#589 Be the Change

December 6, 2021Scott Benner

Dr. Arwa Al Hamed is creating the change in Saudi Arabia that people need.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 589 of the Juicebox Podcast.

I had a terrific conversation with r1. Let me tell you a little bit about her. She came to the United States from Saudi Arabia. When she got to the United States, she got herself a PhD, and then moved back home, where she is now a nurse scientist, and the first pediatric nurse practitioner in the country of Saudi Arabia. I think you're gonna find that our conversation is about more than diabetes. It's about how difficult change happens. And it shines a spotlight on one person's effort to make that change. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're from the United States and have type one diabetes, or from the United States, and care for someone with type one, please take just a few moments to go to T one D exchange.org. Forward slash juicebox and fill out the survey. It'll only take you less than 10 minutes. It helps people living with type one it helps research and it supports the show

this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Today's episode is also sponsored by touched by type one, please head over to touched by type one.org. Or, and and or find them on Facebook. And Instagram touched by type one helps people living with type one diabetes. And you may be very interested in how they do that. There are links in the show notes of your podcast player and links at juicebox podcast.com. To these and all of the sponsors.

Dr. Arwa Al Hamed 2:10
My name is Arwa Al Hamed. I am from Saudi Arabia, identify myself as a pediatric nurse practitioner. Right now I'm not practicing per se but I'm an assistant professor at the University. In the School of Nursing, where I am teaching pediatric nursing to undergrad I'm also doing clinical instructing for the pediatric nursing care course. I'm also involved in research with pediatric were affected by chronic illnesses focusing on their cognitive functions, psychosocial health, as well as transitioning and quality of life.

Scott Benner 3:00
Wow. Okay, well, how does that all happen? Let's um, how old are you?

Dr. Arwa Al Hamed 3:05
3033 Are you reaching? 34?

Scott Benner 3:08
Have you been in college since you were seven?

Dr. Arwa Al Hamed 3:13
Yeah, I think I've been in school most of my life. I practiced nursing. I own the bedside for three years. But then I immediately joined the post grad where I just came back from the US actually, two years ago. So yeah, for more information I did my master and PhD in the US. Part of it in New York and and other parts in Ohio, Cleveland. This is where I met Julia Blanchette. That's right, three,

Scott Benner 3:45
Angela has been on the show a number of times. And she introduced us. Yeah, that was really sweet. So how do you when you decide I don't want to be a bedside nurse anymore? I'm going to get a PhD. What's the what's the search, like for where to go look for it.

Dr. Arwa Al Hamed 4:02
Right? So it's actually it was not a time where I didn't want to do bedside, I would never stop doing bedside. But at that moment, in the place where I was working, it sounded to me like a dead end. And I was I found myself into studying more specializing more in academic areas, because at that time, my only option was either to continue to be only to on the bedside or do admin work, though the career path for nurses at that time was not not promising from my perspective, in terms of higher education. And I was, yeah, I was always hoping that I finished my undergrad and then proceed to Masters and PhD immediately. I was worried that continuing to be on the bedside area will prevent me from doing my master's in PhD. At that time, there was no option to go to do my masters and PhD through through the hospital. So the only option was to me is moved to academia. And there was opening and they wanted people to come and work there as teaching assistants, and then they would sponsor them to go and do their masters and PhD. So they come back and teach at that time, and we still have a big shortage in faculty in the nursing, undergraduate studies,

Scott Benner 5:38
what's the length of time you spent in the US?

Dr. Arwa Al Hamed 5:41
About seven years?

Scott Benner 5:43
Wow, by yourself? Or did you go with family?

Dr. Arwa Al Hamed 5:46
No, by myself? Of course, family we'd visit every now and then.

Scott Benner 5:50
No, but still, you moved from where you are now to? Yes. The Midwest of the United States or Vegas? Not really, wherever you are not in Ohio.

Dr. Arwa Al Hamed 5:58
I started in New York, I started New York, actually, I was very shocked with the snow. So many times I wanted to go back just because of the snow. So I'm very glad that my brother was with me. Initially, he came with me for first three weeks to just help me settle, etc. If he wasn't there at that time, I would have been in Saudi because I couldn't stand the snow. Like you didn't make sense to me. People. Oh, it's that. Yeah.

Scott Benner 6:27
The people listening? Well, no, because we started recording after we talked about it. But you started in a room that was a little noisy. And I said you know it, but is that you said it's air conditioning? And I said can you turn it off? And you were like, No, I'll die. Yo, I just know must have been? I mean, how what's the temperature outside where you are now?

Dr. Arwa Al Hamed 6:45
About 100 to 200? Yeah. And that's only the beginning.

Scott Benner 6:50
Your summer runs concurrent with ours. So you're in spring right now moving into summer?

Dr. Arwa Al Hamed 6:56
Yes, yeah. But you know, our spring is basically your summer. And then it gets different summer that you will never have, hopefully, you'll never experience. Unless you happen to visit in the summertime, which I don't recommend.

Scott Benner 7:10
You think I'll just burn up like a piece of paper, probably.

Dr. Arwa Al Hamed 7:14
Especially in the central parts of Saudi. If you go south to be nicer, it's mountainy. heli. But in in the central area. It's really, really hot and dry, and dusty. We get lots of sand storms. So you know how you guys spend most of your winter indoors. We have the same thing. But in the summertime, most of the monthly spend in the summer are indoors just because we cannot do anything without Daisy. So it's you're either in a mall, in the restaurant or in the house. Yeah, mostly indoors

Scott Benner 7:50
and the trunk of your car has seven cases of water and it just in case you stopped.

Dr. Arwa Al Hamed 7:56
Actually, you wouldn't do this because it will be very hot. It's not drinking anymore.

Scott Benner 8:02
What about in the evenings? How? How much does it cool down?

Dr. Arwa Al Hamed 8:07
Um, it's still very hard. Sometimes some nights are nicer than the others. But generally, it's not really nice. Gotcha.

Scott Benner 8:18
Wow, that sounds terrible. But I understand being scared by the snow because I hate the snow. And I was born here. So you see it and and that wind, right? Especially in New York City, people who've never been there don't know that the wind whips one way through the city. So you can be walking down one block where you're where you're shielded from it, and you're just like, Oh, this isn't so bad. Then you get to the intersection and a wall of frozen air just hits you.

Dr. Arwa Al Hamed 8:46
Right, will make you be tearful. I didn't know that kind of a phenomena. You were crying in the wind just because of how strong is the wind?

Scott Benner 8:57
Yeah, I must have been hacking a shop. Okay, so you're in? You're in New York for a while, and then you went to Ohio after that? Correct. Okay. So you get a master's and what was your PhD in?

Dr. Arwa Al Hamed 9:11
Um, so I did my masters as a pediatric nurse practitioner, and I finished and immediately got accepted in Case Western, in the in their PhD of nursing program. And my focus was basically the cognitive functions, together with some specific cognitive measures and quality of life in children who are living with chronic renal disease, or early stages of renal failure.

Scott Benner 9:44
It's interesting. Let me ask you another question. Before I get to that, though, the US health system versus what you were coming from in Saudi Arabia were their vast differences or was it fairly similar? What did you find?

