Dr. Matt Bush: Health Disparities In Hearing Health

Join me in a conversation about how social determinants of health are critical conversation and considerations for improving hearing health care for individuals and families.  Dr. Matthew L. Bush is an otolaryngologist, neurotologist, and professor at the University of Kentucky.  He received his medical degree from the Marshall University Joan C. Edwards School of Medicine in Huntington, W.Va. He then completed an Otolaryngology research fellowship and a Neurotology and Cranial Base Surgery fellowship at The Ohio State University Medical Center and Nationwide Children's Hospital Research Institute in Columbus. Dr Bush has a personal history of growing up in rural West Virginia -- driving a passion and purpose to engage in clinical research focusing on healthcare disparities in  hearing healthcare. Dr. Bush has published multiple peer-reviewed papers and has received grants supported by the National Institutes of Health. His reasearch and clinical focus has moved the field forward in thinking outside of the “ear” and influencing positive change looking at the 5 domains of social determinants of health to improve access to care. In this episode, Dr. Bush challenges each of us to start with ourselves and ask the question “What Can We Do?”.  Dr. Bush challenges each of us to physically spend time in the community listening and learning.  

You can listen to this episode wherever you access podcasts and at: www.3cdigitalmedianetwork.com/empowear-audiology-podcast

For more information about Dr. Carrie Spangler- check out her Linktree at https://linktr.ee/carrie.spangler.

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

Announcer: [00:00:00] Welcome to episode 49 of Empower Ear Audiology with Dr. Carrie Spangler.
Carrie: [00:00:16] Welcome to the Empower Audiology podcast. I'm really excited to introduce our guest today. It is Dr. Matthew Bush and he received his medical degree by Marshall University and in West Virginia, and he completed an Otolaryngology research Fellowship and Neurotology and cranial based surgery fellowship at the Ohio State University Medical Center and Nationwide Children's Hospital Research Institute in Columbus. He is board certified by the American Board of Otolaryngology, both in otolaryngology and in neurotology and cranial based surgery. Dr. Bush is actively engaged in clinical research with a special focus on hearing health care disparities. He has published multiple peer reviewed papers on the topic and is supported by the National Institutes of Health. His research and clinical efforts are focused on providing timely access to care for children and adults. He has received multiple awards for his teaching and research and is involved in multiple national organizations as well. So, Dr. Bush, welcome to the EmpowEAR Audiology Podcast.
Matt: [00:01:28] Thanks, Carrie. It's a pleasure to be with you.
Carrie: [00:01:30] Well, I just wanted to say it was a pleasure to meet you last month when we had an incredible flight experience as we are trying to get to a common meeting in Oklahoma and we got to spend quite a bit of time delayed in the Atlanta airport.
Matt: [00:01:51] Yeah, you know, adversity tends to make lifelong friends. And when you're stranded somewhere or dealing with some of the the craziness that is life as we know it now, whether that's through travel or the pandemic, you know, impacts, we're just thankful to find, you know, birds of a common feather and friends in our in our field. And so, yeah, we by chance were able to huddle together and and sort of make a plan and and move on through the adversity.
Carrie: [00:02:22] Yes. Well, it definitely made our wait and delay a lot more enjoyable than in the airport but thanks for being a part of this today. And I always like to ask my guest to have ventured into our little niche of hearing health care. How did you decide to specialize in ENT and working with children and adults with cochlear implants.
Matt: [00:02:50] Well, I have been very, very fortunate to have just some really immense mentors and really incredible opportunities that led to where I am today and allowing me to be in employed and do my dream job. That's that's that's the thing I would I'm thankful that what I do is not I get paid to do it, but I would do it for free if I if I had to, because it's just that rewarding and honorable to be able to be involved in the life and the care of patients that are entrusting so much to us. But I grew up in West Virginia, the last of four children in a family of four with two parents who were high school sweethearts. They didn't go to college and raised in an environment where we really valued community and connection and family, but education, health care resources, those things weren't necessarily at the front or the foremost of our brains. And thankfully, we were blessed with health in our family. We didn't have any major health problems in our nuclear family, but certainly those influences of rural health and rural health care were a part of things that I saw early in life and was was witness to the influence, kind of the directions that I went in health care.
Matt: [00:04:10] My grandfather was a woodworker, really, a jack of so many trades, as many rural farmers and people who existed and survived through the depression tended to be. But he was a woodworker and would make all kinds of very interesting things. He would make kind of the casing for like grandfather clocks and then find the the components that you would purchase to sort of make people a sort of a makeshift grandfather clock, but just really was somebody that used his hands to do really cool things. So I knew I was headed down a path to use my hands or at least some kind of manual skills. And as health care became an opportunity, then the as I began to think about the different disciplines and had the different mentorship opportunities in health care, it was clear that otolaryngology was a field with so much diversity of the types of patients and the things that we would treat. But I really became fascinated in the in the anatomy, the physiology, the complexity of the auditory system and the ear the ear surgery where fractions of millimeters make a huge difference between hearing or not hearing or a smiling face or a drooping face. So that that type of the stakes and the complexity really very much appealed to me.
