Medical Student Standing with the 99%

Three weeks ago, I marched with the 99 percent movement in San Francisco. I have been to marches before, but this time I went explicitly representing my new profession. I went to the protest wearing my white coat with a group of about 5 classmates. Here’s some of us with our signs on the SFist blog:

Just as the 99 percent/Occupy Together movement is broad, each of us medical students probably came to this movement from different backgrounds and with different political perspectives. However, we were united by our commitment to stand with the 99%, many of whom will be our patients, as they struggle for a U.S. and a world with a more equitable distribution of health, with access to healthy food, quality education, dignified work that pays fairly, and well-being for all. My classmate also posted about the march on her blog Immodest Witness. Before the march, we discussed whether or not to wear our white coats. There were mixed feelings in the group. In many ways, the white coat can be a symbol of power that separates physicians from our patients and the rest of humanity. However, in the context of a social movement for justice,  the white coats can also a powerful symbol of our profession standing with the people who we serve. After the march, we starting reaching out to other classmates and organizing support for the movement amongst our fellow medical students. We encountered a very positive reaction and quickly grew to an informal grouping of about 35 students. People started stopping us in the hall to talk about the movement and how they could get involved.

Last week, as I prepared for a final exam, I watched from afar as the Occupy Oakland camp was raided and attacked by police. Being from Oakland, I was saddened and angered to see my friends and neighbors gassed and beaten by the police while peaceably assembling. I was especially angered to see this attack carried out under a pretext of protecting public health and safety. I was all too ready to sign this pledge by public health workers and students to support the Occupy movement. I was also deeply proud of my city that day and the next, when 3000 people nonviolently retook the plaza they had been driven from the night before. That same night, hundreds of people prevented a police raid of the OccupySF camp. Maria Del Pueblo (director of Causta Justa :: Just Cause) summed up the events of that evening: “Last night, after inspiring nonviolent street protest, and with advocacy by labor & community to the mayor, Occupy Oakland took the plaza back. Last night, after forming a human barricade of campers, community organizers, and labor leaders, Occupy SF prevented a police raid. Last night we got a taste of what it’s like to be part of a movement that is too big to fail.” I knew that I had to prioritize studying for the exam, but my heart was with the people in Oakland and San Francisco.

All of these events led up to the General Strike and port shutdown in Oakland yesterday.

The strike was called by the General Assembly of Occupy Oakland in response to the police attacks, but also as a bold strategic move to further the goals of the 99% movement. I participated in the General Strike with over 15 of my fellow medical students. Many more expressed support for our actions. This time, instead of wearing white coats, we decided to join the street medic team. This was great way for us to offer a concrete skill in service to the larger movement.

November 2nd, 2011 will go down in the history books as a victory for this mass people’s uprising. There was participation from teachers, students, labor unions, tenant organizations, immigrant justice organizations, people who are unemployed, parents, children, and so many more. I saw thousands of people in the streets of Oakland shutting down banks, distributing food, speaking out against an unjust system, and envisioning the world we want to create. In the evening an estimated 20,000 to 50,000 people marched on the Port of Oakland to shutdown that hub of global capital and to stand in solidarity with the dockworkers.

After participating in this historic moment, I am excited for what the future holds and filled with love for the capacity of this movement to imagine a better world. I plan to continue organizing future physicians to join this movement, both in our own self-interest and in solidarity with our patients and the communities we work in. Returning to school today, many people expressed interest in and support for the General Strike. I am also thrilled to hear the buzz about where this movement will go next. I have heard talk about occupying foreclosed houses to return residents to the homes they have lost to the banks. And on that note, I’ll leave you with another quote from Maria Del Pueblo:

“We had 50,000 people in the streets yesterday demanding the redistribution of wealth. If the media is so intent on reporting on broken windows instead, I’d like to take them to some streets in East Oakland, where there are rows of empty houses that Black and Latino people were foreclosed out of, with dozens of broken windows and rats living where families used to thrive.”

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Drawing Inspiration

Last Friday I went to an event called 40 Years and Counting: Living the Legacy of Attica and George Jackson. The event was at The Eastside Arts Alliance and was a benefit for Critical Resistance, a “national grassroots organization committed to ending society’s use of prisons and policing as an answer to social problems”. The evening was moderated by Rachel Herzing, a longtime prison abolition organizer and co-founder of Critical Resistance. There were four speakers/performers who shared their art/music/poetry and their reflections on being cultural workers and organizers in movements for social justice. Eugene Thomas talked, via recorded interview from prison, about his experience as an organizer on the inside and the inspiration he has drawn from the writing and legacy of George Jackson. Maisha Quint read her poetry and spoke about her exposure to the inhumane conditions in women’s prisons through her work as a medical advocate. Kiwi Illafonte performed some rhymes

and spoke about how the legacy of the black liberation movement affected him as a young Filipino man in Los Angeles. Melanie Cervantes spoke about her artistic work with Dignidad Rebelde, and showed slides of their prints, which have been utilized in movements, protests, and marches from Oakland to Arizona and all over the world.

