Scholars present Policy and Advocacy Service Projects at Mount Sinai’s Third Annual HRSJ Health Equity Symposium!

Scholars present Policy and Advocacy Service Projects at Mount Sinai's Third Annual HRSJ Health Equity Symposium!

Congratulations to the HRSJ Scholars and second year leaders, Emmett Kistler, Kamini Doobay, Ruyan Rahnama, and Vir Patel, for a wonderful celebration of human rights, health equity, and social justice at the Third Annual HRSJ Health Equity Symposium, which was held May 6, 2014 at the Icahn School of Medicine at Mount Sinai.

Click here for a gallery of photos from the Symposium!

The twelve HRSJ Scholars presented the progress and results of their year-long Advocacy and Policy Service Projects to members of the Mount Sinai community, from fellow students and faculty to members of the Auxiliary Board and deans from various departments. Among the projects the Scholars presented were:

- Creation of an interactive googlemap of the different types of sponsors of school-based health centers that provide pediatric mental health services in East Harlem
– Development of HERS: Health Evaluation Re-entry Survey, a tool to assess the health needs of women with a history of domestic violence who are coming home from prison
– Outreach to increase health insurance literacy and enrollment in East Harlem

Photo (from L to R): Ray Cornbill, John Rhee, Ann Crawford-Roberts, Scott Jelinek, Amalia Kane, Eric Woods, Ann-Gel Palermo, Ian Jones, Annie Brown, Jeremy Levenson, Krupa Harishankar, Alexis Karlin, and Stephen Supoyo. Not shown: Gracie Himmelstein.

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Social Justice and Medicine Career Panel

The Human Rights and Social Justice Scholars Program
invites you to a
 

Social Justice and Medicine Career Panel

5:30-7pm, Monday, January 24th, 2014, 13-01
featuring
 

Dr. Steven Itzkowitz – Colon cancer community outreach and awareness

Dr. Dinali Fernando – Advocating for survivors of torture seeking asylum in the U.S.

Dr. Makini Chisolm-Straker – Sex-trafficking, transgender healthcare, and global health

Dr. Demetri Blanas – Harlem Residency for Family Medicine

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Scholar Reflection: Alexis Karlin

karlia01Health, Human Rights, and Advocacy Elective – Fall 2013

Mental health as a human right

On Thursday, November 14, Dr. Craig Katz spoke to us about his own experience in the field of global mental health. While he spoke about the critical role of mental health specialists following crises, he recalled a singular experience at one of the sites where he and his team came following an environmental disaster.  Dr. Katz recalled that the teacher was grateful for their presence but asked, “Where were you before?” This question that drew attention to the absence of mental health care in a country already ravaged by civil war and terrorism even prior to the environmental catastrophe. According to Dr. Katz, this question caused him to challenge his own approach to global mental health, leading him to envision mental health care as a form of preventative medicine. This is an ideal that is not realized even in the United States, where there are over 500,000 mental health professionals (though even this number represents a gross shortage of mental health care professionals). Dr. Katz suggested that in order to implement this ideal, mental health care professionals could train community workers in mental health care – including screening and counseling techniques. His recommendations spurred a discussion among the students present as we considered different methods of implementing a preventative mental health care system.

Dr. Katz then posed two questions to the class as a whole: 1) Is mental health care a human right? 2) Is mental health a human right?

In my opinion, mental health (and, by necessity, mental health care) is not only a human right, but it is a societal necessity. The following statement is so easily taken for granted, so easily ignored, so easily forgotten: everyone deserves happiness – not only to be free of depression or of crippling psychiatric problems, but to be happy and fulfilled. Depression and other psychiatric illnesses originate from the same place as any other disease – partially genetic, partially environmental in source – yet they are absurdly stigmatized in most societies (show me a place where an individual’s depression is openly discussed and I’ll show you… forget it, I have other things to do). What can we do against this stigma, which has such devastating consequences for individuals and societies as a whole? Indeed, to separate “mental health” from overall health makes no sense to me whatsoever, when it has been proven that our mental state can have drastic effects on how our bodies function day-to-day and in the long-term (think psychological stress and heart disease, think depression/anxiety and IBS, think…the list goes on). In the end, it’s all about chemical interactions and molecular pathways, right?

And not only individuals, but complete societies suffer from these enormous gaps in mental health care.