Matt: [00:05:35] I think one of the most influential things that sort of made head neck anatomy and the in the ear anatomy come to life was that while I was in medical school, I lived adjacent to the basic science campus portion of the medical school. And in Huntington, West Virginia, I went to Marshall University and the GROSS Anatomy Lab were hiring medical students to work with a head neck anatomy professor to work on dissections that would be used for testing purposes. So different structures would be pinned and used for testing the next class of medical students. So I was basically paid as a medical student to do head and neck dissections and explore head and neck anatomy. It's a bit morbid, I realize, and I don't know, probably some of those old scrubs still smell a little bit like formaldehyde, so it might bear some of the the memories of that that employment. But honestly, that was one of the most impactful things that just let me take a front row seat of all of the amazing anatomy and complexity of the ear, the skull base. And so these formative experiences just sort of really directed me down this very rewarding field.
Carrie: [00:06:53] And that's a great history. It sounds like you said you're growing up in the rural parts of West Virginia and then finding your niche in college really spearheaded you in some of the work that you do right now. And I know you have a heart for humanitarian work, which I want to talk about today, too, but you also have done a considerable amount of time studying health care disparities. And so I'd like to maybe spend a little bit of time talking about your research on health disparities and how that impacts access to health care. Can we start a little bit with? Well, first of all, before we go too much further, I also thought, do you want to share a little bit about what your role is right now at the University of Kentucky?
Matt Bush: [00:07:46] Yeah, sure. So at the University of Kentucky, I am a professor and vice chair for research in the Department of Otolaryngology. It's a program that I have a lot of connections and a history with in that I did my residency here, so I went to medical school at Marshall in Huntington, West Virginia, and then came here for my residency program. And the residency is very different, not larger than it was when I was a resident. Here we have a number of residents and faculty and researchers. So it's a it's a it's a busy growing place. It's been an exciting place to be a part of. I've also had an opportunity to be involved in health care disparity research and health care research related to policy. And so I have I hold an endowed chair that is supported by a foundation for Healthy Kentucky that supports research and scholarly activity to promote health care access, research and policy changes. And so that has been an a career expanding and also opportunity enriching situation to be able to work with colleagues that are in other disciplines, such as in public health or in behavioral science or in other fields to be able to kind of consider where does hearing fit in all of this? Often when we think of health care access or health disparities, we're thinking in terms of some of the the big diseases, the cancer, the diabetes, the obesity, the heart disease, some of those big, bigger items that are affecting millions and billions of people worldwide. But there are so many things that, as we know within the hearing world, that hearing such a such a precious, cherished sense that we all value until it's taken away. So that's the that's the what I do here at UK is involved in kind of not only the clinical side of things, but also in research and then education with residents and medical students.
Carrie Spangler: [00:10:03] Yeah. Wow. You have a lot of hats that you're wearing. And I.
Matt Bush: [00:10:10] Know in.
Carrie Spangler: [00:10:10] The day outside of the university as well, but which kind of leads me to some of your research and maybe taking a deeper dive into how the social determinants of health impact hearing loss. Is there anything that kind of like a story or a patient that was a driver to digging deeper into this?
Matt Bush: [00:10:35] Yeah, You know, any good researcher or any good research project is rooted in real life experiences that I'm a firm believer of that as I mentor medical students and residents, that unless it means something to you personally and professionally, then you might complete the task, but you won't necessarily enjoy it and it won't be really like a springboard to other work or, you know, you kind of creating your own path. So that's an issue that is definitely something that has influenced me, that my work in health care access and health care disparity as it relates to hearing loss is all rooted in experiences that I had not only as a kid growing up in a rural community, but then also attending a medical school that focuses more on rural medicine, and that's the primary recipients of the care. And a lot of the research activities are in rural communities within that portion of West Virginia, but also in my residency where I am now in Lexington, Kentucky, at the University of Kentucky is right at the at a county that is adjacent to a wide region known as Appalachia. And the Appalachian region stretches from Mississippi to New York. And 8% of the US population is in is in Appalachia. About 30, 25 to 30% of the population of Kentucky reside in Appalachia as well. And Appalachian is Appalachia is determined by your county that you're in, and that's determined by the Appalachian Regional Commission, which decides which county is Appalachian or not. And that's not really a voting process. It just is what it is. But this is a region that's had a historical challenges with socioeconomic depression. Access to quality education, health care and health disparities. And poorer overall health care outcomes. And the Kentucky contribution or portion of Appalachia has been one of the most socioeconomically depressed regions of all of Appalachia, but then also of the entire United States.
