For Roli Dwivedi, MD, her journey—and her passion for improving health equity—started about 20 years ago. After completing medical school in India, she worked as a medical director in a charitable clinic for an underserved population in rural India. That experience turned out to be instrumental in solidifying her commitment to helping break down health disparities.

After completing her family medicine residency, she began looking for a role that combined community health, academia, direct patient care, and community-based research. She found all of that at CUHCC, where she had rotated as a resident and completed her GYN training rotation, which she now teaches.

"When I trained at CUHCC, it was truly eye opening," she says. "It was just like global health in the backyard."

A commitment to health equity

At CUHCC, around 80 to 90 percent of the patient population is below the poverty line, and more than 50 percent of the patients are on Medicaid. It is also the second largest urban clinical site for education.

Since her training days, Dr. Dwivedi has since become a physician at CUHCC, medical director, and currently the chief clinical officer. Her role allows for what she loves most: working in care delivery, education, and community-based research. In line with her own values, she and CUHCC's governing board uphold a mission of health equity for all patients. Each year, upwards of 150 medical students and residents get to experience this commitment to health equity firsthand during their rotation at CUHCC.

From the perspective of a teacher, Dr. Dwivedi says, "It gives me the perfect environment for teaching the future healthcare professionals how to provide culturally informed care and how to provide interprofessional care."

The model of a true family physician, Dr. Dwivedi also derives fulfillment from her passion for primary care that addresses the whole person. Part of the nature of her role is overseeing multiple clinical services—medical, dental, psychiatry, and others—which gives her that valuable multidisciplinary lens through which she sees her patients.

"Having all these services helps me create a whole-person care model," she says. "It fulfills my passion for primary care because the core of primary care is prevention. You are not only taking care of one body part, but also the whole physical, mental, social, spiritual, and cultural health. It gives me a unique way of looking at a person as an individual and what their needs may be."

Improving access to care, improving health outcomes

Because so many CUHCC patients have a significant number of social determinants of health, one of Dr. Dwivedi's priorities is ensuring the clinic is as well-equipped as it can be. She also devotes herself to a model of teamwork and collaboration, which she views as essential to providing good care. This became particularly essential as COVID-19 began to hit CUHCC patients disproportionately hard.

"We communicate and collaborate with many basic-needs organizations that are focused on housing, food, and shelter," she says. "With patients who are experiencing homelessness, for example, it makes one pause and think about how we can provide better care by creating structural changes. I cannot do it alone; I have to establish those partnerships."

Dr. Dwivedi's team at CUHCC recently worked with Hennepin Counties Healthcare for the Homeless for an event that brought community-designed testing directly to people. CUHCC is also a leader in the U's Mobile health initiative, an effort to bring COVID-19 testing to people who struggle to visit the clinic—those dealing with language barriers, lack of transportation, or homelessness. Through this partnership, the CUHCC team and others in the initiative are able to improve access to care and do their part in helping to improve health outcomes.

At another recent event, CUHCC hosted 16 imams in Minnesota from both urban and rural areas. All received their vaccinations at the clinic and then addressed the community about why it is important to get the COVID vaccination. Dr. Dwivedi spoke about Ramadan, acknowledging the importance of celebrating together while also offering facts about the vaccine and how to stay safe.

Educating future family physicians

When asked what is most important for the future generations of family medicine physicians to learn, Dr. Dwivedi has a few recommendations based on experience.

"They really need to learn how to do culturally competent telehealth," she says. "There is beauty in doing telehealth care, but there is also risk."

She sees a major restructuring happening in telehealth in the next few years, including a boost for mobile health. To help providers deliver the best possible care, Dr. Dwivedi recommends that learning the art of team care—virtual as well as in person—will be crucial. During the care of one patient, a provider may need to work with a medical assistant, nurses, lab technicians, interpreters, or resources like local shelters if the patient needs a place to sleep when they're discharged.

Dr. Dwivedi works with family medicine residents who rotate at CUHCC for a month. She makes it a point to weave culturally informed care into the curriculum she teaches while exposing residents to events such as the elder Imams' vaccination event at CUHCC to show how to encourage vaccine confidence within a community.

"So many people that I have trained and worked with at CUHCC comment that they have never received this level of culturally appropriate education before. So it's very valuable."

These events illustrate opportunities for family physicians like Dr. Dwivedi to offer information to people by meeting them where they are—and making sure they are hearing it from experts they recognize and trust.

"Empathy is a very important part of care as well," she affirms. An example of this is understanding where patients are coming from when they may have low confidence in the COVID vaccine.

On implicit bias and vaccine confidence

The phrase "vaccine hesitancy" has been thrown around a lot in recent months, usually when referring to certain groups of people. Dr. Dwivedi believes it is critical to shift to thinking about it in terms of vaccine confidence.

"'Vaccine hesitancy' implicitly puts people into groups," she explains.

In a recent tweet, Dr. Dwivedi summed it up this way: "Change the language to vaccine confidence, be transparent, educate, answer questions, reduce (the) knowledge gap, and offer the vaccine. Communities and people are smart; they can make the decision."

Implicit bias can creep into meetings, conversations, news articles, podcasts —anywhere. Even if it's unintentional, implicit bias can cause people to start thinking a certain way. A blanket statement like "Somali or Hmong people are hesitant to get the vaccine" is not reflective of an entire community.

"It is misinformation ... Just fundamentally wrong information when I talked with the community leaders," said Dr. Dwivedi. "What was happening is that the wrong information was being circulated in the social media that those communities use, leading to low vaccine confidence."

"People are looking for the right information from the right resources. This is where healthcare needs to step up because we are the right resource, and we need to create the channels to help increase confidence in the vaccine."


Read more about Dr. Dwivedi's involvement in CUHCC's COVID vaccination clinics and other events: