On the subjects of disease and disparity, the NIH focuses on the genetic code inside individual bodies and ignores the wider contexts within which these bodies live, work, play and get sick. The NIH overlooks societal inequalities and gives genes too much credit.
When I applied for medical school, I knew I was signing up for hard work. I knew I would have to spend countless hours studying, that my sleep cycle might never be the same. But I had not expected this.
When I was six, a set of strawberry hair ties foiled my endeavor for independence. My mother had a way of twisting the plastic ornaments at the end of her operation so they sat together like two friends on a bus, neat and obedient at the crown of my head. Despite my assertions, (“I can do it myself!”) I could never align their orbits.
The cultural competency framework that has become the mainstay of medical education is often times employed in incredibly reductionist ways. It seems to propose that exposing physicians to homogenized, static and packaged ideas of culture will aid them in estimating patient behavior, preference or response in the clinic, thereby diminishing health care inequality. Training like this paves the way for even well-intentioned student-doctors to be explicitly ignorant under the auspices of clinical benefit. It spoils the good intent to create better patient outcomes by legitimizing the validity of stereotypes and the development of physician bias.
One year ago, on December 10, 2014, over 3,000 medical students participated in the National White Coat Die-In. We knelt to the ground, rested our backs on concrete and tile, looked up at the ceiling and contemplated what it meant to be a citizen. We embraced a deafening silence pregnant with the implications of erasure. Our bodies, cloaked in the privilege of a white coat, painted a complicated image of advocacy and appropriation.
Approximately one in three women under the age of 45 have had an abortion. Approximately one in three women under the age of 45 have a tattoo. Think about your community. How many tattoo parlors can you think of? How many can you easily access? How many abortion clinics can you think of? How many can you easily access?
Today, there are more people in jail for drug offenses then there were prisoners for all crimes in 1980. People of color comprise more than 60 percent of those incarcerated, yet represent only a third of the country’s population. While the issues leading to the disproportionate incarceration of people of color are many, I wish to focus on a single contributor which is the most important cause of America’s dramatic increase in incarceration — the structural racism readily apparent in our country’s approach to drug offense convictions.
On my left, the ragged, meaty stump of a severed neck stands upright like an abandoned signpost. A classmate examines it carefully. She is petite. She stands on a stool to obtain a better angle for observation. She cranes her neck, twisting the very muscles she is studying back and forth, back and forth.
For me, hepatitis B booster shots feel pretty much as pleasant as being sucker punched in the arm. You can imagine that it didn’t inspire much elation when I scrolled through my calendar to see, spelled out in big red letters, a reminder for “Hep B #3.” Now, as I reflect, this reminder feels like a victory of sorts.
A woman once told me that babies cry at the slightest breeze because that is the greatest level of discomfort that they have yet experienced in their short lives. It is a reminder that we can persevere through life’s tribulations. That we grow from adversity. That new challenges make past trials smaller. That this, too, shall pass.
In the recent White Coat Die-In demonstrations orchestrated by medical students across the nation, aspiring physicians displayed solidarity with the message that racial injustice is a public health concern that merits the attention and efforts of health care professionals. It is clear from the mobilization and investment of our medical community that there is a desire to engage in clearer articulation and understanding of the health disparities landscape.
This afternoon, medical students across the country, from Providence to San Francisco, will lay down on sidewalks and atrium floors in their white coats to express solidarity with ongoing victims of racial violence. As aspiring health care professionals, we don our white coats for these “die-ins” to express our commitment to the idea that racial injustice can and should be framed as a public health issue demanding our attention and efforts.