Category Archives for interviews

Dr. Holder Creating A Better Future

Dr. Cheryl Holder

M.D., The George Washington University School of Medicine, Washington,D.C.
Resident, Internal Medicine, Harlem Hospital, New York, New York
Fellowship, Community Clinical Skills Scholar, Department of Family Medicine, University of
Miami, Miami, Florida

Specialties

Internal Medicine
HIV

Biography

Dr. Holder commenced her career in medicine as a National Health Service Corp Scholar in 1987 working for medically underserved communities in Miami-Dade County. Under the tutelage of Dr. Lynn Carmichael, known as the “father of Family Medicine,” Dr. Holder
supervised University of Miami Family Medicine Residents during their Internal Medicine rotation at Jackson Memorial Hospital.

From 1990 to 2009, Dr. Holder served as Medical Director for Jackson Health System’s North Dade Health Center, which is located in one of
Green Family Foundation Neighborhood HELPTM’s target communities. As Medical Director, she developed a HIV care and treatment program with funding through the Ryan White Care Act. She has participated in various CDC and NIH advisory and programmatic review panels
for HIV treatment and vaccine research. Furthermore, Dr. Holder directed the first school-based health center in Miami-Dade County, founded the Florida Coalition for School-based Health Care services, and participated in the effort to expand school-based health care in
Miami-Dade County. Based on her community work, she received the Robert Wood Johnson Community Health Leader Award in 1995 and continues to receive leadership development support from the foundation. Dr. Holder has devoted her medical career to serving underserved populations. In September 2009, she joined the Herbert Wertheim College of Medicine and is focused on teaching medical students about working in underserved communities. Her interests include community- and school-based health care, HIV medicine, and medical school pipeline programs to promote diversity. Dr. Cheryl Holder is the Director for the Period 1 Primary Care Preceptorship, which is part of the Clinical Skills Course.

Select Publications

1. Cheryl Holder and Liliane Nerette Louis. “Pumpkin Soup is for Sunday” EducaVision Inc.,
2010.
2. “Girls Are Most At Risk”, Miami Herald, Thursday, November 12, 1998.
3. Cornwall-Jones, C.A., Holder, C.L. “Early Olfactory Learning is Influenced by Sex in
Hamsters But not Rats”.Physical Behavior, 1979, Dec. 23 (B), 1835-48.
4. Botelho, R, Engle,B, Mora, J, Holder, C. Brief Interventions for Alcohol Misuse Primary
Care Clinics in Office Practice 38 (2011) 105-123

 

TRANSCRIPT OF INTERVIEW:

[Armando Cruz]  Hi, this is Armando Cruz, and welcome to Success Spotlight. Today, I have the privilege to introduce you to Dr. Cheryl Holder, and I wanted to tell you a little bit about what she’s done (before I get her on the line). She’s a graduate of George Washington University, she did a residency at Harlem Hospital, and she’s worked here at the University of Miami as a fellowship and a community clinical school scholar, and is currently at FIU. Now, Dr. Holder worked from 1990 to 2009 as a medical director for Jackson Health System. She’s worked with different families and family programs, as well as helped to establish a lot of areas in HIV. She’s really reaching out especially to our Miami community. So, I want to welcome her. Dr. Holder, how are you?

 

[Dr. Cheryl Holder] Thank-you, Armando, for having me.

 

[Armando Cruz]  Oh, it truly is a pleasure.

 

[Dr. Cheryl Holder] Yeah. So, tell me more about your program.

 

[Armando Cruz]  I’m sorry, say that again?

 

[Dr. Cheryl Holder] If you could just tell me a little bit more about your program and what we hope to accomplish today…

 

[Armando Cruz]  Yeah, sure, so, my idea was for us to have a brief conversation, I’ve mentioned—we met at a panel that FIU had for students interested in the health field, and one of the things that really impacted me was your life story and why you do things. And one of the biggest things that I always talk about to everybody is how important passion is towards achieving whatever goal…and when I heard you speak, I heard you speak with something that unfortunately, I don’t hear from a lot of doctors and from a lot of other professionals out there. So, one of the things that I would love for you to do is maybe share a little bit of that story, why you decided to become a doctor, and we’ll just take it from there.

