I have learned that patients seek health care services at free clinics for a myriad of reasons and some are atypical. There were specific populations I expected to see: the uninsured, underinsured, undocumented, and those without access to transportation. Yet there were other populations I was more surprised to see, namely patients who had insurance but preferred their experiences at free clinics.
Yet, I am worried that these stories of heroism are harming the very people they celebrate. By creating an ideal “health care worker” as an endlessly altruistic individual, it stigmatizes the medical workers who refuse to take on these risks — even though there are many legitimate reasons not to. I’ve talked to doctors in China who have watched their friends and colleagues die during the SARS epidemic, who have watched the government break its promises to support their families after their death, and who, as a result, are no longer willing to volunteer on the frontlines. I’ve watched videos of nurses in the U.S. crying after they were forced to quit their jobs because hospitals are not providing them with the personal protective equipment (PPE) necessary to keep them safe. Many of them said that they were afraid of getting infected and spreading the disease to their high-risk family members. Who can say these are not real concerns? Who can call these physicians and nurses selfish and irresponsible?
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. Trump’s executive order is formalized by the Center for Medicare and Medicaid Services’ (CMS) Hospital Price Transparency Final Rule, which applies to every hospital in the United States and is set to be effective on the 1st of January next year.
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.
The incidence of chronic disease is strongly correlated with aging. According to the Information Theory of Aging, aging results from a progressive loss of genetic material due to gradually worsening cellular repair mechanisms. This cellular erosion leads to a nearly interminable list of diseases, including but certainly not limited to cancer, heart disease and neurodegenerative disease.
Mrs. H’s story is just one of millions of Americans who have become victims of structural violence and suffered from the social determinants of health. With a clearer understanding of the complex factors that contribute to patients’ health outcomes, I now aim to reunite the erroneously separated domains of medicine and social sciences.
In Nicaragua, where I was born and raised, we routinely stayed at home for dengue outbreaks, violence and hurricanes. I had experienced at least three lockdowns as a child, and now as an adult, I was experiencing another. Although the Nicaraguan lockdowns I experienced happened in the 1990s, the COVID-19 lockdown was still familiar.
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.
I agree that protesting is best done in peace, / But wasn’t that tried by taking a knee? / Or hashtags that said Black Lives Matter, / And praying that change would come with the chatter.
Tonight, there are families who will go to bed / Without having eaten dinner. They will slip / Through sheets of faded blue, stained with
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.