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Zach Klaassen: Hello, my name is Dr. Zach Klaassen. I'm a urologic oncologist at the Georgia Cancer Center, and we are joined today for a UroToday discussion with Dr. Daniel Simmons, who is a senior pastor of Mount Zion Baptist Church in Albany, Georgia. Thanks so much for joining us, Dr. Simmons.

Daniel Simmons: Thank you for having me. It's an honor.

Zach Klaassen: We are delighted to have you today. This is going to be a great discussion. We're looking at, basically, a follow-up discussion from a presentation you gave at our cancer center a couple of weeks ago looking at faith-based recruitment and screening for prostate cancer. I want to just start off from a high-level view, if you could just give us an overview of the program that you guys have down in Albany, Georgia.

Daniel Simmons: Okay. First, I'd just like to say the program really started because we had a visit from the people at Morehouse School of Medicine. For people who are not familiar with Georgia, it's in Atlanta, we're in South Georgia, rural area, came down, talked about the problems associated with prostate cancer, the suffering, the death, and how all of that could be prevented with early detection and some education, and just had a conversation about how we could improve on early detection.

Out of that conversation came a project. The unique thing about it is the people at the Morehouse School of Medicine didn't bring us a project. They had the community to build the project. And so we brought several partners to the table in the faith-based community, the hospital community, what we call the regular everyday people at the barbershops, et cetera, and just put our minds together and talked about the issues and we developed the program.

Zach Klaassen: That's great. I think, too, just to give our listeners some context who are not just in the United States, but globally, Albany is a very rural community and it serves a lot of communities around it. It's about four hours south of Augusta. I see a lot of patients from Albany as well, and they're wonderful people, but just access to medicine and access to care and screening is quite challenging. So you're in the heart of that area.

Daniel Simmons: Yes.

Zach Klaassen: Tell us about, with this program over the last several years, how has this led to increased screening for prostate cancer enrollment in clinical trials? As our listeners know, there is a lack of African-American representation in a lot of these clinical trials. And so just tell us about how that program has translated into those developments.

Daniel Simmons: What we have been able to do through the program is bring men into the system, if you will, that never participated before, that, if there was some appeal from the hospital, wouldn't have participated. The key has been, again, it is organically grown out of the community. And so, for example, the numbers grew because in communities, in those zip codes that are hardest hit, we have clinics in those areas, and the men in those communities were part of planning those activities through their churches and through their barbershops. And so men who normally wouldn't go to the hospital, wouldn't go to a doctor, matter of fact, most of them didn't even have a primary care physician, they came to the place where they worshiped, where they buried their dead, where they married their children, where they come for solace when they're in need. And men, again, who ordinarily wouldn't come, they started coming.

In those clinics, they were screened, they're at the clinic, our partners, the hospital, other urologists who were not necessarily part of the hospital, but they were screened and there was follow up made available to them. The other piece of that is we empowered men in every local church that participated to go out and start recruiting other men to come in. And so we had men in their fifties and sixties who never had a PSA.

Zach Klaassen: Right.

Daniel Simmons: Who didn't have a primary care physician and never been to a urologist and all of those kinds of stories. And the numbers just picked up. Inclusion of the barbershop ministry, we call it Shop Talk, having those conversations drove men into the clinics.

Zach Klaassen: Yeah, absolutely. You said something during your presentation at the Georgia Cancer Center, which really resonated, and it's taking this screening to these people. And there may not be a clinic in some of these small towns. It may be at the church, correct?

Daniel Simmons: Right. Correct. And that's the key. That's the key. Taking it to the community. One of the things I said there, and I believe it, that if the medical community would embrace it, you have access to a clinic in any community where there's a church.

Zach Klaassen: That's right.

Daniel Simmons: That church can be converted into a clinic in a matter of minutes, and people will come.

Zach Klaassen: You look at these small communities, not just in Georgia, but across the country, there's a post office, there may be a grocery store, and there's a church.

Daniel Simmons: You got it. You got it. Everywhere.

Zach Klaassen: We got built in public clinics.

Daniel Simmons: Yeah. And what you don't have in these communities, as you know, the rural hospitals are closed, and then when the hospitals are closed, a lot of the primary care physicians in those areas leave as well.

Zach Klaassen: Yeah, absolutely. But what's really interesting, and I think it's an important point, we talk a lot about risk factors for prostate cancer on UroToday, but getting these men into the system is not just for screening for prostate cancer, but it's screening for high blood pressure, diabetes, all these other things that are the silent killers of folks in America. Tell us about some of the other screening and medical support that you give these men when they do come in.

