Notes from the Field: Q&A with Michael Hole

Michael Hole, MD, MBA is a first-generation college graduate and former social worker turned Harvard- and Stanford-educated physician, professor, author, researcher and serial entrepreneur in Austin, Texas. See below for excerpts from our conversation with Dr. Hole about his efforts, especially during COVID-19.

Tell us about your job at The University of Texas.

I’m very fortunate, truly. I wear three hats.

First, I’m a ‘street doctor’ for children experiencing homelessness. My clinic is on wheels, traveling to serve patients where they live—which brings to life how public policies impact our neighbors in need.

Second, I lead Financial Health Studios, a university hub for redesigning health systems. We aim to improve people’s health and cut health care costs by helping folks afford basic needs and save for the future.

And third, I teach civic entrepreneurship to future lawyers, doctors, business leaders and policymakers. In my classes, graduate students build companies with potential for social impact, like Good Apple.

What’s Good Apple?

Good Apple is a doctor-prescribed grocery delivery service fighting hunger. For every box of healthy food delivered to a subscribing customer, we drop another on the doorstep of a nearby, low-income family in need. We partner with local farmers to rescue unsold produce, as well as food pantries and medical clinics to boost their impact. And the stories we hear are downright moving.

Any examples?

Sure. One client said her family often had to choose between buying medicines or food until Good Apple started helping.

Another single, pregnant mother felt relieved she no longer needed to take a bus to the grocery store and risk exposing herself and her two toddlers to the coronavirus.

And another lady caring for her blind husband full-time told us the deliveries helped her save money and energy while she awaits her own surgery.

Nowadays, I’m reminded, perhaps more than ever, how privileged I am to have a job, much more one that brings me so much meaning and joy through stories like these.

So what’s your role at Good Apple now?

I’m Good Apple’s Founding Advisor, so I work alongside Zack Timmons, a medical student, to lead and scale the company.

Has COVID-19 impacted the company?

Yes, significantly. Before the pandemic, we had about 50 active subscribers. Now: over 750. I’ve been really touched by how people are stepping up to help their neighbors, especially with our “Stay Home, Stay Healthy” program.

What’s that?

In partnership with the City of Austin, we’ve been able to leverage our infrastructure to begin delivering healthy food to older adults and people with chronic illnesses in quarantine. We’ll deliver about 250,000 pounds of food to 8,000 people in central Texas over the next two months. May I read you a note we recently got from a local nurse?

Please do.

Thanks. She says, “Bless you. You delivered my elderly, homebound mother with a bounty today. Her joy was practically uncontainable. Thank you so much. I’m a nurse trying to care for many people in many ways right now [during COVID-19], and you took a huge strain off of me. I just can’t put in words how grateful I am for you helping me shoulder some of the weight.”

Stories like this help us push hard to serve as many people as possible nowadays.

How are you handling the rapid growth?

We started hiring local residents, many who had lost wages or jobs since the pandemic hit, as food packers and delivery drivers. Neighbors in need helping neighbors in need, if you will.

Also, our volunteer force is growing, we have generous funders, and our partners—from local farms and food pantries to health providers, city government and transportation services—are stepping up in big ways to meet needs. It’s clear we’re stronger together, especially now.

To get involved, what’s the next step?

Thanks for asking. Please consider checking out GoodAppleFoods.com.

During the 2019 PLS program, you were working to start another organization, while scaling your national nonprofit, StreetCred. Any updates?

Sure. Early Bird, the college scholarship fund for babies born into poverty, has secured funding and partnerships. We’re set to launch this fall, assuming the pandemic slows.

StreetCred, which helps low-income families file taxes and build wealth while they wait in doctors’ offices, has returned about $5.3 million to roughly 2,700 families. Our very first client was a grandmother raising a 3-year-old boy and making about $7,000 a year in Boston. She used some of her tax refund to buy “luxuries”, as she put it, like winter blankets. Since then, we’ve seen clients use the money to pay off debts, fix cars, buy medicines, eat healthier, pay rent and utilities, save for college, start businesses, and so on. In other words, these refunds give people dignity and a better chance at realizing their American dream.

Also, StreetCred recently started a collaborative to share best practices, now with 38 partners in 23 states and DC. Amid the pandemic, the team is working to make sure our clients know how to claim their stimulus checks. We can’t deny race and socioeconomics are playing a role in who is being hit hardest by the virus.

Do you have a website?

Yep. It’s www.myStreetCred.org.

And you’ve recently launched an organization to help small businesses, right?

That’s right. Main Street Relief, which you can find at MainStreetRelief.com, is a trained volunteer corps helping small businesses in the United States survive and recover from economic crises, like COVID-19. It’s very personal for me. As businesses go, so do our hometowns.

