Post 3: White Coats for People of Color – Combating Racism in Healthcare

There are a few things in life that are truly black and white. Recently, a lot of issues surrounding racial identities have stirred the pot in terms of political affairs and the idea of what constitutes racism has dominated headlines. Growing up, I used to think racism and racists could be easily defined. It was simply good or bad, and anything that was racist would immediately be called out or challenged. It was part of the charm of living in an era with advanced technology and educational opportunities. It is unclear when I started to muddle the line between what is racism and what isn’t and began to see how prevalent it truly is in our society today.  Before my time at Project Healthcare, the process of delivering and receiving healthcare was much simpler for me. The last ten weeks have presented some of the most rewarding, challenging, and personally gratifying learning experiences that have completely changed my perspective on healthcare and how health is determined. 

Humans have a desire to have clearly defined boundaries and place things under categories. It is this same desire that lets us feed into the system that chooses to use our differences against us rather than embracing them. We set ourselves up to have implicit biases that inform our interactions with different people. Being aware of the biases we all hold is especially important for people working in health-related professions. 

To say that race could mean the difference between life or death is not an exaggeration. Because of systemic factors such as residential segregation, and past and present policies, members of ethnic minorities are at a higher risk of chronic health conditions. These same groups are less likely to receive the same level of preventive or equitable care as their white counterparts. Before this summer, these facts were just statistics. It was difficult for me to imagine how this could be true. Spending hours observing provider-patient interaction in the Emergency Department has made me realize how racism still persists in our system, even though everyone I have spoken to wants to see the opposite. 

A case study during a weekly Social Emergency Medicine course discussing a patient’s immigration status and implications for their healthcare.

 One of the biggest barriers to remedying the issues of race in our healthcare is a lack of concession in a healthcare setting. In the words of Dr. Kamini Doobay, a physician in Bellevue’s ED and a board member on NYC Coalition to Dismantle Racism, “We can’t attack something without acknowledging it. By not acknowledging the issue, we are perpetuating it”. Racism is a difficult and uncomfortable topic. Even saying the “R-word” makes people uneasy. We avoid holding each other accountable by not talking about racism;  instead thinking avoiding the issue helps solve it.         

Working with one of the most diverse patient populations in the state, it can be difficult to maintain a conscious level of cultural sensitivity for every individual. The healthcare providers I worked with this summer were some of the most empathetic and softhearted individuals I have ever met, yet many of them exercised unconscious changes in their stature and conversation that differed the treatment of patients of color versus white patients, which certainly had an impact on the quality of care individual patients received.  A lot of patients who came into the ED held strongly negative preconceived notions of the doctors that were treating them because of either previous experiences with healthcare providers, or the notion that their doctor is white so only prefers white patients. A common theme throughout the entirety of my summer was a desire for patients to see more providers of color. While changing the representative demographic of current and potentially future healthcare providers is an issue for the larger larger health system to deal with, taking the small effort to build bridges with patients of color and exercise cultural sensitivity will be extremely beneficial at the individual provider-patient interaction. 

         

Without a stethoscope around my neck or a white coat on, I appeared to be removed from the system that perpetuates racism, unknowingly or not. Patients felt comfortable telling me things they wouldn’t share with their doctor or nurse that were absolutely important for their overall well-being. Nearing the end of this experience, I am having a difficult time reconciling the idea that earning the qualifications necessary to help people with their health issues could change the perception of me as a person who genuinely cares about a patients well-being into an untrustworthy figure, even though the latter is false.         

Project Healthcare has given me countless memories and experiences to reflect on. From seeing brain surgery on my first day to the inside of a lung, my fondest memories are those spent speaking with patients and hearing their life experiences. Having the opportunity to interact with people from all walks of life is an incredible one, and something that I encourage every individual to seek out. Working with the other Project Healthcare interns as well as the providers in the Emergency Department, I am confident our small acts to combat racism in healthcare will not prove to be futile. A future with equitable healthcare is absolutely possible, but requires that all participants are actively holding each other accountable to create tangible change.

       

Project Healthcare interns bonding and getting some sun after a lunchtime picnic.

Post 2: Seeing Vulnerable Populations in a New Light

The word jail immediately brings to mind images from a first-grade field trip to my town’s holding center. A group of sodden-looking seven year olds walked through a row of cells under an overhang of harsh fluorescent lights. Afraid to step too far to the left or the right, we walked past cells with people’s heads hanging low to avoid making eye-contact with the curious, small faces cautiously peering in. Even as a first-grader I remember having a pit in my stomach as I passed through that long hallway. Automatically associating the jail with terrible crimes and people my parents told me to avoid at all costs, my insides churned at the idea of imprisonment. On a separate occasion, a driving instructor directed me to a high-security prison. Eyeing the silvery barbed wire and high gates, the instructor commented, “I wonder what you have to do to end up in there,” sending chills down my spine and my hand to place the gear into reverse. 

