DAP Health Magazine Issue 4 2023

IMAGINE

Lift to Rise is partnering with DAP Health and others to erase desert homelessness.

Words by Kay Kudukis • Photos by Noé Montes for Lift to Rise

Collective impact: a network of community members, organizations, and institutions advancing equity by learning, aligning, and integrating actions to achieve systemslevel change.

Even before 2011, when the term was first coined in a paper published in the Stanford Social Innovation, Heather Vaikona had been putting “collective impact” into practice in England, networking organizations to get behind a common cause to drive toward something.

In 2014, having returned from overseas and serving as the resource development director for United Way of the Desert, Vaikona was invited to an investor meeting. “The significant amount that all local funders were investing in was FIND Food Bank,” Vaikona says, which sounded fantastic until data showed food insecurity was still a thing. It was a symptom of something bigger. “Folks said, ‘What would it mean if we formed a coalition to try to tackle the root cause issues?’ Everyone in the room said, ‘Yeah, you figure it out, and come back and tell us.’”

Vaikona hit the road, lifted the hood at all the existing coalitions, and listened. “I heard loud and clear the importance of having an academic data partner using a results framework.”

Enter USC Professor Gary Painter, a leading economist who prompted Vaikona and FIND Food Bank to successfully apply for a $500,000 grant from Feeding America on behalf of FIND.

“We did a valley-wide needs assessment between 2015 and 2016,” she says. “Gary did quantitative data analysis: If we were to move one or two or three indicators, what would radically shift conditions for all residents? And then qualitatively, we asked 1,500 residents to identify their biggest obstacle to economic stability and it was overwhelming. Everyone said ‘housing.’” The data matched.

The Coachella Valley’s number one industry, with a whopping $7.1 billion dollars (2022) is, not surprisingly, tourism. The number-two industry surprises some: Agriculture brings in $600 million annually. That means the valley is home to thousands of hospitality and farmworkers, many undocumented.

Statistics show that 40% of the Coachella Valley’s workforce is employed in hospitality and service sector jobs that pay between $15,000 and $33,000 annually. The average onebedroom apartment in Palm Springs currently averages $1,822. That’s $21,864 per year. On the lower income end, it’s a non-starter; on the high end, factor in utilities, food and household goods, car, phone, and gas expenses, and you’re in the red.

Affordability is an extraordinarily civilized word used to define a crisis in America resulting in 600,000 homeless Americans, which increased since 2022 by 11%.

It was already a problem in 2018 when Lift to Rise, the low-income investment fund founded by now CEO Heather

Above: Lift to Rise received a $15 million allocation from the state budget to go into We Lift: The Coachella Valley’s Housing Catalyst Fund to encourage affordable housing development. Pictured from left to right are Lift to Rise board member Matt Horton, Lift to Rise President and CEO Heather Vaikona, Lift to Rise board member Nadia Villagrán, Assemblymember Eduardo Garcia, and Lift to Rise board member Bea Gonzalez. Right: Lift to Rise celebrated its firth birthday in July.

Vaikona, was born. Its mission? To build 10,000 affordable homes in the Coachella Valley by 2028.

And then, COVID-19 hit.

DAP Health Care Coordinator Specialist Regional Coordinator Veronica Garcia grew up in Coachella as one of six kids raised by a single mom who worked as a farmworker and at a citruspacking plant. Weeks into the pandemic, people she knew socially were coming in, scared of facing homelessness. “In the beginning, there was no work, and if there was, they didn’t hire as many farmworkers,” she says. “It was really hard on the East Valley.”

Garcia gets emotional describing the impact Lift to Rise had on her community after the org showed up at one of her staff meetings to share details about its United Lift Rental Assistance Program.

Vaikona explains why: “We deployed emergency cash assistance to 5,000 folks and beyond, and the great thing about that is we got to see everyone’s applications and analyze the data. More than half said they weren’t going to be able to pay their rent. We already had this rock-solid partnership with Riverside County, and honestly, the Riverside County Board of Supervisors does not get enough credit. They made the largest allocation of Cares Act funding in the country to build what became our United Lift Rental Assistance Program.”

The balance in Lift to Rise’s PayPal account — linked to a donation button on the org’s website, which rarely got any action — suddenly ballooned by $100,000 in two hours. Vaikona and her team had no idea what was going on until an excited phone call from a colleague announced that Lift to Rise had just been featured on PBS Newshour. At the end of the day, a small army of like-minded Americans had independently donated $600,000.

Last year, Lift to Rise received the California Nonprofit of the Year Award and, along with other organizations, partnered with DAP Health and Coachella Valley Housing Coalition to fund a 61-unit affordable complex called Vista Sunrise II, currently being built on DAP Health’s Sunrise campus in Palm Springs. It will house those with chronic illnesses who are facing homelessness, and residency will include health care services provided by DAP Health.

By its fifth birthday, Lift to Rise had plenty to celebrate. Here’s its highlight reel:

• Due to its advocacy, Governor Newsom created a $600 million kitty, made catalyst funds eligible, and Vaikona expects they’ll be capitalized with at least $40 million by 2024.

• We Lift — its housing catalyst fund in partnership with Riverside County, Rural Community Assistance Program, Low Income Investment Fund (LiiF), and 70 community partners — has funded seven projects totaling 500+ affordable housing units, and has deployed $3.5 million in loans, with 1,600 units under construction.

• Its Resident Leadership Table, comprised of 14 community leaders, is dedicated to Lift to Rise’s mission.

• Its Collaborative Action Network, made up of more than 60 partners, sets strategic pathways to housing security through economic mobility.

As impressive as that is, Vaikona will not go gently into that good night, resting on laurels. She expresses a viewpoint that leaves those conflating altruism with economic challenges rather … uncomfortable.

“We don’t have a resource problem when it comes to homelessness. We have a value problem [relating to] how we view those who are unhoused,” she says. “Our economy is based on significantly underpaid labor. In that way, the economy is exploitative. It is not Mother Nature, something we have no control over; it’s a complex set of individual behaviors and choices and transactions.” If someone told them to build three million houses right now, Vaikona says they could do it if it weren’t for all of the barriers imposed by people.

We don’t have a resource problem when it comes to homelessness. We have a value problem [relating to] how we view those who are unhoused.

And here’s the most difficult pill to swallow, according to Vaikona: “It’s really ‘Who do we love?’ and frankly, ‘Who don’t we love, and why?’ If we love people, we will go to the wall to ensure their care. It’s a real existential question: What does it mean to be alive on planet Earth? Why am I here? And what do I owe my fellow human? We’re holding structures and mental models about who is deserving and not deserving of support and care. We could solve all of our problems very quickly if we operated from a different value system. I think we have to step back and look at our obligation to each other. We can choose to build a radically different future than the one that we live in.”

Imagine all the people, living life in peace.

~ John Lennon & Yoko Ono.

Where Barbie Fears To Tread

With “Barbie” being the biggest movie of 2023, it’s a perfect time to not only raise awareness, but to actually do something about the state of women’s care. It may surprise you to know that DAP Health is already the projected leader.

Words by Kay Kudukis

Training doctors and medical students that there are differences, and changing methods of research to include the biology of women, are all preliminary steps to changing the culture of women’s health care.

efficient electronic ones. She also wants to address the issue of women missing appointments. “We are looking into an Uber health account so we can begin offering transportation services to our patients,” she says. Many families have only one car, and during clinic hours, the husband often uses it for work.

Terrazas seconds Caldwell’s concerns that lacking selfcare is a major issue. “Your health should always be a priority,” she says. “Women tend to be the caregivers and make the health care decisions for our families. If we’re not well, who will replace us? Preventative care keeps us healthy so we can take care of our families. We cannot afford to skip it.”

Professor Karyl E. Ketchum, Ph.D. — who also serves on DAP Health’s board — is the department chair of women, gender, and queer studies at California State University, Fullerton. She brings good tidings: “Healthy women are better able to engage in economic activities, both within and outside the home, contributing to increased household income, economic growth at the community level, and improved living standards.”

With such strong and strongly empowered women in place within its leadership and workforce, DAP Health (which estimates that more than half of its patient population is female) is set to galvanize women throughout Southern California thanks to much-needed improvements in female-specific health care. What a perfect premise for a … “Barbie” sequel!

Fade in:

Palm Springs Barbie, in vintage Bob Mackie, sips a chilled beverage in her immaculately appointed Midcentury Modern doll house as Pregnant Midge gushes over the award-winning, holistic, patient-centric care she is receiving at DAP Health.

Barbie is inspired to create an “In the Pink” world tour, and to kick off her opening speech, she uses the words of yet another member of DAP Health’s governing body in Palm Springs, U.S. Soccer Foundation Chief Revenue Officer Ginny Ehrlich: “So many are headed in the wrong direction when it comes to women’s health. But not DAP Health. Instead of stripping women of their ability to determine what’s right for their own bodies and well-being, we are offering them the respectful and comprehensive health services they need … and deserve!”

Greta Gerwig, call me.

Women of Impact, the newest initiative for DAP Health, came together through the passion of a powerful group of community, board of directors, and staff members dedicated to setting the “gold standard” of health care for women and children in our community.

“We all know there are severe gaps and barriers to good quality care for the women in our community and the families they care for,” says WOI Chair and DAP Health Board of Directors Vice Chair Lauri Kibby. “Our goal with Women of Impact is to fund programs that will address those gaps and educate the public about how they can be part of this movement.”

