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Robin Kish (Host): Have you delayed seeing a doctor because of COVID? If so, you're not alone. Medical professionals are sounding the alarm to stop procrastinating, especially when it comes to how important an in-person checkup with a physician can be in preventing cancer. We'll explain the meaning of cancer screening on this edition of Here For Your Health. Welcome to the Health Care District of Palm Beach County's podcast Here For Your Health. I'm your host, Robin Kish. Our guests today are both with the American Cancer Society in Palm Beach County, Florida. Georgette Valls-Delgado is Senior Manager of Cancer Support Strategic Partnerships. Welcome Georgette. And Lindsay Bennett is Senior Development Manager. Thanks for joining us Lindsay.

Lindsay Bennett (Guest): It's great to be here, Robin.

Host: So we're talking about the C word today. Cancer. It's the second leading cause of death in the US after heart disease. Research published in June of 2020 by the National Cancer Institute predicted more than 10,000, 10,000 additional deaths from breast and colorectal cancer due to poor screening rates during the pandemic. That's a big number. Georgette, should this study be a wake up call for getting to the doctor as soon as possible to get a checkup?

Georgette Valls-Delgado (Guest): Absolutely Robin, because when it comes to finding and fighting cancer, early detection can really make the difference between life and death. And we are seeing staggering numbers of routine screenings for breast cancer, colon cancer, skin cancer, and other malignancies, very very overdue since the start of the COVID-19 pandemic.

For some people, such as those who have a personal family history of cancer or are at higher risk, it's even more critical that they go back to screening and that's because people who have delayed their screenings are being diagnosed at later, more advanced stages when treatments aren't as successful than they might've been as if they would have caught something earlier.

Host: Lindsay, how has screening and early cancer detection impacted you, personally? You can definitely relate to this, can't you?

Lindsay: Absolutely Robin, both of my parents are two time cancer survivors. And my mother both times had breast cancer and both times early detection made a huge difference for her. She never had a lump. She felt something weird when she bent over and she was an advocate for her own health and her own care and made appointments with her doctors immediately.

So she was able to get it early. Get the treatment early. And I think that made a huge difference in her recovery and because of her cancer journey and my father's cancer journey, so having, you know, a lot of cancer in my immediate family history, I have my regular mammograms and ultrasounds so that I can be proactive with my health.

I've been younger than the recommended age to start those screenings. But I knew how important it was, that I'm a much more likely candidate to develop breast cancer. And so I needed to be proactive. I needed to get those screenings and stay on top of it. My father survived both skin cancer and renal cancer. By actively going to his dermatologist, he was able to take care of that skin cancer quickly before it spread, or it required further into intervention or treatment. And, you know, you can't do any better than that. You know, you can't trade that early detection. And like Georgette said, helping those treatments be a lot more helpful, a lot more useful than if it was a later detection.

Host: Exactly. So Lindsay, when you share your experience publicly as part of your job, I'm sure there are some folks who really they're afraid to find out, right. They're afraid to get the screening done because they, they don't really want any bad news, but I'm sure you hear stories from people in the community after you tell them what it meant to your family, to be proactive about their health, what do they share about cancer and the meaning of screening?

Lindsay: Yeah, I hear, I hear the fear a lot. I actually heard the fear from the time I was in college and I would share that my mother had recently been through breast cancer and you know, the people, oh, my mom said she'll never go because she just doesn't want to know. And, you know, we've got to know, you've got to know, you've got to be proactive.

A cancer diagnosis is not an automatic death sentence. There's a lot of really great treatments and things that can be done. So the earlier we know, the better. And recently, because I'm of an age, a lot of my friends have needed to go and get their mammograms. So I've been able to talk them through it and I've had quite a few of them so I can walk them through the whole thing.

So many stories that you hear about mammograms and, oh, it's so uncomfortable and it's so painful. It's really not that bad. Come on. You know, we're women, we can do this. I've also had to have a few biopsies and some of my friends have had to now. And so being able to talk them through that.

This is what you can expect. Just having that voice to say, I survived this, you can do this, you know, this, this is nothing. You'll be, you know, so much more relaxed once you know that everything's okay. And that really is one of the best parts of my job, being able to educate people and reassure them. And I, I hear frequently from people who don't have insurance or are under-insured and, you know, we've got to not let that stop people from having access to care. And especially to these early screenings. Cost should not be the concern when it comes to getting these important life saving screenings.

