receives massage in this country, we have so many people that we’re not tapping into that can help expand public health, in a way, so helping people get better health outcomes. We can look at reducing anxiety, stress, and helping with depression and helping improve sleep. There’s so many different things that we can do with massage therapy that impact people in so many different ways across so many different criteria.

Ann Blair Kennedy:

So, when we look at that stress information, we know that we can help them. We see in the literature that we’re starting to see some of those mechanisms as well. It’s just, I think, so important to get some more outreach and get more therapists in the field that we can reach more people.

Whitney Lowe:

So, sharing ideas, start looking for ways to reach out and make those access routes possible.

Ann Blair Kennedy:

Mm-hmm (affirmative).

Whitney Lowe:

And then, how about Project COPE? Are there ways that you would like to see people participating there that you can take a pitch for here?

Ann Blair Kennedy:

And thank you for bringing us back to that. So, what we have seen in the data that we have been gathering, not surprisingly, the massage therapists that are part of this along with other health care providers. From a massage therapist perspective, at least, most of them are women. You would expect them in a profession that it’s more women, but we’re not seeing representation of men in our study, male massage therapists, at least.

Ann Blair Kennedy:

As I said, one of the things people can do in the study is to upload a video, a short video blog, that’s one of the things we ask them to and we give them some prompts. Kemi’s job on the study is to review all these. She’s starting to watch them over time. I’m going to hand it over to her and let her tell you a little bit about some of the things that she’s been seeing and about who’s coming and giving us those blogs, as we call them.

Kemi Balogun:

Sure. Yeah. So, like Dr. Kennedy mentioned, we are looking for more diversity amongst our participants. As it stands right now, all of these log respondents for video diary respondents are white. We have two who are male. So, this is a call-

Whitney Lowe:

Two out of how many, do you think?

Ann Blair Kennedy:

About a hundred.

Kemi Balogun:

About a hundred or so.

Whitney Lowe:

Okay. All right.

Ann Blair Kennedy:

We have more respondents than the whole project but, like we said, not everybody gives us a blog.

Kemi Balogun:

Exactly.

Whitney Lowe:

Okay. So, a hundred video responses and two of thm are male.

Kemi Balogun:

Yeah. So, we need more diverse voices. We need to hear everyone’s story and experience. I’m just going to briefly go over some of the trends that I’ve noticed in those video responses.

Kemi Balogun:

So, at the beginning of the pandemic, there was a lot of discussion of financial concerns and unemployment, how long is this going to go on? I need to make ends meet?

Kemi Balogun:

Then, once the stay at home orders were placed, the discussion kind of shifted more towards missing work, a large portion of the respondents are massage therapists, so a lot of people were seeing things like, “I miss my work. My work brings meaning to my life and I don’t have the right now.”

Kemi Balogun:

Then, once states started reopening, there was a lot of frustration that was expressed over the lack of clear guidelines or even realistic guidelines handed down from leadership within massage therapy. A lot of discussion of, “Well, what is the right thing to do? Should I go back to work? Is it safe?”

Kemi Balogun:

Now, there’s more of a conversation around, “Well, maybe my decision is to just leave massage therapy. I might just consider a second or third career or maybe it’s time for early retirement.” So, that  was interesting.

Whitney Lowe:

That is interesting. How common would you say that is?

Kemi Balogun:

I would say about six to eight respondents so far.

Whitney Lowe:

So, approximately, so far in this small sample, six to 8% of people saying, “Well, maybe I’m just kind of exit.”

Kemi Balogun:

Exactly. And here recently, there’s been a lot of conversation around the use of masks. There’s just this controversy over, “Well, should we be wearing masks? Should we require clients or patients to wear masks?” So, that’s been interesting, too. Lots of different opinions when it comes to that.

Whitney Lowe:

I imagine. I imagine. Well. You’re asking for participation. So, say a male or anybody practitioner, why would I do this? Why would I come give a video diary? Who’s going to see it? Is it private? Who’s it help? That kind of stuff.

Ann Blair Kennedy:

We’re doing this for a couple of reasons. One, we’re wanting to kind of triangulate our data a little bit, so when you’re doing mixed methods, numbers are great, so we can do great things with numbers. We can know how many or how much of something, but we don’t necessarily get the why. That’s what the videos can get us a little bit more of. We can get more in depth into the why and it can help explain why we’re seeing the numbers that we’re seeing. That’s why I work in a mixed methods way. Yes, they will be private. We study staff see them and mostly, that’s Kemi and Kendall, our two medical students. They’re the ones who –

Whitney Lowe:

I’m not going to be on YouTube if I give you a …

Ann Blair Kennedy:

Absolutely not.

