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In light of bias, student project explores ‘Health Caring’

As Pennsylvania College of Technology student Bryan M. Bilbao, of Old Forge, sat in a hospital room with his aging grandmother near the end of her life, he noticed a difference in the way health care professionals interacted with her.

Providers entering the room asked friendly, caring questions of his grandmother’s roommate: “Are you feeling OK?” “Do you need anything?” But the same bedside manner did not reach his “nonna,” Italia Cusati. Cusati, who was born in Italy and moved to Uruguay to work when she was 5, did not speak English.

Perhaps hospital employees were intimidated about initiating a conversation with someone whose language they didn’t speak, Bilbao reasoned. But he longed to see some attempt at communication with his grandmother – a simple question to which she could say yes or no, some empathetic body language.

Two weeks after his grandmother died in July 2020, Bilbao began classes in the physician assistant studies major at Penn College.

Inspired by the experiences of his grandmother, Bryan M. Bilbao, of Old Forge, explored disparities in health care as he completed his combined bachelor’s/master’s degree in physician assistant studies at Pennsylvania College of Technology. Bilbao graduated cum laude in August.
Inspired by the experiences of his grandmother, Bryan M. Bilbao, of Old Forge, explored disparities in health care as he completed his combined bachelor’s/master’s degree in physician assistant studies at Pennsylvania College of Technology. Bilbao graduated cum laude in August.

The experience with his grandmother, along with his work in a crisis center (he holds a bachelor’s degree in psychology) where he felt patients were sometimes treated as numbers rather than as people, congealed with Penn College classroom lessons about culturally competent care and disparities in health care. He was moved to make a change within his prospective profession.

The change started, Bilbao said, with learning more about how those who fall outside “normal” – due to their language, physical or intellectual ability, race, sexual preference, or gender identity – are treated differently by health care providers.

For a final project in his Summer 2021 Medical Decision Making course, Bilbao developed a video sharing the story of Italia Cusati and interviewed 10 people with diverse backgrounds about the disparities or difficulties they had experienced while seeking health care. The video quickly gained traction, amassing more than 12,000 views.

For his capstone project, presented in August to culminate his Penn College education, Bilbao flipped the script.

“I wanted to do it again. I wanted to expose it more; I wanted to find more,” Bilbao said. “But I started asking myself a different question: ‘What are we doing well? Are there people like me who are trying to make an impact?’ And that’s, I guess, where it stemmed from. It stemmed from just asking the question: ‘What are we doing right? There’s so much negative that I found; there’s got to be positive somewhere.’”

Over the past year, he spent 100 hours on a new video project that shares the efforts of those who are working hard to ensure that all are treated with the same attention and care.

Among those interviewed for the hourlong video, titled “Health Caring,” are Dr. Denise Johnson, Pennsylvania’s acting secretary of health and physician general; Sharon L. Larson, an executive director and resident faculty member at Main Line Health’s Lankenau Institute for Medical Research; Ryan Tolbert, an executive for bandage company Tru Colour; Victoria Ho, former American Academy of Physician Assistants Student of the Year; other leaders in the physician assistant profession; and current PA students.

 

“So, it was just an insane project to see that there are people like me, doing better than me, and they are actively taking a role to make the world a better place, especially in health care,” Bilbao said.

What he hopes others will gain by watching “Health Caring” is that every person should be treated as a person.

“Treat everyone like it’s your mother, your sister, your brother, your best friend,” Bilbao said. “I think people lose sight of that, especially when they’re busy or they do have implicit biases that they let go.”

Bilbao will think about treating others like he would treat his nonna.

Bilbao spent a great deal of time caring for his grandmother in the last two years of her life. When she became very sick on his birthday, July 26, 2020, Bilbao took her to the emergency room and spent the next two days – until her death – in the hospital with her.

“I always say that there wasn’t a place or a person that I would have rather have spent my birthday with,” he said.

His grandmother, grandfather and parents immigrated to the U.S. from Uruguay about 35 years ago. While his grandfather, mother and father worked long hours, his grandmother stayed home with Bilbao and his three sisters. He recalls sitting in their Old Forge backyard together, looking up at the sunflowers his grandmother planted and laughing at the alley cats.

“She was my best friend,” he says. “She just always took care of me.”

He continues to carry a sunflower in his lab coat to remind him that each patient he sees is “somebody’s somebody.”

Bilbao was selected as student speaker at Penn College’s Aug. 6 commencement ceremony and was bestowed the Lewis H. Bardo Memorial Award, presented to a graduate who exemplifies devotion to duty, helpfulness to others, friendliness and high ideals.

Over the next few weeks, he will study for the Physician Assistant National Certifying Examination and has accepted an emergency medicine position with Apollo MD, circulating between the emergency rooms of Wilkes-Barre General Hospital, Moses Taylor Hospital and Regional Hospital of Scranton. He also plans to take a few days to finally mourn his grandmother and dedicate his academic honors to her.

“One day, once I get experience and start practicing medicine a little more, I want to be a mentor – a preceptor – taking on PA students of my own, trying to advocate not only good health care in terms of learning your medicine, how to prescribe proper dosing, how to diagnose properly, but also taking care of the individual,” he said. “That’s my goal, and I want to get that through to students.”

He hopes to join the Pennsylvania Society of Physician Assistants and, perhaps eventually, the American Academy of Physician Assistants to work toward legislation that would address health care disparities within the profession.

He’s also newly engaged to be married and looks forward to having a family and taking care of his mother, Silvia Cusati, who works 60-80 hours a week as a certified nursing assistant for populations with cerebral palsy. His never-take-a-day-off father, Marcelino Bilbao, has also inspired his work ethic.

“All these awards or honors, I appreciate them. But I wouldn’t be here if it wasn’t for them. I wouldn’t have the life, or these opportunities or these experiences had it not been for them – had it not been for Marcelino, had it not been for Silvia, had it not especially been for Italia. They’re the ones who deserve the credit – not me.”

They are part of his “Why.”

“Everybody has a ‘why,’” Bilbao explained. “I think people, when they get stressed, anxious, depressed, angry, they feel like they’re not making an impact in their community, or they just feel like they’re living day to day with no sort of reason, … I think we just have to always remember, when these feelings of uneasiness happen, just remember your ‘why.’ … Once you have that ‘why’ that keeps pushing you, it’s like my grandmother, Italia Cusati. When I feel stressed, I think of her, and not only do I get this nice, comforting feeling, but I realize, I can be taking care of somebody’s nonna, too.”

While Penn College currently offers a combined bachelor’s/master’s degree in physician assistant studies, it will begin accepting students into a stand-alone master’s degree in physician assistant studies in Fall 2023. To learn more, call 570-327-4519 or visit the School of Nursing & Health Sciences.

For information about Penn College, a national leader in applied technology education, email the Admissions Office or call toll-free 800-367-9222.

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