 

[Dr. Cheryl Holder] Ok. Well, I am pretty lucky—I’m one of those folks who my life mission and everything that I wanted to do perfectly aligns with what I do day to day—so, I love taking care of patients and I love working to improve health. It’s what I’ve wanted to do for as long as I can remember—I think I was telling the story of what kind of always sets into my mind, what’s pushes me to want to make a difference, and when I was a young girl, I had come to this country from Jamaica, I was about nine, ten, and we lived in East Ney York, Brooklyn, and that is a very poor community, very different. We have Spanish, Caribbean blacks, a few whites, American blacks, everybody sort of living in this interesting community. And one of the fun things that the kids did since there weren’t many playgrounds and you kind of just stayed on your stoop, kids would jump on the back of a city bus, at the top of the block, and jump off at the bottom of the block…and unfortunately, one day this little girl jumped off and fell and hit the back of her head and she just laid there…and it seemed like an eternity to me—I mean, I was young, so it may not have been more than a few hours, maybe 20-30 minutes, but it seemed like hours. The only thing I remember was that everybody on the block kept calling the police, calling the ambulance, calling somebody for help, and nothing came. No fire truck, no ambulance, nothing. SO the police showed up and they waited, picked her up, pout her in the car, unconscious, and took her off. I just kind of always remember how everybody—how we all felt so helpless and we all thought she’d passed. I don’t know what happened in the end, but there was a feeling that maybe there was something we could do, maybe something better. So, it just continued on where  I ended up in science, and worked in another area, another poor community in Queens, called South Jamaica—and it was much the same thing repeating—and just knowing there was something else we could do better. And I also enjoy people, working with people and making a little difference. I may not have made tremendous changes, this is almost thirty years of my career, but I thought I’ve just chipped away one person at a time, just a little bit—and I’ve been very fortunate that I’ve had some successes. But jus day-to-day, going in and working with people who are trying to do their best—and we try to do our best. So, over time, we just do what we can. But I’ve been fortunate; I’ve been pretty blessed about this.

 

[Armando Cruz]   …and you, I was just going to ask, I think you mentioned something that is worth repeating, you mentioned your life mission aligns with what you do on a day to day basis, and from what it sounds like, somebody may say, oh, you know, wow, she got lucky. I really don’t believe that that was luck, you took the initiative and did all these things with the help of other people, and yeah, there were things that helped you along the way…but did you think that was luck, in your point of view, or do you think you created that luck by your experiences, and what you decided to do—the actions you took?

 

[Dr. Cheryl Holder] Well, it’s both. Success is opportunity with preparation. Because I could be incredibly prepared to do all of those and not have lots of opportunity, so in one sense, the opportunities come in how society aligns itself with what I want to do, so I never see it as one or the other. You’re right, it’s not all luck, it is a combination of just being in the right place, the right time, and being prepared…being a physician, it’s a lot of years of studying and working and sacrificing, so I could make each step. I always tell kids that I would go to parties like everybody else, but I may have only gone for two hours, and I’d go at the right times and made sure I got home to get some sleep so I could get up and do my work, so, some folks will go partying all night, and do everything, and not be able to do that balance. But then again, I also love studying, I love reading. My mom always said I would always be buried in a book…and I would use my book to get out of my household chores. That’s what I enjoyed doing. Again, my brain and the way I learn, and what I like match how society rewards things—but I do feel it is opportunity and preparation, and whether it’s luck or God, it’s definitely all has to come together. I’ve been a physician since 1984, I’ve seen a lot of incredibly talented people, really brilliant people, much more brilliant than I’ve ever been, and they just didn’t become successful. They were in different circumstances, born in a way that they didn’t get the support they needed at the time they needed it to make that next step. Hello?

 

[Dr. Cheryl Holder] Yes, sorry, my call just dropped. I’m sorry; I missed a little chunk of it…

 

[Armando Cruz] Oh, ok. What was the last thing that you just said?

 

[Dr. Cheryl Holder] Were you recording?

 

[Armando Cruz]  Yes.

 

[Dr. Cheryl Holder] Except, I’ve seen people who’ve had lots of—they’re just really bright, talented people, yet they haven’t been successful because they haven’t had the opportunities that I’ve had.

 

[Armando Cruz]  Right.

 

[Dr. Cheryl Holder] And just things haven’t been perfectly aligned for them. So, I know it’s a combination, but you can’t avoid being prepared. You have to be prepared. But I mean, you have to do your part, and it’s easier when you find what you’re really passionate about.

 

[Armando Cruz]  So, being a doctor, would you say being a doctor is what makes you passionate about it, or is the fact that you get to help people? Is it more the concept of helping the people makes you passionate, or the doctor part?

