Episode 110: Transforming Maternal Healthcare Through Telemedicine, Trust, and Resilience

In today's episode, we're diving into resiliency and into how telemedicine is reshaping maternal fetal care. You're listening to BIO from the Bayou, empowering biotech leaders with the tools, assets, and expertise to improve healthcare outcomes.

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Serving the entire Gulf South, but recorded in the heart of New Orleans. Welcome back to BIO from the Bayou. I'm your host, Dr. Elaine I'm Elaine Hamm, the executive in residence at Tulane School of Medicine. And today's guest is Dr. Luisa Caprano. She's a CEO physician, high-risk pregnancy specialist, and founder of World Gateway Perinatal Consultants, a virtual maternal fetal medicine practice to answer the increasing need and eliminate costly travel time for patients. Welcome to the show. We're, we're really excited to have you.

Thank you, Elaine. I am very glad to be here and thank you so much for inviting me.

Well, and one piece I forgot to mention is that you're also an author, a published author, which we love to see as well. You recently published a book, Push Then Breathe. Tell us a little bit about that, and then we'll talk a little bit more about you.

So Push Then Breathe: Trauma, Triumph, and the Making of an American Doctor. It's a memoir. It is about my first 15 years in America and how I became a physician at the end of these 15 years. culminates with my graduation day and at the age of 34 from medical school. And like I said, it starts, um, it dips in into my childhood life in communist Romania, former communist Romania, and goes through this visit, which was supposed to be 2 months worth.

Yeah.

2 months worth of visit. Yes. And in a foreign country, I wasn't speaking any English. Came about a month short of the age of 19, and these 2 months through a set of very unfortunate circumstances transformed itself in, in a lifetime. So it portrays the first 7 years of my life under very, very terrible and abusive conditions, how I escape from that environment, got my citizenship, American citizenship. Joined the Air Force.

Wow.

Uh, got into, got into the medical school and graduated. That is all in a very, very much nutshell. It actually made Amazon booksellers in 2 categories. And I was very, very thrilled. I was not expecting. And it's all on the 3 platforms. It's on audiobook, ebook, and paperback.

I love it. Well, and one piece that continuously comes up is this resiliency piece in your story, whether from a healthcare or business perspective. How do you personally define resilience as you've gone through your career?

Resilience to me, and let me say this, nowadays the word resilience gets thrown a lot.

It does.

And every time, most every time, okay, Most every time I hear from people that I don't think they understand the true meaning, I kind of roll my eyes and I'm like, you have no idea what resilience is.

Yeah.

I mean, just imagine that you're going on a hike, okay? And it's dark and you do not know your environment. You don't know anything. You don't really have a flashlight and you just keep stumbling and you keep stumbling and falling and getting up and it's getting darker, the dusk turning into dark. And then And as you keep going, you're like, you know, I just don't think I can go any further. And then you see this light, very faint light, but it sounds so unsurmountable that you are not sure you're going to make it. But yet you keep thinking, what's the alternative? And then you keep going, you get up and keep growing. And whether you are kneeling or you are— Carrying your body through branches, just doing unimaginable. And you finally get there. Well, by the time you get to that light and you achieve the goal that you started with when you started going through those woods, unknowingly that you are actually going to head out to that light to begin with, you are a transformed human.

Yeah.

Okay. That is, a part of you that will never be the same as before you started this atrocious, you know, journey. So yes, to answer that, resilience is the art of transforming yourself, but also transforming those obstacles that you encounter over and over and over again into stepping stones. It's like, okay, one more. Can I just make one more? closer to that. And that is resilience. That, and you know, they say, okay, so you're done at the end of that particular journey. You're going to stop and enjoy. Well, life is funny like that. You think you got it all and then you just get hit with another transformation, with another obstacle, with another trial. And it just becomes through life, the more you get this, It becomes an exercise without you wanting it, right? But it's okay, I'm going to do this. It just, you reflex, it's not to be like, I'm just giving up. You're like, okay, well, bring it on. That works. Let me just do another one. I mean, it just becomes, it's like brushing your teeth.

Yeah. Yeah. Well, I like that viewpoint of resiliency as transformation. I think there's always this Negative kind of connotation as we think about resiliency, because there's usually some kind of tragedy or obstacle or immense challenge that you have to go through. But it really does change you. It changes you emotionally. It changes you genetically. We've seen that time and time again of stress impacting the epigenetics as well. But it really does transform you, and you get to look back at that journey through the woods and say you did it. And if you find yourself in the woods again, you know that you can— find that light again because you've, you've had that data now to show you that, you know, one step in front of the other will get you through that very dark forest. So I like the transformation piece of the resiliency. It's important to remember because, ooh, it can be hard when you're, when you're in that forest to think about that piece of it too. So.

