To Your Health

Collaboration, in many forms, illustrates we really are stronger together

Living creatures generally don’t like change.

In addition to the obvious reasons a pandemic causes unhappiness, the disruption of routine and the creeping, unsettling feeling of newness has left many disconcerted, forced to abandon prior comforts and adapt to new, often virtual, ways of living at lightning speed.

As we look to the future, we find ourselves wondering which of these changes will be here to stay and how they might actually improve our lives.

One new approach is the emergence of telehealth, in which health care providers meet with patients via video chat. In this chapter, local health professionals discuss the benefits of this relatively new concept and why they think it is here to stay.

Change also put the budding partnership between NCH Healthcare and Lee Health into high gear. Here, we take

a look at the health care systems’ collaboration and its Stronger Together initiative.

As Southwest Florida’s source for PBS and NPR, WGCU has broadcast the latest developments in medicine, disease and health care for more than 35 years. Possibly more than ever, WGCU’s mission is focused on education at the intersection of health and public policy, presented here in èBella èXtra.

This èXtra chapter’s hometown hero is Susan Mangicaro, who recently returned to Naples after spending three weeks in New York City on behalf of International Medical Corps, organizing strategies for a health care system in peril. Susan’s story reminds us all that we are stronger together.

Here’s to your health.

“Sometimes good things fall apart so better things can fall together” ~ Marilyn Monroe

 
 

The Way of the Future

Telehealth is here to stay

by Julia Browning

When COVID-19 forced business closures and sent people into their homes, health care providers had to accelerate plans to ensure patients could continue treatment, even remotely.

Fortunately, the telehealth model allows doctors to meet with patients remotely via phone or video conference. In recent months, the concept has gained greater acceptance for its remarkable convenience. Necessity, though, is what launched it to the forefront of modern medicine.

“There’s increased access to care because of increased convenience, no travel time and no gas cost,” says Gaynell Anderson, listing the many benefits of telehealth access recently added to her services at Absolute Physical Therapy in Bonita Springs.

Like many health care providers, when in-person visits during the pandemic became impossible, Anderson quickly introduced clients to the telehealth platform.

 “There’s no waiting room time, which can decrease people’s chance of catching new illnesses,” she says. “It eliminates (the need for) childcare and elder care and increases access for people in more rural areas who are further away from their doctors or clinics.”

But telehealth isn’t necessarily a new concept. Health care professionals realized long ago that telehealth was the medical model of the future, and Lee Health began developing its telehealth infrastructure in 2015.

They just didn’t know the future would arrive so fast.

Payers Gotta Pay

“We recognized the value of telehealth and started the development, but frankly, besides a few key focus areas, we never really got a lot of pickup on it,” says Kris Fay, chief administrative officer of Lee Physician Group, home health and physician services.

“Physicians were concerned, patients were concerned, and the payers did not pay for it, which is key.”

Before the pandemic, Medicare coverage of telehealth services was limited, with tight restrictions on which services, practitioners and technology qualified for use.

The Coronavirus Aid, Relief and Economic Security Act removed these requirements so that telehealth could be widely practiced and covered under most insurance plans. But it is unclear how long restrictions will be lifted. For now, at least, the need is great.

“We went from pre-COVID-19 doing maybe 30-40 telehealth visits a month to doing 37,083 visits (in the

last three months),” Fay says. “It’s worked out really well. Physicians became more comfortable with the level of assessment they could provide via telehealth. My prediction is that it is here to stay.”

As Seema Verma of Centers for Medicare & Medicaid Services says, “The genie is out of the bottle.” Now that patients and providers are seeing the benefits of telehealth, it’s more likely to remain.

 

Broad Reach

Pre-COVID-19, most medical providers couldn’t treat a patient in another state, as the provider had to be licensed in the state where the patient was located.

But many states, including Florida, temporarily waived in-state licensure requirements, which local doctors are finding extremely beneficial for seasonal patients.

Dr. Sharla Gayle Patterson, an NCH Healthcare System breast cancer surgeon, points out the challenge those restrictions posed. After building that relationship, both patient and provider would prefer to continue working together. Now that the restriction is waived, she’s not sure that it will go back.

