Caitlin Whyte (Host): Welcome to another episode of, In Their Words, brought to you by UPMC in Central PA. In this compelling installment, we're joined by two remarkable healthcare professionals at the forefront of women's health. Denise Turoczi, Clinician for gynecology at UPMC Magee Women's and Dr. Joshua Kesterson, Gynecologic Oncologist and Medical Director of Gynecological Oncology with UPMC in Central PA.

 Together, they unveil the groundbreaking Mobile Wish or women's health services unit. A pioneering initiative, bringing vital gynecological care to those who need it most. Our guests share their firsthand experiences of the challenges and triumphs encountered in this innovative approach to healthcare delivery. Listeners will be moved by the personal stories and pivotal moments that reinforce their commitment to do this crucial work. Join us as we explore the transformative power of accessible healthcare and the dedicated professionals, making it a reality in our community.

Denise Turoczi, BSN, RN, OCN: I am Denise Turoczi. I'm a Clinician for the GYN Oncology Division at UPMC Magee's Women's. I have been with UPMC for two years. I have worked with my Medical Director, Dr. Kesterson, previously at Hershey, and he's going to introduce himself.

Joshua Kesterson, MD: Hey, my name's Josh Kesterson. I am a Gynecologic Oncologist and also have the privilege of serving in the role of the Medical Director of the Department of Gyn Oncology. This will be my third year with UPMC and Denise and I have had the pleasure of working together for the last several years.

I think when it comes to the need, it's a matter of realizing that not everyone is able to access healthcare or have the same level of care as we're fortunate enough to have, with having insurance and a supportive social unit and having the means to access healthcare at multiple different spots. Which certainly we take for granted I'm afraid too often, and there's other people who are in a similar situation whether it be from a geographic isolation, whether it be from socioeconomic kind of limitations, whether it be from a lack of insurance or, all too often we see people who don't have control of their you know, own body in a lot of ways, certainly not in control of their reproductive health.

 So realizing that you know, its very basic level, we're human beings trying to take care of other human beings. I think that involves being a little bit more creative in how we allow people to access that care and what kind of services we're able to provide for people. Because the way it's set up right now, it's certainly very insurance and I think socioeconomic status friendly for others more so than people that aren't able to reap the benefits of the advances in the technology that we currently have at our disposal in medicine. So, very long winded answer, I'm sorry, for trying to make sure that we aim towards treating everybody the same, and that everybody has equal access to care and in a lot of ways, a right to kind of exist on this planet in their healthiest state I think was the impetus and the drive for Denise and I when we generated this idea.

Denise Turoczi, BSN, RN, OCN: And the idea actually came too because we noticed in the GYN Oncology Department an increase in cervical cancers. And when I went back, a lot of those cervical cancers were single moms that had a lot of barriers to care. And when we were talking about it at a provider's meeting back in April of 2022; we started throwing out ideas on how can we reach the unreachable? Like, how can we get to these women that are unable to get to a brick and mortar building?

And that's when the idea of a medical mobile unit going to those rural areas, going to the areas of need kind of came to fruition and Dr. Kesterson asked myself and one of the nurse practitioners, Nicole to start leading or looking into some kind of program that we could do this. And so, we actually had our first meeting May of 2022, and then we were able to get in touch.

We found out that the UPMC had an addiction recovery RV. And we spoke to the director of that and to the physician and they allowed us, that's how we were allowed to have this 36 foot RV every Tuesday to kind of get our numbers with the hopes that with this being quote unquote kind of a pilot study on the back end so that we could prove to the state and to federal that, hey, there really truly is a need for this and, we're reaching women, hopefully, before they need us in Gyn Onc care, especially with cervical cancer because it is a preventative cancer, just with pap smears and exams, and unfortunately these ladies are not following through with this because they're just lost to care because of multiple reasons.

So, we had our first meeting May of 2022. We were able to secure the RV unit for Tuesdays. We were able to secure four different locations throughout Central Pennsylvania for those Tuesdays. And we saw our first patient, actually the first Tuesday in June at Newport.