What’s the backstory?  

I grew up in an 800-person rural Indiana farm town where my parents operate a small, family-owned golf and restaurant business. Like so many Americans, they’re getting hit hard right now.

When the CARES Act passed, I started helping my parents navigate their options for emergency financial help, which turned out to be fairly complex and intimidating. We eventually applied for [Paycheck Protection Program] loans and an [Economic Injury Disaster Loan], but I worried about others keeping their doors open, especially those mom-and-pop shops with even less resources and time.

Meanwhile, I have so many friends and colleagues, including from PLS, fired up to help. So, Main Street Relief gives volunteers like them the knowledge and confidence they need to help small businesses, entrepreneurs, and independent contractors find stable footing, free of charge.

So you’re in-touch with other Presidential Leadership Scholars?

Of course! Regularly. They’re my second family. Recently, I wrote a few academic articles alongside several PLS doctors on how best to care for vulnerable populations amid COVID-19. And the Class of 2019 is having ongoing conversations about how to collaborate across sectors to fill gaps in the pandemic response.

What else from PLS are you carrying with you nowadays?

Simply being part of the PLS community during this pandemic highlights how downright privileged I am. Access to resources, whether money, health care or networks, matters more than ever in my lifetime. And that’s why my PLS classmates—who are testaments to the American people’s generosity and optimistic spirit—are working harder than ever to serve our country. They renew my belief in a better day to come.

Notes from the Field: Even Though We’re Apart, We’re Together In This Fight

In the middle of lockdowns and social distancing, it can feel like the world has shut down.  It hasn’t.  Filled with bursts of ingenuity, compassion and collaboration, life still goes on. I was operating on a perforated colon cancer, and in the midst of my rapid fire shouts of “6 more liters of sterile irrigation” and “reload the bowel stapler”, I noted the compassion of the OR team, from the nurses and techs to the anesthesia crew, in their meticulous care for this single patient.  In the time of COVID-19, despite how stressed and stretched they each were, they still had the ability to make that one patient in front of them the center of all their efforts. 

I’ve also seen ingenuity birthed from necessity, both locally and nationally.  When we needed to conserve sterile surgical gowns and medical students could no longer scrub into surgeries, Baylor Surgery residents jumped in to help me host an impromptu dry suture lab, teaching our Baylor medical students suturing techniques on improvised simulators. 

Baylor students being taught suturing technique.

And when college campus were shuttered, Dean Toni Doolen from the Oregon State University Honors College offered to transform laptops into classrooms, so I delivered a virtual lecture from Houston and discussed health policy with West Coast pre-med students. 

Delivering a lecture to pre-med undergrad students.

Even though we’re apart, communities are still coming together.  Through WhatsApp group chats and google doc sharing, I worked with a community of Presidential Leadership Scholar physician leaders from Johns Hopkins, Emory, the American Hospital Association, and others to pool our expertise and experiences from the frontlines, and created a compilation of best practices for hospital preparedness during COVID-19.  I’ve never met some of these scholars in person, and yet, this collaboration birthed from social media discussions is being published by NEJM Catalyst to help hospitals across the country implement strategies to mitigate transmission, conserve resources and support health care providers during the pandemic.  

During the COVID 19 crisis, I’ve seen compassion, innovation and collaboration.  Even though we’re apart, we’re together in this fight.  This gives me hope.

COVID-19 + Cyber Crime

During my journey with the PLS class of 2017, I was able to obtain a 501c3 status and funding to start the Cybercrime Support Network. Our public-private partnership is giving a voice to victims of cybercrime and online fraud and providing resources to report, recover and reinforce security after an attack. PLS Scholars continue to help us engage key stakeholders and obtain funding to grow and serve more victims. Our servant-leadership organization has grown from one employee to 24 in under 3 years thanks to the support of the PLS Scholars Program. Fraudsupport.org has served over 500k victims over the past year. Please send family and friends there for resources to report, recover and reinforce their security as cybercrime and online fraud increases during this challenging time.

Kristin Judge

The Coronavirus outbreak has global attention and is a national emergency in the United States. Since cybercriminals prey on fear, we can expect to see more and more COVID-19 scams as the situation progresses. Learn more about common scams taking place during the pandemic:

Charity scams: You may see charities that you don’t recognize asking for donations in the wake of COVID-19. Verify all charities on the IRS tax exemption site. Our recovery page lists action steps to take after donating to a fraudulent charity. 

