Contributing Writer
University of Maryland School of Medicine
Poorna is a Class of 2019 medical student at the University of Maryland School of Medicine. Before attending medical school, she studied chemistry at the University of Maryland, College Park. Her interests include health policy, health tech, and health journalism. When she's not studying, she's probably reading, writing, hiking, or indulging in the occasional Netflix.
Everyone told me medical school would be hard. I thought I was prepared, but nothing actually prepares you for medical school like being in medical school. I was accustomed to working long hours, the constant stress of exams and little sleep. What I wasn’t accustomed to was the absolute dearth of creativity in the coursework.
This is the first installation of a three-part series entitled “Ten Lessons from Flint” in which I speak with Professor Marc Edwards of Virginia Tech, pediatrician Dr. Mona Hanna-Attisha of Hurley Children’s Hospital, and Michigan State University and interim Dean Dr. Aron Sousa of Michigan State University.
Researchers like Professor Marc Edwards and Dr. Mona Hanna-Attisha were not the first people to speak up about the water crisis in Flint. In June of 2015, regional EPA employee Miguel A Del Toral, Regulations Manager of the Ground Water and Drinking Water Branch, issued an internal memorandum entitle “High Lead Levels in Flint, Michigan – Interim Report.” This document described the lack of corrosion control protocol and high lead levels. It was released to officials within the Environmental Protection Agency (EPA), Professor Edwards and Flint resident Lee Ann Walters, whose home water contained extremely high lead levels, as confirmed by city officials.
Exposing contaminated and corrosive water in Flint was necessary and life-saving, and the story garnered significant national attention. Yet not every situation calls for advocacy in such a public way. Advocacy for individual patients and patient safety is also crucial. Whether you’re advocating for an individual patient in a hospital or the public on the national stage, becoming an effective advocate requires practice and training. With the right training and understanding of the advocate’s tool kit, we can advocate for positive changes on behalf of individual patients and the public.
On a recent visit to my parents’ home in Upstate New York, just as the snow had finished melting and our tulips were beginning to sprout, my dad and I went out for a walk. As we made our way down our driveway to the railroad-tracks-turned-walking-trail that runs through the woods near our house, we bumped into one of my dad’s patients. With a hearty grin, the middle-aged man proudly told my dad how his morning blood sugars were improving. My dad beamed, and gave him a big high five. Later, as we walked along the trail, he told me how thrilled he was to see this patient getting the exercise that would help treat his diabetes and high blood pressure.
On November 27, 2015, a horrific shooting at a Planned Parenthood clinic in Colorado Springs left three people dead. This tragedy is a stark reminder of the grave consequences that may accompany inflammatory political rhetoric and poor legislation. After his arrest, Gunman Robert Dear declared “no more baby parts” to investigators. Dear’s terrifying actions have been linked to the national ongoing attack on reproductive rights as well as inadequate gun control laws. As a medical student, I fear that we will have many more Robert Dear’s in this country unless we make sure that political interests do not continue to impede on patient-provider relationships.
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.
I learned to see the world through words. Words I picked over all day at school then curled up with under my covers long after I was supposed to be asleep. I reflect through writing, turn to all 1124 pages of my worn Lord of the Rings every time I go through a hard time, and dream best with my head pillowed on a book. Yet I never realized how fully these words and stories shape my experience of the world until I entered medical school, a space where the world is not often viewed through the lens of stories.
Vaccines have become a cornerstone of modern public health and have greatly reduced the burden of infectious disease across the globe. They are also the center of major debate in America. Conjuring furious arguments with divided opinion, where vaccine safety gets more attention than vaccine effectiveness. In the era of Facebook, Twitter and every imaginable social media outlet, opinions and facts flood computer screens, distorting truth and instilling doubt. To support an argument, it is not difficult to find an article or group that agrees with you. Medical professionals constantly find themselves concerned and restrained by an apathetic response to reason and science.
The images of water from Flint, Michigan water came into my mind and I lingered at the sink a few minutes too long. I became heartbroken for the children whose bodies may have been irreversibly and negatively impacted. I became enraged at a system that would prioritize saving pennies over properly protecting its citizens from preventable harm. Governor Rick Snyder, his appointed “emergency financial managers” and other leaders allowed this crisis to develop over years as they mistreated Black citizens through racist policies, violated the public trust, and endangered lives. A significantly poor and majority black city was told it was okay to use polluted water to prepare their children’s dinners. Families washed their dishes in what could be mistaken for urine. They scrubbed their pearly whites with toxins to avoid cavities.
It is 1 p.m. on a Wednesday, and 250 medical students are filing into the lecture hall to listen to a lecture on health care and society. The chatter is not one of excitement, but of disconcertment. Many students complain that their time would be better spent studying hematology. These are not uncaring students who disavow the needs of the disabled, but a generation that demonstrates a palpable reaction to the way that medicine is taught. We may be quick to fault them for their alarming aversion to a discussion on ethics, but we must also consider: is ethics meant to be force-fed?
I approach the holiday season with apprehension; it conjures up memories from my youth of disunity, abandonment and what seems like intractable melancholy and disappointment. King Solomon in the book of Proverbs, which is in the Ketuvim of the Hebrew Bible, states that “hope deferred makes the heart sick,” and merely writing these sentiments produces a visceral feeling of a sick, empty heart.
Contributing Writer
Cleveland Clinic Lerner College of Medicine
Joshua Niforatos is a medical student at Cleveland Clinic Lerner College of Medicine. Born and raised in the suburbs of Chicago, he eventually made his way to University of New Mexico (UNM) where he earned bachelor degrees in both cultural anthropology and biology. He then went on to earn a Master of Theological Studies at Boston University School of Theology where he studied theology, anthropology, and ritual.