Host: As we learn more about the Wish mobile unit, Denise and Dr. Kesterson, dive into the way their services are received by the community. And how they handle difficult situations that may arise.

Denise Turoczi, BSN, RN, OCN: We have not had one person that came on that RV that we have treated that said, I'm not sure why you're here. Every single one of these ladies has been so grateful, so thankful. I don't know how many times we've heard, I'm so happy that you're here with us. You're here for us. Not only are we giving care physically to them, but we're also helping them kind of close those gaps to their barriers to care. For instance, I had a lady that I worked with in South Harrisburg that she was spending over $200 a month in Uber.

She's a single mom. She works night shift. She's in low income housing. She had food insecurities. She had financial insecurities. And so I was able to get her numbers to different organizations that could actually help her pay the electrical bill, you know, that could help her with, there's one program out there that they actually drive them to work and if you have to stop at a daycare, they'll make a stop at the daycare, but they can get you to and from work.

So there really are organizations out there, it's just getting those numbers to those patients so that they can get into those programs, those different programs and she was so grateful and, you know, we've had other women that we've realized that they're at high risk for breast cancer.

So we were able to get them into the high risk breast clinic, get them their mammograms. A lot of these women are on the Healthy Women's Program through the state of Pennsylvania, where they can get free mammograms and cervical exams and pap smears, as long as they fit the income levels.

You know, I have ladies down in Lancaster City that we were getting to mammograms that would have never gotten a mammogram before, that are homeless. So there's honestly, it has been well received. I haven't heard one negative thing as of yet.

Joshua Kesterson, MD: Yeah, and I think what Denise highlights there is that I think there's this perception that it's a van where you access care with whatever resources and personnel on the van, and it's just not the case.

It's almost this ripple effect where you access to care, right? And, to the credit of Denise and the team, it's just putting these resources in a place that's accessible for these women and to let these other charitable organizations reach out as well.

So, to kind of have you know, a repository of all these things that are out there and finding out different ways that we can treat the individual patient for what they have and like we've talked about, these ladies aren't able to access the system in a traditional way, so having a non traditional approach to get hopefully an optimized outcome has certainly been a rewarding process.

Denise Turoczi, BSN, RN, OCN: With the human trafficking, you know, there's different safe houses in each of these areas that we serve. I will be honest with you, because we've only been running this for 3 months, we have not run into a "victim" at this time. But if we do, we have certain things that we have in place, processes in place, if the female comes on the RV, you know, different things that we have to do as providers, with not only providing the care physically, but also emotionally, making sure that this person gets to the correct location that they need to get to. We've had a patient that was in the women's children protective. You know, we just have to be very sensitive to how things are handled.

Now, I will say, the providers, myself, my clinic staff, on the Tuesdays that we go out, we love it. Like, it's really disappointing if the van is, the RV is down and we can't get out to a site because of some reason but we absolutely enjoy going out together, reaching these people. Just listening to their stories, giving them the comfort, the listening ear, the empathy, I mean, it is, it's very rewarding and it's like one of my favorite times of the week.

Joshua Kesterson, MD: I'll say, I think to Denise's point, it ends up being where the quality of the care that we're able to provide is going to be directly proportional to the quality of our awareness, and that awareness is only going to happen by being empathetic listeners, by being present, and by being accountable to these women, right? And when you show up on a Tuesday, and you show up the next Tuesday, and you have caring, kind people that are there for all the right reasons to try and, you know, elevate this marginalized population to optimize their outcomes, not only like medically, but emotionally, physically, spiritually whatever it may be that they need, and to treat each interaction as just that interaction. And I think the unique thing about it is, is that we don't have a one size fits all approach, right?

Because there's going to be so many different stressors, so many different circumstances and variables. Each interaction, whether it be within a more urban environment, whether it be a more rural environment, and depending on where that patient is in her circumstances at that time, but to Denise's point uh, to be present and to be empathetic to what they're going through, realizing that we don't have all the answers, right?

We're not going to get it all figured out. But if we can truly work on being an advocate and a partner with these women, yeah, I think it really speaks to why we all went into this, and it's trying to it elevate humanity a little bit at a time, and if that happens in a 26 foot purple van, so be it.

