By Kristi Eaton for The Daily Yonder.
Broadcast version by Roz Brown for New Mexico News Connection for the Public News Service/Daily Yonder Collaboration

The man had died three years prior. His widow was seeking about $700 a month in benefits under the Black Lung Benefits Act, a federal law allocating money to miners who suffer from pneumoconiosis or black lung disease.

"We were discussing all the problems that the widow had gone through, and that hit home very hard to the people who participated in the program," said Dr. Akshay Sood who had launched Miners Health ECHO shortly after moving to New Mexico.

When Sood moved to New Mexico, he was quickly overwhelmed by patients, many of them former uranium miners who were suffering from radiation exposure and couldn't find a single physician who would accept their federal benefits card. Many of the patients came from Latin America or were from rural isolated communities. Some didn't speak English.

Miners Health ECHO is different from traditional telemedicine: Whereas telemedicine supports a one-to-one transactional visit between a patient and a physician, telementoring supports a community of learners.

While a number of the leading research universities with strong name recognition offer training in lung diseases, many are not congruent with the rural populations that need them most, Sood said.

"The best programs exist at Harvard, at Yale, at Seattle, at Emory," he said in an interview with the Daily Yonder. "The need is in places like New Mexico, Montana, Wyoming, Utah."

Some of the most well-intentioned researchers and academics working also don't quite understand what rural people really need, he added.

"When you work in rural communities, you realize that rural people have a shortage of resources, but they don't have a shortage of innovation," he said. "And they innovate with what they have, and they do a really, really good job at it. And homegrown solutions are incredible, and you have to learn from them."

And sometimes it's giving space to people who may otherwise be unable to have a voice. Miners, Sood said, often come from underrepresented and underresourced populations. They lack advanced degrees, and in New Mexico, more than 70% come from minority backgrounds, he said.

A typical program starts with an introduction and announcements, Sood said, which lasts about five to 10 minutes. An expert usually speaks for about 15 minutes, followed by questions and answers for 20 minutes. That is followed by a case discussion, which takes about 30 minutes. Finally, the case is summarized and notes are exchanged, with the program lasting about 75 minutes.

"There's geographic diversity," he said. "There's cognitive diversity, so it's relevant to all stakeholders. Otherwise, what happens is that the two stakeholders that take up a lot of a lot of verbal space are physicians and lawyers. And so we have to make sure that there's adequate space for other stakeholders to articulate their opinions."

Specialized medicine is often expensive, and is typically distributed in populated areas and close to more affluent populations, said Bobbi A. Gore, program manager with Black Lung & Outreach at Miners' Colfax Medical Center in Raton, N.M.

"Miners who need specialized services are often in rural and less affluent communities," Gore said in an email interview with the Daily Yonder. "Telemedicine overcomes this bias, and encourages distribution of specialized medicine to miners that would otherwise be unserved or underserved."

"These are real problems real people face," Sood said. "They're very few people who want to deal with the compensation system, because, typically, they're complicated. You don't get compensated for filling out all that paperwork... It's very clear that you can't help a miner with chronic disease without addressing the compensation benefits issues as well."

Kristi Eaton wrote this article for The Daily Yonder.

People who are part of the Deferred Action for Childhood Arrivals program, known as DACA, will be dropped from their CoveredCA health plans at the end of August.

The move comes after the Trump administration changed a Biden-era definition of "lawfully present" to revoke health care eligibility for thousands of immigrants.

Christine Smith, policy and legislative advocate for the nonprofit Health Access California, said people only have a few weeks to get medical appointments in before their coverage ends.

"If you're enrolled in Covered California and you're a DACA recipient, the Trump administration just ended your coverage," Smith emphasized. "People should use as much of your health care as you can before the August 31st deadline."

The Centers for Medicare and Medicaid Services defended the move, saying it will save taxpayers money. CoveredCA estimated the change affects about 2,400 DACA recipients in the state who make too much to qualify for Medi-Cal and have jobs not providing health insurance. They can still buy private insurance but it is much more expensive. People who prepaid for their coverage can seek a refund.

Smith predicted it will be a blow not just to those who lose coverage but to the state's health care system as a whole.

"The lines in the ERs are going to be longer because people are not going to be able to get affordable preventive care," Smith projected. "They're just going to get sicker and then end up in the ERs. People will overall incur more medical debt. Hospitals will have more uncompensated care."

The change is nationwide. As of mid-July, about 538,000 people in the DACA program across the U.S. are ineligible to enroll in any state-based insurance marketplace and are unable to access premium subsidies or cost-sharing assistance.

Artificial intelligence is appearing more prominently in many aspects of life and research suggests older populations are curious, yet remain wary of using the technology in their everyday lives.

According to Stats Indiana, there are more than 1.5 million Hoosiers aged 65 and older, or 18% of the state's population. Experts said it is likely the demographic will use AI in some form in the next few years, either by choice or necessity.

Dr. Shaun Grannis, vice president of data and analytics for the Regenstrief Institute on Aging, said AI offers real benefits.

"It can reduce loneliness through conversation, provide reminders for medications and appointments," Grannis outlined. "It can support cognitive stimulation via games, storytelling, news updates."

The technology can also offer a low-pressure way to access information on public services, he added, which is valuable for those with mobility issues or those who feel intimidated by technology.

Grannis cautioned any tool which can be used for good can also lead to problems. He noted AI can create a false sense of companionship and mask social isolation. Overdependence is a legitimate concern, he argued, if the technology becomes a "crutch" for all forms of interaction.

"All cognitive activities or decision-making, it can actually lead to and create a negative feedback loop, lead to a decline in engagement and even basic self-management skills," Grannis explained. "This is risky."

Grannis believes one solution is designing AI systems to complement, not replace, human interaction. He stressed it can be done though building broader support ecosystems including family, friends, caregivers and community services. Grannis emphasized it would encourage real-world activity, prompting the user to go for a walk, call a grandchild or attend a local senior event.

If you have an extra five minutes, you can save a life because you can learn cardiopulmonary resuscitation at no cost from a new mobile, hands-only CPR kiosk.

The new kiosk is in the lobby of Saint John's Health Center in Santa Monica. The machine's touch screen gives a brief overview of hands-only CPR and you can practice right there, on a mannequin.

Dr. Rigved Tadwalkar, cardiologist at St. John's, said it is an easy way for people to get more comfortable giving chest compressions in an emergency.

"It's a lot like a video game but of course, a lot more important than a video game," Tadwalkar pointed out. "It gives real-time feedback about the depth and rate of compressions, proper hand placement, which are all factors that influence the effectiveness of CPR."

The American Heart Association operates the St. John's mobile kiosk and a stationary model at L-A-X with support from the hospital. Santiago Canyon College in Orange County also has a mobile hands-only C-P-R kiosk now through September, sponsored by Edwards Lifesciences.

Steven Munatones, an Orange County business owner, said he survived what's known as a "widowmaker" heart attack which led to cardiac arrest nine years ago, thanks to his 17-year-old son, who gave him immediate CPR with instructions from a 911 operator.

"You don't have to put your mouth to anybody's mouth," Munatones explained. "You just put your hand on their chest and pump. He saved me, and others can do the same, anywhere. So, it's absolutely a lifesaving, heroic act that anybody can do."

Statistics show 350,000 Americans suffer from cardiac arrest outside a hospital each year and about 90% die, in part because they do not receive CPR. About 70% of those cardiac arrests happen at home, so people often depend on family or friends to give CPR before an ambulance arrives.