Yes. And you know, it also starts with self-doubt.

Always.

Because you're like, Because that's what it is, you know, people who give up, you know, they think that they cannot do it.

They can't.

Yeah. They self-doubt, they are ashamed. So after you self-doubt yourself, right, then you're ashamed. You're like, oh my God, I can't believe I didn't do this. And then self-loath. You see, it's just all that is such a vicious cycle that you have to fight through the woods, really.

Yeah. When I first saw your book title of Push Then Breathe, my first thought was around your career around pregnancy. I thought of push, then breathe, but I see the double meaning here of push, then breathe also being part of that resiliency. But let's, let's talk a little bit about the pregnancy piece. So you've, you've really dedicated your life to these very complicated, high-risk pregnancy care, particularly for women that, you know, face some of the most complex medical challenges. I mean, we always have sort of a Pollyanna view of pregnancy, but it is such an incredibly challenging medical transformation that women undergo when they're pregnant. And so what really drives your passion for that maternal fetal medicine? And then follow on to that, how has telemedicine and telehealth really helped with that?

I am driven by the privilege of helping women. It started with the desire to help people. And I, as a child, I was a very sickly child. And then after a surgery, which really was life-changing, you know, and I just realized that how much power of doing good a physician can have and to restore health. And to me, that is both an honor and the duty. And it started of, you know, I really, really want to be a doctor to help people. But then as I went through my own challenges and also very, very, I have very high-risk pregnancies. I wanted to be a high-risk pregnancy physician. You know, pregnant women go through one of the most vulnerable and high-stakes moments of their life, but also is the most happy and rewarding field in my mind. I mean, what other specialty has this, you know, reward? You know, I think we OB-GYNs are like, you know, we want instant gratification, even if it lasts 9 months, that's okay.

Yeah.

But it's just that Okay, I am bringing something to you.

Yeah.

As opposed, you don't feel like you're fixing all the time. You are really making something new with your patient.

Yeah.

So, my turf in medicine to me is where science, humanity, and purpose interject. Telehealth in particular has completely reimagined how we deliver care. So, Just think about how it was before COVID And I do give talks on telemedicine and I give talks on my company and how we deliver care in telehealth, telemedicine, high-risk pregnancy telemedicine.

Yeah.

So when we started picking up with telehealth through, over or through COVID and continued it after COVID, it removes barriers.

Yeah.

It removes barriers, geography, transportation, fear, because now you don't have to come into a doctor's office and see, you know, like, okay, how many more times am I going to get drilled about my social history?

Right. Or I have to fill out this form one more time.

Yes. And then, you know, it's not like that. You know, it's just the patients. And we have 2 sides. We have video visits and then we have telemedicine visits. Telemedicine visits is for patients who come in, While they're pregnant, we do an ultrasound and I say, we, I have teams on the ground. So everybody is in person in my clinics and I'm the only one that's remote.

Oh, interesting. That's different.

And then you have the video visits. The video visits, actually, I feed in into, there is an app, is a HIPAA compliant app. And the patient connects with me. I connect with the patient and we have a discussion about, and that goes very much with the preconception counseling. And so patients who are not pregnant, but they desire to be pregnant, they have very many high-risk conditions. And we discuss, we, you know, we, I'm kind of a medical and mental therapist and physician and detective. I mean, it's just a blend, how to optimize you as a patient.

Yeah.

For a successful pregnancy for you. And for the baby.

Well, just probably even knowing that you have access to care at your fingertips or your phone probably is a huge stress relief. I mean, just to know that you're gonna have to make an appointment and wait 3 weeks and then travel and, and go through a lot of effort to go in, into a clinic, knowing that you have someone that's close by, close to you in terms of time. Has probably, probably helped women in terms of, of just that burden of worry and concern.

And I tell you, the no-show rate is just plummeted. I bet. Yeah, just— yeah, that's why I'm like, can I please have a no?

Yeah, I just, I need a break. I need to go to the bathroom. There's, I mean, it's the—

It is. Yes, it is so important. And, you know, seeing how there is some financial threats when it comes to reimbursement. You know, that is threatening not only this part, but also the Medicare patients who are not pregnant because besides self-pay and private insurance, we have Medicaid patients.

Yeah.

So, but it's, it's still nevertheless, imagine if you take this away from, from women. There are a lot of them that live far away, Elaine, like 2, 3 hours away. They have no transportation. They have nowhere to leave their kids with, you know, and Yeah. It is just last week I had another podcast and the host said, how come these people from the upper echelons do not see the need? And I said to them, says, well, it's very simple. If you haven't walked in that person's shoes, you'll never understand.