Host: Being a nurse or a physician is a role that takes commitment and passion. Let's find out more about how our guests got to where they are today and the reasons they love the work they do.

Denise Turoczi, BSN, RN, OCN: Well, I will say that being a nurse for 28 years oncology wasn't initially where I was at. I was more ICU and trauma. Oncology kind of fell in my lap, I guess you can say and then once I started taking care of oncology patients and understanding the diseases and the different treatments and stuff, and realizing that, you're creating this stress factor with these patients and we're not just talking about one or two visits, we're talking about throughout their whole treatment trajectories.

And I just really, I just loved it. Like, I was able to walk these people through a very difficult time in their life and just help the ones that maybe didn't have the support system like others did. And just creating those gaps to come together with their different barriers. If it's a home life situation or if it's, there's financial barriers. I just really enjoyed just walking with it through the patients.

I mean, I liked my ICU and trauma days, but those were days where you have one or two patients and you're basically keeping them alive, and you're explaining a lot of stuff to the family, whereas this in oncology, I find that just having those bonds and walking with the patients and their families and being there and being that shoulder to cry on and that hand to hold, I just realized that was my purpose. Like, I love it.

Joshua Kesterson, MD: Yeah, I mean, I think it's been a journey. I mean, coming out of medical school and residency, you know, I think initially, and I still am, intrigued by the complexity at the same time the absurdity of it all that for the most part these are medically complex elderly patients that have a malignancy that you end up doing technically challenging complex cases on.

And then administering chemotherapy, radiation therapy, immunotherapy to try and affect an ideal outcome. So I certainly enjoyed the intellectual challenge of that but like Denise mentioned, when you start working with these patients, you realize, and I mean this very sincerely, that we do have best patient population out there.

 Just the kindness of these women and the opportunity to be able to get to know them through the continuum, because we get to take care of them through the spectrum from, you know, the worst day of their life, the diagnosis, through the surgery, through the chemotherapy, through the recurrence through the sequelae of the good and the bad of those interventions.

And you really do develop these bonds where they become, you know, a part of your circle, a part of your community, a part of your family.And the ability to get to know these people as individuals in their roles that they have in life, but you really get to see it because you don't get to just know that they're a mom because you know the kids.

You don't get to know they're a wife because you know the husband. You don't get to know, you don't have to believe they're grandparents because the grandkids are coming with them. To be able to really kind of take care of this whole person through this whole continuum, it has been incredibly rewarding.

And, I think you can appreciate in short order from this interview with Denise that you end up really drawing other like minded individuals. And so you really have this opportunity to work with great people and you put great people in a room or great people on a van and great things are going to happen.

So it continues to be rewarding. And, the source of that reward, I think, evolves and grows, but in new ways each year, it really has, blossomed, and I'm more enthusiastic about it now than ever, and it continues to grow each year.

Host: So, what is the hope for the future of the Wish mobile unit, and for GYN oncology at UPMC in Central PA? Our guests provide some insights into their hopes and dreams for what may be to come.

Denise Turoczi, BSN, RN, OCN: In a perfect world, our own medical mobile unit so that we can get out Monday through Friday and to hit different areas. There's so many other areas that really could use this RV. And then ultimately increasing our services because right now, with what we have, we're unable to really have a bed with stirrups.

So, you know, we're kind of improvising. We're doing different things to help our providers to be able to get a good exam on these patients. We would ultimately like to also be able to provide extended services as far as colposcopies, like, if we see something that needs a little bit more in depth look, can, having that instrument on the RV to be able to have our providers do that.

Ultimately down the road, could we add to a fleet? Could we have like an obstetrics where there's prenatal exams given, because we are partnering with the OBGYN division of Magee as well. Those are kind of like what we would really like to see. I mean, we've, I've gotten a call already, about can we see a mother that's pregnant with twins and unfortunately we can't because we're preventative right now.

But if we could have two RVs, one that's specific for obstetrics to be able to get out on a different day of the week that the preventative isn't there. Those kind of things.