Dr. Arwa Al Hamed 10:00
Okay, so right now we kind of have both systems if if I would say, yes, the Saudi has the government funded health care system, meaning that every Saudi citizen is entitled for free health care, and we have certain amount of government hospital in addition, we also have private sector like health. Health services being offered through private sector, meaning we have hospitals, private hospitals, that if you want to go pay out of your pocket, you can, you can still do that. Now, it's increasing, it seems like the country is even now giving more support to private, private companies to open and establish more hospitals, clinics, etc. So both of them are flourishing at the same time. Generally, everyone is entitled for this special also those who go to the military, or work in the military, or in the National Guard, for example, in my case, they also can have their access to their military hospitals. What happens is, because of that, still, we you're not, you're not going to get quick access to health care, unless, of course, if it's emergency emergency rooms are open, but thinking about dental health, dermatology, or like those primary health care services, we will have to wait sometimes months to get appointments. And this is where you might choose to go to private. It's not completely for specific services, if you if you need there are also the

Scott Benner 11:47
I'm sorry, for the speed of being seen, where are their quality differences as well?

Dr. Arwa Al Hamed 11:53
No, for that, mostly for the speed of being seen. I'm pretty lucky living in the US because we're still a little bit centralized, where all the good services are located in Riyadh. So you would really or in this case, the government hospitals, as well as the private hospitals offer pretty good quality. I personally would choose to go into government, because most of the government, hospitals are educational, or university hospitals. So you're being treated with very, you know, long standing. medicine, medical colleges and nursing schools, etc. With that being said, I'll also need to make clear is a few work in companies, some, some big companies, they offer also your they can offer you what you call medical insurance. And it depends on of course, in the coverage level, etc. They have levels, depending on your position, etc. And now the country is moving toward pushing all those who work in private sector to to offer all their employees

Scott Benner 13:12
will be can insurance. That's interesting.

Dr. Arwa Al Hamed 13:14
So that's why it's now it's confusing. We have both systems. Right? Well,

Scott Benner 13:18
it's also interesting that here, people are complaining about health insurance and pushing for a private, you know, a lot of people want a private answer, or excuse me a government answer where everybody's sort of covered, you know, at the same rate, and there you have that, and you're moving towards medical insurance.

Dr. Arwa Al Hamed 13:40
I don't think we're moving but I think

Scott Benner 13:43
it's becoming more prevalent.

Dr. Arwa Al Hamed 13:46
Right, it's, it's, I think it's because of the high load that the government hospitals are facing, especially from those who are not covered under military hospitals, we have many military hospital, big hospitals. So the load will for the other like, citizens will will fall on to some big government hospitals, where you will have to wait, sometimes months, sometimes years to do procedures. And I think one strategy is that the government is trying to support more entrepreneurs to open private hospitals and then we will help you paying for for for insurance, just make sure that everyone has at least an option. So they don't have to wait months and months for the government. Right? You know what I mean? So you will still be entitled for the government service, but instead of waiting, you can still have other options.

Scott Benner 14:47
Okay. Now, what about the standards of care? Did they vary between there and here or were they pretty similar?

Dr. Arwa Al Hamed 14:54
Right, many hospitals in Riyadh and in Jeddah, the two Me in large cities in Saudi and the East in the East Coast, we have an another two big cities. Most of the hospitals there are JCI accredited, I think joint commission accredited most of them. So I'm assuming most of the hospitals follow the US standards, specifically the military hospitals. Surprisingly, a lot of them worked or collaborated with, develop what United State developers like, for example, in my case, in my hospital, they they collaborated with some companies from the US early on to establish those standards, even in terms of equipment, etc.

Scott Benner 15:53
What have been in diabetes, specifically, if you're if you're diagnosed there today, what happens do you get, you don't get regular and NPH insulin you get? You get modern insulins, right, like some version of Novolog, Humalog, that kind of stuff. Correct? Right? And do people start off with injections? Because I get a lot of letters from people living in your area? Asking me if I know how to get CGM and insulin pumps there, that actually happens frequently. Are they not readily available?

Dr. Arwa Al Hamed 16:28
Um, they are. But again, I would still consider, well, it's very important to mention that still services are mostly, like heavily provided in central areas or big cities. So maybe you will hear that from residents have rural areas or areas far away from the central areas or from the large cities in the kingdom. The other thing? I think, yes, it depends on where they are from, or that they're, depending on the supply, or if they got those new equipments. I also noticed some people are a little bit afraid of the pumps. In my family, a few of my cousins actually have type one diabetes. And two of them, actually, their parents are not very comfortable having the pumps, so they still prefer the injections. But they are still they're here. They're offered. And I think it's based on preference.

Scott Benner 17:39
Yeah, I actually know a few families that fly to America buy products and cash and flight back. And maybe, maybe things are changed since even I've heard those stories. That's a it's, I mean, it makes sense to that, as you get further away from population centers. Can't care. I don't know if it slips or if maybe just the ideas haven't gotten out. Because there's fewer people. And you know, they don't get a chance to see each other using them. I would also wonder how you keep insulin cool. They're like, yeah, they

Dr. Arwa Al Hamed 18:15
will it same, same thing. Same thing applies to the US in the summertime, they will always move with their small refrigerators with them. Okay. All right. But we don't do lots of summer activity in the summer time. So unlike in the US, for example, in the US, you would be worried right about kids going camping or going for the beach or going for sports. I'm very, very limited. Things we do out during the summertime, so they're always in the refrigerator.

Scott Benner 18:45
has these.

Dr. Arwa Al Hamed 18:47
Yeah, referring back to the to the pump, over the one I give wrong information. There might be other factors that I'm not only pretty aware of. So yeah, I'm just not one to be honest enough. I might not be very familiar with all the other factors.

Scott Benner 19:06
Okay. No, I appreciate that. I just, I'm just interested in your perspective. So when when you get your PhD, I guess that kind of drives your, your your focus moving forward. So you come home, was it always the plan to come home and practice? Yes, it was. So you come home with an eye on helping with the cognitive issues. And you're you're in this one focus right now. Is that right? Or do you move outside of it as well?

Dr. Arwa Al Hamed 19:33
I know a little bit outside like for example, lately. Actually, Julius specifically inspired me to look at that variable, where transition specifically that we don't have transition clinic that transition clinic by itself is a new idea. In some specialties they started applying them, for example in rheumatology They already have transition clinics to treat kids who are moving from childhood into adulthood. But for type one diabetes, despite the high the high prevalence here, they don't. And what's also concerning to me compared to the US is that we consider children as as to be treated in the pediatric clinic. If they are from one day old until 14 years old, only. Unlike in the US, where they can continue with the pediatrician until they are 21. I'm not wrong. We're 24

Scott Benner 20:44
You can stay with your knowledge here. I'm sorry. If you're in college, you can stay with your nutrition till you've graduated. I'm sorry, you broke up,

Dr. Arwa Al Hamed 20:55
right? No, I'm here. He only until 14 Once they get into it.

Scott Benner 21:07
Or why you just disappeared? We lost our Yes, I'm back to the dog get you? Yes. Yeah. I'm okay. No, no, it's fine. Yeah.

Dr. Arwa Al Hamed 21:22
So that was concerning to me. Because I was wondering what happened to those kids? Do we just send them to the adults? area? Starting from 50 years old? How about if they're, like, even if you're considering them physically at puberty? In terms of mental or cognitive? or you're not? You don't know yet, you know, even deciding who's mature and who's not takes a psychologist to review that it's right. So they just at 14 years old, they just discharged from the pediatric area, and they send it to adults, where everything is different, their approach is different providers different and the family should not be involved that much, and all that has an influence on their compliance.

Scott Benner 22:10
Can I? So is that cultural that age cut off? Or is that? Yeah, it is?

Dr. Arwa Al Hamed 22:17
It's, it's a Yeah, because I'm not sure if you're familiar we consider for a boy who was at puberty, or a girl who was at puberty, they're considered already mature. Oh, so you have to, for a female she has to cover up from other male who are not from her family? And for the for the male, he cannot be cannot be with other females who are not among his family, or they're not? They shouldn't they should cover up. I see. So in that case, we regularly admit, admit them in pediatric units. Of course, that was mostly before we had shared rooms, etc. So usually the sitters or the those who are admitted with the patient are usually mothers. So for this patient to be boy at puberty was very inconvenient. So usually they they put that cutoff limit. So they it's for segregation purpose is to help segregation.

