As medical students at Emory, we spent our first six months building a firm conception of what it means to be healthy. It did not take long to appreciate how much of our patients’ health would be determined by their social context before they ever walk into our clinics and hospitals. The importance of adequate and healthy nutrition, safe housing and manageable stress is clearly linked to patient outcomes. We can see these issues on the ballot in every election. In this sense, voting is healthy.
The idea of prescribing housing sounds too good to be true, the exact kind of thing you would expect to see on a medical drama. It couldn’t possibly work in real life … or could it?
The Iranian Consultative Assembly, the equivalent of a parliament, legalized living non-related donations in 1988 and set up a new government-run transplant matching system. Within this novel framework, living donors could choose to have their organs typed and registered in advance. If they are needed, a third-party independent organization, the Dialysis and Transplant Patients Association (DTPA), would set up contact between the donors and recipients. The donors would be compensated by a payment from the government, free health insurance, and sometimes additional payment from the recipient. The payment from the government is said to be in the range of $2,000-$4,000.
Moreover, homelessness and COVID-19 both disproportionately burden marginalized populations — in particular, Black communities and Native Americans. When COVID-19 began spreading through the community, it came as no surprise that it would disproportionately impact those living in congregate homeless shelters. Overcrowded shelters, the inability to physically distance, and poor access to handwashing and hygiene facilities are coalescing for an unsafe environment that could accelerate disease transmission.
There is a cost crisis in medicine: the health care industry accounts for about 18 percent of the GDP in the United States, and predictive models see this increasing in the coming years. This is a problem for the country as a whole as an estimated 41 percent of working Americans have some level of medical debt.
Now, I am a fourth-year medical student standing at the foot of a tall ladder. The hierarchy of medicine requires that I follow some unwritten rules in order to climb. Throughout my training, I have gotten the sense that one of those rules is: avoid trouble, good or bad. Of course, now, doctors are beginning to find their voices through movements like White Coats for Black Lives. But as a young trainee, I sometimes feel the sentiment directed at James in 2018: shut up and doctor.
President Trump signed an executive order this past June that directs the Health and Human Services Department to develop a rule requiring hospitals to disclose online the prices that insurers and patients pay for common items and services. The rule also requires hospitals to reveal the amounts they are willing to accept in cash for an item or service. However, hospitals not complying only face a civil penalty of $300 a day, giving them latitude to effectively ignore the executive order.
As many urban academic medical centers have become the world’s leaders in research and patient care, their bordering neighborhoods have suffered through decades of disinvestment and economic blight. Medical students often receive their first years of training in hospitals that serve these disadvantaged populations. While the current focus on social determinants of health represents a rising cornerstone of medical education, what else do medical students need to know about inner city poverty?
For a variety of reasons, the substance use population is particularly vulnerable to the impacts of the COVID-19 pandemic. Based on data from previous financial crises, the emotional toll will increase rates of new substance use, escalate current use, and trigger relapse even among those with long-term abstinence. There may be a significant lag before these changes are detected and treated because health care resources are being funneled toward the pandemic.
As I grew up, I felt these lines and had a vague idea of where they lay. I knew where in Louisville I felt “safe,” and I also knew where the “bad parts of town” were located. The lines and their forced labels serve to enhance the lives of some people, myself included, while limiting others. Two cities exist within one border separated by an undeniable feature — skin color.
In collaboration with the Australian-American Fulbright Program, I spent 2019-2020 examining the treatment of substance use disorders in Australia through the lens of animation. As part of this project, I created a pair of educational animations focusing on the Medically Supervised Injecting Centre (MSIC) in Sydney’s Kings Cross. This series, entitled Up the Cross: The Uniting Medically Supervised Injecting Centre, examines the founding, protocols and benefits of the MSIC, which was established in 2001.
Hahnemann’s doors stay closed and our patients are waiting. While Philadelphia has stopped negotiations, we, as students with futures in health care, cannot accept this. We demand that Freedman provide free use of Hahnemann for the duration of the pandemic.