Joshua Kesterson, MD: To piggyback on what Denise is saying, you know, I think this whole initiative is a credit to Denise and the team and demonstrates, the real life concept that the goal exceeds the objectives. And so the reason that this is, I think, incredibly uplifting is in what we're able to do, but also what we're capable of doing. And that is kind of unresolved potential that I think keeps us coming back. And I'll tell you what's going to happen if I can look into the future? We're going to have our own mobile unit.

We're going to offer more services to more people. I think we're going to be able to really generate some community buy in and demonstrate that there are other ways to access the system and to receive care; rather than this rather static, outdated model. I think people talk in the future about the death of distance and I think this is really one way that we're gonna contribute to that and the downstream effects.

I think are only positive in that, like I said, we have good people, taking care of good people uh, for good reasons. I'm really excited about it, and I suspect in two years I'd like to have a model and a, and a protocol set up whereby, you know, Denise and the team are going out teaching other people how to build this, so not only in our region are we trying to elevate care, but really trying to develop a model where others are able to, you know, address whatever regional limitations and deficiencies they may have with this model as we roll forward.

Because I think what Denise and Nicole and the team have been able to do is a lot of the, the tough plowing as it were, and I think we've been able to learn on the fly and certainly learn with the best of teachers being experience. And to make that a smoother transition for other people that are looking to start something similar. I think it'll speak to the hearts and minds of everybody here to really elevate care, not just in the Harrisburg area, but, I think it's limits are limitless.

Host: When it comes to the support of the UPMC Pinnacle Foundation, Denise and Dr. Kesterson are advocates for the vital opportunities the foundation provides.

Denise Turoczi, BSN, RN, OCN: No, I just, I think it's awesome that we do have a Foundation that they're willing to help us on the back end of, you know, because we do have women that are coming on to this van that have no insurance and even though we're giving them the information to get that insurance, we can still take care of them and they don't have to worry about a bill and Foundation has been so helpful and grateful with kind of picking up some of those costs on the back end.

So, you know, we greatly appreciate it. I greatly appreciate Mindy's input. She's helped me with letters of intent and just her knowledge with what happens with funding. It's been amazing, like, to be at UPMC and actually having this kind program.

Joshua Kesterson, MD: Yeah. I mean, I think it's one thing to talk the talk, but unless you can write the check and fund the project, then you ain't walking the walk. So, I think, we're trying to be very intentional about all these things. You know, we have an objective, we have a mission, we have a calling, and it's one thing to say and it's another thing to go out and get it done.

And I think we're building some good inertia with this project. And it's going to be hard to quantify the impact in a traditional manner, but certainly when we start looking at the lives that we've impacted and are going to impact it and see that community that's also going to be elevated in very real ways with these contributions that we're able to provide.

I think it speaks to the mission of the Foundation to really address these things that aren't typically taken care of in our commercial model that we have at present, you know, within healthcare. So, like Denise said, having this personalized approach where we need to kind of do things on the fly sometimes, you know, this isn't protocolized in a lot of ways, and each situation is going to warrant a different intervention. So to be able to have those resources that we can lean into is everything, you know, so, we hope to generate continued funding from the Foundation, continued backing from the Foundation, while also showing it as a proof of principle and proof of concept that we can roll this model out and generate additional funding, not only for our medical mobile unit but also as an awareness about the Foundation and the good work that they're doing.

Host: As we come to the close of this episode of, In Their Words, we'd like to extend our heartfelt, thanks to Denise Turoczi and Dr. Joshua Kesterson for sharing their experiences and insights about the Mobile Wish Unit. Their dedication to improving women's health through innovative, accessible care is truly inspiring. The Mobile Wish Unit is more than just a medical facility on wheels. It's a beacon of hope. A lifeline for many and a testament to what can be achieved when healthcare professionals think outside the box. We hope this episode has shed light on the challenges faced in women's health care and the innovative solutions being implemented right here in our community. We invite you to join us for future episodes. As we continue to explore the inspiring stories and groundbreaking initiatives shaping healthcare in our region. Until next time, friends and listeners.