Between the Lines: Everything Your Medical School Didn't Teach You About Health Equity

In this episode, medical students Nick Sookhoo and Andrew Sullivan explore the current state of primary care for transgender individuals in the United States. Transgender rights are under attack from all directions, and queer and transgender individuals often still find it difficult to access basic healthcare with dignity and respect. Andrew and Nick are joined by James Lauren, a queer trans nurse practitioner (https://www.jameslaurennp.com/) working in primary and gender-affirming care in New York City and currently enrolled in the Hunter College Doctor of Nursing program with expected graduation in 2025. In the interview, James explores the question of continued resistance toward gender-affirming practice among providers and what might be some of the driving forces behind that resistance. The episode demonstrates that gender-affirming care should be just like any other aspect of the practice of evidence-based medicine: data-driven and with risks & benefits weighed in a case-by-case basis with patients. Through early education and exposure, medical students can be a part of systemic change such that the next generation of queer and transgender individuals do not have to face such difficulties.

Everyone deserves to die with dignity. But does every individual have an equal opportunity to do so? Hospice care was established to give patients some control over the dying process, but what factors are necessary to ensure access to adequate end of life care? Join us as MS1s Cameron Klepper and Peter Khouri discuss these question and more under the heading of "Death Justice." We welcome Toni Warren and Amanda Neveu of the Joan Nicole Prince Home who shed light on this topic through their many years of experience running an end-of-life care center.

Black individuals face a 3 to 4 times higher rate of maternal mortality than their white counterparts. In this episode, medical students Kayla Schacher and Iqra Nadeem highlight the stories of Sha-Asia Washington, Amber Rose Isaac, and Shamony Gibson, three Black women who died during or shortly after giving birth, in order to illustrate the tragic impact of this disparity. They are joined by Christine Miller, a full-spectrum community doula and spiritual herbalist to discuss how doulas can support and advocate for people before, during, and after they give birth to help avoid tragedies like these.

Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016‒2017 | AJPH | Vol. 111 Issue 9 (aphapublications.org)

Information about Momnibus Legislation:

JustBirth Space

Beloved Birth Village

In this full length episode, medical students Luke Morales and Katty Wu are joined by Cara Page a Black Queer Feminist cultural/memory worker, curator, and organizer of 30 years in a conversation to explore the concept of healing justice and where the medical community stands in terms of harm and help. 

In part 2, Andrea and Vivek are joined by Seongun Chun, the Senior Manager of Health Policy at the New York Immigration Coalition (NYIC). Ms. Chun describes the unique experience of healthcare for immigrant Americans, drawing on her experiences as a Korean-American immigrant and her expertise in the field of health policy. She reviews the barriers to healthcare access for immigrants and talks about how we can improve the healthcare system to benefit all patients. She recognizes the drastic rise in anti- Asian American hate crimes and names the sources of pervasive racist ideologies. We learn about the devastating effects that the COVID-19 pandemic have had on the immigrant NYC community and delineate the effects of Public Charge on healthcare access.

In part 1, medical students Andrea Martinez and Vivek Shah reflect on immigrant healthcare, discussing the negative impacts of public charge, ICE detention centers, and cultural incompetence on mental and physical health of patients with an immigrant background. By relating this topic to their personal experiences as the children of immigrants, they give the audience an introduction to the tangible effects of healthcare inequity on life, health and attitudes in the household. In this episode, they review the xenophobic history of public charge, the horrifying condition of immigrant detention centers and the value of culture competence on adherence to treatment plans and attitdues towards the healthcare industry. They are joined by Bharat Shah,  a 79-year-old South Asian immigrant from India who moved to the U.S. in 1992 as he comments on his experiences receiving healthcare in America. Bharat shares his opinions on the US healthcare system, comments on the value of having healthcare providers who communicate in language, and compares the virtues Indian healthcare.

Andrea discusses the effects COVID-19 has had on interpretation services before our next episode on Immigration Healthcare.

Read the article this episode was based on: https://jamanetwork.com/channels/health-forum/fullarticle/2771859

In part 2, Chanelle and Isabella are joined by Jose Saldana, the Director of Release Aging People in Prison, or RAPP. Mr. Saldana describes the unique health challenges of the aging incarcerated population, who often suffer from multiple chronic conditions that cannot be properly managed in prison. He challenges the racist and vengeful system of prolonged incarceration and advocates for compassionate release to allow for rehabilitation and re-entry into society. Chanelle and Isabella reflect on the accounts they heard of the inadequacies and injustices of prison health care and discuss some systemic changes to mediate these injustices. They end with recommendations to health care providers to ensure they are best meeting the needs of individuals with criminal justice involvement.

In part 1, medical students Chanelle Simmons and Isabella Giunta explore the impact of mass incarceration on the health of individuals and communities. Through collected anecdotes, they illustrate the failures of prisons to provide their inmates with adequate health care, even in life-threatening situations. They also describe the history of racist policies and practices that allow for this inhumane treatment. They are joined by Jarell Daniels, a prison reform activist, mentor to youth emerging from juvenile detention, and research assistant at the Center for Justice at the University of Columbia. Jarrell shares the obstacles he faced while trying to access health care in prison and discusses the necessary changes to be made to ensure people in prison receive the care they need.

In part 2, together Anjali, Andrea, and Carla describe mental health care that goes beyond medications and hospitalizations to both treat and prevent mental health crises. Anjali and Andrea further reflect on the role of medical providers in the violence and traumatization of people with mental health concerns and describe what changes to our medical education are necessary to prepare physicians to provide appropriate, compassionate, and trauma-informed care.