Scott Benner 23:20
Make sure I understand continued, yeah, make sure I understand if my son was diagnosed, right as he hit puberty in that age, then my wife could not go with him to the hospital. Because there'd be a commingling of genders is

Dr. Arwa Al Hamed 23:39
no no, no. admission for admission, your jewelry for convenience, but no role to prevent anything. No, they can still go and do everything together. But I mean, for convenience purposes, they organize it that way.

Scott Benner 23:51
So this one cultural idea, leads leads to separating, like putting children into adult care was something that's really confusing that they're probably not ready for it. Because at that age, I mean, I have to be honest, at that age, I was like, stupid. I didn't you know, I didn't understand anything and I had no context for anything still. I guess I didn't grow up where where these kids did so maybe I would have been more mature at that age. I'm not sure. But that's incredibly interesting. So you said that the care differs between the segment of children in the segment of adults how does how does the idea of carrot change

Dr. Arwa Al Hamed 24:30
like for example consider how the care in in pediatric clinics for example is always family centered right? You're not gonna be able to access the child without his parents in and most of the cases are usually mothers. But now with with moving to adulthood, your family or or not really The focus you are the focus now your should be all of a sudden, the one who is taking care of all the details, including scheduling and compliance and not only prescribe administering your medication, but following up all these different appointments and supplies, etc. So the approach is different. Now you're not only communicating, you used to communicate with the whole family, but with adult you mostly communicate with the patient. How does that work? And the other thing

Scott Benner 25:35
I like? How does that end up working out? Like, is that a, like a? Okay, rock solid? Everybody's doing really well and super healthy? Or is it problematic? Somewhere in between?

Dr. Arwa Al Hamed 25:47
It's a it's actually a very good question. Because when I came back, and I noticed that I, I communicate with some of the endocrinologist, we work with the pediatric endocrine, and they, they told me that they they tweaked a little bit within this system just to keep their patients with them until the physician feels very comfortable. discharging the child from pediatric to adult. Which is to me it's nice, but at the same time, it takes a lot of effort from the physician side to our would it go assess the

Scott Benner 26:27
kids, right? Yeah.

Dr. Arwa Al Hamed 26:29
And yeah, they still have to what to call it compromise that it's a bit and talk with with sometimes admin people or you know, hospital admin people, because they they keep pushing for that, like, you have to move this child to adulthood he's he's already in the system, he's 14 You need to move into other then they will go and a little bit Jani advocate for their patient to just keep them under their care until they feel comfortable. Making sure that the child started to be independent, start administering his medication or following up his coming at least to the clinic, sometimes alone, etc. And once they feel ready, they, they they transferred them, but it's not always possible. Sometimes you will have to do that.

Scott Benner 27:21
What are a one seagulls there?

Dr. Arwa Al Hamed 27:25
Huh, I don't have an accurate number. But I'm assuming

Scott Benner 27:31
Well, what would you ask some what would you hope someone wish was aiming for? If you were if you were I would

Dr. Arwa Al Hamed 27:41
say six 6.5? I would say okay, that's fine. Five

Scott Benner 27:46
is diet there. There any cultural differences in foods that make type one management easier or more difficult?

Dr. Arwa Al Hamed 27:55
Um, I would say yes, it would make it more difficult just because the, the culture or the lifestyle here is is sedentary a little bit because especially that the weather people are very reluctant to go out with that. Weather, especially in the summertime. And summertime, or summer weather specifically coincides with summer vacation, which is quite long. And not every not all kids get to travel or do activities. Most of them are indoors. gyms and look or to to to participate in a gym or something indoor usually costs money. It's not possible for all families to offer that for all their kids. So I would assume the the diets with all the options, we have people like dessert here, people like variety of food, we have vary. Now the fast food thing is, is becoming an expert here. Like making all sorts of us fast food, but now we no longer have changed restaurant or we do but we're very becoming very, like good at making our own local restaurant or fast food and especially kids that they're like adolescents or, you know, they cannot resist all these options, especially in the summertime. So I'm assuming it would be a little bit difficult. I personally noticed that when I came back, people eat lots of snacks, unhealthy snacks here compared to in other countries where snacks are limited here. They have a lot of options. It's very tempting. We're very very good at making dessert here. Very, very good, like insanely good. You're welcome by the way.

Scott Benner 29:50
We We've exported all of our best goods to you to learn from McDonald's. Congratulations. That's terrible. Can I ask just from a personal like standpoint? What? Is there anything you miss about the US? Either professionally or personally a lot.

Dr. Arwa Al Hamed 30:15
Um, I miss a lot. I miss the weather, I miss the green life, I get very attached to the lifestyle where I do go out during the summer all the time to parks, mountains, lakes, rivers, I miss all this, to be honest with you. I missed the diversity very much. I kind of got addicted to it. So now every time I go out or socialize, I get bored very quickly, because people are mostly the same here. There's from the same culture from the same place. We you know, we don't have a lot of we don't have a strong immigration history. We do have expats coming to work here, but not immigration, per se. So people don't end up mixing and being just one. One country. No, we still have a lot of people coming to work, but not so much mixing. And unless you make active efforts to do that, which I ended up doing, I ended up joining meetup groups as if I'm still in a new country, just to just to fill that need of meeting new people or diverse people every time. That's interesting.

Scott Benner 31:26
Yeah, I guess you ask a question. And once it gets answered the same way, four or five times in a row? Not a lot of excitement about asking it again.

Dr. Arwa Al Hamed 31:33
Exactly. Yeah, exactly. It was always interesting here to conversate with people and you'll always hear different religion, different culture, different ethnic background, there are different interests to like people who usually do the same thing that a majority of people are kind of similar. And even there, and you know, we're very social oriented. Society here, we still like to fit in. And it's, it's now it's changing at least. But still like the overall picture is that everyone looks the same talks, the same, does the same thing. So on

Scott Benner 32:23
you made me think of earlier, I kind of had a light bulb go off in my head when you said people are either at home or in the mall. And it reminded me of a time I visited the Dominican Republic, and there was this mall. And it just felt like everyone was in it. It was it was the busiest place I've ever seen in my life. And it never occurred to me that it was about getting out of the hot weather. Until Ryan just said that. And the the idea of diversity, that's not going to change there anytime soon, I would imagine.

Dr. Arwa Al Hamed 32:56
It's actually changing in Riyadh, specifically in VR, but now is becoming like a very big hub for all new companies and new investments and with with most of them the vision of 2030. All this is they're attracting more businesses to open and beyond. So a lot of people coming to work in Riyadh every year, right? It's interesting. Yes, it's very interesting. Compared to before, now, I see more and more opening up. If you go out now you see a lot of people from different places, going out more before with with COVID. And all the travelers restriction, people would come work and then they travel, you would rarely see them coming out in the weekend or coming to entertain in Riyadh. But now with the COVID restriction, I came to realize how much diversity we have in Riyadh. Because now with all the travel restriction, people ended up spending their weekends you're spending their vacations and be out. So you start seeing people from different countries and places in Riyadh, some of them are and I think you and I think it's going to get even more diverse because the plan is to have like, more foreign companies opening their headquarters and beyond. So I'm expecting to see more and more that's

Scott Benner 34:29
like that. That's probably particularly exciting for someone like you who's lived somewhere that's more diverse.