Host: You're right. And we're going to get to more on that in just a bit. I wanted to share some statistics that at the end of 2021, after a year of COVID taking a very heavy toll on this country, the Centers for Disease Control and Prevention reported, that screening rates for breast and cervical cancers fell by more than 80% with the most severe declines occurring in populations of low income women of color. Lack of resources, insurance and transportation, as well as limited access to care as you mentioned Lindsay, put underserved communities at greater risk of cancer. And we know that when cancer goes undetected, it can lead to higher death rates. So with that in mind, Georgette, how is the American Cancer Society working with primary care clinics, like the Healthcare District CL Brumback Primary Care Clinics to screen all patients, including those living in underserved areas?

Georgette: So Robin, health equity is really something that has been at the core of the work that we do at the American Cancer Society Every day. And that work is ongoing. The work that we do with our partners, like Healthcare District of Palm Beach, who have that same work and goal in mind every day, which is to ensure that everything that's being done has at its core, health equity so that everyone has access.

So this is not new work that we've been doing or that our partners have been doing, but certainly the pandemic definitely intensified existing disparities in cancer screening. So as a response, last year in 2021, the American Cancer Society launched a Get Screened Campaign to educate and encourage people to schedule regular cancer screenings and to really get back on track.

And then in part, as part of this campaign, we also enhanced the existing work that we're doing with our partners, like the Healthcare District's CL Brumback Primary Care Clinics to support them in their efforts to ensure that these groups who have systemically experienced social or economic obstacles to screening have access.

So, we really started working more on projects together that explore and address the unique need of each community and how best to promote screening and ensure that there is access because every community is completely different. We also enhanced educational materials and resources for healthcare partners to utilize in improving communication. And then also to increase screening rates. We also convened partners and we're convening partners from across Florida to really make sure that we're having meaningful, impactful discussions that explore health equity, promising practices, what we could be doing better and ensure that people, especially those in underserved areas have access to screening.

And I think, you know, policy is so important, Robin because without cancer being a legislative priority, you know, we, we really can't make the proper headway. And we do have as part of our organization, the American Cancer Society Cancer Action Network, and that is our non-partisan advocacy arm. And this team really ensures that legislators understand that cancer has to remain a priority and we're talking about throughout the continuum of care, which definitely includes the prevention and screening. And you talked about that huge drop in cervical cancer and breast cancer screening rates. And one of the main priorities that this team works on in the state of Florida is to ensure that there is adequate funding every year for the Mary Brogan Breast and Cervical Cancer Early Detection Program.

And this program is so special because it ensures that women who are uninsured and meet criteria, have access to cervical cancer screening and breast cancer screening for free. And should they have a positive finding or a cancer, there, there is policy that kicks in to ensure that they have the treatment and they have access to treatment, regardless of the fact that they're uninsured.

So our team really works very hard at ACS CAN to make sure that funds are allocated every year. And then our health system partners and our primary care clinic partners can then participate in this program with the state and participate in this breast and cervical cancer, early detection program to then add an extra layer of support to their community and then provide additional cervical cancer screening and breast cancer screening access to their community members, especially those in the most underserved parts of the community.

Host: Great resource information, Georgette. Thank you. And you know the American Cancer Society has some excellent questions and answers about the meaning of screening on its website, cancer.org. And I'd like to run those questions by you. Now, there are some of the same questions that those who are listening to this podcast may have.

So here's the first question and I'll direct it to you Lindsay. If I don't have any symptoms, do I still need to get screened?

Lindsay: Oh good. That's an easy one. Yes, absolutely. As I said, my mother didn't have what you would think of, I think what we all think of as symptoms for breast cancer, she didn't have a lump but she knew something was wrong. And when you look at symptoms for cancer, they can be really varied and a wide range of symptoms.

So it's so important that you're getting those screenings you know, when your doctor recommends it, when we recommend it, you can find that information at cancer.org and we can share some of that. Screenings are hopefully going to catch something before it's a big deal. So you, you know, and it can catch other changes.

It may not be cancer, but there might be something else going on in your body that then you can be proactive about. So you gotta really pay attention to your body. So if something is weird, you go in and you say, hey, maybe it's not time for my cancer screening, but let's talk about this with a doctor. But absolutely look at those guidelines of when you should start getting those cancer screenings. Talk to your doctor, find a doctor, if you need to and get those cancer screenings scheduled.