You can join Women of Impact — or get more information about the WOI tours that began this fall at Centro Medico Cathedral City — by contacting James Lindquist at jlindquist@daphealth.org or Chas Kidder at ckidder@daphealth.org.

Left: DAP Health's Women of Impact Committee members photographed by Zach Ivey.

Her rise to the C suite came in 2021. With Borrego Health then serving more than 120,500 patients (roughly 463,000 annual visits) throughout Riverside and San Diego counties, being chief operating officer was a big job. It’s an even bigger job now that she serves in that capacity at DAP Health. It’s a role that was previously absent at the organization — one created just for her.

“Corina is simply a force to be reckoned with,” says DAP Health CEO David Brinkman. “Her journey is such an inspiring one. She’s a doer whose presence is nonetheless so warm and welcoming. I’m tremendously excited to have her keep doing what she does best for us now that we are one, integrated health care agency.”

Here’s an anecdote from her early years, which shows why Velasquez has been so successful: She was working with a provider who had a reputation for being “a little too direct” (as she gently puts it), when he snapped at her in front of a patient.

“I went into his office when we were done, shut the door, and said, ‘Let that be the last time that happens. I’m here to work with you. So, let’s make this a good day.’ He just looked at me, then smiled and said, ‘We’re gonna do just fine.’ After that, it was a really good relationship. At the end of the day, everybody wants the same thing. Sometimes, they just need a different map on how to get there.”

Now 39, Velasquez can look back and offer advice to other young adults, no matter their situation. “Even when you don’t believe in yourself, be curious enough to ask the questions because that can open so many doors to things that you never thought you’d even be in the right vicinity of.”

Before DAP Health’s acquisition of Borrego Health, when things were up in the air, Ruiz one day felt inspired to call Velasquez to say, “I just want to thank you. I know what you’ve done, and what you’re capable of doing. We don’t know exactly what you do for us behind the scenes, but things happen because of you. Good things.”

As it turns out, Velasquez has core values — strength, truth, justice, optimism—that she shares with Wonder Woman. Like Velasquez, Wonder Woman has profound healing, telepathy, and supernatural leadership powers.

Isn’t it interesting that Wonder Woman and Velasquez have never been seen in the same place at the same time. Make of that what you will.

Now that DAP Health oversees a total of 25 clinics in Riverside and San Diego counties, this broadened area of service brings increased challenges to care. “We recognize that addressing social determinants of health is important to improve patient outcomes,” says Enhanced Care Management Operations Supervisor Claudia Barron. “First and most importantly, we conduct patient assessments, and we go beyond medical conditions. Our case management teams are trained to address social determinants of health, like housing insecurity, transportation barriers, financial challenges. And we also understand that every patient is unique and has their unique challenges. So, we focus on creating personal care plans. We also get trained by our health plans so that we can connect patients with resources.”

“We early on learned that having a great doctor and fabulous medicine is not enough,” says Senior Director of Social Services Zayda Welden, who oversees the nonmedical programs and services for HIV clients. “All these other factors are so important, or as important, as having the best infection specialist.”

Clients have the best intentions, but if they cannot get here because they are living in the back dumpster of some building that offers shade — and if they leave, someone else will come in and take the place — they’re not going to leave. If someone is not able to walk to the bus stop two miles to get on the bus and come in for the appointment, they’re not going to come in. If they don’t have money to buy gas, they’re not going to come in. So, we can have the best clinic and the best treatment available. If they are not coming in, then our work is not done.

Welden continues: “Clients have the best intentions, but if they cannot get here because they are living in the back dumpster of some building that offers shade — and if they leave, someone else will come in and take the place — they’re not going to leave,” she says. “If someone is not able to walk to the bus stop two miles to get on the bus and come in for the appointment, they’re not going to come in. If they don’t have money to buy gas, they’re not going to come in. So, we can have the best clinic and the best treatment available. If they are not coming in, then our work is not done.”

To address this barrier, DAP Health has instituted transportation programs. “We have the ability to give clients bus passes and gas cards,” says Welden. “Now, not everybody has a car, so we have bus passes available for them. We have two kinds: one that is for seniors and disabled individuals, and one that is a regular monthly bus pass.”

It should be noted that, at this time, the medical transportation benefit is funded through grant programs limiting access to HIVpositive clients living in specific geographic areas who qualify.

Welden also cites food insecurity as a negative social determinant of health. “Every patient who comes into the clinic gets asked a few questions in regard to food insecurity,” she says. “If they say, ‘Yes, I need a bag of food for the next two or three days,’ then we will provide that bag of food, no questions asked.” DAP Health’s nutritionist carefully chooses the nonperishable items that go into the bags, ensuring that they are both shelf stable and nutritionally substantive.

“A lot of people downplay the importance of access to good, nutritious food,” says Tobe. “That’s going to be a social determinant of health — making sure people are able to eat several balanced meals per day. There’s fresh water. We found out that in our Oasis clinic, there’s not fresh water. That’s another social determinant of health.”

At said Oasis clinic (also known as Centro Medico Oasis, located in the town of Thermal), most clients work in agriculture, an often-grueling business with long hours and low pay that can profoundly affect health and well-being. “What we’ve gathered from talking to patients is that not all of them have or work for a company full-time where they get vacation, benefits, and all that,” says Oasis Clinic Manager Israel Ochoa. “The majority of them get three sick days, so once they’re gone, they don’t get paid. A lot of them would rather work unless it’s really, really necessary, or they’re really sick. They don’t have the luxury of benefits.”

Some clients also don’t have the luxury of literacy. “Centro Medico Oasis is 95% Spanish-speaking,” says Ochoa. However, for roughly 60% of the community, the first language is Purépecha, a Spanish dialect from Central Mexico. While these clients speak Spanish, there are some differences that prevent them from fully understanding it. When it comes to reading and writing, it’s Purépecha, not Spanish, that’s used. Most of the staff at the clinic speak English and Spanish, but there are times — during mental health appointments, for example — when clients and providers need interpretation assistance. For that, an online translation service is employed.

From environment to education, work to worship, many factors influence health outcomes. “Negative social determinants of health…don’t discriminate. Anybody can face them,” concludes Tobe. Identifying and implementing programs to address them is the key to combatting them. “It’s really all about creating different access points or ways for people to obtain different services,” he continues. “It’s coming up with innovative ways to be able to eliminate that red tape, reduce those barriers, and meet people where they are that’s going to help support people living their healthiest and best life.

“With this marriage between DAP Health and Borrego Health, I think we’ll be able to take a lot of the foundational work that we’ve done…[and] then build on that infrastructure and replicate different programs — or even create new programs to address different social determinants of health for our complex patient population.”

Impactful Planning

Karla Kjellin-Elder and Jeff Elder wanted to give back. Then they discovered planned giving at DAP Health and created a bona fide legacy.

Words by Greg Archer • Photo by Peter Grant

The way the light catches on the silver lettering of the Karla Kjellin-Elder & Jeff Elder Social Services Wing signage at DAP Health encourages another look. Maybe it’s the modern design — sleek, long, and lean — or the way the name spreads out so boldly along the wall. Regardless, you’re bound to notice and possibly wonder: Who are the Elders?

It’s fun keeping up with the engaging couple. In conversation, it becomes vividly apparent that Karla Kjellin-Elder and Jeff Elder have long been committed to giving back to their community. This is true as it relates to DAP Health, specifically when the couple began to mindfully plot out their estate plan. They saw all too clearly how a legacy gift assists the nonprofit in continuing to ensure the overall health and well-being of the community.

DAP Health does — nurture the whole person, not just the ailments, not just a condition. That’s why the term ‘social services,’ to me, sounded like a big hug.”

That department at DAP Health connects clients to social services for which they are eligible. This includes ensuring individuals have access to food, housing, transportation, home health care support, and more.

“We want to give, and be part of the community,” Jeff says. “If you’re part of a community, you help make it a healthy community, a really functioning community.”

The Elders first got involved with HIV/AIDS-related services with AIDS Services Foundation Orange County, which now is under the Radiant Health Centers umbrella. They had lived in Orange County at the time and eventually rooted themselves in the organization — Karla was extensively involved with the food pantry, while Jeff was on the board and became president. When they moved to La Quinta in 2018, they realized it was time to take a tour of DAP Health.

If you’re part of a community, you help make it a healthy community, a really functioning community.

“It was unbelievable and overwhelming what DAP Health was doing,” admits Jeff of discovering the organization’s reach. “AIDS Services Foundation hadn’t been able to do all that yet. You saw what could really happen out here in the desert. So, we got very excited about the organization and wanted to get involved.”

The Elders began attending various galas and Partners for Life events, suddenly finding themselves among people who were passionate about helping. The more involved they became with the nonprofit, they donated their time and resources, and learned more about planned giving — specifically, opportunities for “naming rights.” DAP Health’s social services wing was brought up.

“‘Social services’ sounded like a motherly thing,” Karla shares. “I think DAP Health strives to be a kind of family for people who may have lost theirs because of ailments or whatever. That’s very sad, to think that somebody is basically homeless, even if they have a home, because they have nobody to nurture and care for them. That’s the good thing

They’re both quick to point out that when it came to establishing some kind of legacy gift, they wanted it to benefit DAP Health. To that end, they created their firstever trust, and divided it into five parts — one each for their four children, and one part for a charity of their choosing. Their intention was clear. Each child would need to donate 10% of whatever they received in the inheritance to a charity of their choice, but to make the donation in the Elders’ name.

“We set up a donor-advised fund, and that fund is how we donate 90% of the money,” notes Jeff. “There are two organizations we give a lot of money to — DAP Health and The Living Desert. And so, when we pass away at some point, our children can give to various charities, and we would expect that a big portion of that will probably go to DAP Health.”

Planning it all in advance brought about a stronger sense of clarity and vision for the Elders. “To me, it’s like having or donating to a utility. It’s just something you do,” Karla says of philanthropy. “So yes, you can take your inheritance and give it to your kids, but it’s also important, I think, to have a portion of your money go to a charity, just like a portion of your income goes to a utility and a portion goes to rent.”

There are several kinds of donations accepted by DAP Health. To be sure, individuals can give money. But assets can also be considered. This can be anything from donor-advised funds, life insurance, and real estate to retirement plan assets and appreciated securities.

“There’s an entry point for everyone when it comes to planned giving,” says DAP Health Interim Chief Development Officer Chris Boone. “You can volunteer at one of our four Revivals store, you can give money, you can participate in our annual Health Equity Walk, go to a gala. There’s something for everyone.”

End-of-life conversations, however, may not always feel comfortable. “Sometimes, having those kinds of conversations can be difficult, because you’re talking about end of life and the decisions you’re trying to make,” Boone says. “But at the end of the day, the conversation is always centered around, ‘What do you want to leave, and what

Top row (left to right): son Parker Kjellin-Elder (28), granddaughter Juliet Harrington (12), daughter Allison Harrington (42), daughter Tess Mason-Elder (39), and son Barret Elder (42). Bottom row (left to right): Granddaughters Marina Elder (8), Zara Rose Harrington (7), and Vivienne Elder (10). Photo courtesy of the Elders.

do you want to be remembered for doing in this world?’ Planned giving is all about impact, and helping others in your community.”

Moving forward and into 2024, Boone says he and the DAP Health team are excited about new possibilities that have emerged. In addition to sharp attention on planned giving, the goal is to have the organization’s Vision Forward capital campaign wrapped up in the next year, which, he says, “is a fantastic milestone. We can’t wait to celebrate our success thanks to donors like the Elders.”

Another significant opportunity to expand DAP Health’s impact is the recent acquisition of the Borrego Health system, which saw the nonprofit go from serving 10,000 patients a year at two locations in the Coachella Valley to more than 100,000 patients a year at 25 clinics located throughout 240 rural and urban zip codes from the Salton Sea to San Diego. The list of services offered now includes OB-GYN, pediatrics, urgent care, pharmacy, and veterans’ health — all of which will be covered under DAP Health. “We’re really excited about it because it really opens the door to a whole new community of folks to help. And that’s going to be huge. It’s a big thing to chew on,” Boone notes.

The Elders admit they were nicely taken aback when they first saw their names on the wall at DAP Health. Deep down, it felt like a full-circle moment for the couple, who have long been donating their time and resources to charitable organizations, and, in turn, making an impact.

“We tell people, ‘If you have money, give money. If you have time, give time. And if you have both, give both,’” states Jeff. “We’ve been fortunate. Some people hoard their money, so that when they die, their kids have this giant inheritance. We gave our kids a good education and raised them well. And they seem like they’re OK. Our plan really is about getting as much as we can out of life while we’re still alive, but whatever is left, a big piece of that should still go to charity because we really should be helping.”

Learn more about planned giving at PlannedGiving.DAPHealth.org.

Leave a legacy of love

Would you like to make a profound impact that will last long after you’re gone?

By remembering DAP Health in your will or trust, or by beneficiary designation, you can provide lifesaving health care to the most vulnerable members of our diverse communities throughout the region of Southern California we all call home. If you believe all people deserve access to health care, no matter who or where they are, please visit PlannedGiving.DAPHealth.org.

The Plight of the Migrant Farmworker

THE HEALTH CARE NEEDS OF AN ESSENTIAL YET MARGINALIZED COMMUNITY REQUIRE SPECIAL ATTENTION THAT IS LONG OVERDUE.

Words by Trey Burnette

Migrant field workers are one of society’s most indispensable people. They’re the frontline of not only the United States’ $162.7 billion agricultural industry but, arguably — considering their hands are the first to touch the harvested food consumed by virtually all Americans — of the nutrition and health care industries.

They’re also one of the most marginalized and neglected populations. A whopping 23% of farmworkers in the U.S. live in poverty. The average individual’s annual income falls between $12,500 and $14,000 ($17,500 to $19,999 for families). And neither does the National Labor Relations Act of 1935 (which permits private sector employees to organize into trade unions, engage in collective bargaining, and go on strike) nor the Fair Labor Standards Act of 1938 (which preserves the right to a minimum wage and “time-and-ahalf” overtime pay for toiling more than 40 hours a week, plus prohibits the employment of minors in “oppressive child labor”) cover most workers. Beyond the low pay and lack of many workplace protections, health care is one of the most significant stressors for farmworkers. Some 25% of them depend on community health centers.

Of the 2.5 million farmworkers who live and work in the U.S., 500,000 to 800,000 reside in California. Their age falls between 14 and 61, and most have been working for 18 years. Some 34% of them identify as women. Another 400,000 are minors.

In 2021, the U.S. Department of Health and Human Services reported that, of the 1,015,162 agricultural workers and their family members who received health services, the most common diagnoses were being overweight/ obesity (25.5%), hypertension (11.4%), diabetes (9%), anxiety disorders, including post-traumatic stress disorder (5%), other mental health issues (7%), and asthma (2.5%.) But that isn’t the full scope of the health issues facing this community, because only 56% of U. S. field workers have health insurance. In California, that number drops to 37%. No matter where they are, many never seek help.

Nationally, 64% of workers are estimated to be undocumented — that figure is 75% in California — and most government programs, except for emergencies and sliding-scale payments, require documentation. Fortunately, on January 1, 2024, Medi-Cal expands full-scope health care for all income-eligible residents of California, regardless of immigration status.

Israel Ochoa manages DAP Health’s Centro Medico Oasis in the agricultural town of Thermal, just southwest of Mecca. He is the son of migrant farmworkers, and most of his days are spent serving farmworkers and their families. His assessment of his clinic’s patients aligns with the national statistics. He says access

to affordable, nutritious food is a leading cause of their health issues. Fieldwork is arduous manual labor; the workers are up before sunrise and have to power through an excruciating workday. They rely on inexpensive sugary beverages like Gatorade, colas, and juices to stay hydrated and maintain energy, and eat a lot of processed food that “keeps” and can be eaten throughout their long workdays.

Furthermore, their children’s diets are not immune to their parents’ work schedules. Typically, 2.5 families live in one mobile trailer, and the kids are usually left with breakfast food they can make without having to turn on a stove — cereal, Pop-Tarts, or microwavable dishes. All eligible California children can get a no-cost breakfast and lunch at school, but obtaining those meals in the summer is difficult, if not impossible, because moms and dads can’t afford, or aren’t allowed, to take time off work.

Fear of being fired is also why workers don’t take personal or medical time off. They’re generally contracted, getting paid in two ways: by the hour ($15.50, plus 40 cents per box of product harvested and packed) or just by the box (about $4.25 per). Workers should get three sick days per season,

but aren’t paid if they don’t work. Most avoid reporting job injuries for similar reasons.

There are many other barriers to prosperity for farmworkers in the U.S. The lack of legal residence status is an obstacle. Nationally, 64% of workers are estimated to be undocumented — that figure is 75% in California — and most government programs, except for emergencies and sliding-scale payments, require documentation. Fortunately, on January 1, 2024, Medi-Cal expands full-scope health care for all income-eligible residents of California, regardless of immigration status. Obtaining preventive and routine care at a clinic will help people avoid emergency room visits and more severe illnesses.

Veronica Garcia is a care coordinator specialist regional coordinator and certified enrollment counselor at DAP Health. Alongside five siblings, she was raised in Coachella by her single farmworker mother, who also toiled at a citrus-packing plant. She does frontline community work and says her employer has an excellent outreach program. With the expanded Medi-Cal program, more people will be counseled and given health care. Outreach is critical because

CAN I TELL THEM WHO I AM?

AFTER 17 YEARS

AT PFLAG, PALM

SPRINGS RESIDENT — AND OUT & EQUAL’S NEW VICE PRESIDENT OF LEARNING — KNOWS ALL ABOUT DIVERSITY, EQUALITY, AND INCLUSION IN THE WORKPLACE.

Words by Victoria Pelletier • Photos by David A. Lee

Jean-Marie Navetta’s bio at PFLAG ended with the quip, “Jean-Marie is, most importantly, living proof that philosophy majors can get real jobs.”

Of course, Navetta is far more than a “philosophy major.” Educator, advocate, leader, prophet, sage, dreamer, superwoman? Now we’re getting closer. Navetta’s illustrious career in the diversity, equity, and inclusion (DEI) space through LQBTQ+ education and advocacy points to her why in life. She envisions a world wherein no one needs to ask the question she’s often asked herself on the first day of a new job: “Can I tell them who I am?” For those committed to actualized DEI in business and beyond it, the universal answer must become, “Yes, you can!” And one must not lose any sleep over it.

I recently sat down for a Zoom interview with the Palm Springs resident as she prepared to take on a new professional role as vice president of learning at Out & Equal, “the premier organization working exclusively on LGBTQ+ workplace equality,” per the nonprofit’s website. “Through our worldwide programs, Fortune 500 partnerships, and our annual Workplace Summit conference, we help LGBTQ+ people thrive and support organizations creating a culture of belonging for all.”