“People want to get that second opinion from people in other states,” Patterson says. “How amazing would that be if we opened it up and you could get an opinion from anywhere in the world at any time?”

Dr. Sarah deLeon Mansson, a cardiologist at Physicians Regional Healthcare System, shares the desire to continue working with her seasonal patients. Recently, she was able to treat patients for the first time who had flown up north for the summer. Additionally, she points out, the ability to treat patients in distant parts of the world has potentially lifesaving effects.

“You can get medical care to patients you wouldn’t have access to before,” she says. “There are doctors now who are very specialized in their fields, women’s heart health, for example. That isn’t offered in every hospital system.”

With telehealth, a patient can be treated by a specialized professional without having to incur the cost of travel.

 

Doctor’s Orders

Of course, the necessity for traditional doctor visits are far from obsolete. And though physicians are quick to express the pros of telehealth, they’re also aware of the cons, such as the necessity for certain technological equipment and uncertainty surrounding insurance coverage. And even with advanced technology, such as the Apple Watch, which can monitor your heart rate, some tests require appointments.

“There are some things you just can’t do on video or on the phone, like getting a mammogram, colonoscopy or lab work. Those things have to happen,” Patterson says.

“At NCH, there are very strict safety protocols in place. I wouldn’t let your fear, at this point, override your need to keep up on those preventive things.”

A hybrid method of both traditional and telehealth care seems to be the preferred model for safety and resourcefulness during these times and into the future.

 

Aligned for Health

NCH and Lee Health’s joint campaign aims to make ‘SWFL Stronger Together’

by Kathy Grey

Months before COVID-19 became a ubiquitous term the world over, Paul Hiltz took the reins as CEO of NCH Healthcare System and immediately embarked on a 90-day “listening tour” to survey the needs of the community. 

One of his initiatives was to meet with leaders of Lee Health and form a concerted bond to protect the health and lives of the people of Southwest Florida. The two health systems, he says, “needed to be partners.” He and Dr. Lawrence (Larry) Antonucci, President and CEO of Lee Health, met to form that bond.

“Larry and Paul saw this as an opportunity to become further aligned,” explains Chris Simoneau, chief foundation and development officer of Lee Health.

Hiltz’ 90-day listening tour was wrapping up when news of an ensuing pandemic became inevitable, and the two health care leaders put their budding partnership into high gear.

 “COVID-19 has no boundaries, and we want to work stronger together for Southwest Florida’s benefit,” Simoneau says.

In March, the two health care systems formalized the campaign “SWFL Stronger Together,” in which the partners share research findings, critical outcomes, education, staffing, supplies, all manner of protocols and every aspect of responsible patient care.

Hiltz and Antonucci confer at least three times a week, and because NCH is part of the Mayo Clinic network,

they collected vital information for Mayo Clinic’s ongoing convalescent plasma therapy research from their two local health care systems.

 “These human trials take a lot of data to understand their efficacy, but the community has rallied,” Simoneau says, noting that locally recovered COVID patients have contributed their blood plasma to the science.

 

Facing Challenges

As partners, NCH and Lee Health also share patient issues in Southwest Florida, including blood shortages, people postponing regular doctor visits and, alarmingly, avoiding necessary trips to the emergency room.

Patients steering clear of hospitals for fear of contracting COVID-19 resulted in a downturn in the hospitals’ heart attack and stroke cases in the months of April and May, Simoneau says. And that’s not a good thing.

“They are suffering and not coming to the hospital, so they’re sicker when they get to us.”

Educating the public about best practices has been at the forefront of the SWFL Stronger Together campaign. What have become societal norms, like frequent handwashing, social distancing, staying home when possible, wearing masks in public, 14-day quarantines following exposure, and avoiding crowds, cannot be emphasized enough.

Although adopting best health practices seemed to have leveled the initial peak in COVID-positive cases and critical hospitalizations, the daily rate fluctuates.

 

Continuing Collaboration

As leaders of their health care systems, Hiltz and Antonucci — and staff members of NCH and Lee Health — realize the essential nature of collaboration.