Host: Okay. Here's another one. Georgette what age should you be to get screened?

Georgette: Sure. So screening for different types of cancer is recommended at different ages. So I'm going to go through through the age range, but all of this information is available on our website on cancer.org as well. So for cervical cancer screening, it's recommended for people with a cervix beginning at age 25. Breast cancer screening is recommended beginning at age 45 with the option to begin at age 40. And, you know, I want to remind everyone, Lindsay did talk about how she's at higher risk because of her family history. So she started even earlier. So even though this is a standard recommendation, you know, Lindsay, Lindsay knows that because she has that family history, she spoke with her doctor and started earlier. So it's important to note that as well. For colorectal cancer screening, it's recommended that everyone begin at age 45. At age 50 and older, we recommend men discuss prostate cancer with their doctor.

And then a little bit earlier at age 45 for African-Americans or persons who might have high risk of prostate cancer due to family history. And then people who currently smoke or have a history of smoking should discuss lung cancer screening with a doctor beginning at age 50.

Host: Great information. Oh, here's another question, Georgette. Different types of cancer must present different types of symptoms. So are there any general cancer symptoms that we should be looking for?

Georgette: So we can talk about some of the more common signs and symptoms that may be caused by cancer. However, many of the ones we're about to list can cause other problems as well. So really the important thing is to know your body as Lindsay stated before, and if you feel like something is not quite right, it's probably time to go ahead and make an appointment with your doctor and talk to your doctor about it. So you, if you're experiencing fatigue or extreme tiredness that doesn't get better with rest, swelling or lumps, anywhere in the body, a thickening or a lump in the breast or other parts of the body, pain, especially a new pain, that's not, you know, apparently for any known reason or that doesn't go away or gets worse.

Any kind of skin changes or a little lump on the skin that may bleed or get scaly, or perhaps you have a mole or a mole that changes or may get you know, different appearance, different shape, different colors, really important to pay attention to that, especially because we're in the sunshine state and we're out and about in the sun, cough or hoarseness that does not go away.

And then really, headaches, vision or hearing problems that are persistent and don't go away. So again, these are signs and symptoms that are most common, but there are many more and they can also be attributed to other things. So the most important thing is if you notice any major changes in the way that your body works, the way that you feel, especially if it lasts long or it gets worse, it's time to let your doctor know.

Host: Excellent. So we've been talking about the importance of seeing a doctor for a checkup, but what if you don't have a primary doctor? Who should you talk to about screening Georgette?

Georgette: Absolutely. So the first step is to contact your insurance company, to see which doctors or providers are covered in your plan. But if you don't have insurance, you can check with community health centers like our partners at Healthcare District's CL Brumback Primary Care Clinics, which see all patients, regardless of their ability to pay.

You can find more information on our website as well, cancer.org. And there is a section that you can search for and it's the section is how to get screened if you don't have a doctor or you can call the American Cancer Society, National Cancer Information Center, which is available 24 hours a day, seven days a week at 1-800-227-2345.

Host: Great. And you can call the primary care clinics, the CL Brumback Primary Care Clinics with the Healthcare District at 561-642-1000 to schedule an appointment. Lindsay, how much do screenings cost and what if they're not affordable?

Lindsay: Well, that, that is a much more difficult question. I liked my first question better. It was much easier. Um, If you do have health insurance, you want to start there, call your insurance provider and they should be able to give you a cost for cancer screening. So it's a mammogram or an ultrasound. For me, I have a diagnostic mammogram because of my family history, but for most women you won't need that. You'll just need a regular mammogram. Some are covered at no cost, which is amazing. And we need to keep that moving forward. There might be costs for follow-up appointments or additional tests if they're needed, but most of the time everything's going to come back normal and you're not gonna need any additional testing.

If you don't have health insurance call your local community health center. The health department, call you guys at your primary care clinics and maybe they can point you in the right direction. Call our one 800 number. Again, that's 1-800-227-2345. And the people there can, you know, point you in the right direction.

Going back to breast cancer, many, many moons ago, I was unemployed. And so had, you know, Cobra health insurance, and it was not the best. And I knew that I needed my mammogram and ultrasound. So I timed it for October because one of the diagnostic centers near me was doing them for a very reasonable cost without insurance during the month of October.