The concept of vulnerable populations was first introduced to me in Sociology of Body and Health. Some populations, such as pregnant women, the elderly, or racial minorities, made sense to me, and others, such as the incarcerated population, caused me to raise my eyebrows. 

How can a population that is known to illicit violence and unrest among the community be considered vulnerable? Working in Bellevue’s Emergency Department (ED) and learning more about Riker’s Island, the largest jail in the world, has taught me a great deal regarding the circumstances surrounding incarceration in the United States and in particular, its intersectionality with race and gender. 

Riker’s Island Jail, home to New York City’s main jail complex.

Riker’s Island, home to New York City’s main jail complex, has recently been under fierce debate. Known to house up to 15,000 inmates, and notoriously known for the violence and corruption within its walls, it has been proposed to close within ten years by Mayor Bill de Blasio. The plan, though highly controversial, aims to reduce incarceration rates by 25%, create a more humane environment within smaller jails, and provide inmates with more opportunity for growth and recreational activities. Studies have shown that providing inmates with educational and therapeutic socialization, as opposed to traditional solitary confinement and violence, is indicative of a positive return to citizenship and a lowered re-incarceration rate. 

Part of a doctor’s job is to release patients back into a safe environment, but what happens when that environment is a vague and misunderstood idea? Healthcare providers often fail to fully comprehend the true conditions that incarcerated individuals are released into. Oftentimes, inmates are mistreated, abused by other inmates or guards, and are constantly being disrespected. Learning more about what it is like to live on Riker’s Island, I realize that my uneasiness surrounding the idea of imprisonment isn’t necessarily placed on the prisoners themselves–rather, on the unrealized dangers surrounding the prison system in the United States that has turned what is meant to be a system of rehabilitation and reform into a grossly violent and unjust environment. 

Kailef Browder, a teenager held at Riker’s Island for three years without trial was eventually released with dropped charges.

Take Kalief Browder, a sixteen-year old African American boy at the time of his arrest. Browder was held in solitude for over three years at Riker’s, without trial, for stealing a backpack. Ultimately, the trauma of abuse and confinement led Browder to commit suicide when he was released back into the custody of his parents at age nineteen. Browder’s trial had continuously been delayed by the courts until they decided to drop his charges, but at too large of a cost.

Graph depicting the racial disparities in incarceration rates. Data is taken from Prison Policy Initiative.

It is not a secret that incarceration rates disproportionately affect people of color. African Americans are more likely to receive longer, harsher sentences than their white counterparts and are more likely to become incarcerated in the first place. There is little evidence to indicate that either race is unequally committing the same crimes, so why does this discrepancy exist within our jails? Imprisonment is a life-changing event. Having a criminal record makes it extremely difficult to obtain employment in the United States because of the stigma surrounding incarceration, regardless of the crime committed. 

This stigma is something I personally encounter at Bellevue. Incarcerated patients treated at Bellevue come from Riker’s Island. Nearly 85% of inmates at Riker’s are still awaiting trial. The liberty of “innocent until proven guilty” is something that I consciously have to remind myself of when I see a patient handcuffed to their stretcher or a corrections officer hovering in their corner. Making an effort to remind myself that this person could be in for anything, from subway fare-evasion to multiple homicides, has helped me come to the rationale that it is not my place to judge or fear them. Their basic human right is to receive the same quality of healthcare that is given to every other patient that walks through the ED. 

A personal goal of mine, after learning more about Riker’s Island in particular and observing the care given to incarcerated individuals, is to distance myself from the ideas I was taught surrounding imprisonment. Realizing that there are many factors that determine incarceration beyond simply committing a crime, I have shifted my view on prisoners to see them as capable of redemption and of having a second chance in our society. Changes in my body language and time spent speaking with prisoners, reflective of how I interact with other patients, helps incarcerated patients recognize my positive take on their current state.  

The incarcerated is a population that I will inevitably encounter as a future healthcare provider and I am so grateful to have interacted with them in a healthcare setting as my career is just beginning to develop. I understand their positions as a vulnerable population better. Following this experience, I want to educate myself more on the vast number of issues surrounding mass incarceration and I stay hopeful that proposed criminal justice reforms will begin to stabilize the inequalities that permeate our justice system. 

I recognize there is a much larger societal movement needed to address vulnerability among our groups, particularly the incarcerated, and so I leave you with some food for thought: “Of all the forms of inequality, injustice in health care is the most shocking and inhuman because it often results in physical death.” -Martin Luther King Jr.