 

[Dr. Cheryl Holder] You know, it’s both, because—you can help people in so many ways. I could’ve helped them being a nurse, I could’ve helped them being a teacher, and I could help them the way you’re helping. But what is it about medicine that is different? And that’s been, for me, because I’ve always like sciences, I like the challenges, I like thinking about different processes and trying to put the puzzle together to see how then I can make this person healthier… So in many ways, the field is exciting to me. I’m constantly reading medical journals, and unless I had an interest in the field, I definitely wouldn’t stay in it. So, it’s both that medicine offers me that opportunity that nothing else would as the vehicle to do my work, so…I couldn’t do what I do without being a doctor, as well as I do, because it is in itself inherently a challenging, interesting field that everyday is rewarding to me, and then I can also help. So, it’s a combination. The medicine is important.

 

[Armando Cruz] And so, what do you, as a doctor, what is your approach in serving others as a doctor and as a person. Possibly, how has that changed throughout the years as you’ve been practicing?

 

[Dr. Cheryl Holder] Well, I don’t know if it’s changed or if I’ve improved what my basic desire has been, which has been, from my thinking back just wanting to help that girl and making sure that she gets the care with dignity, you know? There’s no reason anyone should sit and wait for an ambulance and wait for healthcare. In a situation when you’re capable—I know there’re some places in the world where it’s just not possible, but if you can, you should. We’re living in a society that is capable of responding, and then, why can’t we make sure that we find a way to do it well—do it kindly, do it with care, do it with compassion? So that’s what I do, and try every day that whoever I meet, whoever I care for, they’re going to get the best that we can; compassionate care, understanding care, accepting them for who they are, understanding what they want.

 

[Armando Cruz]And so, you’re explaining this to me, and I’ve seen this, but it sounds almost common sense, as a doctor, that those would be the principles and the values that you want. I would say as a person, those would seem almost values that everyone should have, but it’s not that common, that common-sense…

 

[Dr. Cheryl Holder] Everything gets in the way. Now, with all the pressures, the pages of bills, the means and the ways we’re reimbursed, we can’t spend the time—just to translate all of this takes time. We often in medicine are being pressured to not have something as valuable as time. It’s great to say I’m compassionate, but if I have five minutes to get a whole story, diagnose and treat and then send you out, you’re not going to feel it very well. So that’s what’s happened to medicine in many ways that we have not been able to get control of what is important to really achieve our goals. We had it for a while, but now everybody knows the economics, and physicians are feeling that pressure. Many times, our training has caused some changes, as we’ve done studies that when the students come to medical school, their compassion score is really high, but by the time they leave, it’s dropped. Something has happened. So now, we’re changing how we’re teaching, we’re trying to have students understand the patients a little bit more, being able to sort of overcome the barriers that we have. Yes, we have time, but how to be effective, efficient within the time limit, and still be able to communicate to our patients that we understand and we care. Sometimes, we’ve found that very simple—if you don’t interrupt your patient in the first minute or two, you’d be amazed by how much the patient feels differently. So, even if you have only 5 or 10minutes, if you didn’t interrupt them the first minute, it’s a whole different experience. So, we want to get back to how things used to be, we want to be able to spend more time with our patients, and that’s why we’re hoping how medicine gets reimbursed and we define quality gets changed a bit…but until then, we’re looking at different ways we can improve that encounter, so that the physicians don’t come across so callous, even though most doctors, I know, are not.

 

[Armando Cruz]  Right. I see that, and I know as a physical therapist, we briefly talked about this, the same thing is happening in physical therapy realm, so obviously, in this particular, we’re talking about something more global, just the whole system…there are always those people who are outside that box, who are different. I’ve heard of different doctors creating their own payment system. Now, granted, it tends to lead toward being able to attract people with means, that they can pay for it, so in that sense what they end up paying for is obviously the expertise, but they also are paying for the attention, whereas now you can focus a little bit more. Do you think that the medical community as a whole should start exploring something like this, or, do you foresee that the way the medical system is going right now, has to be completely redone, or tweaked in different aspects, would you say?

 