And so, even with insurance, it would have been more expensive than I was able to get it in October. So pay attention to things like that. October is Breast Cancer Awareness Month. So there are a lot of diagnostic centers, mobile mammograms that come out in October to help out women and men who should be getting those breast cancer screenings.

So, pay attention to things like that. Ask around, ask your doctor, again, go to the Healthcare District of Palm Beach County. Call, you know, I'm sure you guys have a lot of amazing resources or call our 800 number, which again, 24/7. So don't feel like, oh, I don't get off work until late and nobody's going to be there to answer me.

There's somebody there to answer you. Don't be afraid of the cost. Tackle that too, because again, it's just the most important thing you can do for yourself is get screened and be proactive. And then, you know, if something needs to be done, then you're ahead of the game.

Host: Again, Lindsay, what if you're nervous or worried about going into a medical office for screening?

Lindsay: I completely understand. You know, I understand any time, but certainly, you know, coming out of the height of the COVID pandemic but I think we all need to just be honest with ourselves that it's totally normal to feel nervous. It's totally normal to feel worried about going in for a screening.

Some screenings, you know, can feel a little more invasive than others. So a big part of allaying that fear, I think is knowledge. Or talking to a friend, maybe you have a friend who's been through that particular screening.

Like I was able to talk my friends through their mammograms and ultrasounds and say, you know, this is what it's going to be like. And it's so not a big deal. Knowing what's going to happen can sometimes help that fear and anxiety go away. Also, knowing the current state of your health is going to make that worry go away.

You know, I know that getting a diagnosis, a positive cancer diagnosis can be scary. You know, I've been through it with both of my parents but being able to take care of that early and get treatment if needed, get surgery, if needed, that can potentially lengthen and save your life. My father gets worried every time we go to a follow-up to the hospital that saved his life when he had renal cancer.

But he always gets great reports. They're always, you know, so amazed at how he's doing, but I understand why he's nervous that you, you know, especially if it's not your first journey with cancer, but my mom and I are, you know, a little pushy with him and make sure that he goes, because again, if there is a problem, let's jump on it.

Let's be proactive. Let's take care of it now. So, sometimes we just have to, you know, do some deep breathing exercises, write down what those fears are, write down those questions. You know, if, if you're going through this and your doctor says, hey, I think you need to get this screening. Talk to your doctor, write down those questions that you think of in the middle of the night.

And, you know, call them up or make an appointment and say, you know, I just thought about this. What is this going to be like? And, you know, I really think it is that sort of adage, that knowledge is power and it, it does help get rid of that anxiety and that fear. I understand being nervous and worried. Wear your mask, if you know, that's a concern and go take care of yourself and get those screenings.

Host: I was going to ask Georgette that same question of COVID being a concern to many still is going into a medical office for a doctor's appointment or a screening safe? What are you telling folks, Georgette?

Georgette: We're telling folks that it absolutely is safe. So yes, yes. And yes. So facilities offer screenings have safety precautions in place. It is safe to resume your regular screening and it's best to schedule your test as soon as you can, especially critical if you're over. So duewe understand the hesitation, Lindsay and I do as well.

But you know, we work with our health system partners throughout the state. You know, I have had my a well-check and I've had a screening recently. There were protocols in place. You know, the staff was masked up. I could visibly see that the staff was following cleaning precautions. And so it definitely, yes, it is safe to go in.

You don't want to wait and you don't want to potentially delay you know, finding something early, as Lindsay said. We have, you know, there's so many hesitations apart from the hesitancy of potentially finding something, but now added is that COVID you know, that that's still concern of COVID, but at the end of the day, you know, really finding something potentially early is going to be the key to ensuring the best outcomes. So don't wait, get your screening scheduled, call your doctor, call your primary care clinic and get it done. That's our message.

Host: And you can often schedule a Telehealth visit with the physician, if you don't need to be seen in the office, we should point that out as well. And to Lindsay's point, it's always good to have someone with you when you do go for an office visit, if it's possible just to kind of hear what the Ddoctor may be saying. Take notes and remind you of questions or think of questions that you may not have thought of asking. So having an advocate, there is also an advantage. The pandemic also caused a significant vaccination gap for school-aged children. What vaccine is recommended to prevent cancer that children can receive at an early age Georgette?

