Fellowship Essay

(I got rejected, but I love this essay)

I decided to become a doctor because I want to defend the right of every soul that crosses my path to live healthily and happily. When I was honest with my abilities, interests and achievements at that pivotal moment in my life when I chose this profession, medicine made the most sense and the path into it was clear. As a student doctor, I have made a great effort to ensure that my focus was not solely on the human body, but also the humanity which animates it. The human existence is the marriage of a myriad of disciplines and experiences and I never want to forget that.

I believe that my studies thus far in the humanities, social justice, and the health sciences will help to contribute to a vibrant conversation about conscious medical practice, identifying bias in both negative and positive contexts, and the next ethical step in the evolution of medicine, should I be deemed worthy to receive this Fellowship.

It is my sincere belief that this fellowship will help me continue my education in a subject that is a necessary component of modern medicine: ethics. For me, the Holocaust is one of many appropriate beginnings for my continued enrichment in the history of ethics for personal reasons as well as practical ones.

My practical reason is related to my career choice in medicine. The research and evidence demonstrating the existence of the social determinants of health now is astounding. The social determinants of health speaks to an understanding that one’s wellbeing is not just intrinsic to the individual but also contingent on the milieu by which they are surrounded and the sphere they occupy in their society. Race, gender, sexuality, religion, immigration status, socioeconomic status and many other things can affect the severity of the same disease in two individuals with different backgrounds. It has been very well demonstrated that those belonging to marginalized groups tend to have poorer health outcomes for most diseases. We as current and future clinicians tend to focus more on the avoidable, downstream manifestations of these social determinants, an expected consequence of how we are instructed and trained. We’re more likely to treat an anxiety and depression complaint with a medication than take a step back and realize that the anxiety and depression of our patient is a function of a poor, single mother with job and food insecurity, almost no social support and poor literacy skills being denied necessary aid from the government because she filled out her forms incorrectly as English is her second language.

And often, even if we are aware of all of that, our power to help such an individual may be limited to that prescription.  However, we’re uniquely poised in the present climate of medicine to start addressing those identifiable upstream social determinants of health, at the societal level.

The role of the doctor is changing and has been changing for some time. There are a plethora of medical complaints that no longer directly need a physician to be addressed. While I will still defend to the death the need for primary care providers, this role that was once just filled by physicians is now being filled by capable and diverse teams of specialized providers.

As the presence of clinicians is less necessary in the clinical settings, I believe that doctors need to practice medicine in the macro scale: no longer one patient at a time, but in the public health and health policy arenas, where the health of entire demographics can be effected for the better by our meticulous clinical training and problem solving skills. This is important because now we as clinicians, the traditional harbingers of health, can work actively to address those social determinants of health that contribute to the frightening health disparities in the United States and worldwide and unnecessarily burden healthcare systems. What is more, often, the populations with greatest health disparities are those with histories wrought with dark times of humanity that many would like to forget: exploitation, legal and social discrimination, bloodshed, war and deliberate wrongdoing; wounds that have long needed dressing.

As someone who wants to defend the right of every soul that crosses my path to live healthily and happily, how can I not address the social determinants of health that I take so much time educating myself about? The answer is that I cannot and still expect to achieve that goal. Therefore, addressing the social determinants of health and health disparities, learning the history that contributed to them, and the practices that maintain them is a matter of medical ethics.

The Holocaust blatantly demonstrates what I still find to be true in many subtler ways today: the illness that is killing people is a function of a society that is sick. All atrocities committed in the name of supposedly advancing science must not be forgotten and the medical ethics which evolved in response to should be a pillar in the education of all future physicians. The Holocaust changed Medicine forever. The unspeakable human experimentation carried out by doctors can serve as both a cautionary tale and a lesson of the importance of practicing medicine methodically but also with a conscious.

Ignoring the past and not addressing the wounds that it left behind on the present would be irresponsible.  We deem ourselves healers. That being said, if we are silent then we are complicit in the sickness that afflicts our society and we betray our oaths and divine calling of medicine. I hope contribute to the field of medical ethics and medicine in the future, addressing health disparities and continuing the work of exposing all wrongs committed under the guise of advancing the field of Medicine. Whether in Auschwitz, on Indian Reservations or in the underserved rural south town of Tuskegee, Alabama, there is much learning and atonement to be done.

Through these hard lessons, we can better heal the gaping wounds that still mar us.

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Continuum

This image really spoke to me today.  I was just reminded that when we encounter people, we get a small slice of someone on a continuum of life.  And for that one or handful of interactions, there’s so much more leading up to that moment…  While we may want to write off someone for a terrible first impression, you have no way of knowing if they are going through a loss, trauma or just hit a rough patch… not all of us were blessed with the skill of “faking it until you make it”. Because before that heart develops those scars that reinforces its strength, it’s wounded, it hurts and it has to heal…

So I try to give each person I encounter the benefit of the doubt unless I have some compelling reason not to.  If our interaction was sour, maybe that’s not the best version of themselves…. we’ve all been there.  I give them a chance and I’m usually pleasantly surprised.  Hope you all do the same.