[Dr. Cheryl Holder] Well, you know, I’ll be honest. I come from a poor background where many of my family has never been insured, so we’ve had to undergo longs waits, lots of problems, and so I’ve seen it from both ends. I’ve seen it from the side where we have no resources, and now I’m fortunate enough that I’m a physician, I have health insurance—and I’ve seen it from that side. So, I think the system that will work with this culture—and that’s also part of what we teach at FIU—is understanding the culture, and understanding what works best for people within the culture. For me an ideal esteem would be a single payer, where it streamlines the paper work, and we develop the system to just pay for the care overall, not this individual billing and finding a way to make it work…but that’s not going to happen, because that’s not American culture…so within the American culture, then I see finding ways to tweak it, finding ways to get more people insured. If we had more people insured, we wouldn’t have this pressure to get the few paying people in our doors and have the few paying people cover the bills for everybody else, which is what is happening now. So, until that happens—and I don’t know what’s going to happen with the affordable care act, which offered a way for more people to get insured than any other act out there—until that happens, there are going to be many, many ways. And for physicians who try the VIP model, you know, if it brings them back to their ethical responsibility in the way they see as best, I have to support them. For other physicians who work on the HMO model, because they feel it might give them the flexibility, what I see as supporting every physician and finding a way to practice method in the most ethical, appropriate manner that guarantees the most healthcare for all the patients that we serve. To that end, right now, it’s going to be many other ways. One of my biggest problems—you asked me about what I see is the worst thing every day—is when folks are uninsured. I work at Jackson two days a week. One day I work with the insured, the second day I work with the uninsured. With the uninsured, I had a patient who came in with a stage four of a malignancy, that’s the worst stage…and I’m like, what happened? This is a working man, and he kept putting off that he was feeling weak because he had to support his family. He was only able to take off when everything got so bad, but he was able to have his son help him out on his job. So here it is, this guy had a possible diagnosis that could’ve been treatable. Now, if he had had insurance or someway to access healthcare in our system, and not wait, we could’ve saved him, his family, he’s only in his 50’s, and this gentleman is going to have a premature death if the stage continues on. We could’ve prevented…and everyday, I deal with this, every time I work…so, for me, some of the biggest issues is trying to get folks access to physicians…because I don’t see physicians as taking care of sick people only… our goal is to get you when you’re well and keep you well, and we need to change that whole concept of ‘sick,’ you know? You only come to the doctor when you’re sick. If we could get rid of that whole way of thinking, that whole paradigm and change it into, you’re going to be well…everyone should see a physician, everyone has a right to healthcare, everyone is going to use the service, because our goal is to keep you well, not to treat you when you’re sick. To me, that’s the whole problem with the whole healthcare discussion; because they’re talking about, when you ever have to take advantage of healthcare…I’m like, what?! Everybody should be brought up saying, “that’s what I’m going to do, not wait until I’m sick.”

 

[Armando Cruz]  Right, right. It’s a cultural thing, though, because if someone, I think, were in Japan, that it’s flipped—in other words, as a physician, you don’t get paid for your sick patients, you only get paid to maintain your patients well…I would say that that would almost make more sense.

 

[Dr. Cheryl Holder] I agree.

 

[Armando Cruz]  [Laugh] Now, in order to do that, that’s something else, but I think that makes more sense.

 

[Dr. Cheryl Holder] Yeah, everyone would have to see their physician. So that’s your goal, is not to wait…and our society, like you said, supports that. I didn’t realize that’s how it was in Japan…

 

[Armando Cruz]  I don’t know if it still is, I heard it a while back, that that’s the way the system was, I’m not sure if it continues that way, but just thinking about it—there’s a whole mindset paradigm shift that our society and our culture is not really used to…it’s that what you’re saying, ‘alright, I’m not sick, I’m not going to the doctor.’ At the same time, often doctors, because they’re so pressured and they go to get moving, that’s what they end up focusing on because that’s what shows up…and so even the doctors at some point start relating their job to treating sick people and not keeping people healthy—because that’s all they see. When you’re exposed to something enough time, you almost start thinking in that way. I think what you just said was right on, and something for all of us—if we start focusing on health versus sickness, we’re going to be in a much better place.

 

[Dr. Cheryl Holder] That’s exactly, that to me is our big problem in our society. We just don’t understand health, and how we define health. Health is not absence of sickness. Our goal is from the day that baby is born, right through work; we’re all assigned to a physician. In my ideal world, we’d all have primary care—and that primary care, like you said, similar to that Japan system, I just Wikipedia’d it quickly to get the idea, and they’ve developed that system you described in 1961, where they provide universal healthcare and allows virtual access to pretty much a lot of preventative services from very early. And that does allow—and you see the life expectancy in Japan, it’s the best in the world.

 

[Armando Cruz] Right. I guess, it has the most centenarians…

 

[Dr. Cheryl Holder] Yeah, 86 for women…it’s some fact that from 1961, their whole system is focused on prevention and keeping you well—you’re going to live longer. There’s also this other fact in Japan that supports your health—their diet, their exercise, their whole culture…it does support how they live, but still, having access to healthcare…

 

[Armando Cruz] And it’s funny, because I was reading a book the other day and I can’t remember which one that I read it on, but the author was talking about being called as a consultant for a health fair for school, for the kids. And so he asked, what were the topics being presented in this health-fair, and so the person in charge said, “oh you know, we’re going to talk to them about diabetes and we’re going to talk to them about depression and all this…” and he goes, “well, this isn’t a health fair, this is a sick fair! You haven’t mentioned one thing of health, everything here, everyone has already got something, or it’s already in a negative frame. What if we repositioned everything in such a way where diabetes and depression don’t have to be part of the equation because we’ve addressed it with our whole lifestyle change?” I think that’s more along the lines of what you’re alluding to, that whole mind-set.