Matt Bush: [00:12:56] So practicing in this area, I'm privileged to care for patients that live in throughout the region, but also this population coming from Appalachia, where we're seeing these challenges on a real visceral level that are impacting their lives And caring for patients here has impacted me as a father, me as a human being, and me as a physician, but then of course, me as a researcher as well. So as a resident, I, I was really just struck with some of the challenges in some of our pediatric cases. I mean, we had not just once, but on multiple occasions we would have a child who was anywhere from 4 to 5 years of age who would present to our clinic and had basically fallen through the cracks, through so many different safety nets or potential opportunities or appointments, and a child that might have been labeled as autistic or a child who had had so much, so much time, but yet so many little resources, so little resources and so little opportunities to actually receive clarity and diagnostic care, to receive clarity and treatment options and direction of care. And when you see a five year old that doesn't hear and doesn't have any means for communication, that's really impactful. And that really influenced me. And and as I then went off and sowed my wild academic oats and finished fellowship and other training opportunities and came back and that was something I realized that I don't know how I'm going to do it, but I need to figure out some way to define and describe and address some of these children that have fallen through the cracks or some of these patients that have really just lacked resources and opportunities.
Carrie Spangler: [00:15:01] And statistically, I know you mentioned about the statistics for the Appalachia region region, but how how much does that impact those with hearing loss? Do you know?
Matt Bush: [00:15:17] Well, I think that one of the biggest challenges for the whole Appalachian region, as most as much of the region that's from Mississippi up through New York, are rural communities. And so Appalachian might be a certain flavor or flair or regional imprinting of rural communities. But some of the issues that face that that vulnerable populations might face in rural communities are ubiquitous. And that could be whether you're in sub-Saharan Africa, in South America, regardless of where you might be. There are concepts and there's principles that affect individuals where there are health care deserts and limitation in access to any kind of health care provider, let alone a specialist in health care. And I think that's one of the biggest things that I think of when I think of Appalachia is the overwhelming hearing health care provider shortage that is throughout that whole region. That creates a huge blockade for anyone that would try to access hearing health care, whether they had means or the health literacy or not. If there's no providers, it's just going to be more difficult. It's going to be more costly to seek that care out. So that's one of the biggest things is is the the lack of expertise that's within those regions geographically. Mm hmm.
Carrie Spangler: [00:16:49] Yeah. And I think if the World Health Organization, they have five different domains that they kind of look at as far as social determinants of health. And I thought we could take a deeper dive into how this can either positively or negatively impact access to hearing care. And I know you've done a recent study and published an article really kind of diving into this as we look at student or individuals with cochlear implants. But you kind of mentioned that health care access and quality. Does anything else stand out in that area besides the lack of qualified professionals?
Matt Bush: [00:17:32] Well, if you look at each of those domains, you know, it sort of gives you these concepts and these things, these these things outside of the genetics and the actual biologic mechanisms that can influence health, either, like you said, positively or negatively. And so within the domains you can find and could describe the the people, the populations that are either getting the really good health care, really getting the great health care outcomes, getting the great access or have great quality, or you can define those that do not. And that's certainly not something that's just, like I said, isolated to rural communities. There are plenty of populations throughout the entire world whether that would be an urban environment or rural that would face these challenges when it comes to health care, access and quality. We have, I think, begun to describe where there is not access or where there's limited access. I do think we we are challenged a little bit in defining and describing the quality and the quality of of health care, especially as I think about rural communities. There are there may be some hearing health care providers, but perhaps they only see adults. They don't see children. You know, they're not willing to take Medicaid insured patients. So there there can be issues of quality as it relates to certain components of the the population that you're dealing with. And I also think there's a lot of opportunities within that particular domain of interventional work, you know, of I mean, and this is where I'm involved in is interventional work in that area. But I still think that there is much work to be done to consider initiatives and programs, grant funded proposals that would work to address health disparities. And and I think the NIH is doing a lion's share of the work to try to really push and promote researchers to do this. But it's a there's got to be partnerships to be able to think along these lines to address health care, access and quality. It's a it's a multi level aspect to deal with.
Carrie Spangler: [00:20:01] Is there anything that you have found maybe in your area of Kentucky to help move that needle a little bit as far as health care access and quality? And you mentioned grants and programs that to be supported? Is there anything that. You know, I've.