Yeah, absolutely. Yeah, you don't understand. I mean, I, in a long ago life of mine, I worked at a free clinic and you don't really understand the burden of just even getting a simple blood pressure of, well, you can walk into any CVS and get that done. Well, how far away are they from the CVS? Is there a bus stop nearby? Do they have access to it? They have to take off work, and they have kids, and they can't take off. I mean, there's so many things that factor into something that we probably, living a charmed life as we do, don't think about on a daily basis. The poverty of being poor is so— it can be overwhelming. And how do you deliver care in that situation and in that environment?

And you know, like I said, you have to be there and, you know, everybody has a different life. I remembered, and I sometimes reminisce about that. I remember having to need to go to CVS and having to buy some cold medicine and looking at the price and I'm going, I can't afford this. I'm putting it down. I lived this life. So I know I get so passionate when I see that, you know, you guys, you guys don't see The need. You don't see the need of telemedicine. You don't need to see the need because you have never been in that position to not be able to think, how am I going to not even pay rent? Just how am I going to feed the family or the kids for the next 2 weeks until my next paycheck? I got $5 in my pocket.

Yeah.

It's mind-boggling. So yes, my practice, I'm very, very excited about it. I have started it in 2023. And when I launched Element MFM, it was about 6 months after my brick and mortar practice has closed down. I was the corporate director of a large medical practice through pediatrics. It was Texas Perinatal Group of San Antonio that closed in August 2022 due to financial difficulties encountered after COVID.

Wow.

And the change in the, the pay care.

Yeah.

Um, so think about this, like I said, you know, the huge gap, too many women, especially in the rural and underserved area, have no access or very little access to, to high-risk pregnancy care. So to give you an example, there are 59 million women of fertile age. In the United States, there are 1,578 maternal fetal medicine specialists like I am in the United States. But now those are all comers because think about the ones that were part-time. Think about the ones that are retired, but still show they are MFM because they are not yet, they haven't put their signal, the signage. Saying, hey, I am retired or I pulled out my certification. I mean, we name it, right? So then 99% of us are concentrated in the urban areas, high pregnancy centers, correct?

Right.

So, but you know, most people don't live in high concentration urban areas.

Right.

Where are our, and the higher the risk, the more further away they are from us, right?

Yeah.

Yeah.

Because they have the social determinants of health that are against them.

Yeah. And so thinking about some of these, I mean, you've seen a lot of aspects abroad. You've traveled to Latin America and Sub-Saharan Africa, and you've done a lot of work in those spaces. And how has that shaped your, how you approach medicine in the US and the things that you see in the rural areas? I mean, we're in You know, Louisiana, a lot of rural areas in our state. What are some things that you've seen there that we could apply in our own, literally our own backyard, even though those backyards are very large and, and rural?

So working across all those areas, Latin America, you know, South America, Sub-Saharan Africa, I've been, I just came 6 months ago from Kenya. I go there and teach residents, OB-GYN residents, and, you know, practice high-risk pregnancy. Taught me that women's health, it's more than medicine itself. Okay. It's about trust. It's about cultural understanding and being mindful to that.

Yeah.

It's about the infrastructure and the disparities between, you know, different countries and especially different countries and America and the education, the education piece. I always say, and a lot of people don't understand this again. And every time I come from these trips and I step back on American soil, I sigh. I gotta go home.

Yeah.

And people are like, why? I said, because really nowhere else, uh, we are so blessed like in America. I mean, we have so much that we can healthcare and, you know, otherwise, but talking about healthcare, imagine what we have at our disposal. When you go there, you do more in, in this, in these areas, you do more clinical medicine. Okay. Meaning I have to go by my gut feeling. I don't have all these toys that I can use at my disposal to enhance my medical decision-making. It's like bare bones. Okay. And I have to trust myself. I have to also respect, you know, their cultural beliefs and do the best. You know, it's like, I'm just going to give you an example. If, you know, the baby has something that it's lethal or, you know, the baby dies or the mom gets very, very ill, it's, you know, they come together as a family and we pray there as a physician and medical personnel because that's all they have. Yeah. And, you know, you have to hang on to something, right?

Right.

In order to keep going. So. We have to remember here too, though, that, you know, think about California. Think about, you know, like you said, I spent 7 years in Mississippi. I know the Delta. Yes. I know.

You know that bayou. Yeah.

And that they are high risk, you know, diagnosis and, oh my God, I have, I have never seen so much fetal growth restriction, you know, in, in the belly, in the uterus.

Yeah.

So many patients in second trimester that I've seen in the Bayou. I mean, like, wow, it's just mind-boggling. But again, the real impact happens when we listen first, we build these relationships and people trust you.

Yeah.