 

[Dr. Cheryl Holder] It’s perfect, that’s what we have to reframe in this country. You’re right, you go to a health fair, it’s not about hearing all the deathly diseases you’re going to have, it’s how can we prevent it—what can we do with your lifestyle. But lifestyle changes are difficult, we know it, but we have to be able to tackle things like this.

 

[Armando Cruz] Right, right. And so, now you are on the professors there at FIU, or you’re one of the chairs, or…

 

[Dr. Cheryl Holder] None, I’m one of the professors in the department of Humanities, Health and Society, and within that department—and that department works for what we call ‘medicine and society,’ one of our big courses—and so we show how to impact the non-biological factors, and those are things like education and where you live and all the different social determinates of health. How does that play into your then becoming ill? So, it’s not simply, yes, you may have a genetics that say you’re likely to become hypertensive, but what are the other factors that came together that pushed your genetics to show that you end up being with high-blood pressure, and that’s what we try and show and teach the students—that there are all these other factors that play a role. If you’re going to take on the whole patient and be a holistic provider, you have to understand more about that patient and the disease—and it’s not a disease, it’s a patient…they live within a community, they’re exposed to certain environmental issues, they’re so many factors there that you have to address in addition to what’s going on physiologically, to bring down that blood pressure. So we’ve tried now to bring all the factors together, so it’s not a complete disease model like we were talking about, but it’s really showing that holistic approach involving the community, involving wellness, and trying to prevent that illness from spreading across the community. So the entire community can understand that, this hypertension is obesity, this stuff is happening, but how can I then reorient my community that it becomes a more walking community, a more health-focused community, where it’s about having a farmer’s market, and exercise programs, and just getting more educated and trying to get better jobs. So we look at the whole factor involved, and we do this through a program called green family foundation neighborhood health program. We do a lot of classes, and it’s just the whole approach to medicine. That’s why I’m here, it’s again, another mission alignment where I’ve been very fortunate that this school came around at a time in my career when I wanted to do more than just the basic healthcare and do a community prevention programs, but bringing it back to the student and building it from the beginning, so the physicians understand this approach and have a chance to apply it to our training so that when they get out, they’ll be way ahead. They’ll know and advocate or, if I want my patient to lose weight, it’s not just giving them that weight loss pill. It’s then fighting from the sidewalk, fighting for programs in their community that’s going to help them to move. It gets a little bit bigger. It’s a great approach, and hopefully we’ll see some outcome.

 

[Armando Cruz]  Well, that’s very encouraging. For me this has been a life-long pursuit, getting people to understand that there’s no one thing that’s in an island…everything is connected, how you’re feeling, what’s going on at home, where you live, who’s around you—that’s a big one. Who are you associating with? The top five people who you most associate with are essentially the average of what you end up making on a yearly basis, and most likely the same thoughts that those people have, you will have very similar thoughts. So, who you’re around makes a big, big impact as to who you become.

 

[Dr. Cheryl Holder] Absolutely. You know, we take it in our division, part of the big thing that we do is interdisciplinary. Because, physicians, we’re not islands, we can’t work alone, we’re trying to get out of the silo, and learn from your disciple, nursing, social work, and working together to make that difference in our community and with our patients. So, just being a physical therapist, we know…you’ve got to be involved. Our patient with arthritis, there’s no way as a physician that I’m going to take care of the patient with arthritis without bringing in a physical therapist, without having them learn to get back up and move, strengthen the muscles, or an occupational therapist, how they can work to change how they put their clothes on and do different things. So we’re learning to be inter-professional, and we’re starting right now with the medicine students who even take the classes together with nursing students, social work students, so they can start now understanding that we have to work as a team. So, we’re really taking medicine—this is the 21st century, and how we’re going to approach patients and change that whole framing where it’s not all about sick.

 

[Armando Cruz] I’m glad that it’s happening at FIU, since I’m so close, and I’m an alumni so it’s exciting to see that FIU is bringing it into the forefront, I think it’s really going to make an impact. I’ve known for a long time that FIU has been able to capitalize and really focus on something that—I don’t really think was looked at, which was the whole cultural part—we definitely have the resources here being that we’re such a huge melting pot, so it’s good to see that we’re taking advantage of it and becoming leaders in that industry, in that are.