Matt Bush: [00:20:20] Well, you know, I think some of the the basic things are making sure that within our own health care system that, you know, it starts with us. I mean, the solutions aren't isn't someone else's issue and someone else's job that if we're part of the problem, but we're also part of the solution, so we have to work together. So I think that's that to me has been the first start. It's like asking myself as a physician at a major teaching institution, state funded medical school and hospital system, you know, how do we work to improve the quality, the access for our patients that either do know us and have seen us or don't know about us and or has been have been unable to see us. And so thinking about what you do programmatically is, is first and foremost. And I think that that has influence then what we look at in research proposals. So, you know, when I first got started in health disparities, I think I was maybe thinking like a surgeon, like, let's just get get to this. Let's just fix this problem and maybe not like a public health researcher, but, you know, to take a step back and to think, okay, telemedicine could help. But what if there are there's no literally no bandwidth on the other end of the of the screen? And what if the individuals don't have any kind of other tools or means to be able to give us some objective information on auditory function, especially in pediatric diagnostics and pediatric care? It's that much more complicated. So what we've done is realize that if we're going to address this problem, then we've got to make partnerships, partnerships with the community, partnerships with state funded clinics and programs that provide broader public health services than even that we are able to provide to some remote regions.
Matt Bush: [00:22:21] And then through some of those partnerships, develop some research protocols and ideas of, for example, we have a NH funded patient navigator program where we use a parent who has been through the EDHI system and the early hearing detection intervention and uses that parent and embeds that within the EDHI system. And we're studying to see is that effective to take infants who fail a screen or referred on newborn hearing screen and help them achieve a completed diagnostic test in the audiology clinic. And that's not just our clinic that would be in state funded clinics throughout the state. But those things were born out of no shows that that we were seeing within our own practice. And so and then as we talk with with the state partners, how can we then study this to show is this effective? Is it saving financial resources and and work hours in less work or less opportunities lost? Those are things that research can help address and answer. But there's just a really a great need for clinical trials and pragmatic trials that address this. It's we can't just stay in the let's describe the woeful disparity that we have with this population or look at some of the causal factors of why those patients don't come to the audiology clinic or don't get their cochlear implant at 12 months of age and they get it at five years of age. Let's work to develop interventional clinical trials. And that's that's really what I think, that it's important to move forward.
Carrie Spangler: [00:24:06] Mm hmm. Yeah. I like what you said about, you know, it starts with us and asking those questions from our perspective and then being able to implement some different programs and interventions and research and programs to try to help navigate through that. I know there are some other domains that in your research that you've talked about to and how that impacts access to care. One of the things was education access and quality. So do you want to expand on that and that the any kind of correlation between educational level and the access to like let's say, cochlear implants?
Matt Bush: [00:24:49] Yeah, it's a it's a really another very deep swimming pool to to just begin to jump into and to think about and the complexities. It's easiest for us as health care providers to sort of do work in our own sphere. But the educational environment, the educational quality and access is a bit foreign to us in some situations, at least from some research and scholarly activity. So I do think that there is ample evidence in. A an array of literature, including our own, that demonstrate, at least in the pediatric population, that parental education, parental health literacy influences pediatric care in general, but certainly pediatric hearing health care. Parental educational level has been linked to the timing of diagnostic services for infants, but also is connected then therefore to treatment timing. There are differences even in some research. As we looked at participants who have received cochlear implants and looking at parental level of education and there is a correlation between the actual language outcomes from children after cochlear implantation and their parental education level as well. So yeah, that's a that's a big issue. But certainly adult literacy and adult health care literacy and adult educational levels also influence access to care and their willingness to pursue treatment. We know the abysmal numbers as it relates to the penetration and utilization in the market of evidence based treatments such as hearing aids or cochlear implants among adults, and those have just not budged much above 10%. So we're seeing likely in rural communities that the educational level, it's much likely to have a lower penetration or utilization of those treatments in that population. We've we're just in the process of submitting and publishing a paper now where we've evaluated cochlear implant information that's available on searchable websites. And if you do web searches and get cochlear implant information and we're looking for non industry sponsored sources of information initially just to describe the readability.
Matt Bush: [00:27:28] And in general, the AMA recommends that we would not put out health education or health in health education for information or materials that would be beyond a fifth or sixth grade reading level. It needs to be clear and simple. It needs to have a limited number of really long, multiple syllable words, which we're really good at throwing in all kinds of complex wording into our websites and our information because we want to be comprehensive. But the problem is, is that if you look at some of the top websites, again, this is in in under review now, not in press yet, but we'll see if it gets published. But the the evidence is overwhelming that every essentially every website that we've found has a reading level no less than 10th grade. I mean, it's just overwhelming how much that we have written, well beyond the knowledge, the understanding and even the educational level of what would be recommended for public health information. It doesn't mean that we can't describe complicated things. We just have to do a better job of it. And we might look in our academic centers or within our climate control, you know, cochlear implant centers and feel like the problem is that the patients are not getting the education starting in elementary school. They don't have any health literacy and other areas of their life. They're their primary care doctors aren't providing them the resources of educational materials. So we're kind of again, like looking at others is like the problem. And then this this evidence shows like we're not putting out educational materials that are really likely to be understandable by the the larger population.