Daniel Simmons: There's screening for cholesterol, there's screening for hypertension, there's screening for diabetes. The diabetes and hypertension is a very common thing that we see in most of the men. And depending upon the age, there's also conversation around colostomies and other issues that are common to our area.

What happens is, in those clinics, in addition to the PSA, they get those screenings and then there is follow up based on the result of those screenings to say, "This is what your problem is." And that follow up is coming from a trusted voice. And then there is this push toward care. "This is what the problem is. It's not going away, and here are your options. These are the people that are available to you to help you, and if you need assistance to access this, we can help you with that." The hospital has been wonderful, other healthcare providers in town have been wonderful, and seeing these folks even when they don't have insurance.

Zach Klaassen: Yeah, it's important. I want to spin off of that comment, it's an important one about the follow-up. This is not just a one-stop shop where you come in and then they disappear again. There's follow up. Just take us through that process a little bit in terms of even going to people's houses and knowing or going back to that church. Just tell us a little more about the follow-up process for these men.

Daniel Simmons: The follow-up process is this. The hospital was kind enough to give us a nurse navigator. So the nurse navigator, she gets all this information and everybody gets something in the mail, email, or something about your results. But those people who have abnormal results, that nurse navigator reaches out to them. And if for some reason she cannot reach that person, then there's information about what church that person was tested at, she reaches out to us, and then we join in the effort to reach out. That's going to the home. And even the nurse navigator goes to the home.

And then the other layer of that is sometimes the nurse navigator is able to convince the person to get help, and that is excellent, but then sometimes she's not. And that's where the whole team comes in. Those men and women that have been trained in the church to do it, the pastors, and if it was not the pastor that brought them, it was the barber. We get involved, we encourage, we support, and we get the follow-up. They are connected with whatever area or specialty care they need, or if it's just a general physician, they get that connection.

Zach Klaassen: Absolutely. I think when we talk about Albany and the service you guys are providing, and I know we're sort of doing some connections with Augusta and Dr. Avirup Guha has been a huge leader in that, he's one of our cardio oncologists here at the Georgia Cancer Center, if somebody's listening in rural Texas or rural Arizona, how do we expand this program to all of these communities across the country that need the same setup? Are you guys expanding beyond your borders? How do we get this to all these rural communities?

Daniel Simmons: Well, the plan is to expand beyond Georgia around the country, and here is what I think needs to happen based on what we have to go through to get started. There has to be a shift in mindset by everybody involved, first in the medical profession. There has to be a shift in understanding that the medical profession alone cannot solve this problem. No matter what the outreach is, no matter what the disease, you can't sit in the corporate office or in the doctor's office and design a program that will work. You need some help. The community has to be involved.

The mindset change for us is, while we do have some of the solutions, we don't have all the solutions. So there has to be a partnership based on the recognition that neither one of us can do it alone. And so the medical profession and the whole community comes together and we work out a model that works for us. You got to have the right people. You got to get them in the right places. As Colin says in the book, you got to get them on the bus. You got to get them in the right seat on the bus, and the community can do that.

Zach Klaassen: Yeah, absolutely. Is there anything that we haven't touched on that you think would be important for our listeners?

Daniel Simmons: Yeah, I think that part of the ongoing process that everybody can work on to make it easier for us to work together is, again, people in the medical profession doing this for every patient, to just start treating that patient as a person and not a disease and to show respect, and part of that respect is listening.

My wife and I had had a conversation. She went to the doctor and she told them what she wanted and they gave her everything but that. They totally ignored what she was saying, and rather than that, they followed some script. "Well, it is time for this, that." But she said, "That's not my issue. This isn't my issue." And they never treat.

One of those things is this she doing during COVID, people postponed stuff. So she was past due for a colostomy, she was past due for a mammogram. The doctor wouldn't even listen to her desire to go ahead and do that so she could catch up. And so listening and honoring what they say, even if you don't do it all, but at least listening, showing respect.

And then on our side as the patient, we need to start speaking up and cooperating with the doctor, taking responsibility for your care, and communicating what's going on. And then the last thing I would say is just recognizing how important partnerships are. There may be that lack of trust initially, but we can work together, build that trust, and transform our communities.

Zach Klaassen: That's very well said. I was completely taken aback when I heard your presentation a few weeks ago, and I think having this message on our site is going to be unbelievable. This is not the typical conversations we have on UroToday, but it's so important to hear from people like yourself in the community who are transforming care in a very rural setting where there is challenges to care and access to care. And so, I can't thank you enough for your time, and I know this is going to be well, very well received, so thank you very much, Dr. Simmons.

Daniel Simmons: All right. Thank you again for having me, and enjoy the rest of your day.

Zach Klaassen: You too. Thanks so much.