Whitney Lowe:

I like being on YouTube.

Ann Blair Kennedy:

Well, you can do that, too. If you really want to upload it, you feel free, but you need to do that privately.

Whitney Lowe:

Thank you. Okay. So, video contributions are private. They’re being viewed by researchers to round out your quantitative data to help you answer the why question.

Ann Blair Kennedy:

Yes. And we’re hoping to be able to follow people over time. Like Kemi has said, some people are maybe leaving the profession that we hope that maybe five years down the road, we’ll have this fantastic database and we can go back and see who stayed in and who left, who is still doing great now, what has happened to their career, what has happened to their patients? We’ll be able to follow these people in this study for decades if we choose to. And this whole study started very, very quickly because the pandemic kind of evolved rather quickly. Within two and a half weeks, we had the study up and going. So, we are really excited that we’re still professing through with, getting more people in and people can still join today. It is a rolling enrollment, so people can join the study today and stay in it. They can drop out later if they want, but the idea is to get more and more people in so that we can continue over time to follow and see what’s happening within a profession across the board and all of these different health professions as well, how are people doing, because you see news reports.

Whitney Lowe:

Mm-hmm (affirmative). That’s right. We hear the news reports. We hear the news reports. We read on social media, we read what people are saying in the forums, but to actually contribute your story to a larger project that has this potential to be followed over time, that’s unique and that’s absolutely fascinating. I tell you, it’s a nice, I’d say a reassuring reality check to me to hear your numbers, 68% saying they’re leaving because those stories always impact me when I read those.

Whitney Lowe:

I know it’s natural, it’s inevitable, but to get some sense of how common it is or you’re saying not so common as we might think, then that helps me, actually. I look forward to seeing what comes out of your study both in terms of the numbers you get and the kind of stories that people are willing to share.

Ann Blair Kennedy:

We have over 700 participants.

Whitney Lowe:

Fascinating.

Til Luchau:

Oh, that’s great.

Whitney Lowe:

Yeah. We’ll be sure to put the information about participating in the show notes, but where would people go right now if they wanted to participate?

Ann Blair Kennedy:

So, we have social media, which has the links to everything in there as well. So, we’re on Instagram, Twitter, and Facebook and it’s generally under Project COPE, Chronicling healthcare prOviders’ Pandemic Experiences, because there’s apparently a few other project copes out there. So, that’s what you’re looking for. We also have a website which I hope you all will link for us, so I don’t have to say it out loud right now.

Whitney Lowe:

Yeah, but social media Project COPE you say, Project COPE, Chronicling healthcare prOviders’ Pandemic Experiences. Okay. Got it. We’ll link to that.

Til Luchau:

Great. We will make sure to plug that into the show notes, too, the other link for the site as well.

Ann Blair Kennedy:

Thank you very much.

Whitney Lowe:

Yeah, great. Well, thank you-

Kemi Balogun:

Thank you.

Whitney Lowe:

… all both very much for your discussion. There’s some fascinating issues, a number of other things that I’m sure we could dive into for much greater length here, but I really want to thank you both for some very insightful commentary and interesting views on some of these different things that we’re wading ourselves through right now. Really, I think we can all mark this as a big period of growth for us in lots of different ways here.

Til Luchau:

Yeah. Thank you both.

Ann Blair Kennedy:

Thank you very much for having us on.

Til Luchau:

We should say, “Thanks” to our sponsors and to stop by our site, thethinkingpractitioner.com for show notes, the links we mentioned, transcripts, and lots of extras. Whitney, where can people find you?

Whitney Lowe:

They can find us on the interwebs over at academyofclinicalmassage.com and also on social under my name, Whitney Lowe, on Twitter and Facebook, lots of other places over there. Til, where can people find you on the web?

Til Luchau:

Advanced-Trainings.com, or my name Til Luchau, on social. You can email us questions. We love to get your questions, your stories, your complaints, if you got them. We love all that stuff. Email us at [email protected] or look for us on social media and those places we mentioned.

Whitney Lowe:

Yeah, and follow us-

Til Luchau:

Yeah. Please follow us on Spotify, rate us on Apple Podcasts or wherever else you’re listening, tell a friend, and thanks again to our guests today.

Whitney Lowe:

Yeah. Thank you to our guests and thank you all for listening in. We will see you again soon.

Ann Blair Kennedy:

Thank …

 

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