Social media scams: Social media is a tool that cybercriminals use to distribute false information and capitalize on panic. If you’re looking for information on social media, visit trusted profiles like the CDCWorld Health OrganizationFederal Trade Commission, and the Better Business Bureau

Romance scams: Many of us are staying home due to the outbreak, so we are spending more time on the internet. Cybercriminals will try to capitalize on this heightened internet traffic to lure people into romance scams. If the person you started chatting with online asks you for money, it’s probably a scam. Take a look at these romance scam red flags and recovery resources for help. 

Phishing Scams: Emails impersonating the World Health Organization, the CDC, and other reputable sources may hit your inbox. Don’t click on emails impersonating these organizations. For accurate info, go straight to the source. Visit the World Health Organization and the CDC’s websites. If you’ve accidentally clicked on a phishing link, visit our recovery page on FraudSupport.org

Robocalls: Calls from cybercriminals pretending to be government organizationsfamily members in distress, banks/credit card companies etc. are on the rise due to the coronavirus outbreak. Robocalls are less easy to detect than they used to be, the caller ID can be adjusted to make it look like the call is coming from your area code. This establishes a false sense of trust. Visit our Phone Spoofing and Robocall recovery page for help. 

Work-from-home Small Business Concerns: Many of us have moved to remote work in light of recent events. Make sure your employees are trained to uphold cybersecurity practiced from home. The Cyber Readiness Institute has created a guide to securing a remote workforce, utilize these tools and tips to get ahead of cybercrime risks. Our Small Business Resource page has a curated list of tools to help you keep your SMB safe. If an employee within your organization clicks a phishing link, visit our SMB phishing resource page for recovery steps. 

Malware: Fraudulent links can install malware on your device. If your computer has been infected by malware from a malicious link, visit our recovery page here.

What Matters Most?

Prioritizing time to support our children’s education during COVID-19 closures.

We can’t do it all.  That much has become clear, if it wasn’t already.  Managing our work and home lives is challenging enough in typical times; throw a pandemic into the mix, and it can be enough to tip the scales to “unmanageable,” even if we’re not on the front lines of response and support.  (Let’s take a moment to honor – and consider the realities of – all those who are.)

As members of the PLS community, we should also take a moment to consider all the advantages and privileges we have as we encounter the daily realities of quarantines and closures.  Some of us may be perceiving that, given all these advantages, we should somehow be able to do it all – that we must – especially when it comes to our children’s education.  As a 22-year educator, I will tell you that we really can’t … and we shouldn’t.  Becoming an effective teacher takes years of training, practice, and professional development, so there’s no point in pretending you’re going to become one overnight.  Furthermore, teachers – whether in traditional schools, virtual schools, or home schools – spend weeks designing, internalizing, and preparing to implement each element of curriculum, time and expertise most of us working parents simply don’t have.   The detrimental effects of the stress people may put on themselves and their children in an effort to replicate school in this new reality far outweigh any potential academic development those efforts might yield.  

So, what to do?  Obviously we want our children to keep learning for the duration of school closures, and we can make that happen in authentic, real-life, and largely stress-free ways.  Whether your child’s school has sent out dozens of emails, directions, and links to online resources or they’re left to their own devices, here’s a simple way to think about how to prioritize time – and how to integrate daily learning – using Maslow’s hierarchy of needs.  

1.  Let’s start with the essentials:  our kids’ physiological needs.  The first things to plan for in whatever semblance of a daily schedule you can muster are meals and sleep.  A well-nourished, well-rested child is much better able to cope with the wacky new realities we’re facing.  Plus you can involve your child in deciding on menus, making shopping lists, following recipes, and preparing food together: life skills, food science, and math! When the going gets tough, the tough bake cookies.  

We all need time for physical activity too.  Dedicate time each day for movement and exercise.  It doesn’t have to be anything fancy: do an online workout video if your child is so inclined, but you might find a game of tag or a kitchen dance party is even better.  Being home together presents a unique opportunity to build healthy habits.

2.  The best way to create a sense of safety and security is to establish and follow a basic schedule and set of routines each day.  This will help you too as you try to navigate work calls, meeting deadlines, and not eating all the cookies you’ve baked.  Allow for some flexibility, but stick to general times for things like daily chores and meals, and also plan consistent time for things you and your child enjoy, whether that’s a walk outside, a game of Scrabble, or watching a favorite show together.  Predictability creates a sense of stability, and it gives kids the concrete knowledge that less enjoyable things will end, while ensuring they have specific activities to look forward to each day.  

Academic work time and any school schedule requirements should be built into the daily plan, but they shouldn’t dominate.  Organize schoolwork into time-bound chunks based on your child’s age and attention span: for younger kids, 15-20 minute blocks for a total of about 90 minutes per day; older kids can typically handle 45-60 minute stretches for up to 3 or 4 hours a day.  This doesn’t need to be drudgery; you can and should allow time for your child to learn about topics of interest to them, which supports their need for self-actualization.