For example, not a month goes by without another mass shooting in the United States, without violence between gangs or factions, without another terror attack in some area of the world, without rage (often justified) and the exploitation of that rage by leaders who are excellent at Exploitation of the Enraged. The exploitation of masses, of those seeking a target for their rage, for the suffering they or their loved ones have endured throughout a lifetime or generations. Rage may not be a symptom of a mental or emotional illness; rage may be a legitimate consequence of a world in which injustices multiply like drug-resistant diseases in poor or underserved areas. Yet rage without a clear target can be used, twisted, and manipulated. Yes, the rage has a much deeper source, located in structural inequities that have survived, unchallenged, for generations and generations. Yet we can see – particularly in the United States, where gang violence is virulent in certain places, where young people acquire firearms and decide to shoot at others indiscriminately – that we need more mental health care, and that this is, indeed, a social issue. We need (more) services for those traumatized by war or other forms of violence, we need services to be free of cost, we need preventative mental health care to become the norm.

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Scholar Reflection: Gracie Himmelstein

himmeg01Health, Human Rights, and Advocacy Elective – Fall 2013

Racial Disparities in Healthcare

On Thursday, November 7, Dr. Nina Bickell and Dr. Neil Calman came to speak to the HHRA elective about racial disparities in medicine.  Their career paths demonstrate two powerful ways of approaching this issue – Dr. Bickell has worked to address racial disparities in medicine through research, while Dr. Calman has done so through advocacy.

The first thing that came to my mind upon reading about this week’s subject was that I don’t like the word disparity – it allows for a description of inequality, without requiring the speaker or author to address what or who is responsible for it.  To my mind, a discussion of “disparities” should be merely an introduction to a discussion about what caused the disparity in the first place, and what can be done to intervene. In other parts of medical school, however, the conversation has generally stalled at naming disparities, without discussion of advocacy or intervention.  Thankfully, any worries that Thursday’s class would follow this same trajectory were unwarranted, as both Dr. Bickell and Dr. Calman were eager to discuss practical applications of their work.

One major issue raised during Thursday’s class was the two-tiered system of care provided in many hospitals, whereby wealthy patients are sent to one part of the hospital (be it the faculty practice or private inpatient floors), while poorer patients are sent to another.  Having done previous research in the field of social inequality, this piqued my interest.  There is an abundance of research at the international level, which shows that across countries, greater inequality is strongly correlated with a variety of negative health outcomes, including higher infant mortality and shorter life expectancy.  This got me wondering whether inequality within a hospital could also lead to negative outcomes.  It seems that the intuition among many doctors is that inequality makes care worse even for those ostensibly benefiting from the system – the wealthy.  In fact, one doctor told me that when he was in medical school, the students would joke that the best thing you could say about the private pavilion was that it was pretty close to a decent hospital.  A brief search returned no quantitative studies on the issue, and I imagine that data is hard to come by, but interesting to think about nonetheless.

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Scholar Reflection: Ashwin Ramaswamy

ramasa02Health, Human Rights & Advocacy Elective – Fall 2013

Prisoner Health Lecture

This past week, Dr. Ernie Drucker and Dr. Homer Venters spoke with our class about the relationship between Incarceration & Health. From the start neither speakers minced words: the relationship is absolutely negative. By almost any measure, the psychological torture and structural violence of prisons causes irreparable harm to the people who are housed within them.

Like most polarizing topics, it would have been easy for the evening to be dominated by a stark, but simple, condemnation of the system of punishment in this country. But the conversation did not end just there by virtue of our speakers, both of whom have to work within this reality to help fix this broken system, by doing three things:

1) Exposing what is happening to health and human rights in prisons.

2) Using data to craft solutions to these problems.

3) Applying pressure.

The first solution delineates the importance of continued research into this area – without research and exposure, this is a problem that will be ignored and will surely become worse, even more so because it is a crisis that does not directly impact the very people who can affect it.

The second solution is using the tools presented by information systems to craft inventive solutions to fix these problems. Dr. Venters remarked on how he used the newly implemented electronic health record (EHR) at Rikers Island Jail to show the incredible prevalence of head injuries caused by correctional officers when they use force, and that this had an immediate effect on policy.

The third solution speaks to the invisibility of this problem – without people advocating for those in prisons across our country (and the world) the problems will surely become worse. Administrators and politicians are constantly at odds with advocates of health and human rights; it is this discussion that helps keep the soul of the prison system afloat.

It was increasingly difficult to see how I – as a physician – could impact such a monstrous problem in our society, but I think that helping to implement these three strategies is definitely a start.

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Scholar Reflection: John Rhee

HJohnrheeealth, Human Rights, and Advocacy Elective – Fall 2013

Reproductive Health and Women’s Rights Lecture

During class today, we were fortunate to have two experienced OB/GYN physicians with a diverse array of experiences come speak with us about women’s health and reproductive rights.

Now, this was all very familiar because I am actually taking two different classes in Health and Human Rights. One is an MPH class and the other is this nexus course. My MPH classes (both Health and Human Rights and Introduction to Global Health) have recently covered the importance of reproductive health as well as the social injustices many women suffer throughout the world due to inequalities in healthcare access and delivery due to a myriad of reasons including stigma.