 

[Dr. Cheryl Holder] Yep, you’re absolutely right. I think FIU is the most diverse of the universities, I think in Florida for sure. I think possibly Nashville is up there as one of the most diverse universities…and using that diversity, in that diversity you get strength, because you’re getting all different approaches, and bringing them all together, and then you work together, and that really takes you to another level. So, that’s why I want the medical school to really build on the diversity and innovate around healthcare delivery…

 

[Armando Cruz]  Alright, so, now let me ask you—switching the topic—one of the things I remember you saying you’ve been a part of so many different community projects and—tying it back to your experience with that girl, that you didn’t want to see another girl wait half an hour, hours, to get treatment. So what’s near and dear to your heart? Any projects that you’re working on right now that we should be aware of? Something that’s really on the forefront for you.

 

Well, what I’ve been trying to do is link the whole concept of health…we have a health and nutrition program with this group that I work with, the black physicians, the national medical association, we have a local chapter here, and we’re in the community promoting health and educating nutrition…and we take it to kids. The biggest thing that I’m linking is the pipeline, which is trying to get more kids from underserved communities interested in science so that they can be competitive and eligible to pursue a science career, and hopefully some physicians come out of it. It kind of takes you way back, but the most folks that are we have that are educated about basic math, algebra, chemistry, their literacy and their understanding of the world and health becomes easier. It enables them to be able to make better decision within the community. Because I think back to that little girl jumping on that bus and jumping off. I know it was just fun, but there were some adults around, people around who just kind of let it go. That was a regular thing; it was a strange occurrence that this was happening. So it’s just, the more educated we are in society, the better decision we’ll make, but taking that education, I now link the whole getting the kids better educated in just basic math and science, getting them exposed to science and health on the weekends in their communities—hopefully, between FIU bringing all the students out, bringing the mentorship program, bringing everyone together, I hope over time that we’re going to develop a different understanding and awareness within the community. So, that’s what I’m working on now, much more than anything, I’m trying to just develop that. I guess like little circles, that whole sphere of influence where it gets wider and wider, what health is, what nutrition is, what staying well and the role that the physician will play in your life—and getting folks wanting to be doctors, because they see medicine as an exciting, wonderful career, like I’ve been doing, and helping them prepare to do that so they know they’ve got to do well in algebra, they know what tutoring resources are out there…the families will know how to help them, too. So that’s what I’ve been working on for the last year, just trying to get a program in [place that will work in the—right now I’m in Miami Gardens but hopefully we’ll be able to replicate it throughout, that develops a whole group of folks who will be able to encourage science, teach, and get folks who are really able to read and write and do math and science well, so at some point, they’ll choose a health career. And if not, they’ll still make better health decisions and support each other make better decisions…and seeing medicine and healthcare as more than being sick.

 

[Armando Cruz] Right. I love that you guys are going after the kids, because obviously, you have to anticipate and go ahead. If you’re dealing with it later on in life, it’s only harder to make the changes. So if you’re already educating the youth from now, it’ll be easier—the same way you guys are already doing at FIU for the future doctors and how they’re integrating with all those other disciplines and how they’re understanding how the community impacts, and the culture impacts. Now, your program is able to impact these kids in such a way, have you been able to figure out a way to make it last? One of the biggest obstacles that I’ve found working with kids is often times, it has a lot to do with the parents. In my particular case, parents will come to me and they’ll say, ‘oh, you know, my daughter is 15 and she weighs almost 200 pounds.’ Well, obviously, she’s eating and not doing exercise, eating poor food, but she doesn’t have a job, and she doesn’t do the groceries, so how are you getting it so that the parents—which have control over the kids lives, are able to reinforce what you guys are teaching? Is that an obstacle you guys are finding, and if it is, how are you guys getting over it?