Give your child a sense of agency by working to make a schedule together or giving them parameters (must-dos, may-dos) and having them create a schedule on their own.  Talk about a life skill! You’re also getting at elapsed time, executive functioning, and logic as they try to fit all the pieces together.

3.  This sudden disconnection from friends and teachers can be jarring for school-age children, so work in some deliberate time for connection.  Ask your child what they would like most – some are really eager for virtual play dates with friends and calls with extended family, while others just want to sit and talk with a sibling or play a video game together.  Some schools are hosting virtual classes or online student meetings, and extracurricular groups are hosting online rehearsals and practices.  

Kids can practice their writing skills by composing letters or emails to friends and teachers and crafting notes of appreciation to family members. Families can “meet” for online read-alouds and game nights.  We can and should acknowledge that it doesn’t feel the same, and that makes it even more important to prioritize opportunities to cultivate a sense of love and belonging.

4.  Shifting to different modes of learning and accessing schoolwork can breed striking levels of frustration, even – and especially – for children who typically thrive in school.  Our kids need daily validation of what they’re doing well and sincere acknowledgement that it’s okay if something is difficult.  One of the most challenging parts of this work-from-home / school-from-home dynamic is trying to be present for your own professional responsibilities and be present for your child when they need help with schoolwork.  Don’t try to make those things happen at the same time. Schedule specific times when you can be available to assist with school work, and help your child develop plans and strategies for what to do if they encounter something they can’t figure out independently. 

Self-esteem comes from feeling empowered to accomplish tasks and solve problems on your own, and from having a sense of self-direction and choice.  Encourage your child to set a goal for the day, make a plan for how to reach that goal, talk through some strategies for what to do if they get stuck, and then make time at the end of each day for them to reflect on how they did by talking with you, writing in a journal, or filling out a simple google form (my son’s favorite).

5.  Let your kids do what they love!  Leave some openings in that schedule to allow for flexibility and time to pursue passions, whether that’s playing music, painting and drawing, practicing a sport, building with legos, dancing around wildly, or reading quietly.  Self-actualization may seem more remote than ever in these circumstances, but our kids generally have a lot more control over their time these days, which could open up fantastic new possibilities for them.  Encourage them to make the most of it.

Through it all, remember that you share these same five basic needs.  Be patient with yourself and your child.  If the schedule isn’t working, change it — and don’t feel like you have to follow it rigidly.  Ask for help when you get stuck or feel overwhelmed. Allow time and space for the life moments that matter most.  And make sure you build some time in that schedule to take care of yourself too.  

Jane Henzerling was a 2017 Presidential Leadership Scholar and is the Managing Director of Professional Learning at T.L.P. Education, a non-profit that partners with 400 diverse schools across the U.S.  Previously she served as Assistant Secretary for Policy, Innovation, and Measurement at the New Mexico Public Education Department, and she founded The Mission Preparatory School in San Francisco, CA. In addition to consulting with school systems and education non-profits, Jane serves on the boards of Atlas Corps and DreamHouse ‘Ewa Beach charter school.  She graduated summa cum laude from Skidmore College with a degree in Spanish and earned an MEd in Educational Leadership from Northern Arizona University.  Jane lives in Santa Fe, NM, with her husband and 11-year-old son.

It’s all one song.

Class of 2020 Scholar Maria Kim reflects on the current state of the world, lessons learned so far from the PLS program, and her hopes for the future.

That’s what Neil Young barked back at the man in the audience who shouted “It all sounds the same!”. The songs, how they turn, their lazy S curves, and the yarn of the tale – for this concert goer, it felt all the same; and for Young, that’s all good because each ditty was just a turn in the conversation – it’s all one song. 

Mike Hemphill, Director of Academic Programming at the Clinton Foundation, shared this Young-ism at our inaugural session of the 2020 class of Presidential Leadership Scholars. This quote has hovered over and haunted me ever since, because it keeps ringing true. That if we take any chapter of who we are, or who we serve, or how we lead, or how we love in isolation, it may feel clunky and disjointed and may not make sense. We have to understand the prequel to appreciate the now. We have to tease the sequel to propel that now forward. We have to know that our stories are perceived and received in the context of our observers, that – as Mike would say – “we are born into the narratives of other people.” It’s all one song. 