Georgette: So the vaccine to help prevent human papilloma virus or HPV infection is what, what is recommended for boys and girls between the ages of nine and 12 and is safe and effective and it is incredibly important because HPV is known to cause cancers of the throat, the cervix, and the male and female organs.

So in total, it is known to cause six different types of cancers. So by giving our children, this vaccine between the ages of nine and 12, boys and girls are now able to, their bodies are able, it's able to prevent more than 90% of HPV cancers when they get older and most children in the United States can get the HPV vaccine for little or no cost. Most parts of Florida, you can get the vaccination at no cost through primary care clinics, through different programs that the state has. So even if you don't have insurance, there is access. And you know, I think that when we historically think about the HPV vaccine, it is still synonymous with preventing cervical cancer, which is just one cancer, but I want everyone to really think about it.

We have the power as parents, grandparents, caregivers, guardians to give our child of one vaccine. It's two doses, but it's one vaccine and help them prevent up to 90% of HPV cancers. So we have that gift and I, you know, we talk about that in our program of work, Lindsey and I all the time, but I feel like I'm never in, I'm always in awe that, you know, as a parent, as grandparents, guardians, caregivers, we always want to do the best that we can for our kids.

And there is no manual. So I feel like almost like this is a gift. I have the power to have my daughter be vaccinated who is of age now at nine years old, and I know that I am helping to potentially prevent six different types of cancers when she gets older. And you know, cervical cancer is definitely the cancer that I feel is most synonymous being recognized as being prevented by the HPV vaccine, but throat cancer, especially in men, has now surpassed cervical cancer. So, so important too, to make sure that not just girls are being vaccinated, but that we're really vaccinating our boys too.

Host: Yes. And that information is so valuable as a parent, what Lindsay was saying earlier about knowledge being power, knowing that you're not just protecting against one type of cancer, but a broad spectrum of cancers at an early age. And then, you know, that's kind of, you're done right after that first vaccination session or treatment is completed.

Georgette: Exactly. And so just to, just to point out the vaccine is between the ages of nine and 12, and it's going to be two doses. And then after age 13, they may need an additional dose. That's something to discuss with the doctor, but it's really just two shots in and out, quick, and you are helping to prevent six different types of cancer when your child, your grandchild, when these children get older.

Host: Excellent. And Lindsay, you talked about family history of cancer relating to the need for cancer screening. How important is it to know your family history when it comes to protecting yourself or your love ones?

Lindsay: I think it's incredibly important. I mean, I speak from experience, you know, I started many, many, many moons ago or longer ago than I'd like to admit that with my breast cancer screenings and my cervical cancer screenings because of my mother's history. We have some other cancers on my mother's side. We didn't know as much about my father's family history at that point. And we do now. But because of that, he had to kind of be even, you know, he had to stay on top of things too, because we didn't know. We were going in blind with my dad. My mom and I are very lucky to live in Palm Beach County and share the same doctors.

So her, they know our family history, they know my mom's journey. They're, there they're very protective of HIPAA, but they also know that I know everything she's been through cause I'm frequently a part of her caregiving team. But if I didn't have the same doctors, then it would be my responsibility to make sure that they knew everything. Okay. My mom had cancer, you know, for the first time in 1997 and then here, and you know, this is what she did, this, these were the treatments, this was the kind of cancer. So I would really need to know that information. So, sitting down with your family and kind of having that conversation, you know, you, when we started, you said we were talking about the C word and you know, a long time ago, that's what it was.

And it was whispered. And you didn't talk about anybody who had the C word and you were kind of sent home, you know, and made comfortable. And that's not the world we live in anymore. You get those screenings. We need to talk about this. We need to say, you know, oh yeah, this is what my mom had. And so I need to be very proactive with these screenings.

Our guidelines that Georgette shared, they're a starting point and they're an amazing starting point. And if you have no family history, that's where you start. But, being open and honest with your doctors, talking with your family about your, your family history can make a huge difference. And when you start those screenings or the frequency of those screenings after I had to have a biopsy, then I had a follow-up mammogram after six months instead of a year.

So just being able to make sure, you know, everything was still fine. Boy, what a relief that was, you know, every time I went in and she'd say, oh yeah, no, everything's fine. See you in a year now. You know? So again, talking about that, being nervous and worried, of course, that's in the back of my mind, it's sort of in the back of my mind all the time of, you know, when will I have breast cancer?