Carrie Spangler: [00:29:28] Yeah. Which again, you know, we talk about having low numbers overall and then you think about these rural areas and hard to reach people and they're if they happen to look, it would be above a level that they would anybody, you know, a layperson would would comprehend to get the information right.
Matt Bush: [00:29:49] That's right.
Carrie Spangler: [00:29:50] How does the community I mean, how can we maybe look at the community and connectedness in order to get that information for cochlear implants or hearing health care into these areas that don't have a direct access?
Matt Bush: [00:30:10] Mm hmm. Well, communities do play a very key role when when resources are limited and when groups of people are geographically or somewhat socially isolated, they find ways and means to survive. And there's elements of community trust and community sort of a community conscience consciousness of sort of how am I perceived within my community. And that's not unique to rural areas either. But this is a whole another domain that I think we have done little to nothing in at least I'm not aware of, and nor have I personally yet contributed a great amount of effort or output on it. It needs to be done, but we need to really understand that domain, the social and community context of how do people perceive, how do they deal with stigma, how do they deal with helping each other, and how do we work communally and within groups of people to sort of bring the patients to the table and patients having a voice in their care and communities, having a voice in the quality of their care and the access. So that has been investigated in a wide range of of other anthropologic studies and fields, but not necessarily in hearing health care. So I think that's really critical. We're engaged in some research now where we're it's important to us to to study populations and study health systems, again, that are outside of our own. I think, again, like I mentioned, that some of the solutions and some of the ideas innovation will come. It starts internally of how can we help to address the problem or be involved in the solution. But we also know that we do not have the answers.
Matt Bush: [00:32:10] We do not walk in the shoes of those that are in certain communities. So to get into rural communities to as a self labeled rural health care researcher has been critical. So we currently have a funded study through the NIH, supported by the NICD that looks at rural health clinics. And rural health clinics are a unique health care system that has special resources and some opportunities. Some of their billing practices through Medicare and Medicaid have a different process than other private practice or other academic centers, and their charge is to provide care for rural communities. And there's an application process, and they could lose that rural health clinic status if they if their population changes or their practice changes. But that type of a clinic is important for us. It represents kind of an outpost, really a one stop shop for many rural communities and for us to go there and to learn from providers, to learn from patients of what does hearing loss look like in your practice, in your life? What does hearing health care look like? How can we use resources within the community to help address this? And similar to what we've done with the pediatric work, we're interested to see, could patient navigation sort of a leader within the community, a well respected person who could could provide some health literacy on a very layman's term, layman level, but also support self efficacy could could support logistics because they are a part of that community, not because they are they going to get paid for this or they're going to be a part of some long term employment for that practice.
Matt Bush: [00:34:11] But we're looking to see how navigation or how communities can be involved in helping their constituents and their residents get access to some specialty care when it's not necessarily available within that quote unquote comprehensive clinic of primary care clinic environment. So this is how we we're thinking about. We really value communities. We value their input. Another plug that I'll make here regarding communities is that I, I preach the good news that everybody that's doing anything related to hearing health care as a clinician or even as a researcher or both even should be engaged and involved and kind of developing a community advisory board, a community advisory board that's made up of stakeholders, of patients, made up of policymakers, perhaps educators, other members of the community, health care providers as people can come to the table. It gives an opportunity, a voice for those that may not have a voice otherwise. A community advisory board shouldn't be a group of cochlear implant surgeons and cochlear implant audiologists and cochlear implant speech language pathologists or educators. It should involve parents. And so that's the thing, is that we want to know, I mean, how can you use it for your health care is that you would hopefully learn about where we're missing the boat, where we're hitting the target, how we can improve things from just a practical logistics sense. But in research, you're learning about innovative ideas, better ways to recruit, better ways to design interventions that are culturally appropriate. And you can celebrate together that that shared work.
Carrie Spangler: [00:36:07] Yeah, that's a great idea to have lots of different voices at the table to really understand the community. But I love your the ideas that you guys have implemented about the patient navigator and having someone trustworthy within that rural community to be able to share information and hopefully get them, you know, whoever to that next step. Because if they don't have a particular provider or center right there in that rural community, if they can build that trust and maybe they would be more likely to go outside of their community to get the health and care that they need.