 

[Dr. Cheryl Holder] Well, what we have done and part of what I’m doing now is with the Green Family Foundation and health program, and that program adopts the families and the household, and we go into the home, so we work with the parents and we work with the families, because just from the parents we talked to about obesity, we did a tour once at the home, and the mom was complaining about the same thing, her seven-year-old was overweight! We went and did a tour of her refrigerator and her freezer, and everything there that she bought that the child liked, she thought was relatively healthy…so she thought she was making better choices, but in the end, they were just high-calorie, high-carb foods. So we taught her and educated her in little changes that she can make that the kid will like to eat, and she will be able o see the weight reduction, because she’s going to make these changes. We’ve been working with her for several months, and I just saw her recently, and she told me, ‘He’s lost five pounds!’ and it didn’t require massive changes. Luckily for us, we’ve been able to go in and meet the parents. With most kids, it’s the parents that you’ve got to work with so as much as possible we try to meet the parents. Even the Saturday program we do in this church, we always tell them we want to meet the parents so they’re there, and we give the class to the parents, and we give the class to the children, and many times they’re together. I do a whole presentation on this soup that Haitians make, Soup Joumou pumpkin soup—it has about 14 vegetables! But we do a lot of identify, taste, and a lot of times we have to teach parents how to introduce foods to children. You’d be amazed; a lot of parents don’t realize the amount of work it takes. You can’t just tell a child, eat this one day, and they say they don’t like it, and you don’t introduce it again you have to introduce at least seven times. You may have to do it every day for almost a month before you have a child’s taste buds adjust to it. Little tricks that we teach them they don’t understand—it takes a lot of tries to get kids to eat the right way—a lot!

[Armando Cruz] Yeah, it’s funny you saying that, because I can recall when I was little—that was one thing my parents growing up made us eat everything. They said, this is it, there was only one there, and whatever was served, that was it. There was an amount you had to eat, and I remember, not that this was the best food, but one night they had Chinese food. And for whatever reason when I was little, I didn’t like Chinese food. And mom said, you’re going to finish this and guess what’s going to happen: until you like it, we’re going to have Chinese foods every single day…so I quickly changed my tune…now again, Chinese food may not be the best food, but the point is that the persistence—look, I’m the parent, this is what we’re doing as a family, this is what we’re going to eat and I’m not making a million different meals just because you want something different. SO to this day, all of my brothers and sisters—all of us eat everything. People say, “Do you eat this?” I say yeah, we don’t have an issue. We’re not picky when it comes to trying new foods.

 

[Dr. Cheryl Holder] Exactly. Yeah, and that’s what it takes. It’s tough, a lot of parents don’t understand, especially younger parents, they didn’t understand this is what’s involved, and your parents were definitely more experienced and knowledgeable about what it takes to get kids to eat properly. So the more we work with parents, the more we’ll see that the parents will eventually come around, and address some of the issues that they use food for—that’s what we also find, a lot of times they use foods for the wrong reasons, it’s reward system, it’s when you’re tired, it’s easier just to give them some food, so, there are so many factors in our society, the way food is used nowadays…and parents not being as tough as they should, being too nice in many ways. It really doesn’t pay off.

 

[Armando Cruz]  Right, you’re doing them a disservice at the end. You’re doing them, and you’re doing society a disservice.

 

[Dr. Cheryl Holder] I have parents tell me, oh, I don’t eat vegetables. So how do you expect this child to change? It has to start with you. You’re going to have the be the one to toughen up and say, ‘Delicious, delicious,’ and pretend you love that thing. But by the end of the month, I’m telling you, you will love it to. So it requires a lot of work, and we haven’t been as successful, but the key is that, obviously, persistence with that child. I find that kids are—if you find that inner child, children don’t give up. When they say something, they just find a way. They keep trying. You have to really try and never give-up. The goal is so good, and when you see that child or that adult lose that five, ten pounds, it’s amazing. They feel so much better—and you see it, since you work on that aspect.

 

[Armando Cruz]  Right. For sure. And so, this is a little bit more volatile question, but what advice would you have for people who want to make a difference in this world and in different communities, where should they start? Because if you look in the news, all they preach is doom and gloom, the world is falling, everything is wrong with it and unfortunately, that’s the message that people get. When somebody hears that on a continuous basis, it’s almost overwhelming. The problem is too big. I can’t do anything, I’m only one person and I don’t have any resources. So where would you encourage somebody to start making a difference?

 

[Dr. Cheryl Holder] Making a difference is habit-forming, it’s like everything else. You’ve got to keep doing it. Now, for most people, charity begins at home. So if there’s something, especially in every home, there’s some problem, some issue we can work on, we just find a positive way. If it’s just taking a person to the doctor, you know there’s somebody there that needs—find a way to take them there. That’s doing charity work, that’s doing good. So start with—just like I’m doing—small spheres of influence. So if you start at the home, there’s some area that you can improve…if everyone can exercise 10 minutes a day, 20 minutes a day—make that be your charity event, you’re going to get folks up and moving, you’re going to make sure people eat one vegetable or day, or eat fruit every day; it can all start at home. And then slowly branch off, there are churches, there are so many programs to go and help…you can even just call 2-1-1 which is a telephone number, and they’ll tell you about all the community services that are out there that need volunteers. If you can’t do anything at all, very much, if you don’t have time—there’s a project at home that you can work on. To me, people do not eat enough fruits and vegetables every day, so if that all they decide, that everyone’s going to eat their fruits and vegetables, at least one serving every day, at least that’s a start. Start slowly.

