I was on a plane heading towards Santiago, the capital of the Dominican Republic. From there, I would take a two-hour bus ride to Mao Vallerde, where we would be working at for most of the week. I was going on a global health trip through Jose’s Hands, an organization that sponsors medical students interested in going on mission trips. For this particular trip, they had partnered with One to the Other Ministries, a Tulsa-based ministry that has been doing mission trips, both medical and non-medical, since 1986. This being my first global health trip, I had no idea what to expect other than the usual warnings of tropical diseases endemic to the area.
The interpersonal ease needed to establish trust between patient and provider might come easily to some, but is only the first barrier. As physicians and physicians-in-training, we ask patients to disclose uncomfortably thorough social and sexual histories which often go beyond the limits of our own experiences. Then we critique them, offering suggestions for risk reduction based on our medical expertise. In order to do this effectively, we are asked to know a lot about communities to which many of us are not members.
Last week marked my first week as a doctor. Like thousands of my colleagues, I began intern year with a combination of enthusiasm and dread. On my first day of clinic, I woke well before dawn, full of nervous energy. I collected my precious intern paraphernalia — my stethoscope, my Pocket Medicine guide, and my crisp long white coat. I filled the pockets of my new uniform, smoothed the hems, and, as a finishing touch, began applying the pins I wore throughout medical school to the collar.
We lead babies couldn’t decipher it. It was pattern matching — something the cognitively impaired couldn’t do very well. Figure out the rules and pick the best option. If I let myself, it did feel futile.
The epidemics of diabetes, cardiovascular disease, cancer and dementia roll through the US and across much of the world, eerily reminiscent to the sweeping cholera outbreaks of Snow’s era. Even in the majority of low- and middle-income countries, these chronic illnesses have already displaced infectious diseases to become the leading causes of death and disability. Yet, the majority of these are potentially preventable.
In December of 2014, one week after the non-indictment of Michael Brown, in-Training published an article entitled “A Lack of Care: Why Medical Students Should Focus on Ferguson.” In it, Jennifer Tsai argued that the systemic racism rampant in our law enforcement and criminal justice systems also permeates our health care system, affecting both access to care for black patients and the quality of care black patients receive. Lamenting that the medical community was largely absent from the Ferguson controversy, she cited startling statistics of disparities in health and health care as part of her call to action. In light of the events last week in Louisiana, Minnesota, and Texas, it’s time to revisit this message.
I walk down Summit Avenue in St. Paul, Minnesota this evening, and it is packed with people. People grieving, people chatting, people holding one another, people holding banners and people giving speeches. July 7, 2016: a black man named Philandro Castile had been killed barely twenty-four hours ago by a police officer.
Among my professor’s stories from Lima, the chicken dinner story haunts me most. It features two students from his time as a middle school teacher in one of Lima’s most dangerous outskirt neighborhoods. A young teacher working at a Fe y Alegria school in North Lima, my professor, Kyle, had promised to take them anywhere they desired for dinner in exchange for exam success. The students requested chicken, standard Peruvian celebratory fare.
Though they make up 5.6 percent of the US population, discussions about Asian-American health appear to be few and far between. According to the Asian-American Health Initiative, a variety of medical and public health scourges disproportionately affect the Asian-American community. Some of these disparities entail disease incidence, while others describe a paucity of certain preventive health measures being delivered to this group.
In 2015, the Institute for Women’s Policy Research published an alarming statistic: on average, women made only 79 cents for every dollar earned by men. Even more alarming was the fact that when the study controlled for qualification or stratified by job title, the gender wage gap persisted. Unfortunately, medicine is not immune to the gender wage gap phenomenon. According to data from the US Census Bureau, women make up one-third of US physicians, but on average make only 69 cents for every dollar earned by their male colleagues. This results in over $56,000 in potential wages lost for women in medicine each year.
In El Salvador, 17 women imprisoned after experiencing miscarriages or stillbirths began a campaign against reproductive injustice. “The 17” were sentenced for up to 40 years in prison for miscarriages or complications during delivery, after being convicted of attempted or aggravated homicide. This was the outcome of a total ban on abortion: young, often unmarried, women of lower socioeconomic status are suspected of inducing illegal abortion when experiencing emergent obstetric complications. Stigma and misogyny play into the result, in which a woman’s health during pregnancy is viewed with distrust.
During our many years of medical training, we study complex physiological processes running the gamut from acute sepsis to the equally devastating progression of chronic diseases. We spend countless hours in lectures and on the wards, attempting to gain exposure to proper medical management of bread-and-butter medical problems as well as more obscure diseases which may only affect a handful of patients annually. However, most medical schools neglect to teach one crucial area of expertise — training in advocacy skills to address social determinants of health.