But throughout all these classes, I find myself a little disturbed by how the debate on women’s health is being framed. I will zero in on one particularly contentious issue to illustrate my point. Last night, the speakers repeatedly spoke about how Sinai is a forerunner in abortion care, being one of the few, if not the only one in this area, to teach residents how to perform second trimester abortions. When someone asked what the policy was for opt-in or opt-out training during residency, the speaker mentioned that it was opt-out but only for people who are doing it for religious or cultural reasons or something like that.

But continuously, I find that these “religious and/or cultural reasons” are framed in an extremely derogatory way. In fact, many times, I find myself feeling degraded after having left a talk on women’s health because speakers frame the issue as though anyone remotely against abortions is extremely backwards or perhaps just plain stupid or at its worst, a monster who wants women to suffer.

Cut. When did this all happen?

I spent a lot of time in college working on various global health issues concerning women’s health. I spent a winter break raising money to fund obstetric fistula surgeries in Tanzania and my senior honors thesis was on how iron deficiency negatively impacts women tea-leaf pickers in India. In fact, as someone interested in global health, I am acutely aware of how important it is to empower women and increase all aspects of healthcare delivery for women because not only is it morally right to do so but also it is one of the most cost-effective and efficient ways to improve the health of a society. Sheryl WuDunn had it right in her book; we need to focus more on women!

But despite my interest in these various issues, I find that my opinions in these discussions about human rights are looked at as though they are not even opinions worthy of discussion. I find that a violation of my human rights because when did my beliefs become so second-class? Although my faith is important to me, I approach the issue of abortion with more of a human rights framework. I believe that human rights is about speaking up for and giving voice to the most vulnerable, and in the case of abortion, I see the most vulnerable as the baby. And, when a couple is expecting a baby, the moment they find out that the woman is pregnant; they already acknowledge that the baby is there. To me, that is life that needs protecting.

But all of a sudden, in these discussions, those who believe this are scoffed at; the discussions are always framed as though there is only one right answer and if anyone believes otherwise… well, they need a lot of catching up to do. And I reject that. I consider myself just as strong a proponent for human rights, and, in fact, I am a 100% certain that I will be dedicating my life to the poor, the underprivileged, the destitute.

I sincerely appreciate all of the speakers’ opinions, and I have learned a great deal from their talks. But I want to make a challenge that the way human rights are presented should be reframed, ON BOTH SIDES. As human rights advocates, we must enter the issues at hand with humility, understanding that our views can possibly be wrong and that we are in a constant process of learning. We must create a space for voice and debate and opinions to flow for that is the only way we can bring everyone to the table and reach a solution that is beneficial for everyone.

I end with a successful example from global health. A US-based NGO has been supported by UNICEF and Macro International for it success in addressing female genital cutting (FGC) in Senegal. The NGO, Tostan, started its work not to decrease FGC but to offer educational programs on human rights and responsibilities to adults and adolescents. In fact, it made a point that it is not an anti-FGC organization but an educational one. But Tostan was able to bring all players to the table for discussion, and it is known internationally as one of the successes in decreasing FGC in many parts of the world. I think Tostan is an important example to look at when thinking about how to bring various players to the table for discussion – to find a solution to the problem rather than accusing one another from the onset and bringing in a set agenda.

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Scholar Reflection: Ann Crawford-Roberts

crawfa01Health, Human Rights, and Advocacy Elective – Fall 2013

Immigrant Health and Rights Lecture

As physicians and physicians-in-training, we seek to appreciate the humanity in every patient before us. Seeing the wholeness of the person first, we can then work to restore his or her health. How does a physician treat a patient whose ability to afford care or seeming deservingness to receive care are thrown into question by his or her legal status? How do events as far away as wars and disasters, legislation and partisanship influence the ways doctors can deliver care? How do technical categories of citizenship and asylum define how physicians can see and respond to the humanity of each person who seeks their care?

In this week’s class, Dr. Ramin Asgary & Dr. Gordon Ngai helped illuminate these dynamics, sharing their experiences of documenting physical signs of torture in a clinic for asylum seekers and of treating immigrants from all over the world in emergency rooms. They spoke of the linguistic and financial challenges immigrants and refugees face in accessing medical care, and the limitations of the Affordable Care Act in increasing access to care for certain groups.

The questions remain: In this realm especially, providing medical care is greatly influenced by politics, on the global, national, and local levels. As this is the case, what (if any) role will we as physicians to these groups have in advocating for larger change? And could there be negative consequences for politicizing our role as care providers?

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