Dr. Arwa Al Hamed 34:36
It is I'm enjoying it very much. i It's true. You don't see any changes at the level of the society like comparing it to people who would be living here for years and years changing even though like building block of the country itself, but you will still see six to see changes people opening up more now and and being more accepting of differences where now you don't have to do active effort to look like everyone else because you start being more than welcome then accepted the way you are. So I'm enjoying it for now.

Scott Benner 35:19
Yeah, I would be excited. Are you married? I didn't ask. No, I'm not. I have no idea what's happening right now. Siri just started talking for some reason that really messed with my head hasn't happened.

Dr. Arwa Al Hamed 35:35
Maybe she wasn't happy with the question.

Scott Benner 35:37
Yeah, I gotta try harder. I marriage question I couldn't hear with my headphones on. Do you think it was? Do you think my speaker just started going? Like, come on, buddy? Try harder? No, I just was. I was just interested. So your your are you? Is that something you're interested in? Marriage? Yeah. Is it uncommon for you to feel that way at your age living there it is.

Dr. Arwa Al Hamed 36:02
Mostly, most of people in my age are married and have kids, including, like me, whether despite of the gender, but I think especially living in Riyadh, again, I will keep pointing back to Riyadh is because even in the other, not only the becoming the hub for all the new jobs and for all career, nice career pathways, people would move to Riyadh, from different cities, even in in the kingdom. So you start meeting people at their 30s, who marriage is not in their priority, because career is their priority, mostly. So now it's becoming common that you see people in my age, or not married and they're okay. They're, they're not desperately looking forward, or they're not facing pressure from the family to get married. It's becoming normal, just another normal. I think it's mainly because of carrier. Most of the people I meet who are in my age and are not married, they're always very passionate about their carrier what they're doing.

Scott Benner 37:28
So it basically breaks down some lines, like you're gonna build a family or you're going to or build a career but it doesn't those two don't mesh well together. Like the idea of two really career motivated people living together doesn't happen quite as much. No, it is not for you.

Dr. Arwa Al Hamed 37:49
But I think it's very interesting. If we start talking about this, I will be talking for like, two more hours. I think, I think what happened is with this transition, that the the to the sudden and quick changes that happened in Saudi in terms of society, and economy, of course, economy has been okay all the time. But now is there a major society changes for example, now, we were driving before we didn't, and all the breaking of the segregation that's happening now in many places, et cetera. So there's major dramatic societal changes. What happened is up in Wilson, their 30s. There, they're still there in between. They're not from those who are before the generation who are older or they're not even the current generation who are already experiencing these changes, that they don't feel anything different for us or people in my age. We're facing lots of conflicting ideas. We continue to compare what we see now compared to what we've been taught to what venues to do or what they've been prevented from doing etc. Compared to now where everything is different. So I think what happens is those who cope very well and adjust quickly and and fit in they they might they need to find someone who's that similar to them. Who who's adjusting well and adopting all those new changes without feeling any conflict, any internal conflict. And and here comes a problem. I think girls are doing much much better in this compared to guys in our age. Where they still not sure if they like what they see now and if they're okay to completely adjust to what they see and they're still stuck to some old Ideas are old about, you know about gender about what to expect from a wife what to expect from marriage, all this? Right? Well, I think I'm in that space and that gap in that space. Yeah.

Scott Benner 40:13
Yeah. I mean, listen, it makes sense, right? Because when, when human rights and civil rights and things like that get more and more available for people, it really does end up benefiting women. exponentially, right? Where, right? Whereas men are like, Wait, so then yes, there's no lady that's gonna clean this stuff and make me food. But you don't like me? You don't get quite the same deal if you're on the other side of it. So that makes 100% sense. And so people are holding out, they're like, I wonder what life could be. I'm gonna wait and make something cool, right?

Dr. Arwa Al Hamed 40:50
Yes, yeah, some of them are actually waiting to be stuck

Scott Benner 40:53
inside the air conditioning. Because

Dr. Arwa Al Hamed 40:57
a lot of girls in Saudi know, they don't want to wait, they feel that they spent so many years in that old mentality. And they don't want that anymore. So they're very eager to live their life to their maximum capabilities and maximum potentials, either at work, or even in social life. So they always have plans when I meet girls in my age, it's, it's, it's very surprising. And interesting, because most of them are in the same page. Most of them, they just want to enjoy all those privileges that we have right now. can travel anytime, anywhere. We can do any hobby that you wanted before, and was not an option. For example, music, playing instruments, you can only do that at your home or practice it with your family, but never something that you can work on or be have a carrier or something that you can make a business out of it. Well, everything is just all of a sudden open. It's kind of distracting even from looking for marriage, believe it or not, you

Scott Benner 41:58
know what it sounds like? It sounds like Netflix for life. Like there's so many. You just scroll and scroll and scroll and never watch anything. You're just like, there's too much to do. I can't pick. But that makes sense, though. And it kind of sounds exciting. What what do you think, started that kind of boom? Was there one cultural shift that moved everything in a different direction?

Dr. Arwa Al Hamed 42:23
I think there are so many. But for example, I give you a very, very simple example. Some of the, I think king king, King Abdullah, previously he was Prince Abdullah Ahmed. And then I think probably I'm not sure if you're familiar with all the royal family members. But King Abdullah, for example, he started a move that was I think, about 15 years ago, where they started the studying abroad program. They have, they created a program where they sponsors students with high GPAs starting from like fifth when they finish high school. And they can sparse they sponsor them for studying abroad. Programs in different countries started with the US, Canada, UK, and many others. But the three main big countries that we used to go is the US, Canada and the UK. It started a long time ago about 15 or 20 years ago, I think the plan would from what you see is that they want to prepare a generation of people who are let's say, Western, educated, they're, they're, they're used to seeing different cultures because think about we've been a little bit Yani introvert for some time, in terms of like exposing to different cultures, different races of religion. So I think the plan was is to not only make them get Western education, but make them mix with other cultures or other religions and and then when they come back, they're more ready to absorb the new changes or that are already happening. So I think that worked for big part of what's happening because those students when they came back, most of them now are the leaders and most of them that say ministries, all the government services or the big, big companies in Saudi Arabia. So I'm assuming that in part worked. And then, of course, the new Prince Mohammed bin Salman, with that knew, of course, that's the first and the only time we ever had a young leader, that young leader and that kind of changed everything because he is I think he has chords to change things that others were very reluctant to change us. They were very afraid to change those social things that were fully yeah thought about it as religion when in fact it wasn't. I think he was just courageous enough to start pushing for those changes that has been already there. But it would, no one has the like, really the chords to apply them or implement them.

Scott Benner 45:35
Right? I have to admit, the first time that I saw in the news that it was a big deal that a woman was driving a car. I was I stopped me for a second I thought, Wait, women couldn't drive cars. Like I didn't. That was not something it even occurred to me. But this is it's kind of fascinating because you're, you're transitioning, but that transition still has to happen culturally and slowly to some degree like you can't I imagine you can't just like if you could just magically flip a switch and move everybody into a different space. It would probably short circuit most people's minds, right. Like it's it's that different from what they're accustomed to and what they were expecting growing up. Mm hmm. Wow, that's fascinating. Yeah,

Dr. Arwa Al Hamed 46:17
but because lots of people don't realize that just give me a minute.

Scott Benner 46:27
No, you're fine. Do we have to shoot somebody away?

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Dr. Arwa Al Hamed 47:32
Yeah, my brother is just looking for my car keys. So yeah, it's people don't realize that we didn't wait for driving to to start developing very quick. Well,

Scott Benner 47:55
are you broke? Are you back? You're not back. Tell me when you can hear me again. Hello, hello. Oops.

Dr. Arwa Al Hamed 48:11
Sorry, mixed environment.