“We have commonalities and synergies. Working together produces far better outcomes than being conflicted, especially in health care,” Hiltz says.

In order to maximize efficiency, Hiltz adds, “Our community assets need to be shared.”

 
 

A Day for Wellness

Join Global Wellness Day from home for improved health

Global Wellness Day (GWD) is a worldwide event dedicated to giving people the tools to live healthier and happier lives. With the slogan, “One day can change your whole life,” GWD, now in its eighth year, inspires discovery of the power within to change a person’s life with daily wellness practices.

More than 150 countries at 8,000 different locations will be tuned in to well-being on Saturday, June 13. In Naples, a series of free Zoom classes will mark the celebration for Global Wellness Day hosted by the Paradise Coast Wellness Alliance and the Spiritual Communities Network. Classes are held every half-hour from 10 a.m. to 5 p.m., teaching wellness principles, including yoga and meditation, Blue Zones, mental wellness, essential oils and cooking.

 

“You will be introduced to a variety of modalities that will help you begin looking at your wellness in a whole new way,” says Gwen Peterson, founder of Spiritual Communities Network.

“Global Wellness Day resonates with the times and will enable participants to live with healthy intentions,” says Peggy Sealfon, founder of the Paradise Coast Wellness Alliance.

Registration for classes is at spiritualcommunitiesnetwork.com/wellness-series.html.

 
 

How Readers Can Help

People, animals, community: locally, there are many ways to help

Area charities need help from the community to continue their important missions. Here are some ways you can give a helping hand today:

PACE Center for Girls Collier has been providing students and their families with food and supplies while they are away from the center. This is possible through the help of donations (www.PaceCenter.org/support-collier) and items collected on its Amazon Wish List. To learn more, visit www.pacecenter.org/locations/collier-at-immokalee.

Animal Compassion Project Inc. operates a no-kill sanctuary and rescue for feral, special needs,

abandoned and community cats. It also provides pet food assistance for cats and dogs in Naples. In just two weeks, it took in 27 abandoned cats from Immokalee. When people lose their jobs, such as in the COVID-19 pandemic, the need is great, but donations dwindle. Animal Compassion Project is in need of the following supplies: Clorox bleach, Clorox spray cleaner, paper towels, Handi Wipes and cat and dog food (canned and kibble). It also needs volunteer help to clean and feed cats, write grants, transport cats and run garage sales. For more information, call 239-825-4093.

 

The Naples Children & Education Foundation (NCEF) created the “Drawn Together. Creating Hope.” campaign which invites children and adults to draw or color on one of four downloadable illustrations representing the four NCEF service categories: Child Advocacy, Early Learning, Medical/Healthcare and Out-of-School Time. As part of the campaign, NCEF is offering virtual Zoom backgrounds that can be downloaded from its website for free. Download or print a coloring template at www.napleswinefestival.com/drawn-together and share your creation on social media with the hashtag #DrawnTogetherCreatingHope or email it to DrawnTogether@NCEFoundation.com, and NCEF will share your illustration on its page.

“The goal of this campaign is to increase awareness, involve the community in our work and create hope for the future,” says NCEF Chief Executive Officer Maria Jimenez-Lara. “Whether you’re a child or an adult, you can help bring NCEF’s work to life.”

 

Cilantro-Lime Shrimp

This tasty shrimp dish is great for hors d’oeuvres or can be served as an entrée over rice or grain of your choice. Add a salad to make it a complete meal.

Ingredients:

½ cup fresh lime juice

¼ cup lime or orange marmalade

3 large garlic cloves, finely minced

½ cup fresh cilantro leaves (stems removed), chopped

4 Tbsp. olive oil, divided

1 Tbsp. soy sauce

½ tsp. red pepper flakes

Salt and freshly ground black pepper to taste

1 lb. large shrimp, shelled and deveined, with tails intact

 

Directions:

  • In a measuring cup, whisk together lime juice, marmalade, garlic, cilantro, 3 Tbsp. of the olive oil, soy sauce, red pepper flakes, salt and pepper.