And that is a feeling that you cannot put money on. People trust you. They don't fear you. Okay. Because this is not about fear. They don't think like you are not experienced enough. They just trust you. And that to me, it's amazing, you know, to have your patient, you know, I was like, oh, I just, I want to talk to this doctor. I want to talk to Dr. Caprana. I want to hear, like, even when I go to Africa, I remember one day I, um, I was coming out of call. It was like 7 o'clock. And this lady, they don't have them in the hospitals because they can labor for days. Right.

So that, right.

Women sit outside the building.

Wow.

Okay. Laboring until they are in active labor. Right. So this woman comes to me and she says, and I had a friend of mine who was an interpreter there, a colleague, and she said in Swahili, and I said, what did she say? He says, I want the doctor from America to come deliver my baby.

Oh, wow.

Isn't that moving?

Yeah. Well, and that piece about trust, you know, this is— I know this is going to be a loaded last question for you, but it feels in America that we've, we've lost some trust with people, and that— and there's probably a myriad of reasons why scientists and physicians are not, you know, being trusted by the American people. What would be, based on your experience in resiliency, what would be a piece of advice that you could give to physicians and scientists About rebuilding that trust with patients?

I come across as a very direct individual and I pride myself for that. I'm very transparent. What you see is what you get. So my first instinct was to reply, slow down, listen to your patients. But then right afterwards, I said, no, the issue is not that, Elaine. The issue is we are being pushed to see more and more and more with less and less and less. So we become impatient. Yeah. We become burned out. We become indifferent. We just shut down. We become like little pawns.

Yeah.

And that is why medicine is no, it's very, very dangerous where we're heading, but it's no longer that, hey, it's, it's an art. Give me my time back. And this, as a, you know, private practitioner, I pride myself.

Yeah.

I want to leave you with this thought. Think about RVUs, right? Medical RVUs is the more you see, the more you bill, the more you make.

Yeah.

And you know, I have never worked in a contract that is reimbursing me for RVUs. And you know why? I said to them, I said, first of all, I'm not a factory worker.

I was literally thinking factory when you said that. Like, it does feel like a factory sometimes, just CCC.

Yeah. And then second, I give him an example. I said, imagine you come to my office with your wife and I scan you. And then I come sit down with you and I say, your baby has this very, very bad abnormality that is life-shattering for this child.

Right.

And then as you start asking questions and probing, and of course, you know, it doesn't take 15 minutes to talk about this, I start looking at my watch.

Yeah.

And at one point, you're going to get frustrated. I would be like, you know, I got 15 minutes. I'm so sorry, but I do have to run. I have another patient because in my mind, I'm like, if I don't see enough patients, I can't feed my people, my family.

Well, and that patient in that next room, that patient in the next room is sitting there in their, you know, paper gown wondering where the heck the doctor is. So you have that another patient frustrated on the other side of that wall too.

So, you see, that is the issue. And when I say to the administrators that, to the suits, they are quiet. They can't say anything else.

Yeah.

Yeah.

It's hard that we've, it feels like healthcare has just really become a business and it's always really important to remember the patient at the heart of this and also to remember the doctor and the scientists at the heart of it too, and the pressures that they're facing. And what you're having to go through to see patients and make sure that they get the care they need. And I, I really love that you're taking a different approach in what you're, you're moving forward and making telemedicine, helping to lower some of those barriers and being able to be more accessible and not looking at a clock so much as being able to connect with patients, however that looks like these days. And, and—

It's a, it's very different. Yes.

Yeah. But it's very important these days.

Very important. It's important because you're now truly as physicians, yes, we are medical, but you know, that patient, it's coming to you and because it's afraid that's losing one of its most important assets, its health. So it is like a session. It is like a therapy. It's not only, oh yeah, I got to fix this. Listen to that person that is scared.

Yeah.

It doesn't know what's going on. Now put on top of it women who, or men even, who don't speak the language.

Yeah.

And then put on top of it now women who are pregnant with the highest pregnancy condition, they can't understand a lick of what you're saying. I mean, it's just—

Added stress to a stressful time. That doesn't help in terms of health. So whatever we can do to lower those barriers and make it easier, I think we should all be for.

Yeah, more affordable, more accessible.

Accessible. Absolutely. Well, it was so great to chat with you today. We really appreciate you coming here and sharing your, your experiences and also some of the stresses that you see of women that are struggling to access care, especially during some of the most scary times in their life as they are going through a major medical transformation, and then also sharing your own transformation with us. We really appreciate you coming in on our show. Thank you.

Appreciate you and thank you so much. And if you ever need me to come in under a different title or a different approach, happy to join you again.

Sounds amazing. Well, as always, we will have her contact information and informational links posted in our show notes, including the book Push Then Breathe. Make sure you check them out to learn more. Thank you again for joining us.

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