Scott Benner 48:13
I'm so sorry. Hey, I gotta cut you off. You. You were gone for about 20 seconds. So I apologize. But you the last thing I heard you say was it didn't just happen with driving? Yes. Yeah. Okay. I'm sorry.

Dr. Arwa Al Hamed 48:27
Yeah. So I'm saying it didn't just happen when we started driving, but it would it started. Very long time ago. We had women working in, in businesses in medicine, and academia, their Dean's, they're working everywhere. From very long time ago, my mom was one of them. And then driving was a very, very minor compared to what we were empowered to do. Long time ago. What was going on is that for some reason, they associated driving with some religious restrictions, which wasn't a right. Connection. It was never a true connection that was made, right? It was very easy for it to like, stay there. Don't touch it. Okay, that's fine. Just keep it it's not really preventing us from doing anything. We can still study, we can still travel, we can still go to the US and do PhD, we can come back and be prime ministers, etc. So it was never a barrier. But

Scott Benner 49:47
if I had to go Yeah. All right. If I had to guess it sounds like one of those things that men who wanted you to wash their clothes and make them food thought, whoo. If we start letting women drive, they're going to get out in the world and figure out it's not as much fun to do my laundry as I told them it was, doesn't that have like sort of like that just like the idea of you restrict somebody travel or their ability to see other people or interact with other people who have different ideas, then you restrict their ability to dream those things. And then you can kind of it's easier to control them than I would imagine.

Dr. Arwa Al Hamed 50:19
Yeah, yeah, of course. Yeah. Although we we wasn't just about like watching the laundry. It's more like, it's more deeper than that. But yeah, it's 100%. True. I, I get I still meet people are compensated with people who would still feel threatened by by having their wife striving for the same exact reason, although they weren't admitted. He would tell you Oh, no, I'm afraid it's too crazy out there. People don't drive nicely, oh, I don't have money to buy another car. They will, they will use all these other excuses. But if you start pushing and pushing and pushing here come to the, to this true, true idea behind it is that it's such Right,

Scott Benner 51:05
yeah, you get you get frightened that people will see a world and think, Wow, this is better than the world I live in. And not come back. Yeah, I mean, and when you're, when you're so accustomed to that being the truth. I mean, giving it away, if you look at it from the male perspective, like just giving it away, must be it must be difficult. You know, I mean, I'm, I'm 50. And in America, you know, I was I was I became a stay at home father in my 20s. It was incredibly uncommon at that time, when I when I did it. And it was looked at unfavorably by most of the older people in my life, they mostly looked at me like, Oh, he's taking advantage of her. And he should be working. And they didn't understand that we thought that this was a the best balance for us, you know, and the way we can make things work. And I will tell you that there have been times when I'm growing up, where I think I love the way my life worked out. But you do wonder sometime like what was it like to, you know, 1950s America, come home and have a bunch of people just treating you like a king walking through the door? You know what I mean? Like, that's never happened to me in my entire life. I don't think I would want that. But might have been cool. Cool to see it one time just to see what it was like, you know, my example about the laundry is because I'm the one that does the laundry at the house. And I want to get away from it. Yeah, I hate doing the laundry. But that's that's not the point. The point is that you guys are making these amazing leaps. And are they? Are they transitioning? I would think not just in the medicine, but everywhere because you're getting new ideas. People have been exposed to more, I mean, you you might well see a real, a real Renaissance.

Dr. Arwa Al Hamed 52:55
Right, actually, with medicine, the medicine started to advance in the country, way, way, way, way back. It was actually one of the few specialties that the country didn't really, or the country sponsored all endeavors related to medicine, from the early ages of this country. So that's why if you compare hospitals in Saudi Arabia, specifically as compared to the other Middle Eastern countries, even other Gulf countries, we have some of the best physicians and hospitals I'm not saying this because I'm Saudi, but this because really, really it's it's it's true. They spend a lot of money in this in the country invested a lot in most of them are prepared either in Canada, Germany, UK, US, and most of them, they've spent their fellowship there. We still collaborating with big hospitals, and big. I'm not sure how you call those kind of companies, but those who develop hospitals. Yeah. So yeah, we a lot of ongoing businesses that started decades ago.

Scott Benner 54:16
Yeah, they're like private for profit hospitals. Hmm. Right. Exactly. Yeah. Well, I just had a question on the tip my tongue and just fell right out of my head. Damn. Shoot, shoot, shoot, shoot, shoot, where did it go?

Dr. Arwa Al Hamed 54:32
Say you're asking about the transition? Yeah,

Scott Benner 54:35
I'm sorry. I blanked out for a second. But yeah, um, the, the idea I'm wondering about is, will like, at what point do we see the information that was brought back to other places, refined by other places, and built on top of like, that's because I don't think that diabetes care. In the US is particularly finished, right? It's better than it was. But you can still go to plenty of places who are operating like it's 10 or 15 years ago. And so my expectation, well, I guess it's my hope is that the diabetes care will become more, two way, meaning people won't go into doctors offices and just be told, Do this, do this, do this. And then you come back, and we'll measure it again later. And we'll change some things. Like I want to see people in a position of power in a position to say, I'm going to make a change to my Basal insulin, or I'm going to, you know, I'm going to come to realize that this meal needs more insulin than this other meal, and not just use some carb ratio, and just, you know, let my blood sugar be high for four or five hours afterwards. And I'm wondering if this spreading of information won't in time lead to people understanding that better? But I mean, do you think people understand that they need to be more proactive with diabetes care? Or do you think that that understanding exists some places and not others?

Dr. Arwa Al Hamed 56:13
What what's good about type one diabetes, specifically, that it's affecting the, unfortunately, at least considering that the prevalence is increasing with recently compared to before, I think it's being affecting the gender, the new generation, who are very, let's say, first of all, they're tech savvy, most of them, they are, they are being raised differently than kids before. So most of them, they, they do things because they want to do what they need to be convinced the you cannot tell them what to do anymore. You need to convince them why they need to do things. So this type of mentality or mindset, is, will make me think that it's possible. Because you see them now I, I interact with a lot of like, let's say, school, school aged school age, kids to dollar since they they're very mature compared to we when we were at their age, and they're very independent, more getting there, they're given more opportunities to practice their independence compared to us back in the days, specifically girls, for example, I was not, I was never allowed to go to pointment alone or everything, my mom would be very worried. So she prepared to go with me. Now, they do everything alone. So I don't I think that this was tacitly tait the implementation of like self care of all the principles of self care or individualized care. However, what I think still might be a barrier is the approach from medicine itself. The like, I think health care providers are not confident enough that those kids are able to do that. And that's why they maybe insist on depending on the parents, so you know, that's this age generation difference where you as an as an adult don't think that they know enough, or they don't trust them enough. But unless if we start adopting this new mentality that no, this new generation is able to do it, just simply because they are raised differently. They've been allowed to experience everything they've been allowed to do do things alone, so they are stronger than when we were at their age. So I think the change needs to start from that provider itself.

Scott Benner 59:05
It's exciting, isn't it to see a generation of people who are less restricted than the one before them, and to see what they kind of do with it. And, you know, obviously, everyone doesn't take it in a great direction, but some people really do. And that idea of self care for medicine really translates to self care for a person in total, just their ideas and their goals and their focuses. Everything is within their control, I guess, and no one's telling you what to do with it. So they're able to explore directions and your people are going to find people are going to find lives that they just never would have been able to find in the past, because they felt so I mean, it's not even that you just felt so much but your parents were scared, like you said, and they would insist Still that fear on you whether that fear was safety, or religion or government or whatever it ends up being, you know, you can't do that. Or we don't do this. We can't say this. We can't go here. I mean, you can't play a flute outside of your house. And now that just, I'm super excited about where, where it's heading. I think this is the a very exciting generation of people to pay attention to. I've always thought that I was interested that you said it to. So yeah, they're

Dr. Arwa Al Hamed 1:00:25
very, very, very self determined for their age, honestly.