  • Reserve 1/3 cup of this mixture in a small bowl for dipping.

  • In a large, Ziplock-style plastic bag, combine shrimp with remaining mixture and marinate 45 minutes in the refrigerator, turning occasionally, to coat shrimp.

  • Drain shrimp and lightly pat dry between paper towels.

  • In a large, nonstick skillet, heat ½ Tbsp. olive oil over medium-high heat until hot. Sauté half the shrimp until golden brown and cooked through, about 1-1/2 minutes on each side.

  • Sauté remaining shrimp in remining ½ Tbsp. oil in the same manner.

  • Serve shrimp with reserved dipping sauce.

  • Yields about 24 shrimp for hors d’oeuvres.

 

Silver Linings

Finding optimism in dark places

These stories harken back to days not at all long ago, when the safer-at-home order was in full effect and people looked for the bright side of relative confinement.

 

Even as the state continues to “open,” many still prefer to stay home whenever possible. Here, we present two stories from ladies who got creative with their time and talent.

 

Fine Tuning

Although èBella sales rep Laura Coleman expected her stay-at-home companion would be a good Netflix binge on her new Roku streaming device, she hasn’t watched a single thing.

“Instead, I’ve resurrected my treadmill habits (down a dress size, thank-you-very-much) and done some household organizing. But my favorite silver lining is that I have more time to practice guitar, piano and vocals, learning new songs and techniques. I also learned a John Prine song after he passed away.”

Communicating Creatively

Cyndee Wooley and her daughter, Bridget, both came down with a stomach flu right before Easter Sunday.

Not confident that it wasn’t the coronavirus, they quarantined themselves for two weeks to protect others.

 

That meant Wooley’s higher-risk mother and father could not come over for Easter dinner, nor could she go to the grocery store for the special meal fixings, an Easter basket or even a card. When Wooley told her daughter that she was really sad about not being able to prepare their normal Easter basket and cards, Bridget was resourceful.

“She told me it was no big deal and suggested that we make each other cards in the morning,” Wooley says. 

After breakfast Easter morning, they pulled out the art supplies and enjoyed it so much, they decided to also make coffee-chocolate exfoliating soaps for Mother's Day, and peppermint-lavender salt scrubs for Wooley’s mom's birthday.

“We don’t need store-bought gifts to make holidays meaningful. We simply need time to talk, laugh and make beautiful things together,” says Wooley.  

Breathing Exercise for Calm

Wellness expert advocates deep breathing

“Take a deep breath” has been solid, longstanding advice for good reason.

The American Institute of Stress reports that taking time out of your day for deep breathing can relax muscles and decrease blood pressure.

Naples wellness practitioner Jennifer Khosla, owner of Lean and Green Body, shares her established method of relaxation in this five-minute breathing technique. Take a breath and enjoy!

SPONSORED

At the Intersection of Health and Public Policy

WGCU’s mission always has included education

by Dayna Harpster

Information for everyone’s health and well-being always has been a part of the public media mission.

As Southwest Florida’s source for PBS and NPR, WGCU has broadcast the latest developments in medicine, disease and health care for more than 35 years. But perhaps never has WGCU’s mission been more focused on education at the intersection of health and public policy as it is today.

In addition to thorough coverage of COVID-19 on national public media, WGCU’s local reporters have been busy putting questions from regional people about the pandemic to a panel of local experts on Gulf Coast Life radio shows most Mondays (news.wgcu.org/podcast/gulf-coast-live). Tune in to 90.1 FM or 91.7 FM at 1 and 10 p.m. Monday through Thursday.

The public is invited to a June 17 virtual town hall titled, “100 Days of the Coronavirus,” sponsored by WGCU, The News-Press and Naples Daily News. Panelists will discuss education, health care, hospitality and the human impact of COVID-19 on local people.

Then, on July 19, a second virtual town hall continues the series with “Open for Business.” Audience members can participate in live polling and a question-and-answer session, as well. Find out more at www.wgcu.org/swfl.

Recently, a photo essay looked at the front line of the virus through health care workers at NCH Healthcare System and another at the vulnerable population of agricultural workers in Immokalee.