The biggest takeaways from our conversation? Inclusion begins with education, and full inclusion means changing systems and the culture. Navetta is deeply committed to all of the above. She reminds me — and all of us, for that matter — that changing systems and culture is especially daunting in the current, uber-polarized environment. “DEI work was a given,” Navetta notes as she looks back on her early pro years, adding that “opposition has become far more sophisticated in how they are resisting it; this level of sophistication should cause us to be concerned and be more vigilant and relentless in our work.”

Bottom line? There’s plenty of work to do to overcome the regression that is afoot in government, business, and broader culture.

Navetta remembers the first time she encountered PFLAG. A teenager at the time, she observed a Pride parade from the sidelines and thought, “Wow…if only.” After earning that golden philosophy degree, Navetta considered law school for a while before settling into communications roles. Heart and mind stirred during those early years in the workplace. She recognized the forward momentum of the inclusion movement and knew she wanted to be a part of an unscripted future in DEI.

A work stint in Washington, D.C. provided the entry point for a career in her education and advocacy work. While working as a press secretary there, Navetta volunteered with a local PFLAG chapter. Impressed by her passion, intellect, and

ability, the chapter director submitted her resume to PFLAG HQ, knowing Navetta’s drive and skills were needed at the national level. The pivot from communications to advocacy and education was now underway for Navetta, and would grow for the next 17 years with PFLAG.

“I had to find my space in the movement,” she says while reflecting on her early days in DEI, so she gobbled as much information as possible, taking deep dives into topics like butch/femme identity. Navetta had experienced, personally, that queerness could lead to discrimination and even hostility in the workplace. Like many in the LGBTQ+ community, she has been leery at times about “being out” in the office, and she understands that many workers remain confused by the difference between acceptance and full inclusion and belonging. “Look around,” she declares with a resolute voice. We need workplace advocacy because, “we’re losing ground on the policy and cultural acceptance fronts.”

Of course, the current political climate does not help advance DEI efforts in education or in business. In the most sobering moments of our conversation, Navetta laments the insidious ways elected representatives stoke regressive legislative action. “Legislation is designed to shut discussions down, and it makes you realize we have to do more.” Pondering the impacts of her work as a DEI champion and guide for businesses, Navetta adds, “Restrictions on how we talk about things in education, government, in documents, etc. means that one of the last places we can have this conversation is in the workplace.”

Legislation is designed to shut discussions down, and it makes you realize we have to do more.

Effective DEI work in the workplace can move the broader cultural conversation forward, though. “Look at marriage equality — there was phenomenal grassroots activism, yet the influence of private sector employers was incredibly powerful in driving change and judicial decisions forward.” Navetta sees business shaping many more DEI advancements. “Let’s use the time and place where people spend more time than anywhere else [work] to educate and advance LGBTQIA+ rights, inclusion.”

Citing court challenges to DEI based on religious freedom arguments, I ask Navetta if she thinks companies might reverse course on DEI progress because of recent legislation and court rulings. Despite the legislative and judicial headwinds, she feels positive about the prospects of businesses staying the course. “Most of the companies that

we see committed will continue on their path forward; most companies understand that [DEI] helps with business performance.”

Indeed, Navetta’s new role at Out & Equal gives her the leverage to scale up her DEI educational work in a way that could have broad, global impact. Immediately, her leadership at the organization’s workplace summit — the world’s largest of the kind — will provide opportunities to present a diverse portfolio of LGBTQIA+ programs to a significant, cosmopolitan audience.

Our superwoman with the golden philosophy degree remains a global force in the DEI space. She feels supported by her wife of 23 years, Jude Medeiros, plus a cohort of generous colleagues. Then there’s the considerable quality of life she has found by moving from grey and chilly San Francisco to warm and sunny Palm Springs in 2018. The local international airport certainly makes her frequent travel less of a burden, and the community of friends the couple has cultivated recharges Navetta’s oft-depleted batteries come evening or the weekend. She’s even found time to volunteer to teach queer youth about their history at the LGBTQ Community Center of the Desert’s satellite space in Coachella.

Basically, Navetta believes she was born at the perfect time into a difficult world, buoyed by infinite possibilities. “I am excited to be educating LGBTQIA+ leaders and the next generation,” she offers with a look of satisfaction.

I, like many of you, look forward to the day Navetta’s question — Can I tell them who I am? — is always answered in the affirmative.

All in the Family

HOW SPOUSES ANDY AND JOHNNY GLORIOSO FOUND THEMSELVES BOTH WORKING IN SEXUAL WELLNESS AT DAP HEALTH — AND LOVING IT.

Words by Trey Burnette • Photos by David A. Lee

Andy and Johnny Glorioso at DAP Health's Orange Clinic

Together for Better Health

DAP HEALTH AND BORREGO HEALTH BECOME ONE INTEGRATED HEALTH CARE SYSTEM WITH A SINGULAR GOAL — TO PROTECT AND EXPAND LOCAL ACCESS TO CULTURALLY COMPETENT CARE FOR MORE THAN 100,000 PATIENTS.

Words by Daniel Vaillancourt

On August 1, 2023, DAP Health and Borrego Health became one in a union sanctioned by both the Bankruptcy Court and the Health Resources & Services Administration (HRSA). Since then, the integrated health care system has operated with some 850 employees serving more than 100,000 patients of all ages, genders, ethnicities, orientations, and socioeconomic status at a total of 25 Southern California clinics located within 240 rural and urban zip codes from the Salton Sea to San Diego.

Prior to the two federally

DAP Health now boasts 850 employees serving more than 100,000 patients of all ages, genders, ethnicities, orientations, and socioeconomic status at a total of 25 Southern California clinics located within 240 rural and urban zip codes from the Salton Sea to San Diego.

under DAP Health’s vast geriatrics, urgent care, and pharmacy services.

“It’s an honor to unite Borrego Health and DAP Health’s missions, as well as our region’s most exceptional, dedicated, and passionate health care professionals,” says DAP Health CEO David Brinkman. “Together, we will build a brighter future where every individual — regardless of who or where they are — has equal opportunity to live a

CEO David Brinkman photographed by Michael Davis.

“We will achieve this by replicating our time-tested, holistic, patient-centered care model, which addresses all applicable social determinants of health (SDOH) negatively affecting the patient population at each of our clinics. By addressing these SDOH — whether they pertain to language and literacy, housing, nutrition, transportation, education, employment and income, addiction, violence, and/or racism and other discrimination — we remove barriers to care, increase our patients’ quality and length of life, and create true health equity.”

“When all of us at Borrego Health were looking for a like-minded FQHC to take us under its wing, three things mattered most,” says DAP Health Chief Operating Officer Corina Velasquez, who served in the same capacity at Borrego Health. “Continued access to health care for our more than 100,000 patients. Continued employment for our more than 600 employees. And mission match — an organization that would share our values and our vision for continually creating more health equity in this region. In DAP Health, we hit the proverbial trifecta … and then some!”

Of note:

• Every DAP Health and Borrego Health location will remain open, retaining its original name, branding, and signage for the time being.

• Some 99% of Borrego Health employees accepted DAP Health’s invitation to join the combined entity. There were no layoffs or forced relocations among existing DAP Health employees.

• Fellow FQHCs Innercare and Neighborhood Healthcare — allies of DAP Health who have regional and cultural expertise in Riverside and San Diego Counties, respectively — will offer guidance, support, and community connections on an as-needed basis.

• DAP Health’s mission — including its commitment to LGBTQ+ health care, HIV care, gender-affirming care, and the Coachella Valley community — will expand as a result of its absorption of Borrego Health.

Over the next 12 months, DAP Health’s fortified executive leadership team — consisting of individuals from both organizations — will analyze all social determinants of health (those nonmedical factors that negatively impact patients’ health outcomes) at all the clinics served. It will actively engage fellow community organizations, government agencies, educational institutions, and businesses to improve health outcomes for all, whether that be by adding programs and services or improving physical facilities. By combining a plethora of strengths, DAP Health will achieve new levels of excellence in delivering comprehensive, accessible, and culturally sensitive care to its diverse patient populations.

Chief Operating Officer Corina Velasquez photographed by Zach Ivey.

A Tale of Two Cultures

HOW DAP HEALTH AND BORREGO HEALTH MARRIED THEIR EXPERTISE INTO ONE UNIFIED VISION.

Words by Barbara Kerr

At DAP Health’s Sunrise campus in Palm Springs, one client is receiving HIV specialty care and a connection to social services, including food and housing, as another receives gender-affirming care.

At Borrego Health’s Coachella Valley Community Health Center in Coachella, physicians are providing obstetrics, pediatric, and dental care for a migrant family, plus specialized care for a veteran’s family.

These stories reflect just a few of the comprehensive services provided by DAP Health, serving the Coachella Valley since 1984, and Borrego Health, serving Riverside and San Diego counties since the 1980s.

Now, the two organizations have become one, offering compassionate health care with dignity and respect across Southern California. Looking to the future, leaders of both organizations are committed to nurturing a true partnership.

Corina Velasquez has a unique understanding of the mission and culture of Borrego Health. Sixteen years ago, she joined the organization as a medical assistant. In 2021, she became its chief operating officer, a role she now fills at DAP Health. “I think the culture is in the need to deliver care to the underserved, making sure that you’re here for your neighbors, your friends, your family,” she says. “Because that’s who they are to our employees.