 

[Armando Cruz]I love that phrase you said, ‘charity begins at the home,’ and that’s very true. Often times, everybody is too busy looking out, and they haven’t reflected, they haven’t done that introspective looking where, what’s going on around me, immediately around me, what can I change right there—people don’t realize what kind of effect…I was speaking to a group and one of the things that I mentioned to them, was, how significant a smile is…in today’s day and age, where everyone is walking around looking at their phone, and nobody looks at each other. It used to be—I’m not that old, but I can recall when I was a kid and the stigma was, if you were in New York, everyone was so busy that they’d run you over—and now the whole world has essentially caught up to that…it’s all speed of light, and nobody’s interacting. Even at a restaurant, and you look at people, there could be two people looking across from each other and they’re both looking at their phone and they’re not even having a conversation any more. That simple interaction is something that people don’t realize, that everybody needs. Everybody’s craving it, but people aren’t taking the steps to give. If you start with giving, n that respect, it’s a  trickle-down effect.

 

[Dr. Cheryl Holder] Yeah, I agree. I’m guilty like the next person, many times, I’ve become caught up with the phone and testing and e-mailing and everything, and I remember back, what did we do? We used to go out to dinner and there were no interruptions, there was nothing, you’d just sit and talk. That’s another thing you could decide to do if you have time to give back, spend that first ten minutes with your family with no interruptions. No TV, no phone, no cell-phone, no texting. Yeah, we have to try that, maybe I’ll try that tonight. [Laugh]

 

[Armando Cruz]  It’s funny, I always tell people, ‘Guys, when I say these things, please don’t assume that I’m perfect and that that never happens to me, because we all fall into it. the first step is understanding it, being aware of it, the next step is taking action, doing something about it, making conscious effort—and that’s a start.’

 

[Dr. Cheryl Holder] Yeah, we teach our med students about goal setting, we give them little things, little smart acronyms, be very specific and measurable, and can you do this? Is it realistic? What’s the time line? So we tell them to SMART everything. Everyday, I’m going to spend the first five minutes with my wife or my husband, and do something. And we use that with anyone who wants to take on a new challenge. Be as specific as you can, measure it and put your time line in it. At the end of the week, how many times did I accomplish a goal? And like, every habit, it takes a while—you got to keep doing it over and over, and keep measuring and staying on track, but it’s not easy. Not ever day it’s going to be fun for us.

 

[Armando Cruz]  If it were easy, you wouldn’t appreciate it.

 

[Dr. Cheryl Holder] Yeah, that’s true [laugh] I guess I wouldn’t have this job, huh?

 

[Armando Cruz]  Yeah, well, what greater satisfaction would that bring to your life…I’m out of a job because everybody’s healthy…huh?

 

[Dr. Cheryl Holder] Yeah, can you imagine that? [laugh] I won’t be, I won’t be, because I’ll keep you well.

 

[Armando Cruz]  Good idea, well there you go.

 

[Dr. Cheryl Holder] I’m really keeping you well. Everybody thinks my job is to keep you there.

 

[Armando Cruz]  Right, right, right, exactly. Well, Dr. Holder, thank-you so much, I really appreciate you taking the time. If someone’s interesting in contacting you or getting involved with any of your projects, is there somewhere they should go or some way to contact you? What’d be the best way?

 

[Dr. Cheryl Holder] The best way is by e-mail, clholder@fiu.edu
Ok, so, CLholder@fiu.edu? Is there anything you’d like to add before we wrap this up?

 

No, just start helping. It’s addictive, it’s fun, it’s good, and it keeps you well.

 

Ok, well, thank-you so much, guys, thank-you so much for being on this call, and hopefully you got a lot of value from this—and start changing people’s lives! I’ll see you guys.

 

What are your thoughts on this interview?

 

 

The Nutrition X-Files: What do Canadians know that we don’t?

I am often asked questions regarding nutrition from when should I eat carbs, to what type of alcohol should I drink? Everyone is different and while there is no magic pill, there is Magic food. Below expert nutritionist, author, strength coach, and all around good guy, the Canadian Sensation -Yuri Elkaim takes you through the questions you asked.

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– When to eat carbs

– How much protein and from where should you eat it

– Recipes for high energy yield

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