Scott Benner 1:00:29
Yeah. It's crazy. My daughter made 35 If you talk to her, and she's exactly she's 16.

Dr. Arwa Al Hamed 1:00:34
Yeah. Yeah, like, if you notice, especially now, these days, for example, I have three brothers. One of them is 40. Of course, they're all adults, but they all can spend time with the friends from all different age groups, like they all together that they have 10 years different from each other. But when they gather with their friends, they have friends from all age groups, and they enjoy their time they travel together, they do things and look, wow, before we didn't do that, we would stick to people at our age. Yeah, even for me, when I when I gather with with my family, we can spend hours and hours conversating with 16 years old, and you would never feel like she's only 16

Scott Benner 1:01:22
I interviewed three girls who were like 1315 and 17. I interviewed them together. They're these three friends who live on this island together. And they all have diabetes. So I was like, I'll just, you know, I never done an interview with that many people before. And it was a little it felt like hectic to me sometimes. But when I got to the end, I thought, huh, that's crazy. I'm, I could be their parents. And we just had a very normal conversation. It was, it was fascinating. Three girls taking care of their diabetes that you know, 15 I think 1617 Like, whatever they were there, they're young, you know, and they just didn't come off as young. Like, don't get me wrong, they're still, you know, they're a little giggly sometimes. And you know, they maybe don't follow sarcasm as well as an older person would or stuff like that. But they're just they have thoughtful, they know who they are. I guess that's really what it ends up being is you ask them a question. And they know the answer. Because they're connected to themselves. They're not just these robots that their parents are controlling through life. They're their autonomous people, and is absolutely lovely, you know, really great, right? I don't.

Dr. Arwa Al Hamed 1:02:34
So, again, good. Going back to the transition. Yeah, I think maybe they are better off compared to other generation. But I think still, right, that the purpose of transition clinics, sometimes it's really not only for the patient themselves, but really, it's for the provider to, to prepare for this transition. Because we we don't have some somewhere in the middle, we either have a pediatric who's very nice, and who will involve the whole family. And then all of a sudden, we will have an adult endocrinologist who is used to older people, and he was just asked specific questions, and he's not going to dig deeper with the patient and just tell them a list of things that they need to do. And then they just go home.

Scott Benner 1:03:25
Yeah, that's a shame.

Dr. Arwa Al Hamed 1:03:28
Hey, but for this specific generation that we just said, I think, physician physicians or, let's say, providers in general, whether professional nurse practitioners, they need to be prepared to trust them. Or at least to be able to assess those kids from different standards or standpoint, not just use our our own ideas that oh, they're they're young, by default. We shouldn't trust them. Or by default, they shouldn't be controlling their condition 100%, etc.

Scott Benner 1:04:07
Yeah, I mean, there are people who are able to do things that their age wouldn't indicate sometimes, and those people shouldn't be left behind. Because you're like, Oh, well, they're, they're 13 they don't understand that I've had kids come on the show, that are astonishingly good at taking care of their diabetes. And they're, they're young, I have one coming up soon, a girl living in Russia, and she's young and found the podcast on her own and figured everything out by herself. It's fascinating, you know, but it's really, really cool. And I think that that shouldn't be taken from people like everyone's not going to get it on a deeper level, but everybody should have the opportunity to try. You know, that's, um, it seems like the old way of thinking about it was most of you aren't gonna understand this. So I'm not going to bother explaining it to anybody. You know, answer my questions. The dials us a little more here. That's it. That's, um, and now there's glucose sensing technology, which just opens your eyes to what's really happening with your blood sugar. Fascinating, you know? Yeah. So what is your goal? Like, what do you, you got all this education, you came home, you're living a, you know, a different lifestyle in Saudi than probably, you know, two generations ago if your family did? What what are you going to do with everything you've amassed? What is your? What is your hope?

Dr. Arwa Al Hamed 1:05:31
Okay. Two big questions of carrier? Yeah, it's a big question. It's a very big question. And then it also keeps changing, I think, because sometimes what you come back, hoping that you want to do is really not feasible for probably not, not going to say not possible, but it will might take you years and years to even do 10% of it. But so you show you I think, what what parts of resilience mean is even your goals, we need to keep modifying them, not necessarily lowering your expectation of yourself. But know, maybe you now have a better perspective of how is it really going on here? Because I may, I may had ideas about what I want to do. But when you come here and experience, life, here are the flow of things and what exactly needed, you might start realizing that there are other other areas that needs to be worked on as compared to what you had in your mind. Or instead of this one, this is more important for the country at this time, specifically. So this is what's been happening with me is that I've been trying to find the right way to reach or not reach, because I don't think there should be one goal that you reach it, and then you're done. No, it's always changing random underneath. So the plan is, when I did my PhD, I focused on cognitive functioning, and how it affects their school performance. And then eventually, their chances of getting accepted in colleges and then getting good jobs for patients with renal failure. But now I'm trying to expand it more on other kids with chronic illnesses. Because what happened, especially with renal, or children with renal failure, although it's considerably a rare condition, especially in developed countries, it's still the focus in their care is mainly stabilizing them. Physiologically, at least, or maintaining Yoni is at least, to stay alive and decrease mortality, decrease morbidity, etc. But the advancement in career or schooling is not a priority at all. Which is I understand why it started like that. But I also don't understand why it continued. Of course, initially, we will just want to make sure they survive, right? But then eventually, what is it just make them survive, but how about their quality of life? How about their opportunities to pursue their life goals without affecting their economy, IQ, status, etc. So that was my plan is to go back and dig deep in the system, and find out those gaps where those kids sometimes just don't go to school because they get admitted quite often to the hospital. So the family feels a burden, and then they stop sending the kid to school. So those kids will, will will not be able to catch up with the schooling system. And some of them don't end up never going.

Scott Benner 1:09:16
They just stop advancing right you so you just end up being as mature and as your age of when you're diagnosed with something like it's almost like getting sick ends your life instead of exactly right instead of figuring out a way to incorporate it into your life.

Dr. Arwa Al Hamed 1:09:36
Exactly. Even sometimes when they get the kidney transplanted the new kidney transplant and they still because of fear from getting infection, it's some families don't send them to school. Of course, we don't have such a role where they can be where they need where they can be referred to protection services due to that, it's still not technically considered neglect. We do have child protection service but like not send them to school per se for a chronic condition is not really something clear cut, you know? So, so yeah, sometimes out of fear, they just don't send them to school and continues being a problem. So I, this is this is where I started developing the research ideas, why and what can we do to prevent that? I heard when I was in the city, I heard that their start, they have some tutoring programs where they can come to the child during his data session, and offer him some schooling, etc. We didn't have that. We don't have that yet. So my hope is was to create this program where it can be a collaboration between Ministry of Health Ministry of Education, where we can have a whole program established for children with chronic illnesses in which they have regular follow up regular cognitive assessments, psychosocial assessment, and it's, you know, embedded in the education system for these kids. So they can sign up on this program once they are diagnosed. So we track them early on, we identify any limitations if they have, if they have specific problems with math, per se, just due to for example, anemia, maybe with with renal patients, for example. Maybe they will have specific problems with memorizing due to anemia and poor memory, etc. Do you recognize that? Do we have that into consideration? If yes, how and what we're going to do about it? It's unfair that those kids are being treated as normal kids, or they should they have all the right to be treated as normal kid, but I'm, I'm afraid that sometimes we will miss some limitations that are specifically to their condition. But we don't know. Yeah, so that they don't do anything.