I was inspired in general by the love and commitment shown by Rachel Herzing and each of the speakers. I was also re-inspired by the work that Critical Resistance does to end the prison industrial complex and to seek alternative ways for communities to meet their basic needs, including safety, without putting humans in cages. I was also inspired to attend the event with two of my medical school classmates. As I’ve probably mentioned before, when I decided to become a physician, I never in my life thought that I would be attending a prison abolition event with two of my future colleagues. That alone makes me feel like I’m on the right path.

More specifically, I was inspired to learn more about prison health and to figure out how I can join the work to advocate for people who are locked up, especially as a future doctor. I’m a long way away from picking a specialty or figuring out what my practice will look like, but I know that I’m committed to working with disadvantaged and oppressed communities. People who are in prison are consistently denied their human rights, including medical care. I can imagine that there are some complex issues when a doctor works to provide care to patients who are in prison. How can one provide care with dignity in a place that is designed to be undignified? How does one maintain confidentiality? What about informed consent? And what about interacting with the guards and the prison power structure? Is it possible to do that work while also maintaining that prisons should not even exist?

What are your thoughts about working inside or outside the prison system? What have you been inspired by this week?

Anatomy Lab and Cadavers

Well, medical school is in full swing. In a month of many “firsts”, tomorrow will be my first anatomy lab of medical school. It will also be my first time ever wearing scrubs. I did take an anatomy class before, but the labs were mostly with plastic models and the instructor provided only a few demos with the cadavers. For this lab, we are put in teams of 4 and each team is assigned a cadaver for the year. We will use dissection and prosection to learn about the human body in great detail.

Last week, we attended an orientation to anatomy lab. I was impressed by the fact that the main emphasis of the orientation was on respect for the human beings who donated their bodies, through the Willed Body Program, for us to gain knowledge and skills that we will use in our future practice of medicine. At the end of each year, there is a memorial service for all the people who donated their bodies, and the remains are then cremated and scattered at sea.

In the orientation, we also discussed the range of emotional and physical responses that can occur in the lab (including fainting). We were assured that any response is ok, and that it’s possible to have a challenging response at first and then be fine later, or to be fine at first and then have a hard time later. There was also a panel of second-year students who discussed their own attitudes and thoughts about the lab and cadavers.

I don’t know exactly what my response will be. As mentioned above, I have seen cadavers before, but haven’t had this much contact. I have also been exposed to death and dying amongst my family and friends and in my work as a home care attendant, possibly more than most other medical students. Those experiences of death and dying seem very separate from this educational experience, but I don’t know if it will also be triggering.

In closing, I would just like to thank the individual people and loved ones who decided to participate in my education in such a crucial and humbling way, by participating in the Willed Body Program. I will strive to use this opportunity well and to always respect the human beings who made such an important gift.

Guest Blog: My former patient. .shot by BART police

[The following letter is my first guest blog, written by Rupa Marya, MD.]

Dear San Francisco,

I am one of your local physicians and have taken care of many different kinds of people during the past 9 years of my appointment as an internist at UCSF, where I have worked at SF General Hospital as well as at the VA and the UCSF campuses. San Francisco is a surprisingly small town, and when you spend enough time in the health care industry, you come to recognize many of the city’s residents. You hold their stories and watch over them, in the hospital when they are ill and in the chance occurrences of running into them on the streets, in the market or painting the town red. It is an honor and great privilege to take care of the people of this city that I love so dearly.

Last month, I learned that one of my former patients Charles Hill was shot and killed by BART police. Per the police, he was armed with a bottle and a knife and had menacing behavior. Per eye witnesses, he was altered and appeared to be intoxicated but did not represent a lethal danger. I remember Charles vividly, having taken care of him several times in the revolving door which is the health care system for the people who do not fit neatly into society. Charles was a member of the invisible class of people in SF–mentally ill, homeless and not reliably connected to the help he needed. While I had seen him agitated before and while I can’t speak to all of his behavior, I never would have described him as threatening in such a way as to warrant the use of deadly force. We often have to deal with agitated–sometimes even violent–patients in the hospital. Through teamwork, tools and training, we have not had to fatally wound our patients in order to subdue them. I understand the police are there to protect us and react to the situation around them, but I wonder why the officer who shot Charles did not aim for the leg if he felt the need to use a gun, instead of his vital organs. I wonder if he possessed other training methods to subdue an agitated man with a knife or bottle.

I feel this situation quite deeply. It is hard to watch our civil servants (police) brutally handle a person and their body when i spend my time and energy as a civil servant (physician) honoring the dignity of that person, regardless of their race or social class, their beliefs or their affiliations. I know it is not my job–nor the police’s job—to mete out justice or judgment of a person’s worthiness. It is also hard because Charles has no voice, no one to speak for him now that he is gone. It would be easy to let this slide and move on with our busy lives, as we all struggle to make ends meet in this expensive city during a recession. I believe this situation  shows us how powerless we all feel to some degree.

I feel outraged and am trying to find the best ways to express it–through creative outpouring, through conversations. I would like to lend my voice to the growing protest of the BART police’s excessive use of violent force and know that weekly protests are being organized on Mondays until demands are met for BART to fully investigate the shooting of Charles Hill, disarm its police force and train them properly, as well as bringing the officer who shot him to justice. The media is portraying the annoyance of the protests to commuters more than the unbelievable horror that an innocent man was shot dead by the force that is meant to protect us. I don’t want to upset commuters or be a nuisance. I would like to be part of educating and not letting this slip under the proverbial rug, in honor of Charles Hill and Oscar Grant, another recent victim of a BART police shooting, and in order to help prevent something like this from ever happening again.

I will be present at the peaceful demonstrations on Mondays in front of the BART Civic Center station, not to prevent commuters from getting home, but to educate a population that may need to pause and think about the value a human life has and the kind of San Francisco we want to live and work in.

If you feel this gravity of this situation and want to lend your voice, please join me at Civic Center Monday August 29th at 5pm to be part of a nonviolent, peaceful demonstration. Please bring a simple sign, expressing your concern. Or just your self to stand in support. If you’re a musician and would be into creating an acoustic street band with drums and brass outside the BART for this purpose, please let me know. And if you support this outpouring, please spread the word.

Thank you for your time and thoughtful consideration.

Respectfully,

Rupa Marya, MD

The Underserved: What does it mean?

I have some problems with the term underserved and I promised to discuss them in a future blog entry. So here we go. This should be interesting, since the word is in the title of my medical school program (PRIME-US, PRogram In Medical Education for the Urban Underserved). From the outset, I should say that my comments will be limited to the context in the United States. The disparities between global geographic regions and nations are also incredibly important!

First, the term underserved is unnecessarily vague. Who are we talking about when we say underserved? Are we talking about African-Americans, LGBT/Queer folks, Native Americans, rural communities, or working class and poor communities? Are we talking about homeless folks, Latinos, Asian-Americans, or people who are incarcerated? Are we talking about women, people who use injection drugs, people with disabilities, immigrants, or people who live in single-room occupancy hotels (SROs)? While I understand the need for some shorthand to discuss issues of economic and health disparity, it is also important to avoid slipping into euphemisms and cliches.

The connotation of underserved also leaves something to be desired. It takes the responsibility away from those in power, the ruling class, and systemic oppression. Instead the onus is on the social services sector to correct the problem of health disparities. If we can only just serve people better, then all these problems will be solved. I do think there is a role for health care providers to have an effect on individual lives and on systems, or else I wouldn’t going down this road, but I also think we need to remember that there are larger forces at play here. There are communities that do not have adequate access to health care, housing, food, clean water, and education. This is not just a small crack in a system that otherwise works well. This IS the system. In capitalism, the intention is that there will always be haves and have-nots. And all of these outcomes and root causes are connected. If I limit myself to looking only at health care, I will miss most of the daily experiences of my patients that actually affect health. So, as a future physician, it is imperative that I provide care with dignity, but also that I struggle for fundamental systemic change.

Having said all that, I do see the usefulness of terms like underserved. When navigating certain systems, such as research, education, and government, it is helpful to have a term that describes one’s work without ruffling too many feathers! Also, as mentioned above, it is certainly useful to have some shorthand. And each time a shorthand or catch phrase is used, we get various connotations that come along with it.

What do you think of terms like underserved, health disparities, health equity, disadvantaged communities, or marginalized communities? Are there other euphemisms you come across in your work?

Week One: community resources, the social determinants of health, and my favorite mutiny

In my first week of PRIME orientation, we continued to meet with community organizations, tour neighborhoods, and discuss our individual goals for medical school and our future practices. We visited Asian Health Services in Oakland’s Chinatown and the Teenage Pregnancy & Parenting Program (TAPP) in the Mission District of San Francisco. TAPP “provides a friendly environment for pregnant and parenting teens to receive support and assistance through comprehensive case management services up to age 19.” They have a Young Family Resource Center (YFRC), which “provides peer to peer support to young families up to age 24.” [Call 415-695-8300 for more info.] We also visited the Instituto Familiar de la Raza, which was founded in 1978 as the first Chicano/Latino focused mental health center in San Francisco.