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PSA

Intolerant atheists are as just bad a intolerant religious zealots.  It’s not your belief system that’s the problem, it’s the ignorant, hardheaded idiocy that you choose to conduct yourself with.  So please respect everyone, as long as they’re not hurting themselves or anyone around them, even if you don’t agree with it.  And life will be better for it.

Haiti Reflection Paper: Familiarly Unfamiliar

We were picked up from Port-au-Prince without much delay or hassle.  Shortly after landing, going through customs and the baggage claim, and alternating between bathroom breaks and watching each other’s luggage, we were ushered out of the airport into the parking lot.  The Haitian men who would be driving us in helped us load our bags into the back of one main SUV, we were divided into groups of four or five,  ushered into one of the six or so SUVs that awaited us, and we were off, whisked away to Thomonde.

I attempted to ask our driver a few questions just as we were hitting the brightly colored, evenly spaced houses that encircled the city before it ended, falling away into plains and wilderness.  My tongue felt too thick and heavy in my mouth as I spoke and the Haitian Creole that came out was accented and awkward with the question.  I was embarrassed to hear it because I knew it was bad, but my driver understood well enough, responding kindly as I relayed the information the rest of the group about how those bright colored houses were built by the President for Port-au-Prince for residents who had lost their homes in the infamous 2010 earthquake.  It would take a few more attempts at conversation and some deep breaths to calm my anxiety before I got some level of fluency that wouldn’t thoroughly embarrass me, though I’m sure my parents would have raised their eyebrows at me and ask me who taught me to speak their native tongue.

I gave a brief cultural competency crash course en route.  People are kind and open for the most part, but it’s probably not the best patient population to elicit a sexual history from.  In fact, sex was rarely spoken of in my home growing up, except to warn us that we should not be having it until we were married.  It was just taboo to mention, even if the inquiry was necessary, professional and purely innocent.  The one rotation in our clinic, I would later find, where my language skills were most limited would be women’s health.  I actually had no vocabulary for my own anatomy.  I learned while eliciting the chief complaint from a woman with a likely yeast infection, the proper adult words in creole for ‘vagina’ and ‘hymen’.

We stayed in a large, stately guest house, a sharp contrast to the often dilapidated, small and non-uniform houses that surrounded it.  Everything in the country looked familiar, but at the same time, drastically different from how I remembered it.  I never remembered seeing such breathtaking landscapes and mountains as a kid, despite riding in the back of an open pickup truck sandwiched between my parents, siblings and cousins.  But then again, my family was not from the mountainous part of the country.  The Haitian houses in my mind were made of clay and earth colored materials and surrounded by rice patties and farmland.  (It really blew my mind that there were no rice paddies.  To my farm owning grandfather, and to our everyday cuisine, rice is everything). The native houses that encircled us were made of wood and cement and often painted.  But the faces were the same, curious and inquisitive, keenly aware of the fact that we were not natives (though I was recognized as Haitian by most I encountered one on one) as we drove by into the gated compound: we were in Haiti, but not really.  We were surrounded by the country, but very much enclosed in a microcosm of Western living, with amenities that catered to us passersby.  It was all lovely, though a very inauthentic experience of living ‘en dehors’, outside of the big cities.

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Lots on my mind looking off into the mountains in Haiti…

I guess my experience in Haiti compared to everyone else’s was different.  It was not life changing or shocking.  I had seen this level of poverty before, though mostly as a child.  But there were definitely constant reminders of it at home.  My mother’s parents were a little better off than a lot of Haitians, but much of our extended family definitely lived in abject poverty, often going to my grandparents for assistance in the form or food or money.  Even the poorest of the poor in America, except maybe the homeless, live pretty well over here compared to the poorest in Haiti.

Even when times were hard for my family growing up, my mother made it a point to make sure she sent money back home along with the clothes and shoes we outgrew.  After political instability made my parents fearful of bringing their minor children to Haiti with them, my grandparents came to visit instead.  They always came with empty suitcases, but they left with full ones and far more than they came with, as we would buy several more to overstuff with goods.  Charity starts at home, my mother would often say, reminding us that though we were very much entrenched in American living, Haiti was still home for her and my Dad.  We were born in America, but we were raised Haitian.

So it was not eye opening at all.  It was all very familiar, just a reminder of what I already knew.  My childhood memories served as a reminder to keep my American privilege in check.

Because of my background and upbringing, every time I go on these kind of trips I ask this (I also went to Nepal a couple of years back and in fact will quote my previous post): “I find myself asking which is the lesser of two evils: introducing temporary aid and interventions that may leave the natives and recipients of our aid worse off if funding and supplies run out or doing nothing at all?  A small bandage on a gaping wound or the uncertainty of letting the wound heal or fester on its own?”  I’m not so blind that I can pat myself on the back for good work done when I understand that we did nothing to affect the infrastructure that perpetuates the poverty and lack of access to basic medical services that we came to address.  We just showed up for a quick fix, one of many I’m sure, because truth be told, the plane there and back was full of white people with their charitable organization’s logoed T-shirts.  I must admit, that was a bit shocking.  That never happened when I was a kid (I mean 90% of Haiti’s population if of black African descent, so I’m just being honest).  So maybe I did find one thing shocking after all.