Matt Bush: [00:36:46] Yeah, we don't know if it works. And that's that's what we sort of maintain this equipoise, that if we knew that it works, then we'd be fools for doing research. But we should just sort of build it into policy. But we don't know if it works. We don't know if it's cost effective, we don't know if these things are sustainable. But that's the beauty of being involved as a pragmatic, community based researcher is that we get to study this in a formal sense and see does it make a difference? And it makes sense. It's not rocket science. I mean, it kind of we know there's value that is there. We don't just we just don't know exactly how that looks in the long run and how that may influence hearing health care moving forward.
Carrie Spangler: [00:37:32] And know you mentioned earlier that, you know, sometimes we need to look at outside of profession to see what's happening there, too. Do you know of any fields of study that have done a good job with like a patient navigation model?
Matt Bush: [00:37:49] We've totally plagiarized the oncology world for patient navigation. Honestly, that's the roots of patient navigation. And, you know, classically like the cancer survivor who completed their chemotherapy, they rang the bell. They're five years cancer free. Those are the folks that often will come back to oncologists and will say, hey, how can I be involved? And maybe in a philanthropic way when to support a cancer center. But some of them say, Hey, I really want to be in the trenches. I want to be with some of those folks in the same place where I was. And there's there's a whole body of research that has shown how in the oncology field that navigators improve the access to care, they improve the adherence to pursue diagnostic and therapeutic treatment and even outcomes in some disciplines and in some fields of of oncology care. They've shown improved outcomes because if you're completing the things that were prescribed, then it would make sense that they overall might have better outcomes. And and that's really important. We published a systematic review. I think it's. the editor will probably revoke my my article now slip in my brain. But it's, I think, oncology nursing. I've never published anything else, never submitted anything to oncology nursing.
Matt Bush: [00:39:19] But it was it was just an opportunity to submit a public or a systematic review related to an overview of what patient navigation has done for those that come from underserved communities and a demonstration that, you know, time and time again and looking at the literature, systematically shows that approval of access and approval of timing of care. And that's exactly why we did that, because we wanted to say, hey, has this worked in some other field? Could we adapt that for hearing health care? Certainly, hearing health care is very, very different than oncology care and the conversations and the population. But there is complexity that is built into what we do. There is complexity because it is not necessarily every single patient that's facing this. It's not as as perhaps known to some pediatricians of how to manage and navigate through profound congenital sensorineural hearing loss or nuances related to CMV related hearing loss. So those are some things that really can provide value not only to providers but to patients along the way. But we'll see. We'll see what the research shows. That's what we're all about.
Carrie Spangler: [00:40:48] Yeah. And then in your own practice right now, have you found anything that you guys have tried to help close that gap of the social disparities with adults and children who are thinking about cochlear implants or getting cochlear implants that might be useful for listeners.
Matt Bush: [00:41:14] Well, I to tie back in with what I said earlier about doing a little bit of introspective work, I think is is an important part of just human growth and development and just learning from our own mistakes. For me, I, I am like I said, I'm doing my dream job and I just am so thankful to care for a wonderful group of patients and a population that entrusts so much when they walk through our doors. And we need to very much value and demonstrate our trustworthiness. I really I really have valued whenever I have a patient from a county that we don't have any other patients in that county, perhaps that has a cochlear implant. I try to really have a conversation with them about. Not only how they're doing, but how. What was their journey like? I really just as a provider and I don't necessarily look to try to build an extra office time. I mean, sometimes we'll just reach out to them separately because I just want to know. Tell me again about your journey to get here, and then I want to learn and listen to them about how could I know there's got to be other people in your county and your community that are having some similar experiences. How could we help them? And through that there have been I mean, I've I've made visits to small little towns and met up at the library or met up at the local watering hole wherever the the older men are gathered around drinking their coffee on Saturday mornings.
Matt Bush: [00:42:57] But, but find a place in a situation where there can be a conversation. I don't know. Maybe in a sense it's just some kind of old fashioned whistle stop tour. And some people say that's not sustainable, That's doesn't fit into my my life and my world. But the whole concept is is listening to our patients and learning from them. And as a researcher who has spent a lot of time in my career of analyzing and trying to understand qualitative data and research I have, I'm in a phase of my career and in a field of my career where I really have to value the the qualitative information and work to obtain qualitative data that is rigorous, that is deep, that will inform the research questions. But again, qualitative qualitative data is what we do as clinicians all the time. So it's not that foreign from us, but I just work hard to try to create opportunities to to, to learn from and listen to the stories of patients and then physically try to visit those places and work with patients to think about, Hey, how could we help others in your community?