Scott Benner 1:12:12
So they don't become disposable. And you don't just see them as a they've got an issue. And now that means they shouldn't enjoy the same ideas that everybody else gets the hope for. It's just exactly. It's amazing. That's beautiful. So you keep bringing them, the idea is to keep bringing them services, that keep them up to speed while they're taking care of their health. Right. Yeah, that's it. I mean, it's so simple, right? Doesn't it just make sense? You know, yeah, people should not because,

Dr. Arwa Al Hamed 1:12:41
as I, as I mentioned to you, when I came back, carry alized, we have other gaps that should start before that, that needs to be fixed. Before we start implementing such programs, for example, we we had, we don't have school nurses yet. Okay. So when you first think about such a program, right, you would think immediately of the school nurse who will be doing the evaluation, or the follow up for this kid, at least in the school, right? Who will be going to do this, for example, cognitive assessment or these regular assessments, I was hoping that this can be implemented in the school system. But if we don't have a school nurse for a specific school or for this specific district, then who's going to do that? Right. So this is where I started realizing, okay, let me modify my goal and start looking for, like, other things related to that to see where the gap is where you can start fixing the the issue is,

Scott Benner 1:13:41
Is it crazy to think that school nursing could become a thing? Like the gift somebody got behind it? Would there be a way to get it funded? And and

Dr. Arwa Al Hamed 1:13:50
I think the funding is just what's what's what's preventing it's, it's, it's a as a law, it has been issued four years ago. But now each hospital needs to have school nurse implementation. Not yet. And I think mainly because of funding issues.

Scott Benner 1:14:11
So you have to you really do have to jumpstart things, they don't just either things start out of necessity, or they start because someone who has the the ability financially gets behind an idea and moves it forward quickly. There's no, there's no other way that things begin really.

Dr. Arwa Al Hamed 1:14:30
Exactly. And you know, what's the major major problem here is the lack of data, unlike in the US were already well established. The search data are there to be to support your ideas, let's say yeah, to support your ideas or to support your proposals for policy health policy changes cetera, we still don't have that. So that's why you come to realize that okay, I need data. In order for me to come and approach decision makers or leaders in the healthcare sector, where they have a lot of huge priorities to come and tell them, you know, what, stop and fund school nursing system? First question that will come to mind. Why, why why now? Why is it urgent, but if you have the data, and if you can show that this is exactly what's going on, those there might be facing additional difficulties making families additional additional difficulties finding jobs. They don't, they just can't, they are not allowed to make good GPAs, basically, just because of how their condition is. So yeah, this is my help starting from the basics and trying to establish some database.

Scott Benner 1:15:42
Well, I hope you are able to figure out a way to make it happen, because it's obvious while you're talking to me, like it makes me feel this way. It's it's, it's obvious why things take so long to come together. Right? Like, it's just it's clear, there's so many moving parts and so many people that you have to talk into it, there's money that has to be raised, and you have to actually do the physical thing, it's not enough to just have a great idea, you actually have to accomplish it afterwards. And then it takes time, then you imagine that you bring in the school nurses, and some of them you hire suck, and then you have to be replaced with other schools, you know, it takes time to get it working smoothly. And thanks. And we all don't have that much time. Like, we're all just like, hey, like my kids in school for this long, or my life is only this long. And then people get frustrated that things like that don't exist. And that frustration can sometimes end up killing your motivation. Yeah, it just takes away your drive. You just think, Oh, I'll never get this done. I might as well go do something different. And you need people to do those difficult things and have those fights. Right? Yeah. So you might as well be one of those people go get them? You know, it's got somebody's got to do it. Somebody has to decide. This isn't I mean, listen, it's a much different scale. But when I began this podcast, I thought, I'm going to talk to people about diabetes the way they need to be spoken to, and not the way that the establishment says, okay, like that, that just needs to start there. Like, we can't just keep telling people, Oh, it's okay, you're fine, you're doing great. Don't worry about it. You know, meanwhile, they're having all the problems that come with out of control blood sugars, and then they're being told by somebody don't worry about it, when they could have gotten actionable information that would have helped them, maybe pull things together a little better. And and instead, we were, you know, oh, we don't talk to people like that. That's dangerous. You can't tell them like you can't tell them how insulin works. Like, shouldn't we at least understand how insulin works? I mean, how many people don't understand how to Pre-Bolus a meal don't have never even been it's never been mentioned to them ever. And they have diabetes. It's, it's crazy. You know, so I just thought, well, I'm going to do it, and we'll see what happens. So sometimes you just got to leap. Because trust me, there were people telling me not to do it. established ideas were very much against it. And I had to fight through many times of people, you know, speaking poorly about me behind my back, or sometimes to my face and telling me that I'm doing it wrong, I'm doing it wrong. And I was like, well, you can do what you're gonna do. And I'm gonna, I'm gonna do what I'm gonna do. And it worked out very nicely. And I hope you have the same kind of success.

Dr. Arwa Al Hamed 1:18:20
What's your background? If I may? I have

Scott Benner 1:18:23
no background with the speaker.

Dr. Arwa Al Hamed 1:18:25
I know, I mean, education. No, I

Scott Benner 1:18:28
know. I know you do. And I don't have any background. I graduated from high school. I went to, I went to work in very blue collar jobs. Okay, I met a woman who was nice enough to recognize that I might be more than my station, if that makes sense. We made a family. And my second child, our daughter, Arden was diagnosed with type one, when she was two, I began using the skills I had writing to write about it online when she was three. And about seven years ago, after developing, I don't want to call it a system, but developing a way of managing blood sugars no matter what you're eating, and keeping a one sees my daughter's a once he's been in the fives for like seven years. And she has just no diet restrictions. And it's because I fundamentally understand how to use insulin. So about seven years ago, I started this podcast, and

Dr. Arwa Al Hamed 1:19:26
I beat this podcast is seven years old, seven years

Scott Benner 1:19:29
old. Yeah. And it's been heard, you know, it's been downloaded. I think we're up to about 4 million now. And it's all over the world. And if you go to just as an example, the Facebook page for the podcast, you will see people constantly all day long, either sharing their struggles and helping each other or sharing their successes and motivating other people. It's really, like astonishing, you know, and it just was, and I will honestly tell you that on day one This somebody established in this community told me you can't do this. Do not talk to people like this, that you can't tell people this stuff. And I was like, Well, I think I think I can. And I'm going it's not a secret. Yeah, well, it is a secret because people are scared to. They're scared to say anything that isn't concrete about diabetes. And I believe that people are smart enough to hear nuance, and apply it to their life. Crazy me. Right. Right.

Dr. Arwa Al Hamed 1:20:27
So yeah, what's the problem telling people that is, is not concrete? Now after COVID? Everybody knows that? Nothing is concrete. Yeah, right. I think people are, I think, again, you know, what, Scott, I really think it's the old mentality that the younger generation are fragile, don't tell them this, they don't need to know this. They don't need to know all the details behind this, and, and so on. So I think you, you came to realize from your experience with your daughter that they are not, they're actually sometimes stronger than us, because they are just born in a different generation. So even I think it came in the right time. Despite all the the recommendation not to it came at the right time, where were kids at this age, are prepared for this level of knowledge for this, that's for these specifications that they're able to do with it, especially that this came with technology, advancing technology, and having this smartphone in my hands with all those potentials that it has, it became very easy for this generation to absorb all those details and apply it in their daily life. Unlike us before, I mean, our generation, we only had TV, and we only watched whatever they tell us to watch whatever they have on the TV. But now they have this, they can choose every moment they have the ability to choose what to read what to listen to, and what to write. So all this gives him this capacity to deal with all the details. Maybe you we are more fragile than them now. Oh, no.