“This organization has been through a lot over the past couple of years, much like many other organizations in terms of COVID-19 and how that’s changed things. But with Borrego, it goes a step further with all the things we’ve had to deal with.”

Velasquez credits the staff for their dedication. “So many of them could have left. But when you look at the staff that are still here — and you ask about their tenure — it’s anywhere from five, 10, 15 years and climbing.”

To answer questions and ease concerns, Velasquez, Borrego Health Vice President of Clinic Operations Nereida “Nedy” Terrazas, and DAP Health CEO David Brinkman took part in an extensive listening tour prior to the official start of the two organizations joining forces. “We went to every single one of our brick-and-mortar clinics over the course of about five to six weeks,” Velasquez reveals. The goal was not only for Velasquez, Terrazas, and Brinkman to answer tough questions, but for the latter to start to get to know Borrego Health employees, and vice versa.

“It was very important to me to travel near and far, accompanied by Corina and Nedy, to visit the many people with whom we would soon be working so closely, in their own workplaces,” says Brinkman. “What was most moving to me was not only to see how long most have been in health care, but to witness firsthand the love and passion they have for the work; the dedication they have to the patients they feel it’s their duty and honor to serve. All of that was immediately apparent from our very first conversations.”

Velasquez believes DAP Health is a perfect partner in terms of patient care. “It is such an alignment of DAP Health’s ability to do the wraparound services — all of the things that are not

direct patient care, from housing to food insecurity — and marrying that with Borrego’s ability to deliver complex care, from women’s health to pediatrics, adults, and specialty. I’m really excited for the future and what’s to come.”

Deanna Drake — who earned a master’s in public health from the University of Minnesota, Twin Cities — is a senior manager at Facktor Health, a nationally recognized consulting firm with expertise in development, innovation, and integration for federally qualified health center (FQHC) health plans and hospitals. The company has been supporting DAP Health and Borrego Health throughout this integration, and will continue for the foreseeable future.

Drake notes that both organizations were established to meet an unmet need for a population that didn’t have access to care. “I think what’s really similar is how they started — their motivations for caring for people,” she says. “And what’s changed, over time, is who those populations are.

“Many people choose to continue working at these two organizations for the exact same reason. They’re passionate about caring for their patients. And those are patients who are typically quite underserved, vulnerable, and subjected to marginalization or discrimination.”

What does that mean to those who turn to the new, blended organization for care and support? “Say you’re a busy mom and you’ve got three kids,” Drake suggests. “You want to know: When I call to make an appointment for my child, is it the same phone number? Can I use my same insurance? Will my doctor or my nurse practitioner be there?

“They want that stability — that reassurance that the care they’ve been receiving will continue and it’s as accessible as it always has been. They want to hear, ‘I’ll be here for you. Yes, it’s the same phone number. Yes, you can use your same insurance.’ It’s really important to get that information to those patients directly through their providers.”

What could the health care partnership look like within the two years? Drake has a powerful and inspiring vision. “It’s an organization filled with very talented leaders — and very mission-driven staff — who have learned from each other to create a system that is truly exemplary,” she said.

Looking to the future, Drake says, “In terms of the quality of the care they’re providing, the quality of their facilities, the excellence in their approach to social determinants of health, they’ve taken the best of both entities and blended that into a strong, unified vision and a mission-driven organization.”

3 Centro Medico Cathedral City 69-175 Ramon Road, Suite D-4, Cathedral City

5 Centro Medico Cathedral City General Dentistry 69-195 Ramon Road, Suite C-3, Cathedral City

4 Centro Medico Cathedral City • 69-185 Ramon Road, Cathedral City

6 Centro Medico Coachella • 55497 Van Buren Street, Thermal

7 Centro Medico El Cajon • 133 West Main St Suite 100, El Cajon

8 Centro Medico El Cajon • 155 West Main St Suite 100, El Cajon

9 Centro Medico Escondido 1111 East Washington Avenue, Suites A-B-G, Escondido

10 Centro Medico Escondido • 1121 East Washington Avenue, Escondido

11 Centro Medico Oasis • 88775 Avenue 76, Suite 1, Thermal

12 Coachella Valley Community Health Center

49869 Calhoun Street, Floor 1, Coachella

13 COD Student Health Center • 43500 Monterey Avenue, Palm Desert

14 DAP Health Sunrise • 1695 North Sunrise Way, Palm Springs

15 DAP Health Sexual Wellness Services

81-719 Dr. Carreon Boulevard, Suite D1, Indio

16 Desert Hot Springs Community Health Center Main Campus 66675 Pierson Boulevard, Desert Hot Springs

17 Desert Hot Springs Health and Wellness (Dental) 11750 Cholla Drive, Suite B, Desert Hot Springs

18 Jay Hoffman Health Center • 29490 Lakeview Avenue, Nuevo

19 La Mesa Pediatrics • 8881 Fletcher Parkway, Suite 200, La Mesa

20 Martha’s Village Clinic • 83791 Date Avenue, Indio

21 Palm Springs Family Health

1100 North Palm Canyon Drive, Suites 104-106, Palm Springs

22 Revivals Thrift Store • 611 South Palm Canyon Drive, Palm Springs

23 Revivals Thrift Store • 68401 CA-111, Cathedral City

24 Revivals Thrift Store • 72885 CA-111, Palm Desert

25 Revivals Thrift Store • 82-150 CA-111, Indio

26 San Jacinto Health Center • 651 North State Street, San Jacinto

27 Specialty Care Center • 12520 Palm Drive, Desert Hot Springs

28 Stonewall Medical Center

68555 Ramon Road, Suites 101-103-104-105, Cathedral City

29 Vista Village Pediatrics • 950 Civic Center Drive, Suite A, Vista

30 Woolcott Dental Clinic

590 Palm Canyon Drive, Suite 212, Borrego Springs

From the Salton Sea to San Diego, there is now a DAP Health clinic near you, ready to provide equitable access to health care.

LEGEND

DAP Health clinic

Revivals Thrift Store

Anza

Mecca

Salton

Borrego

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Not everyone has the same opportunity to access care Not everyone has the same opportunity to access care Not everyone has the same opportunity to access care

Dean’s sensitivity for reaching people comes from a decadeslong career as a journalist. It may also come from the acute understanding of the experience of not always being the recipient of the stories and media that one might want or need.

Growing up in the 1970s in Hardinsburg, Kentucky — a rural county seat with a population of roughly 2,000 people — Dean was a voracious magazine reader. He’d read anything he could grab, from Reader’s Digest to TV Guide. But as a young Black person who knew he was gay from an early age, Dean would rarely see himself reflected in the media he consumed. Copies of Jet and Ebony provided what Dean describes as “a variety of examples of Black excellence and possibility,” but finding Black LGBTQ+ stories proved harder.

The eye for good writing and deep appreciation for meaningful representation stayed with Dean throughout his journalism career, starting in his 20s at the Park City Daily News in Bowling Green, Kentucky and working for papers like the Savannah Morning News.

After a mid-career Knight Fellowship at the University of Missouri School of Journalism, Dean landed in Palm Springs for a community editor role at Gannett daily The Desert Sun. There, he fulfilled a dream he’d had ever since he was that magazine-devouring boy: running a magazine all his own. From 2012 to 2018, he edited

all the editors into a meeting and asked us if we thought an LGBTQ+ publication would work here,” says Dean. “And, if I recall correctly, everyone said no — except me.”

Starting in 2012, Dean ran Desert Outlook with a passionate meticulousness, leading a small team of writers and designers. The monthly printed stories on same-sex marriage and the migration of HIV patients to the desert. Dean fondly remembers interviewing actor Cheyenne Jackson, who gave Dean an equally memorable muscle-bound hug. It was a public-facing role that had Dean attending events multiple times a week— restaurant openings, political gatherings, theatre premieres, and more.

“He had high standards, and he was very conscientious about basically everything he did,” says Michael Jortner, an Outlook contributor and longtime friend of Dean. “He would be on every photo shoot to make sure it was as close to what he was looking for. And it was the same with the writers.”

After Outlook published its last issue in May 2018, Dean didn’t stop to rest. He started work at the District that June. He filled a position that has made great use of his journalism skills and editorial eye, overseeing the publication of the District’s first history book — telling the story of how the foundation formed in 1948 to build Palm Springs’ first hospital, only to grow to grant $80 million to local health care nonprofits. Working with Riverside University Health System, Dean is poised to launch a public health campaign about harm reduction related to fentanyl overdosing.

The demands of Desert Outlook and the District pushed Dean to take a “social hibernation” from the arts, culture, and community events that have so defined his time in Palm Springs. (Dean has also been on the boards of various organizations, such as Dezart Performs and Brothers of the Desert.) It’s a slow-down that Dean says he’s newly emerging from. Recently, he’s worked on his own writing projects, such as contributing a profile of jazz drummer Daniel “Big Black” Ray to Palm Springs Life.

Dean is also launching a new, roving social club called The Mix Palm Springs, which focuses on fostering and celebrating diversity in social spaces. A recent summer camp-themed event at resto bar Reforma featured the lawn game cornhole (AKA bean bag toss) and s’mores. “It’s highly curated at the moment,” says Dean of this new venture, which is currently open by invitation only. “But that’s also part of ensuring that people know it’s a safe, welcoming space.”