Carrie Spangler: [00:44:18] Those are all great ways to get connected in the community community. And when you think about all of the different factors that influence social determinants of health, there's a lot of moving parts in there that you can't really separate out. And like you said, every patient kind of has their own journey. But if you can get take the time to listen and learn from them, you probably will gain trust of that person. And that person creates a ripple effect to somebody else within the community when they share, you know, hey, this Dr. Bush came and had coffee with me in the local, you know, coffee shop and talk to all of us. And then they gain that trust to maybe go outside of their own community.
Matt Bush: [00:45:01] Yeah. I mean, it's it's amazing the impact that that one individual will have for so many patients. And it doesn't matter how how much I tweet or have Facebook posts or whatever, that population is not going to be influenced by social media. That patient that population is going to be influenced by that one individual who came back from Lexington and either loved or hated that that provider or that health care experience, that process they've gone through. And so that's really important for us to try to work with them. And I have learned lots of things about maybe where we dropped the ball or had not communicated, and we've changed practices in how that we will communicate with certain individuals or how we want to provide educational materials or even the order, the way in which we kind of organize clinic appointments. It's it's just amazing how much logistics of health care that we we might think about, just like whether it's widgets or Amazon prime boxes that might be load on a pallet. We think of health care often that sense. But the patients can really, really inform the logistics of what we do. And again, they're a wealth of information. It's just a matter if we have the time and the willingness to listen to them.
Carrie Spangler: [00:46:26] Mm hmm. Yeah, but obviously it makes a big impact for rural type areas. Is there anything I wanted to ask you about your volunteer work in Kenya as well, but is there anything before we kind of leave this topic of. I kind of rural America and health disparities. That may be practical advice if people want to get started. I think you've provided quite a bit of it, like basically going to the community and building trust and listening to others. And then you said you change some of your logistics and practice as well by listening to individuals, but is there anything that I missed?
Matt Bush: [00:47:12] Well, I think I would leave the topic by just saying that work in this field is not meant to be siloed or meant to be proprietary. And if you care about health equity and all populations getting exactly what they need, exactly when they need it, then you can't remain silent. You know, you can't just sit back and just let the status quo go on regardless if it's disparities or discrimination from race or ethnicity, if it's their geography, whatever that that variable might be that defines some difference in outcome. You need to speak up. You need to connect with others that want to talk about this and innovate and create. And I have been amazed by the number of individuals I've been able to meet and have conversations and learn from. And most often, at least at the onset, they weren't Otolaryngologist. I'm very thankful for a rising tide of really bright, public health savvy otolaryngologist that are asking some big questions and doing some great work to address it. But it's transdisciplinary and just speak up, get connected, reach out to me because I mean, I, I eat, sleep and breathe this stuff. So I, I care about it and I think I would I'd love to chat with anybody who wants to talk about it.
Carrie Spangler: [00:48:42] Now, I am glad you're so passionate about it, because we all know, at least in our in our field, that the the cochlear implant, surgery and technology itself is amazing, but it's only a small part of it. And all of the other factors that influence every human being is really what is going to be a positive or negative in their life.
Matt Bush: [00:49:10] Yeah, you're right. You're exactly right.
Carrie Spangler: [00:49:13] So I know when we met and our layover in Atlanta. You also told me that you have a heart for Kenya and you do quite a lot of volunteer and teaching over there. Can you share a little bit about your humanitarian work?
Matt Bush: [00:49:32] Absolutely. Well, I'm about 10% Kenyan, just culturally, not not ethnically or racially. But honestly, I have been amazingly privileged to have an opportunity to connect with some some friends and colleagues that I've been able to develop in Nairobi, Kenya. So I have I have some family friends who are from Nairobi, and I visited Nairobi when I was just as green as I could be, fresh out of fellowship in my first year in practice, I guess I guess was ten years ago now back in January of 2012. But I came to, through these connections, make a relationship with physicians at the University of Nairobi in Nairobi, Kenya, and they have one of the only ear, nose and throat training programs, one of the few audiology programs in all of East Africa. And so this really represents kind of a a only source of education and some even hearing health care resources and specialty care for a huge population. So there's a number of residents that come from other countries within the East African region to Nairobi to this institution to train. One of the challenges has been in hearing health care with surgeries, the the equipment, the microscopes, the drills where we've got tools to do this work. It's not just a knife and some suture. We need some complex tools to do some complex surgery. And that's been a challenge for a publicly funded health care system and medical schools.