Scott Benner 1:22:15
Yeah, I mean, and you just keep getting to enrich yourself any way that you see fit. And I'll tell you to, here's an aspect of forward thinking that impacts the podcast success that you would never consider. But it's it's this is that 1015 years ago, if I would have done this, let's say the technology existed, and I could have done this. It's a full time job. So I can't I have to sell ads on this podcast, if I don't, I can't do this, right. So 10 or 15 years ago, if I had a podcast, this same podcast, and it had ads on it, people would have yelled at me for making money from diabetes, they'd say, Well, you can't make money off of someone else's illness. And ads are insulting to me. And trust me, I've seen it happen to people. But somewhere in the last handful of years, people became savvy enough about the internet, to understand that if you want somebody to give you something that is consistent, and quality, that they're going to need to put time and effort into it, and that they have lives as well, and bills and families. And so suddenly, no one. It's it's an idea that's gone in the world. Like no one watches a YouTube video. And when the ad comes up, yells and screams at the ad you go alright, I understand I'm not paying for this, the ads paying for this, I get it. And now that that's acceptable. That actually supports me because honestly, this is I record with you today, someone tomorrow, another person on Thursday, in the last 48 hours, I've edited together five episodes, and prepared them to be online, I've probably put, I've probably put 45 hours into the podcast in the last four or five days. And wow. And that's a that's a job, right? So now I'm suddenly able to do that because of people's acceptance and growth and understanding of how the world works. Everybody needs to understand reality so that they can have reactions and experiences that are real, and not just, you know, I'm going to be mad at you because you have a podcast and it makes money and I wish I had a podcast you don't I mean or something like that. It's just it's right. It's a growth of people that's allowing us to help people grow. It's really cyclical.

Dr. Arwa Al Hamed 1:24:28
Right? I bet you also have some of your fans are probably YouTubers too, right? Because now all kids are YouTubers. They all talk in the YouTube language. I have my nephews they they know all the details behind how to become a YouTuber. They know how much money they will give you. You they know what what is the guidelines, and how long is your YouTube should be and how many likes you get in order for you to sustain them. I'm talking about kids who are 11 years old. Old are nine years old, you know, the language I'm talking right now is something very advanced. I mean, so that's why I, the the, the it's easy for this generation to understand why you need to maintain ads in your right. Well, you need to have ads in your show, etc. It's very easy, unlike before. So I think it all happened just in the right time.

Scott Benner 1:25:23
It really did. And there also seems to be this idea now that people seem to want good for other people. Like it's not as competitive anymore, I guess, you know. So, you know, so they look at you and they go, Oh, you have an ad in your pocket. That's cool. I hope to have a blah, blah, blah, you know, and they're, they're excited by the, by the possibility. And I talk this way about diabetes as well. Because there used to be a fervor an idea that you did not share your success with insulin online, like don't show people flat graphs, don't show them that you could Bolus for pancakes, because you're showing off and you're making other people feel badly. Well, I didn't believe that what I thought was that if I could do it, then maybe you could believe that you could do it. Right. Like to have an example in front of me. That's like, wow, that's that's possible. Oh, okay. Well, I'll try that. And and I think that people feel the same way about the podcast, older people will look at me and say, Well, you make money from A what now. And they're almost mad about it. Because they because they work the last 30 years in a car, plant manufacturing cars, and I get it like in their mind, I'm sitting in a room and I'm just chatting. And but younger people are like, Oh, that's cool. Because they see it as a way to live. Whereas older people see it as a as a like, somehow, like you cheated. It's an otologist perspective. It's really terrific. I'm excited about what's to come. And I'm excited. There are people like you out there having thoughts like this.

Dr. Arwa Al Hamed 1:26:53
One more last. One more last idea before. Before, it's just a toy for me. I think what's what was although I, I was a bedside nurse, and specifically the unit I worked at was sub specialize in endocrine and natural. So I dealt with lots of newly diagnosed diabetes kids with a lot of decay after they're stabilized, of course, not in critical care, but in the unit. How, however, my experience with one of my cousins who had type one diabetes, since he was I think, 11. And then with Julia, specifically, being the first close friend of mine who, who had diabetes. So it What was nice about this experience is that it simply normalized. living with diabetes, even for me, for someone who was from the health care area, but I never lived with diabetes daily, I never had diabetes as part of my daily conversation or routine or where I have to, like, think about it all the time. Whenever we talk about oh, she will check her blood sugar, she will mention her blood sugar then often mentioned something about the diet or today I had my blood sugar, blah, blah, blah. That's why I'm feeling this now. And it was part of the daily conversation. So it was to me like something normal. I'm not saying normal in terms of like, of course, they're not normal in terms of their physiological needs are different, but at least the they're not isolated anymore. Or just they have to be isolated. Just because you have this condition. It helps having this normalization making even the conversation the terminology. Very, you know, very witty call it it's reacquainted. So everyone knows, and it's not something, oh, you have diabetes. And I don't I don't need to feel sorry about you anymore. I just feel that this is part of life. Someone has a B to someone doesn't and that's it. This is how life but before you don't know that, that there are a lot of people are experiencing this on a daily basis and you have to deal with it. So what I like about approach of Julia, where she used to share this with us all the time is was it was normalizing it to me I was not stressed out or I mean worried when I'm whenever this topic is mentioned in front of me. I'm more prepared to deal with it, even psychologically, that's just because it happens in front of me all the time. Yeah. So I think even podcasts like yours serves this purpose unintentionally, where you're meeting with people, different countries, and you're normalizing that the experience of type one diabetes and making it Very special. Honestly, it's

Scott Benner 1:30:01
an out and proud mentality. It really is. It's just like, I'm not gonna hide anything, you get to see it. And then like you said, after I see it a number of times, it becomes normal to me something that I hadn't seen before. And then it that's it, the issue is gone, it just disappears into the ether. You just, that's all you have to do is, you know, what is it? What do they say? Sunshines the best antiseptic? Is that the saying? I'm probably not, right, right. Now I've said it, and I don't wanna hold on a second, the sunshine I'm gonna find it is the Sunshine is the best disinfectant, which just means, you know, bring things out in the light of day and it it takes care of the rest, you know, and that's amazing, right? Yeah. It's very exciting. So would you say in general, then, based on your studies, and what you're saying is that is to take someone with an illness, who and understand hopefully, that that illness isn't such that it's going to, you know, end their life, if it's something you're going to live with, that you need to get up and get back to normal? As fast as you can. And that you might need to understand that you're gonna need some support in different places. Yes, but that the most important thing you can do is to not stop, keep going. And don't give away the idea that the life you thought you could have is still available to you.

Unknown Speaker 1:31:25
Right? Yeah, absolutely.

Scott Benner 1:31:26
I love it. All right, we did it. Thank you.

Dr. Arwa Al Hamed 1:31:30
Oh, thank you. Thank you for giving me that chance to share my perspective from 1000 miles away. I hope things went very well with the recording. And thank you very much for this opportunity.

Scott Benner 1:31:45
You're very welcome. No, everything's great. You sound terrific. I've got I've got your recording captured here. And I am I'm super excited to share with you. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kaipa pen at G voc glucagon.com Ford slash juicebox you spell that GVOKEGL You see ag o n.com. Forward slash Juicebox. Podcast like to thank touched by type one for their continued in long time support of the Juicebox Podcast check them out at touched by type one.org and find them on Facebook and Instagram. Don't forget the T one D exchange T one D exchange.org forward slash juicebox. Take a few minutes and fill out the survey.