PBS and NPR offer fact-based context and insight into current problems. On TV, PBS NewsHour, Frontline and other shows have followed developments in the pandemic and policing across the country, with national reporters weighing in from the field.

“America in Black and Blue,” airing at 9 p.m. Monday, June 15, updates a documentary with fresh insights since the original 2016 program. Correspondents will report from Minneapolis, Georgia, New York and elsewhere, including voices of law enforcement and everyday citizens.

 

As experts across the country stress that unequal treatment of black and brown people did not begin with the murder of George Floyd, PBS offers programs that give historical context to the recent unrest. Many are on tap for June and July, including “The African Americans: Many Rivers to Cross,” a chronicle of African American history; “Reconstruction: America After the Civil War,” a four-part series; and “Black America Since MLK: And Still I Rise,” a detailed exploration of how the civil rights movement impacted the country.

PBS Kids characters learn lessons along with young viewers on TV, websites and apps about health and hygiene and even help parents explain current events in terms kids understand. PBS LearningMedia provides curriculum and resources for Florida teachers and parents — not only academic subjects but also in gentle lessons about race and heritage.

Next month, WGCU will join a handful of other radio stations throughout the country in “Move to Include,” an initiative to recognize varying abilities of Americans in honor of the 30th anniversary of the Americans with Disabilities Act. Locally, the project kicked off early with a digital storytelling workshop with Best Buddies of Southwest Florida. See those videos at www.youtube.com/user/wgcu.

To learn about health and wellness programs available for streaming, visit wgcu.org. More programs may be accessed by donors to the nonprofit public media station via Passport, a streaming service. For more information about membership, call Kim at 239-590-2361 or email memberservices@wgcu.org.

 

WGCU is a member-supported service of Florida Gulf Coast University.

For the Sake of Humanity

Susan Mangicaro reflects on waging battle in coronavirus-torn New York

by Kathy Grey

It was a whirlwind. Her only son was getting married in California. Family and friends climbed aboard planes to swing in for the celebration of a lifetime. March 13 marked the nuptials of her son, Eric, to his betrothed, Madi.

In hindsight, Susan Mangicaro calls it the “we’re going to be OK phase.” But something bugged her in those celebratory moments, like an incessant itch you can’t scratch.

She’d listened to the news reports. She’d been advised by her peers.

“This isn’t going well,” she thought as she boarded the plane back to Southwest Florida.

Two weeks later, she would embark on a life-altering trip of an entirely different kind.

 

A Road Less Traveled

Susan Mangicaro lives in Naples. As an employee of Hillrom, a provider of medical technologies for the health care industry, she feels fortunate to be able to work from home, here in paradise.

She’s a determined woman; born to be one, she’d probably say.

 “I always wanted to do mission work,” she says, “It’s something I felt called to do.”

She earned a degree in nursing and an advanced degree in public administration. But as a single mom for many years, she realized she’d have to wait to exercise her calling. In 2010, when Eric was in college, she had a chance to deploy with the International Medical Corps (IMC), a nonprofit humanitarian organization dedicated to saving lives. She volunteered and then worked full time as the senior advisor of the emergency response unit for IMC, responding to disasters, crises, outbreaks and epidemics in Haiti, the Philippines, Puerto Rico, the Bahamas, the Congo, and other far-flung parts of the world. When not responding, she traveled to D.C. and Los Angeles, conferring and reporting. Because “global” is the operative word at IMC, calls came in around the clock.

In her time off, the self-described “high-energy person” relaxed by swimming, biking, running and competing in triathlons.

As much as she loved the work, after several years, she needed greater work-life balance. She set up her Naples home office for Hillrom, staying on as an IMC volunteer. Her daily routines became more tenable, and life rewarded her with wonderful things, like the marriage of her son, and soon after, the chance to serve her fellow Americans in ways she couldn’t have imagined.

Driven to Help, to Heal

“I’m very passionate about humanitarian work,” Mangicaro says. “I can’t stand to see anyone suffer, so whenever there’s a crisis or a major disaster, I feel that’s where I need to be.”