But what I appreciated MOST about this trip was our group: they worked tirelessly to provide the very best services that they could with the short time allotted.  However, at night, while reflecting on the day, I saw that most of them understood that much of what they were doing was futile, that figurative bandage.  They were very pensive and contemplative.  They were often vocal of their conflicting feelings and their despair that they could not do more.  Yet despite the sense of futility, it took nothing away from the amount of hard work they did.

That was not only beautiful but also a relief, because I was not surrounded by such likeminded individuals in Nepal and in fact chastised by the most senior of the group for my discomfort with the intrusiveness of much of the trip and my pensive retrospective analysis of the implication of our being there.

So I learned a bit more medical creole, especially about female anatomy!  I learned to be a little more confident in myself because people saw me as more capable, useful and apt than I saw myself.  I wish I had more time to learn about Project Medishare and the steps it take to establish such an organization.  I’d like to learn about their dealing with the Haitian government, particularly the ministry of Health and the country’s hospitals.  I don’t have the knowledge to even know what kinds of questions I should be asking to get that information, so I’m very passive with how I learn in novel situations like this.  I really liked the groundwork, but in order to effect the kind of change in such countries that I really want to see, I need to know more about the framework that is often set up months and years before we even get there.   In the future, I would love to continue to participate in these kinds of programs, but I would love more to one day be with them when they sort of graduate and leave the country.  I would love to work with a program that eventually isn’t needed anymore and see a Haiti (or any developing country) that is self-sufficient and able to improve health outcomes of their own people.

What I would like to see and know more about, which I know will be a huge, exhaustive task, are ways in which we can effect change in Haiti by looking at foreign policy, political action and legislation in America that contributes to Haiti’s plight.  Wouldn’t it make more sense for Americans to look at their own government, something that they can legitimately control with their vote then to just show up in Haiti with the intent to do good?  To me it does, unless the main mission is to self-serve and self-congratulate.  If that’s the case, I don’t want to indefinitely support that kind of initiative.  It doesn’t make sense in my mind because it only benefits me in the long run and I, and I suspect most people on these missions, really want to help the recipients of such aid.

On that same note, I’d like to advise people who want to do this mission in the future and people in general to know more about America’s history and how we as a country and other Western countries are often complicit if not the very cause of the most recent issues that we volunteer to help solve (France, Canada and various parts of Latin America…  I’m looking at you!).  It seems that Haiti is not only the poorest country in this hemisphere, but also has been one of the most occupied by America.  I know correlation is not causation, but the general trend is that the countries that America (or substitute for another Western world power) has invaded/occupied don’t do so well.  I wish more people would ask what’s going on, why that is, and what they could do as Americans to change that on their side instead of assuming that the Haitian people (or Nepali, or insert other countrymen of another developing nation here) need saving.

Blame

I’ve been thinking a lot about blame recently.

I think we blame when we want a quick answer rather than holding ourselves or an individual solely responsible for their actions.  It’s harder to entertain the fact that we as a species are a complex ball of contradictions.  Maybe human nature is not straightforward and cut and dry.  Perhaps we may never have an answer that is purely right or wrong and completely explains a person’s motivations, whether their acts are good or bad.

But you see, that would take time and require us to regularly challenge what we’ve decided for ourselves is truth.  That is scary, to have to believe that there are no absolutes.  So we find answers to the shameful things the best way we know how: we blame.  Someone has to be culpable and guilty.  It’s someone else’s fault.  It’s a culture’s fault.  It’s a religion’s fault.  It’s the parents’ fault.  It’s everyone else’s fault but mine.  Now, content in the fact that we are certain of where the blame lies, the argument ends there for most.

But on some level, I think we all know that it doesn’t end there.  When senselessness challenges our most solid beliefs and our faith is shaken down to the core, we realize that it’s not that simple.  Unfortunately, that often takes great or personal tragedy for us to come to that realization.

And until we do, we keep playing the blame game.

This rant aside, here’s a single lyric to a song that I’m positive will be the next to write itself (because I don’t write songs, I’m simply an instrument they use to write themselves.  These words and experiences are never my own…  And I’m not crazy).

It just got me thinking about blame so I thought I would toss my thoughts out there, failing a complete song…  Hope you enjoy it none the less:

Maybe opening up was a bit of a mistake
But where do you go when your head’s not a safe space?
And the biggest danger comes from within?

It was easy to get lost and forget for a moment
But how dare you accuse me, and say I should have toned it
Down…
When you’re complicit in this sin?

~L.A.

Discipline

I admire people with discipline.  Mostly because I think I lack the ability to deny myself sometimes, even when necessary.

Recently, after some deep reflection, I’ve had to rectify my admiration a bit.  Why?  Because I’ve observed circumstances when discipline just plain sucks.

There really should be a balance of risk taking, pushing yourself, moving forward and withholding or denying yourself something for the sake of ultimate benefit.

Having discipline without being goal-oriented is just… well, restraint.  And who wants to hold themselves back all the time?

Just a thought.