Attention to detail. Respecting people’s needs. Showing up. All in a day’s work for Will Dean. He’s someone who is always looking to do what’s right, to communicate in a very sensitive manner the importance of bringing equity to the distribution of health care.

A Prescription for Positive Change

BY ADDING WELLNESS PROGRAMS TO CONVENTIONAL MEDICINE, DAP HEALTH ELEVATES PATIENT CARE.

Words by Ellen Bluestein • Photo by Zach Ivey

At DAP Health, health care means more than just a routine physical or a sick visit. It means treatment that addresses the whole person and extends beyond conventional medicine to include complementary wellness programs and services.

“It’s all-encompassing, it’s collaborative, and it goes beyond the physical well-being,” says DAP Health Chief Academic and Medical Service Officer Carol Wood, who previously served for six years as the organization’s chief of clinical operations. “It really includes emotional, social, and financial aspects of the patient’s life situation, and each patient is different.”

This integrative approach focuses on body, mind, and soul, and is tailored to an individual’s needs. “We try to address the patient where they are,” continues Wood. “What issues are affecting them that may be making it more difficult for them to be well. It might not be the medical side of things — that might not be the biggest issue.”

DAP Health Director of Behavioral Health Sharareh Gandy, Psy.D. agrees. “I’ve seen a lot of health care shifting toward this integrative model. It’s considering the different parts of ourselves, the different things kind of going on in our lives that impact our overall wellbeing, including our physical well-being, our emotional well-being, our spiritual well-being. And so, it’s been wonderful to see health care acknowledge that and bring in multiple different services to work as one in helping people integrate not only their health care but integrate the different parts of themselves.”

For mental health practitioners like Dr. Gandy, the shift has had tremendous impact. “I’ve been really excited for mental health to be integrated into the medical model,” she says. “Historically it’s been [that mental health care] has been that thing that’s over there, that’s super private. But now, it’s like, ‘Well, it’s here!’ It’s in our day-today lives, it’s part of who we are, it’s a part of our health care, and it’s really reduced a lot of stigma for people. Over the years — with that integrative model and with telehealth — that it’s just increased access to care…and people are a lot more involved and engaged in seeking out services.”

By implementing complementary services, DAP Health acknowledges the importance of alternative therapies as part of routine medical care. “In the wellness department, we offer services like acupuncture, massage, yoga — all those things that aren’t really considered conventional health care,” says DAP Health’s Wellness Center Manager Cory Lujan. “Wellness itself is complementary. We’re to be used in conjunction with, or are married to, the medical side.”

From reducing pain and combating loneliness to addressing addiction and recovery, DAP Health’s wellness department offers a robust slate of programs and services — all of which are free to clients and designed to supplement medical care. These include:

Mind and body wellness modalities, including acupuncture, chair massage, chiropractic care, Reiki, Transcendental Meditation, and yoga, which can help with pain management.

Artistic expression, including clay sculpting, knitting, and quilting groups that bring together those with similar interests, alleviating social isolation and creating friendships. It also serves as a means of self-expression and encourages creativity, bolstering mental health.

Social support groups on topics such as HIV and aging, recovery, stress management, healthy relationships, intimacy, liver health, smoking cessation, and diabetes prevention, all of which impart important information and best practices, help clients navigate their health journeys, and decrease social alienation by encouraging conversation.

Personal development, including stylist and barber services, employment services, and computer proficiency classes that help clients acquire the skills necessary to be gainfully employed and move toward financial stability.

A monthly mobile market from FIND Food Bank, which provides free, healthy food — including fresh fruits and vegetables — ensuring access to the nutrition clients need. Located on the DAP Health Sunrise campus in Palm Springs, the mobile market is open to the public.

Various other programs and services, including a trending topics speaker series, lunch-and-learn presentations, and a book club that spark conversation and enrich lives by engaging clients’ minds and reducing social isolation.

“It’s our philosophy, and we know it to be true, that housing is health care, food and nutrition are health care, spiritual wellness is health care,” concludes Wood. “It’s not all about just going to the doctor and getting a prescription. There are a lot of mental and spiritual things we can provide for our patients that are going to also impact their health outcomes in a positive way. That’s why we do these things. And if more interventions pop up on the radar that we believe might also help our patients, we at DAP Health are probably going to be the first ones to try them.”

Left: DAP Health Community Health Diagnostic Testing & Outreach Supervisor Manny Muro feels the flower power.

We are all broken, that’s how the light gets in We are all broken, that’s how the light gets in We are all broken, that’s how the light gets in

A Safe Space in a Sea of Hate

HOW DAP HEALTH IS ELEVATING LIFESAVING GENDER-AFFIRMING CARE IN SOUTHERN CALIFORNIA.

Words by Jacob Anderson-Minshall

A wave of legislation targeting trans and nonbinary people — especially youth — is radically reshaping Americans’ rights in states across the nation. There are new restrictions on access to LGBTQ+ books, public restrooms, and participation in sports. But the greatest threat to trans lives is undoubtably the recent criminalization of gender-affirming care.

The ACLU is currently tracking 492 anti-LGBTQ+ bills — more than in any previous period in U.S. history — nearly half specifically targeted at transgender, gender-nonconforming, and nonbinary people. In fact, against the advice of the American Medical Association and the American Academy of Pediatrics, at least 90 of those bills will prevent trans youth from accessing age-appropriate, medically necessary, and lifesaving health care. (When that happens, suicide rates also rise.)

Just this year, 19 states (Texas being the largest) have restricted some (often all) gender-affirming care for anyone under 18. Despite the propaganda, genital surgeries aren’t and haven’t been offered to trans kids, but these laws can eliminate access to hormone therapy and puberty blockers. Criminalizing genderaffirming care intensifies the already significant barriers trans people face when seeking medical services.

— working out of both Stonewall and DAP Health’s clinic in Escondido — as the incoming director of specialty programs for gender-affirming care as well as those living with, or at risk of, contracting HIV.

Dr. Halperin hails from New Orleans, a blue city in a deeply red state. It’s “an island of inclusion in a sea of oppression,” he says. But even in places that embrace diversity, like much of Southern California, Dr. Halperin maintains, “We must be aware of the national backlash against so many of the communities we serve, especially those of trans experience. [In Louisiana] I witnessed the impact of clinics that provided reproductive health services and gender-affirming care shuttered due to the politics of hate.”

Manager of Gender Health and Wellness Programs Mita Beach has witnessed the chilling effects the anti-trans backlash has had locally.

“In all of Southern California, there are two clinics in L.A., one clinic in San Diego, and our clinic in Palm Springs that will see trans youth,” they say, adding that there were two or three more in 2021, but providers are being “scared away” by the criminalization of trans care.

Anthony Velasco, a senior nurse practitioner specialist who led the development of DAP Health’s gender wellness program, explains, “In my research on stigma and primary care access among transgender and gender-diverse people, many reported experiencing violence and victimization when accessing care.”

DAP Health aims to turn that tide and improve access to gender-affirming medical care across Southern California.

“Creating safe spaces for all people, regardless of their gender identities” is a natural extension for DAP Health, Velasco says. “We exercise social justice by continuously engaging our communities, interrogating social injustices, and addressing health inequities.”

The same could be said for Velasco, who uses he/they pronouns. He identifies as a “queer person of color, an immigrant, and a first-generation student” who provides care for “systemically and historically minoritized communities.”

Now that DAP Health has absorbed the Borrego Health system, it is poised to further elevate lifesaving genderaffirming care with Cathedral City’s LGBTQ+ clinic Stonewall Medical Center. Dr. Jason Halperin will be leading that charge

As trans people, families with trans kids, and trans adults flee other states, DAP Health is committed to boosting Stonewall Center’s beacon and serving as a safe haven where care is accessible to everyone.

The nonprofit already has “a proven track record of shifting the norm to a more equitable one,” Velasco says. “As we expand our clinics within and around the Coachella Valley, we continue to be committed to opening our doors even wider so we can provide more services to our trans and gender-diverse patients.”

Empowering trans, nonbinary, and other gender-expansive people to walk through DAP Health’s doors is Beach’s job. There are numerous barriers to care that trans and nonbinary folks face, including social determinants of health like lower incomes and lack of transportation.

Just connecting isolated trans and nonbinary folks with each other is difficult in rural areas with a widely dispersed population, says Beach. Another issue is “misinformation in general,” they say. Many don’t know what care is available, or that it is accessible, even for those who need financial assistance.

To overcome those hurdles, Beach has done outreach at every LGBTQ+ event they could find. “I would go and put up posters and signs at coffee shops out in the middle of nowhere, and I would get one or two phone calls,” they say.

Senior Nurse Practitioner Specialist Anthony Velasco

Manager of Gender Health and Wellness Programs Mita Beach

Director of Specialty Programs Dr. Jason Halperin

“But a lot of it is word of mouth.” Beach thinks DAP Health’s track record of “engaging with the community outside of the clinic’s doors” will help spread the word about safe, accessible, and competent gender-affirming care.

Even before the two federally qualified health centers had joined forces, DAP Health’s gender wellness initiative had begun to make inroads.

“We were able to increase the number of actively engaged transgender and gender-diverse patients by more than 400%,” Velasco adds. “Creating an interdisciplinary team and grounding our program using a trauma-informed and patientcentered approach was critical.”

Working with different departments within DAP Health was also crucial in meeting the psychosocial needs of patients, like “housing, social services, access to food, care navigation,” Velasco says. And, with the expansion of DAP Health, “we will be able to offer these services to more trans people.”