In a time like today where we feel uncertain at best, and profoundly lonely at worst, I find myself really reflecting on the past – the long ago past and the very recent past – as if in film strips of time that I can watch and let wash over me in a new way, today. Most recently, I have replayed lessons from the early stages of this fellowship that – when studied in the quiet of covid-19, this unexpected and prolonged space of transition – become profoundly clear, lovely, and actionable. Sadly and unsurprisingly, this past week we were notified that the Presidential Leadership Scholars program has been postponed; and as I see our WhatsApp thread blow up with notes of concern, and melancholy, but most of all support and profound community, I mourn the loss of the experience we were about to have, while also feeling centered by the inaugural experience from which we just emerged. 

From Mike, we learned to “hold openness to learn from unexpected places.” If this crisis in our country – and in our world – is not an example of an unexpected place, I don’t know what is. This moving of the earth beneath our very feet, this silent hurt that the unknown can well up inside of us, and (for those of us who live alone) this echo of our own voice in what feels now an at once cavernous and concave space – it’s all so disorienting, and tethering, and new. Yet inside this labyrinth, we are learning from and leaning on each other in ways I never imagined. For myself as a leader, I am learning the importance of abundant communication – these days can pack a punch, and in some ways, time can slow down when you’re turtled in your own home – away from your general community, disconnected from the daily stimuli of coffee with colleagues, lunch in the staff cafe, in-person meetings galore (did you ever feel like you would miss your meetings as much as you do now?). And so in this shift from abundance to absence (or abundance of one sort [work] to abundance of another sort [family]), we can feel eerily disconnected from the enterprise that used to be our touchstone throughout the traditional business day. To combat this disconnection, we must re-stitch new connection, and we can do this through frequent and robust communication. Communication that’s at once silly, and structured, and sound, and assuring. Communication that’s honest, and transparent, and realistic, and true. People need to know you see them, you feel things with them, you share what you know in the best way you know, and you keep as many of the artifacts, rituals, and traditions as you can alive – in new ways, in innovative ways – so that we all remember even if we are spatially apart, we are socially connected stronger than ever before. 

I also find that the pace of communication has both accelerated and slowed down during this time. I feel the adrenaline of the acceleration – grateful for the precision and the exactitude of decision making during a wacky time of crisis, and the intention of the deceleration – the peace and the presence of being more available to each other because we have less stimuli to distract us. Last month, I had the opportunity to meet Secretary Andy Card (you may remember him as President George W. Bush’s Chief of Staff during 9/11 – the gentleman who whispered in 43’s ear on that fateful day that America was under attack). He shared with me this amazing story of his grandmother Elizabeth French Platz Card. She believed so much in the virtue and the value of each of her children and grandchildren that their biggest fear of letting her down was only beat by their biggest joy of rising to her bar. She used to say to him: “taste your words before they come out of your month.” Clearly, this was an admonition of a young boy who was occasionally at risk of saying the wrong thing, but as I sit with these words today, they have new relevance. Think of the many times you have been asked this week: “how are you?” and you actually stopped the locomotion that is the typical velocity of your conversation, and you slowed down and said, “actually … things have been a little rough. How are you?” Imagine what  happens when we slow down and really sit with the words as they come out our mouths –  not as things to throw away, but as words to lean on and from which to learn. I wonder if the speed of change we’re going through right now creates a slowness of (and therefore a more real) connection. 

In Mike’s words, “we have a tendency of looking through communication to the outcome, as opposed to looking at communication and understanding how we got there.” He argues that the how of our communication often tips the scales more than the what. Today’s forced innovation in how we connect with one another can lead to organic openness to how we challenge one another. It gives us the platform to show up as our better selves and to as Secretary Card’s grandmother would say, “not leave the room before you’ve entered the door.” In the last week alone, I have spent more time talking on the phone or in video chat than I have in an entire month. We are realizing that the only way we can move things forward in an ever-uncertain and fragmented environment is to be actively and meaningfully in touch, is to be present in a way that we’ve never been before. I see more people leaning in on calls, animated, and activated. I hear more voices from traditional introverts who historically have not chimed in as frequently in un-virtual settings. I see genuine joy between colleagues so happy to see one another – albeit on a screen – to see the art they have on their wall, the lunch they made and wished they were sharing with others, the way the furrow of their brow tilts up when someone says something that makes no sense. I see the power of deep and veritable connection, a time that defies “social distancing” while honoring “spatial distancing”, a time that loves up on and enables the power of human connection as the very antibody that we ever more need. And I believe the constraints of today’s space and the place are pushing us to do the very thing Ms. Card implored us to do – which is to be present, with each other and for each other, to recognize that the time together is a gift, and to listen with the whole of our selves so that we can be the best of our selves – not just in this crisis – but for good. 

It’s all one song.