And she was needed. IMC reached out at the end of March, asking if she would lead the response team in New York City as it approached the COVID-19 pandemic apex.

You bet she would.

 “It takes a special skill set and personality to function effectively,” leading disaster response projects, she says. And IMC was more than familiar with her record of success.

On April 2, when she stepped off a plane at John F. Kennedy International Airport, the stillness was almost deafening.

“This is the city that never sleeps, right?” Mangicaro asks. “It was eerily quiet.”

To get to the city, she stood with 10 people waiting for the next taxi. Later, the cabbie would tell her that was 10 people, versus the usual 1,000.

“No one was in the tunnel. It was just surreal from the moment I arrived.” 

And no one — not there on that day, anyway — wore masks or gloves. That reality would soon change, and she would remain on the frontlines of the epicenter of the virus for three weeks, helping the most vulnerable — including hospital systems on the verge of collapse — in the worst times of their lives.

Susan Mangicaro

Fractured systems, fractured lives

As an expert in medical management and disaster response, Mangicaro works fluidly between state and federal agencies with the support and oversight of IMC. IMC has the infrastructure; Mangicaro has the hard-earned, boots-on-the-ground experience.

For three weeks, she worked 20-hour days with hospital management, heads of ERs and critical care units. She made daily rounds wherever IMC staffers were assigned and met with hospital department heads to assess needs. She worked in hospitals in Queens, Brooklyn and the Bronx, and the Manhattan overflow hospital established at the Javits Center.

“Patients were dying regularly,” she says. “One paramedic I had worked with in Liberia and in Mosul, Iraq, said he bagged more bodies at the hospital than in the war. He said seven times more people died here than in a war zone. I’ve served in crises all over the world, but in our own country…”

She pauses, her voice trembling. Trying to hold back tears, she says, “I’m sorry.” She explains that she thought she had overcome the emotional impact, but sometimes it catches her by surprise.

“To see what was happening in New York was just heartbreaking. Doctors, nurses, CEOs in tears,” she says. “We’re not accustomed to this: patients coding and in respiratory arrest left and right … tents set up for screening, hospital overflow, ER overflow … We had to relieve overwhelmed staff because 25 to 30% of them were out sick with COVID-19 or suspected they’d been infected. It put such a strain on the existing staff.”

She ticks off the overwhelm: an endless stream of gravely ill patients, entire hospitals transformed into all-COVID-19 units, securing PPE and supplies, and the time she set up a hospital in the Flushing neighborhood of Queens.

“Ambulances kept pulling up. Every single patient was critically ill. On one side were ambulances, five deep. On the other, refrigerator trucks — two, three, then four — for the bodies. It was surreal that it was happening here in our country,” she says, “but disease knows no bounds and has no barriers.”

 

Coming Home

After three weeks battling the invisible enemy, she returned to Naples.

“It’s bizarre on the other side,” Mangicaro says. I often say I have PTSD when I come home to my little bubble.”

She took care of practical matters, including two weeks of self-isolation, antibody testing and food delivered to her door.

And then, she says, “You go through a transition phase, and you want to go back because the work isn’t finished. You’ve developed lifelong friendships on a very deep level,” she explains.

“But you do need to transition out and get some rest. It takes a couple weeks to decompress.”

Still, she says it was good to connect with New York hospitals on June 1 and learn there was only one death.

“You could hear the relief in their voices.”

 

The Here and Now

Mangicaro reflects on the pandemic and the ongoing protests surrounding racial inequality.

 “In a crisis — and we’re experiencing that now — you often see the best of humanity. I’m a glass-half-full person. I’ve seen the worst, but I’ve also seen the best. Whenever there’s a crisis in the world, it’s joyful to see people helping other people. It’s a beautiful thing to experience. It’s extremely touching to see and experience firsthand,” she says.

“I wish humanity would see that. We’d all be better for it.”

With COVID-19 disproportionately affecting black and brown people in this country, WGCU reporters join their national counterparts in hearing from members of those communities about the twin problems of disease risk and police brutality. Hear what local black leaders had to say about protests triggered by the murder of George Floyd in Minneapolis.

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