Not a definite, but because of my mother's journey, it's always there. So yeah. What a relief. The doctor said, everything's fine. See you in a year. You know? So again, knowing that family history, if you don't know it, try and talk to somebody, talk to those, you know, caregivers that raised you, your grandparents, your aunts, uncles. It's important to know those things and it shouldn't be a dirty secret, you know, it's, it's a health issue. Stay on top of it, find out those things and then write them down, go and talk to your doctor about it. And yes, I do want to, I do want to stress the importance of having a caregiver or an advocate with you. My mom goes with my dad with all of his appointments and vice versa, you know, when my mom had cancer and just having somebody there sometimes gives you that boost of confidence, you know, to ask questions.

But, and if you have those questions in the middle of the night, call our one 800 number. There's somebody there. You know, you never have to go on this journey alone. And I think that's really important too.

Host: Good advice. Well, before we wrap up, any final thoughts you want to share Georgette and then Lindsay?

Georgette: So I think that recently, and I'm gonna let Lindsay chime in as well. But recently I was talking to one of our community health partners about a Breast Health Equity Project that we have coming up in the fall. And we were talking about, you know, all of these concerns and, you know, what the barriers to screening are for women.

And she said something that really resonated. And she said, you know, as women, we just, we can't afford to get sick. We feel like we, we can't afford to get sick. And so I think about that and I hadn't really thought about that, but, you know, we really take on this role of ensuring that everyone else is okay, and everyone else is taken care of, sometimes like before ourselves.

And I see that that happens with me too. And this is, you know, Robin, this is what Lindsay and I do day in and day out on what we talk about. But I have seen where I'm ensuring that my parents are keeping up with their appointments. My daughter is keeping up with her appointments. My husband is keeping up with his appointments and his screening.

And then sometimes, you know, my, my health or my screening appointments kind of go by the wayside. So I thought that was really interesting. And I think, you know, that's something to think about because we are absolutely positively not going to be able to be in that role. I'm not going to be able to be in that role to ensure that my family is taken care of and healthy if I'm not healthy myself. So I'm sure Lindsay can chime in as well.

Lindsay: Absolutely. I'm, I'm not married. I don't have children, but I do step in, you know, and make sure that my parents are getting done what they need to and talking to them about it. I have a roommate. I make sure that he's, you know, doing okay and that he's healthy. And sometimes it's not even just the time it's like, oh, I'm just tired of taking care of other people. So I'm not going to take care of myself. And we can't do that, ladies. You know, we, we take care of everybody else, far too often before we take care of ourselves. I was at a Relay for Life event a couple of weeks ago, and I met a really amazing woman. And she said that she needed a biopsy on her kidney and was scared.

And so we went and found a quiet place that we could talk. And in chatting with her, she takes care of her grandchildren. And I said, I know that this is scary that you, you know, she was worried. She's not going to be able to take care of her grandchildren, if she has cancer. And I said, but you're not going to be able to take care of anybody if you don't take care of this now, and it gets worse and then maybe treatment's longer, or the surgery is longer or they can't treat it. And so get out there, do what you need to, she was going to an amazing hospital. She had amazing doctors and an amazing team, but I could see that fear in her that like I've got so much to take care of. I don't have time to be sick, just like Georgette was saying. And you know, there don't get me wrong, plenty of men who keep everything afloat too.

But women frequently, put ourselves first, you know, put everybody else first. You know, we've got to put on our oxygen mask first, so to speak, to make sure that then we can take care of everything else that we've taken on. So get those screenings, find people to talk to, find a support group, if you need it and, you know, take care of yourself, be proactive and be your own advocate for your health.

Host: Great advice. Make the time for yourself, just like you make the time for everyone else in your life. And I thank you Georgette and Lindsay, for all of your valuable information.

Lindsay: Thank you so much for having us Robin. This was amazing.

Georgette: Thank you Robin.

Host: If you find this helpful, please share the podcast on your social channel and check out our full podcast library for topics of interest to you at healthcaredistrictpodcast.org. Today's podcast is brought to you by the Healthcare District of Palm Beach County. The Healthcare District is a unique safety net healthcare system located in south Florida and provides county residents access to primary care, skilled nursing and hospital care, registered nurses in nearly all of the county's public schools and oversight of the county's trauma system, which includes operating two life-saving Trauma Hawk air ambulances.

Learn more by visiting HCDpbc.org and our clinic's website at brumbackclinics.org.