In Berkeley, we spent one morning at the Joint Medical Program (JMP), a small program in which students complete the medical sciences and a masters degree at UC Berkeley, then finish their clinical training at UCSF. Four of the 15 PRIME students in our group are at the JMP, so it was helpful for the rest of us to understand how it works. JMP students learn through an innovative case-based curriculum and focus on the human, sociocultural, and bioethical dimensions of health and disease.

At UC Berkeley, we met with Professor S. Leonard Syme, a social epidemiologist. He challenged us to bridge the gap between the public health and medical world views. He explained that public health looks for social determinants and root causes, while medicine seeks to build a differential diagnosis and eliminate various possible causes. He asserted that the medical profession has been really good at a few things: antibiotics, acute pain relief, and care after a heart attack being three of them, but that many chronic conditions have been much more difficult to address: diabetes, heart disease, and chronic pain for example. For many of the conditions and diseases that the medical profession has trouble dealing with, poverty is by far the biggest risk factor. Why is that? Well, people who are poor often have less access to resources such as education and health care, increased exposure to environmental pollution, and substandard housing conditions or no housing. All of these and many other factors are related to poverty and health outcomes, but Dr. Syme pointed to something even more fundamental: the lack of autonomy and self-determination associated with poverty. He explained that health risks increase with decreasing control over one’s life and decreasing ability to make meaningful decisions. What I took away from all this was a reminder that what we need is fundamental systemic change. Poverty, inequality, and self-determination must be addressed in order to really change health outcomes.

Back in San Francisco, after a long week of tours and meetings, I went to go see The Coup play at The Independent. Here’s one of my favorite tracks:

 

I tried to record their live performance of this song, but the sound on my phone was not up to the task. Lesson learned. Boots Riley and DJ Pam the Funkstress rocked out as usual, delivering their inspiring brand of revolutionary hip-hop with a full band behind them and Silk E accompanying on vocals. As I was listening to the music and contemplating my first week of medical school, Boots encouraged the audience to use their music as a soundtrack for “whatever work you are doing out in the world.” I felt excited and energized for the work ahead!

 

I started med school today

I started my first day of orientation for medical school today. This is how all med schools should start! We spent the first half of the day introducing ourselves and being introduced to the program. We learned about the differences between health disparities and health care disparities and we discussed how to evaluate cultural competencies. For the second half of the day, we went on a walking tour of health clinics in the Tenderloin neighborhood of San Francisco, including Tom Waddell Health Center, St. Anthony’s free health clinic, the Housing and Urban Health Clinic, Larkin Street Youth Services, and On Lok Lifeways.

I am in a small program at UCSF called PRIME-US, the Program In Medical Education for the Urban Underserved. Each University of California (UC) campus has a PRIME program. Each of these programs is dedicated to training physicians with a focus on care for underserved populations, and each program has a slightly different focus. UCSF has PRIME-US, focused on urban communities; UC Davis has Rural-Prime; UC Irvine has PRIME-LC, focused on care for the Latino community; UCLA PRIME prioritizes leadership; and UC San Diego has PRIME-HEq, which stands for health equity. (Remind me to discuss what I think about the term “underserved” in a future post!)

The PRIME programs were designed to expand the class size of the public California medical schools, but to do so in an intentional way. The administrators agreed that it was not only important to train more physicians, but to do it in a strategic manner that would build new doctors who are committed to serving disadvantaged communities. Initially, funding was promised so that each med school would be able to increase its class size by 10% (about 15 students), but with the budgetary crises of the past couple years, much of this funding has been rescinded. Still, the PRIME programs have persisted in raising outside funds and have continued to train excellent physicians to care for marginalized populations.

In addition to the extra mentorship and training that is provided in the PRIME program, I will also be part of the incoming class of medical students at UCSF. My regular classes will start in 3 weeks. I expect to feel like I have been hit with a ton of bricks. A friend described the first two years of med school as standing in front of an open fire hydrant, and trying to drink as much water as possible. But despite all this, my biggest apprehension about med school is not about the work load. My decision to become a physician was born from my commitment to social justice and my desire to be a part of making revolutionary change in our society. My greatest concern is that I will lose sight of my commitment and my passion.

How have you made decisions about your life work in relation to your values? Have you worried about “selling out”? How do you keep from burning out in your daily work?