Beach is there to connect trans people to appropriate care even before they arrive. They help patients overcome their fears and share relevant details with providers. Making

potential clients feel welcome also takes representation.

“From the front desk to the provider, somewhere in that chain, we have to have some trans and gender-diverse folks.”

Beach, who is nonbinary and queer, is personally dedicated to that effort, currently studying to become a nurse practitioner “because I don’t see enough people that look like me.”

Of course, providing competent gender-affirming medical care isn’t as easy as hiring a few trans or nonbinary folks. Providers need to understand trans care, and how it differs.

“Trans health care isn’t typical health care,” Beach explains. “Typically, when people go to the clinic, it’s because they’re sick or because they have to go once a year for a checkup.” But trans people often need to see a provider more frequently, especially if they are receiving gender-affirming hormone therapy, which needs to be monitored.

Circumstances can also complicate access to care, especially the dysphoria that can exist in a physical body that doesn’t reflect one’s true gender. For example, Velasco points to one study on cervical cancer screenings. When retesting was necessary, trans men waited nearly 420 days, compared to the 80 days cisgender women wait.

IL MAESTRO AT THE CASH REGISTER

VOLUNTEER PHIL MCKINLEY LIVES A DOUBLE LIFE AT DAP HEALTH’S PALM DESERT REVIVALS.

Not long ago, Phil McKinley had a magical moment at the Palm Desert Revivals store where he volunteers. “A guy came up to the register with a beautiful midcentury lamp. We had it priced at 30 bucks,” laughs McKinley, who has been donating his time for four years. The customer used the image search feature on his phone and showed McKinley similar lamps. “He didn’t know if it was real or not. I said, ‘Go home and steam the felt off the bottom and see if there’s a signature. If it’s there, you have a $4,600 lamp.’”

A self-avowed shopaholic, McKinley recalls developing a keen eye for bargains growing up in the small farming community of Avon, Illinois. Many years later, one of his oldest friends in Beverly Hills introduced him to consignment shopping, and he was instantly smitten by the pre-loved.

When he and his partner, David, bought their home in Rancho Mirage in 2016, he became a regular at Misty’s Consignments. On a tour of his lovely, midcentury gem that Frank Sinatra built as a gift to his daughter, Tina — but that she declined, leaving Sinatra to let visiting musicians use it — McKinley points out some particularly spectacular finds, such as the $14,000 sectional sofa they got for $840, and a rare koa wood rocker from Hawaii that he bought for pocket change and was later appraised at over $7,500. “The whole house is practically Misty’s,” he says. “I said to Misty, ‘Want to come over and see

what we bought from you?’ We had Misty and her whole crew over for a party.”

McKinley’s Highway 111 perambulations soon made him a regular at Revivals’ Cathedral City and Palm Desert locations. He got to know Steve, the store manager, who pulled him aside one day and suggested he become a volunteer. Given his Midwestern values, it made sense. His father was a volunteer fireman, and his mother was on the local board of education. McKinley had volunteered at a mental health facility during college.

The problem was his rather demanding day job.

Words by Kent Black • Photos by Lani Garfield • Spiderman Images Courtesy of Phil McKinley

Philip Wm. McKinley

is a theatre director, choreographer, writer, and producer who has staged plays and spectacles from Broadway to Tokyo to Salzburg. Among his nearly countless productions have been “Spiderman: Turn Off the Dark,” one of the 20 all-time highest-grossing productions in Broadway history. His direction of “The Boy from Oz” with Hugh Jackman garnered five Tony nominations, and his production of “Zombie Prom” became a legendary off-Broadway cult classic.

successful ascension of that city’s theatrical ladder.

When McKinley met DAP Health Volunteer Services Manager Marcie Lerner, he decided not to reveal his occupation, only that he was out of town quite often. Lerner told him they had a lot of snowbird volunteers. He could come in whenever he had the time.

Not

He staged “Ben Hur Live” in Europe with 350 actors and 100 animal performers, and directed seven editions of the Ringling Brothers and Barnum & Bailey’s “The Greatest Show on Earth.” Along the way, he has picked up five Tony nominations, seven Barrymore nominations, an Emmy nomination, and a treasure chest of other awards.

long ago, a shopper came to the register, excited at his rare find: a mint

condition program from ‘Spiderman: Turn Off the Dark.’

A co-worker opened the program to the title page and asked if the customer wanted the program signed by the director. My co-worker pointed to me and said, ‘He’s standing behind the register over there.’

McKinley says he had an idyllic, smalltown childhood. He and his playmates put on theatrical productions in the barn next door. “We’d invite all the neighborhood ladies and sell them lemonade.”

He took piano from two elderly spinsters, and recalls staining their piano keys red from picking raspberries in their yard while his sisters had their lessons.

He went off to Augustana College, where he emerged with a degree in education and a job offer to teach junior high school near Las Vegas. One day, a teaching colleague slapped down a flyer for auditions being held at the Stardust and dared McKinley to take a chance. He got the job.

For the next several years, he sang, danced, did comedy for shows three times per day, seven days a week, no vacations. He once performed hours after having all four wisdom teeth out. He fainted offstage after the first number, but was revived and made it out for his second number. He was unfazed. “It wasn’t a job…it was a career.”

After meeting David, his partner convinced him to move to New York. They did, and McKinley began his highly

McKinley found his groove at the Palm Desert store, and says he especially looks forward to working Sunday mornings with Lauren, a young volunteer, whom he helps with sorting through designer clothes. “I love my team,” he says, “And I love my customers. They’re such characters. Colleen Heidemann became a Vogue model when she was 69. She’s a regular Revivals shopper. Whenever she comes in, she’s dressed to the nines.”

McKinley says the community he has found in the Palm Desert store strikes a familiar emotional chord in his Midwestern heart. He recalls Tom, the store’s greeter, who sat in a chair at the front, wearing a funny hat, and welcoming everyone who walked in the door. He’s in awe of Carol, who started as a shopper, and has become a hugely popular jewelry maker. And there’s Connie, a 97-year-old staff member who comes in every day. “She’s a teeny tiny thing, but she does everything…works as cashier, works in the back, you name it. She’s phenomenal.”

For the most part, McKinley manages to keep his superhero/ impresario identity under wraps at Revivals, though every once in a while, worlds collide. Not long ago, a shopper came to the register, excited at his rare find: a mint condition program from “Spiderman: Turn Off the Dark.”

“A co-worker opened the program to the title page and asked if the customer wanted the program signed by the director,” McKinley recalls. “My co-worker pointed to me and said, ‘He’s standing behind the register over there.’ We had a good laugh. That was a fun moment.”

Left to right: Volunteers David Leigh and Connie Lobo, McKinley, Revivals Palm Desert Manager Douglas Marriott, volunteer Lauren Boyd.

McKinley backstage with Patrick Paige as the Green Goblin and Reeve Carney as Spider-Man during a New Year’s Eve 2011 performance of “Spider-Man: Turn Off the Dark” at Broadway’s Foxwoods Theatre, now known as the Lyric Theatre. That’s Anderson Cooper in the background.

Spend Less. Decorate More.

Find yourself at

Let’sStopthe

ShameGame

— AND HOW TO OVERCOME IT.

Words by Maggie Downs

Consider a virtual appointment rather than an in-person one. “Telehealth allows people to approach care in a different way,” says Dr. Gandy. “It removes some of the barriers that come from going into a clinic or doctor’s office, so they can have a different experience.”

Shift how you think about and discuss your medical issue. “People will come into the clinic and say, ‘I was bad’ or ‘I was dumb,’ and I have to say, ‘Stop,’” Daymon stresses. “‘It’s just sex. Let’s take care of you.’”

Make a list of things you’d like to talk about. Inside a medical office, it can be easy to get overwhelmed and forget about the questions you’d like to ask or issues you want to discuss. Having a list will help you stick to your agenda for the visit and can boost your confidence by giving you talking points.

Remind yourself that your health is the most valuable thing, and that you matter. “We’re pretty hard on ourselves,” Daymon says. “And there are so many people in the world who are going to be hard on us, let’s not be one of those people.”

Be part of the change. Although this step goes beyond the individual, all of us can play a role in helping to change societal attitudes in a positive way. According to Dr. Gandy, what we need to ask ourselves is this: “What can we do as a community to help normalize seeking care, and increase awareness about mental health, spiritual health, emotional health, and physical health — everything that goes into overall well-being?”

Shame is so pervasive, so corrosive of the self and so potentially detrimental to health, that there is considerable utility in considering it an affective determinant of health.

CAREGIVING FOR THE CAREGIVERS

HOW DAP HEALTH’S APPROACH CAN BE A MODEL FOR OTHERS.

Words by Maggie Downs

Even if you’re not a caregiver now, there’s a good chance you’ll fill the role someday. Currently, more than one in five Americans provide unpaid care for an adult or child with special needs, according to a 2020 report from AARP and the National Alliance for Caregiving. That’s an estimated 53 million U.S. adults, a dramatic increase from 43.5 million in 2015.

It’s exhausting and challenging work: Navigating the health care system, scheduling appointments, and tending to the health, safety, and comfort of another person, often while juggling another job and one’s own home life. No wonder people have likened caregiving to on-the-job training where nobody has a manual.

Then there’s caregiving during a global pandemic. It’s stressful enough to care for another person even during the best of conditions, but COVID-19 added layers of fear, anxiety, and isolation to an already difficult task.