Matt Bush: [00:51:30] So it has been a really exciting ten year journey of bidirectional education and teaching each other, listening to each other, laughing and learning. And our families of those that are the educators and our family, we've just we've just really connected in so many ways. And I usually make two trips a year to Nairobi, where often we're giving lectures, we're giving, we're involved in surgeries. Most of it's chronic ear surgery, but there are also tumors. There are cochlear implants that are done in the area as well. We're working to kind of build a cochlear implant program there in the teaching institution. And we also, you know, eat, you know, eat and drink together and just and just really become friends and colleagues. What we would do at our normal kind of national meetings. And over these ten years, we've had Kenyan residents, students come here to the US and spend time with us. They've stayed in our home. We've had a blast, or my kids know more Swahili than I do, so they learn a lot faster than than old folks like me. But and then actually, I just bought my ticket last week since the pandemic. I went right before the pandemic started. I went in January, in a January 1st of February 2020. But I just bought a ticket to Nairobi for the first week of October, and I'm going to take my 16 year old son.
Matt Bush: [00:53:00] So it's the first time that any of my immediate family has been able to go with me. And nine days is not enough. I'm like, I need to show him ten years worth of people and my family over there that I need to introduce him to. But it's it's just a part of who I am. And, you know, yeah, some of these social determinants of health, some of this health disparities, I mean, those are things that have been commonalities of things we've researched together and done work together. But I mean, I think it's sort of the the work defining me. I think my passions as a person as kind of lead me down a field like this to do work in rural Kentucky, but also in rural Kenya as well. So we have a nonprofit that we started during the pandemic because we had extra free time to sort of I had some colleagues that helped me create it. We don't have a website yet, so we'll get there eventually. But our nonprofit organization is called the Sikaza Society, and Sikaza is the Swahili word for listening. So the Listening Society is the name of our of our group, and it's all about bidirectional communication and learning. From each other and listening to one another.
Carrie Spangler: [00:54:15] Wow, that's great. You had started a whole nonprofit during the pandemic, and so is it based basically educational, kind of nonprofit, or are you doing actual humanitarian volunteer work with patients?
Matt Bush: [00:54:32] Yeah, it would be both. It's both. So it's a little complicated, but we would want to provide educational grants. It's kind of one of the initial motivations to develop the nonprofit is to support trainees here in the US that want to go there and provide care and do humanitarian work, but then also for their faculty, staff, students that would want to come to the US to provide some some travel scholarships. So that's one of our initial objectives and initiatives. Providing educational resources is also another focus and a goal that we'd like to have for a professional community, whether that would be textbooks or other types of resources that they might need, surgical loops, just purchasing things that our residents look for, that they need to be able to advance in their career, in their otolaryngology, but then also to be a source to vet equipment that might be donated. It's it's difficult. There's so much excess of medical equipment that's just sitting in warehouses throughout the the higher income countries that need to be mobilized into low to middle income countries. And that would be also an arm of this nonprofit. But we're we're pretty young, but we want to be intentional and want to be careful and very, very direct in what we do with the with the nonprofit moving forward.
Carrie Spangler: [00:55:59] Wow. Thank you for being an amazing servant leader in our hearing health care field, because without your passion and purpose, a lot of these ideas and initiatives would not be here.
Matt Bush: [00:56:16] Well, it's my it's my joy. That's that's that's really that encompasses it's all about true joy. And that's that's what I feel real true satisfaction to be able to do what I'm able to do.
Carrie Spangler: [00:56:27] Well, thank you for that. Is there anything that I didn't ask you that you want to share before we close up today?
Matt Bush: [00:56:37] I don't think so. I mean, you hit me with social determinants. I never would have thought ten years ago I'll be doing a podcast on social determinants of health. That's. That's not what surgeons do. So thanks for allowing me to be a bit of an imposter of a of a stunt double for a public health researcher. But now I might I might leave you with just saying if if success learns from from what you're doing. Maybe I'll start a podcast, too, and I'll. I might have to call on you to to give a talk to the Sikiza the listening society and let them listen to you.
Carrie Spangler: [00:57:11] Well, I would be honored to be a guest if that ever happens, but I just want to say thank you again, Dr. Bush, for being a part of the Impact Your Audiology podcast. I think everything that you're doing, we need to think outside of just that yourself. And what you do is definitely outside of that, looking at the whole person and thinking about all of those aspects of their lives that we need to think about and help support and move forward in order to close some of the gaps that we have with health disparities, especially in our hearing health care field. So thank you again for being a guest today.
Matt Bush: [00:57:53] Thank you. Well, you're you're part of the solution, too, because you're thinking outside the box with podcasts, with real stories. And so you're you're doing the good work, too. So we're we're thanks to Atlanta and travel delays where we're we're friends for life now We are.
Carrie Spangler: [00:58:10] So you never would have thought a travel delay would bring you to a podcast today. Right. And listeners, if you enjoy this podcast and the empowEAR audiology podcast, I encourage you to give some five stars and pass it along to anybody else that you think would enjoy listening to it. Thank you for listening.
Announcer: [00:58:34] This has been a production of the 3C Digital Media Network.