Post 1: How Bellevue Project Healthcare is Breaking Down Barriers

Bellevue Hospital, famously known for its psychiatric ward and colloquially termed as the “loony-bin” by many New York city residents, has an interesting and complicated story. Commonly used in popular culture to derive eerie and gothic backdrops such as in The Godfather, Bellevue has a number of misconceptions surrounding it. Inextricably linked with New York’s history, Bellevue has been a pioneer in the medical field and has served the poorest of the poor to the richest of the rich. It has been home to a number of medical firsts and has trained physicians from Columbia Medical School to NYU Langone. Bellevue has impacted countless lives from immigrant families to patients who were turned away by other hospitals. Guided by its “no one be turned away” philosophy, Bellevue has been a haven to some of the most critical patients in New York. For me, Bellevue is home to Project Healthcare.

Project Healthcare provides a comprehensive look at emergency medicine to expose non-medical students to an immersive clinical setting. The program’s biggest goal is to empower students to make well-informed decisions regarding their career. Furthermore, the program aims to curate future healthcare professionals who are well versed in the social determinants of health in order to effectively treat and prevent large-scale health issues. The Bellevue Emergency Department serves a unique and underserved population in Manhattan to reduce healthcare disparities in the state. The hospital treats the highest percentage of  incarcerated, impoverished, homeless, and minority individuals each year, nearly 80% of the state’s underserved population.

Taken after a FDNY ambulance ride along with EMTs Bruno and Danny. We celebrated a busy, yet relatively easy night with quesadillas near midtown.

Project Healthcare interns adhere to a strict schedule of clinical rotations throughout various departments in the hospital. Our primary responsibilities lie in the Emergency Room where we assist doctors, nurses, and other healthcare providers with tasks such as EKGs, listening to patients needs and concerns, and monitoring the quality of their stay in the hospital. One shift in the ER, a patient came in with his thumb partially amputated as a result of an on-site construction accident. I spent the majority of this shift speaking to him about his children, tattoos and favorite netflix TV shows to distract him from the hand surgeon suturing his thumb back together. Though the patient was in a great deal of pain, gentle reminders to breathe and the distraction of our conversation improved his experience, as well as aided the physician in his primary goal. Experiences like these have helped me further my personal goal of refining my interpersonal skills in highly stressful situations.  

Project Healthcare interns learning how to run EKGs during our Stop the Bleed! seminar.

In July, Project Healthcare interns will host a community health fair. My health fair topic is aimed at increasing awareness of Breast and Cervical cancer in order to educate the community on the importance of self-examination, early screenings and yearly physicals. My group has adopted a holistic approach to our topic and will provide resources for nutritious food and clinics that can be utilized by the unique patient population at Bellevue. The hope for the annual health fair is to empower underserved patients to make their health a priority and to bridge barriers in accessing health care services.  

Every Tuesday,  I survey a variety of Public Health topics as part of a social medicine course. The lecture series analyzes a variety of real-life situations seen in EDs all over the country to determine the sociological reasons for why they could have arisen. Weekly meetings and discussing case-studies is inherent to the healthcare field. The Social Emergency Medicine course is led by a variety of guest speakers from NYU and Bellevue faculty, staff, administrators, residents and medical students. These meetings are one of my favorite parts of this program and I strongly believe more healthcare providers should become versed in Public Health topics in order to improve the United States’ healthcare system as a whole. For example, the healthcare system has one of the largest  impacts on our environment. By simply educating providers and administrators on the impact of their practices, cognizant steps can be taken to reduce waste and emissions in order to improve the quality of life for millions of people.

Dr. Kelly Duran during her seminar: Homelessness in the ED. This figure is representative of the number of homeless people in the US on a single night in January 2018.

I frequently think about the kind of healthcare provider I want to be. Developing cultural competency is of the utmost importance to me. I want to be able to provide unbiased and accurate care to patients of all backgrounds and identities. Knowing where a patient comes from is incredibly important for addressing their health concerns and bettering their quality of life on a larger scale. Through my experiences in Bellevue’s ED, it is clear to my peers and me how health is socially constructed beyond simple biological factors.

My participation in this program has exposed me to populations that have been systematically neglected and fallen through the cracks of the healthcare system. My hope is to learn how to build bridges with this population and learn how to proactively create an inclusive and accessible environment for patients of all identities. This optimism is shared with my Project Healthcare peers, who are just a subset of the future healthcare providers. Developing cultural competency and learning how to sensitively interact with patients who come from different backgrounds early on is essential for breaking the cycle of systemically neglectful care that has been impervious to our system from the get-go.

Similar to the breaking down the misconceptions surrounding Bellevue Hospital, it is important to realize when stereotypes and misnomers are at play during patient care. Often times, there is more to the story than the first glance. Simple courtesies and an effort to get to know a patient’s personal history does wonders for their care and experience as a whole. Recognizing when unjustified biases are at play will bring the medical community closer to addressing health inequity and strengthening ties with their patients—something I encounter nearly everyday in my position at Bellevue.