These were the same challenges faced by the professional caregivers — the physicians, nurses, and care team members who have guided us through these tumultuous times.

“The COVID situation was different from anything else a care provider might experience,” says DAP Health Chief Academic and Medical Service Officer Carol Wood, who previously served for six years as the organization’s chief of clinical operations.

DAP HEALTH’S PARTNERSHIP WITH FIND FOOD BANK AIMS TO ADDRESS ONE OF THE MOST SERIOUS SOCIAL DETERMINANTS OF HEALTH: FOOD INSECURITY.

Words by Jim Macak

Angela (not her real name) is middle-aged and permanently disabled with back injuries due to a work-related accident. She gets by with help from federal and state benefit programs. This includes an electronic benefits card from CalFresh (formerly the food stamp program) that allows her to spend $281 each month at grocery stores — a welcome benefit, she says, but not nearly enough to cover inflated food costs.

Several years ago, Angela also started going to a DAP Health nurse practitioner whom she praises not only for the care he provides but for his genuine concern. Her already-favorable impression received an additional boost in June when that nurse practitioner was troubled by a spike in Angela’s blood sugar levels and broached the subject of her limited diet.

Another nurse, as a follow-up, approached Angela and asked if she was aware of DAP Health’s food program. She said she wasn’t, and was soon provided with a large bag of food supplies: chunky mixed fruit, rice, beans, pasta, and more. “And I went, ‘Wow!’” she recalls. In July, Angela received a second bag from DAP Health.

This is not just another example of the nonprofit’s longstanding provision of social services, but a growing link between health care and food insecurity, defined by the U.S. Department of Agriculture as an inability to reliably access sufficient, nutritious, and affordable food. Food insecurity and the anxiety it causes can lead to binge eating once food is available, which can trigger diabetes, bulimia, and obesity.

The link between food insecurity and physical/psychological issues has prompted

Hunger

DAP Heath to take on a more aggressive role in dealing with this, according to Senior Director of Social Services Zayda Welden, who reports that every single patient — no matter what they come in for, no matter whether it’s their first appointment or not — gets assessed for food insecurity thanks to three questions: Have you eaten today? Are you in need of food? Would you like a bag of food to go?

According to Welden, from January through mid-July of 2023, 3,486 DAP Health patients were assessed for food insecurity, and 146 accepted bags of food.

On one particular day, the crowd of residents the unit’s presence usually attracts didn’t appear. Staff knocked on doors at the park, only to learn that border patrol agents had recently been in the area. Many residents were concerned about their legal status in the U.S. and were afraid of leaving their homes even to purchase food. Many hadn’t eaten in several days.

A case manager is also available to help patients apply for CalFresh benefits, or to provide referrals to FIND Food Bank — whose mission, according to findfoodbank. org, “is dedicated to relieving hunger, the causes of hunger, and

the problems associated with hunger through awareness, education, and mobilization of resources and community involvement,” and whose vision is “to create a community that is free of hunger and food insecurity.”

Additionally, one of FIND Food Bank’s mobile units stops by DAP Health’s main campus parking lot on the second Saturday of every month. There, FIND staff and volunteers work with DAP Health volunteers to distribute 60,000 pounds of food each year to patients and non-patients alike. Says Welden: “Anyone in the community can come in and enjoy fresh produce — for free!”

She points out that with DAP Health’s recent absorption of Borrego Health, the combined organization’s annual client base has shot up from about 10,000 to more than 100,000. In addition to its main campus, DAP has one mobile unit and a satellite sexual wellness clinic in Indio. Borrego Health brings with it seven more mobile units and 23 clinics in a two-county area.

Welden says her hope is to expand DAP Health’s food insecurity program organization-wide. “We’re definitely going to have to partnership in a more active way with FIND,” she says.

According to DAP Health Director of Mobile and SchoolBased Services Heidi Galicia, who also serves as the acting manager of Martha’s Village Clinic, a mobile unit makes stops at a mobile home park known for its immigrant community. On one particular day, the crowd of residents the unit’s presence usually attracts didn’t appear. Staff knocked on doors at the park, only to learn that border patrol agents had recently been in the area. Many residents were concerned

about their legal status in the U.S. and were afraid of leaving their homes even to purchase food. Many hadn’t eaten in several days. “Our supervisors got on the phone to FIND Food Bank,” Galicia says. “Within hours, we had FIND there, distributing food.”

Overall, FIND helps 125,000 to 150,000 people monthly access food supplies in Riverside, San Bernadino, and Imperial counties. That’s a sharp increase over the 90,000 it served before the COVID-19 pandemic. And though coronavirus restrictions have eased and the overall percentage of those unemployed has dropped, the number of individuals FIND helps hasn’t decreased, according to FIND Food Bank President and CEO Debbie Espinosa. To her, the reason for this is simple: The cost of food, rent, gas, and utilities has increased substantially. “So even if you have employed people in these circumstances,” she says, “they’re called ‘under-employed.’” They’re simply not making enough money to make ends meet.

While DAP Health patients who suffer from food insecurity are offered staples and referred to FIND Food Bank for more, FIND, in turn, offers referrals to DAP Health for those suffering from physical and mental distress.

DAP Health is a federally qualified health center (FQHC) that receives government subsidies to treat low-income residents. Those who lack insurance are offered a sliding fee scale based on income. According to Community Education and Enrollment Manager Joanna Ibarra, “it makes our services even more affordable for patients.”

FIND’s Espinosa says she’s very interested in seeing how DAP Health further expands services — particularly in terms of food insecurity — and how, teaming with her organization, “we can help in creative and innovative ways to keep up with our community’s changing environment.”

Do You Suffer From Food Insecurity?

Take this short U.S. Department of Agriculture (USDA) survey — and add up the points next to your answers — to find out.

In the last six months, is the following statement often, sometimes, or never true for you? “The food that I bought just didn’t last, and I didn’t have the money to get more.”

Often (1)

Sometimes (1)

Never (0)

In the last six months, is the following statement often, sometimes, or never true for you? “I couldn’t afford to eat balanced meals.”

Often (1)

Sometimes (1)

Never (0)

In the last six months, did you ever cut the size of your meals, or skip meals, because there wasn’t enough money for food?

Yes (1)

No (0)

If you answered “Yes” to the previous question, how often did this happen?

Almost every month (1)

Some months, but not every month (1)

Only one or two months (0)

In the last six months, did you ever eat less than you felt you should because there wasn’t enough money for food?

Yes (1)

No (0)

In the last six months, were you ever hungry but didn’t eat because there wasn’t enough money for food?

Yes (1)

No (0)

Results

Score 0: Low food insecurity

Score 1: Medium food insecurity

Score 2-4: High food insecurity

Score 5-6: Very high food insecurity

THE BENEFITS OF BECOMING A SOCIAL BUTTERFLY

JOINING A CLUB OR VOLUNTEERING FOR A NONPROFIT SUCH AS DAP HEALTH GETS YOU OUT OF THE HOUSE, INTRODUCES YOU TO NEW PEOPLE, GIVES YOU A PURPOSE, AND LIFTS YOUR SPIRITS.

Words by Staci Backauskas • Photos by Zach Ivey

Even though most major COVID-19 restrictions have ended, the isolation and loneliness caused by them linger for many of us.

Being disconnected from the important people and meaningful experiences in our lives was traumatic. In addition, there was no distraction from the weariness, which raised questions about careers, relationships, and other important life choices. Then there was the worry and fear as we watched the virus spread through the world. No wonder we’re still feeling it.

Whether existential or literal, the issues the pandemic created contributed to more people seeking mental health treatment across the country. The Centers for Disease Control and Prevention (CDC) report those numbers increased across the board from 2019 to 2021, with a 5% jump in adults 18 to 44, while 46% of seniors said virus-related worries had a negative impact on their mental health, according to the National Institutes for Health.

Then there’s this late breaking news as we go to press: According to the CDC, the rates of death by suicide in this country are at an all-time high.

The hope was that when it was all over, we would return to our lives already in progress, no worse for the wear. Unfortunately, that hasn’t always been the case.

“The fact that a lot of things were shut down created, and highlighted, what isolation and loneliness look and feel like,” says DAP Health Director of Behavioral Health Sharareh Gandy, Psy.D. “There was a disconnect among people and communities, and we saw a lot more depression and anxiety surfacing as a result.”

Two years past the worst of the shutdown, how do we rebuild connection and community — and reap all of those benefits?

According to the Center for Compassion and Altruism Research and Education at Stanford University, healthy social connection strengthens the immune system, improves recovery time from health challenges, and may even lengthen your life.

Dr. Gandy agrees. “I think our human nature in general is to feel connected,” she says, adding that how we define that connectedness looks very different for each of us.

For some, it means building a relationship with a higher power, or finding new hobbies that provide the opportunity to be around like-minded people. Others plan more frequent get-togethers with family and friends. Then there are those who feel more connected by volunteering.

“I enjoy volunteering to assist the LGBTQIA+ community — my community — to survive and thrive,” says Jerry Hanson, who’s been giving of his time and talents at DAP Health for seven years, going so far as to use his skills and knowledge to help redesign the software for the volunteer program. “I love that [DAP Health] provides a safe, open place to just be who we are, the way we are, in a non-judgmental environment.”

Jo Person is a recent addition to the volunteer team who splits her time between the Condom Club (preparing packets with condoms and lube that are distributed throughout the Coachella Valley) and the welcome desk (where she greets and helps patients and other visitors). Recently retired, Person

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