- Dr. Billy Ray Thomas
Maybe it's because his parents were sharecroppers. That he grew up Tyronza, one of 12 children. That he was one of the first in his family to go to college. That he knows what it was like to be different from the mainstream student at the University of Arkansas for Medical Sciences, what it's like to be a minority on staff.
Dr. Billy Ray Thomas, neonatologist at UAMS and head of its Center for Diversity Affairs, knows that while access to medical care is increasing, thanks to the Affordable Care Act, and that Arkansas hopes to improve the quality of health care with its medical home initiative, there are other reasons that stand in the way of a healthy populace. Half of his job (the other half in the neonatal intensive care unit) is figuring out how to serve the demographic of the population "moving into the insured realm" whose fears of being discriminated against, or lack of familiarity with the system, mean that accessibility doesn't translate to actual care. And how can UAMS attract more to the profession of medicine who understand these fears, people who can communicate with minority populations — African American, Hispanic, gay, transgender, the disabled, people of minority faiths like Muslims, etc. — and can make them comfortable and open about their medical concerns.
UAMS open its Office of Minority Affairs in the 1970s, when the focus for equality was on race. Now, as the Center for Diversity Affairs, the office is concerned with all "marginalized populations," Thomas said. "At the heart of what we do is try to find, recruit and retain disadvantaged and minority students. ... Not just because we need to be diverse. The value is a diverse health care workforce does a better job of taking care of a diverse population."
In the 2013-14 class at UAMS, only 4.7 percent of students were African American, a percentage that has actually decreased in the past five years. The numbers of Hispanic or Latino students has ranged between 1.3 and 3 percent since the 2008-09 school year.
Training faculty and doctors in what Thomas calls cultural competency "is one of the hardest things of any institution," Thomas said. "There are institutions with bits and pieces of programs, and we have an early beginning of a program." Where do you start? With faculty? Students? Cultural competence can't be taught in a lecture hall, the doctor said; "it has to be experiential. ... I think what we're facing here is people don't have a real sense of the health disparities that exist."
For the LGBT population, that includes more depression, suicidal thoughts, drinking, smoking and drug abuse. It means reluctance to visit a doctor or share intimate information. As attendees heard at a conference on caring for LGBT patients at UAMS in January, the LGBT population has a higher risk of homelessness, especially among young transgender females. Lesbians have higher rates of obesity and breast cancer and a lower use of preventative health services. Gay and lesbian children are more likely to have been bullied or the victim of violence. Older transgender patients may suffer ill effects from using hormones long term. There is the issue of HIV/AIDs and stigmatization.
One of the Center for Diversity Affairs' top programs now is its summer mentored research programs. "I think that has made the biggest difference in us being able to attract and retain [minority medical] students," Thomas said. The Center also has science programs that target K-12 students.
"I do think we're making some headway; things will blossom in the next three to five years if we can get past [UAMS budget difficulties]."
Thomas' clinical focus targets another subpopulation: premature and sick full-term babies. During a visit to the neonatal intensive care unit at the UAMS Medical Center, Becky Sartini, head of the NICU, handed Thomas a tiny, beautiful baby born six weeks premature. As Thomas cradled the infant, Sartini made gentle fun of him. He can put a breathing tube in with no problem, she tells a reporter, but he looks a little tentative holding that tiny baby.
One of the reasons Thomas, who did his post-grad fellowship at Case Western Reserve, likes his job, he said, is the people in the nursery, "like-minded" people who care for their delicate charges and who, like him, want to get babies past the acute crisis and give them a chance at "another 80 years."
When Thomas, 61, was doing his fellowship, babies under 700 to 750 grams (about a pound and a half) did not survive, he said. Viability is now at 500 grams (a little over a pound). That's possible thanks to early and good prenatal care for the mother that makes the womb a healthy place for the at-risk fetus, as well as new meds that make up for the lack of secretions in little lungs that keep them from working properly.
Babies born prematurely have a high risk of neurological and developmental problems. Babies born at only 25 weeks gestation can develop normally, "but numbers are low," because of the likelihood of brain bleeds, risk of infection and oxygen deprivation.
Given that, how early is too early to save a baby? "I don't think we're close to answering that question," Thomas said. "I think it's a good thing that we save their lives. We know a large number will have productive, quality lives." The most important thing for a baby's development, he said, is getting a team in place — doctors, the family and social workers — to make a plan.