One of four children born within the span of five years to immigrant parents from the Dominican Republic, Ortega marvels at how his parents ever navigated the health care system with a language barrier. “I look back and I think of all the forms and policies and documents that needed to be signed, all the different things that you have to do to get insurance,” he said. “I saw these disparities growing up without really knowing that that’s what they were.”
A life-long science-lover, Ortega gained admission to one of New York City’s premier technical high schools, studied biochemistry in college, and earned his medical degree from Howard University College of Medicine. During medical school he collaborated on his first academic paper, which focused on surgical outcomes.
The experience impelled him to formalize his research skills by pursuing a master’s degree in public health from Johns Hopkins Bloomberg School of Public Health. One of his mentors was Adil Haider, MD, MPH, FACS, the former director of the Brigham’s Center for Surgery and Public Health (CSPH). Haider had recently received a grant from the National Institute of Health and National Institute on Minority Health and Health Disparities to establish the Provider Awareness and Cultural Dexterity Toolkit for Surgeons (PACTS) Project. PACTS aims to improve surgical care for patients from diverse cultures by training providers to navigate interactions with people of different beliefs and backgrounds.
Ortega came to the Brigham in 2018 and now manages PACTS with Haider and Douglas Smink, MD, MPH, as CSPH’s lead faculty for research and innovation for equitable surgical care. He is overseeing the implementation of the PACTS curriculum at four sites this year, with another four planned for 2021. Surgical residents will complete questionnaires before and after exposure to the curriculum measuring their knowledge about caring for culturally diverse patients, and standardized patient observers will evaluate surgical residents on multiple dimensions of cultural dexterity and communication skills. If the curriculum is deemed significantly influential in improving equitable care, the goal will be to incorporate the PACTS curriculum into training for over 10,000 surgical residents each year.
“We can get equity-promoting tools into the hands of the people who are going to put them into practice and actually provide these interventions,” he said. “That’s what I do now, and I love it.”
The Whole Individual
When he is not directing PACTS’s implementation, Ortega focuses on mentoring residents and fellows in the realm of surgical equity research, while seeking to expand those toolkits to other specialties.
In collaboration with David Bates, MD, MSc, of the Division of General Internal Medicine, and Andrea Pusic, MD, of the Division of Plastic and Reconstructive Surgery, he is working to improve care and access for patients with Limited English Proficiency (LEP), who comprise nearly 40 percent of the 62 million Americans who speak a language other than English at home.
Referencing his childhood in a low-income neighborhood in Brooklyn, Ortega noted that recognizing systemic inequities created by hurdles like language barriers “just came naturally to me.”
His academic work, however, is also keenly informed by clinical training. He recognizes that equitable care is grounded in strong patient-physician connections, which can be jeopardized by doctors’ assumptions about their patients and interfering biases.
“Physicians need to understand that patients are whole individuals. Sometimes we forget that when we see them in a hospital — you’re in this white room; it’s a very sterile environment. You don’t see their living situation.”
For that reason, Ortega sees telemedicine, a lifeline for many amidst the coronavirus pandemic, as a window of opportunity to strengthen patient-physician relationships going forward.
Curing Both Symptoms and Systems
Ever cognizant of the physician-patient relationship, Ortega nonetheless stresses that health care delivery is broader than that — until there are systemic reforms in health care access, individuals’ needs will not be served.
Working with colleagues at the Brigham and at Massachusetts General Hospital, Ortega recently published an article in Health Policy and Technology reviewing telemedical-service policies and outlining recommendations for facilitating their implementation more equitably.
These include sustaining Medicaid’s reimbursement of telehealth services, increasing low-cost broadband services, and bolstering public internet access through institutions like public libraries, which are a particularly important resource for low-income households and Black and Latinx individuals. (The paper cites data from the Pew Research Center, which indicates that 25 percent of Hispanic and 23 percent of Black individuals are reliant on smartphones for Internet access, compared to half that number for white individuals.)
Earlier this month, Ortega participated in both a National Academy of Medicine Leadership Consortium on using digital health to combat the pandemic, as well as an anti-racism conversation at the Brigham’s 2020 Health Equity & Racial Justice Summit, where he discussed CSPH’s commitment to equity. “Our health care system was built with racism interwoven into the system itself, into how we train in our academic settings and in everything we do,” Ortega emphasized. “One of the first things we need to do is acknowledge structural racism, to address it head-on.”
Still, he stresses the need to not only explore what disparities need to be mitigated, but also design initiatives to do so. At the Health Equity & Racial Justice Summit, Ortega stressed the need for more patient participation in clinical research, diverse training pathways to increase representation in clinical leadership, and civic actions that engages policy makers in health equity matters.
“We need to move toward practical ways to undo these inequities, because it’s critical for the future of our country,” Ortega said. “I don’t want research to stay in the published literature on someone’s shelf.”