IAP Health Reflection: Eleane

The Intersection of Different worlds

Every morning, I board the Dudley 1 bus at 8:32 a.m. hoping that I’ll get a seat far from the doors sweeping in the cold January air. I could sit through my 28-minute-long commute thinking about my unfinished tasks at work or listening to music, but instead I find myself curious about the environment that I am in. Sitting to my left, are residents, interns, and physicians on their way to BMC, a large safety-net hospital where I have the opportunity to observe their medical expertise. Sitting to my right, are Bostonians who harbor stories of abuse, food insecurity, unstable employment, and various health struggles. I sit amongst these two groups as an outsider, and yet, together we all walk into BMC. Though this moment is a very small part of my workday, it signifies something special about BMC and the greater Boston area that I have come to realize. 

 Reflecting upon my IAP, I am beyond grateful for the insightful experiences I’ve had interacting with different communities in the healthcare setting. In the Autism Program office, I collaborated with my program supervisors and other MIT interns to strengthen the mission and efforts of helping families affected by Autism Spectrum Disorder (ASD). During patient case studies, I sat in with medical professionals discussing catatonia, enuresis, syphilis, etc. and was intrigued by their thoughtfulness regarding patient care. From caregiver focus groups with families, I experienced first-hand the unmet needs of many families with respect to cultural understanding, clinical support, and access to interventions. Collectively, this IAP has allowed me to dive deep into the complex ethical and systemic issues of healthcare.

A specific example of this occurred during the 2nd week of work when the interns and I attended a Chief Rounds meeting with the Autism Program Staff and pediatric clinicians. This meeting was particularly important because we were discussing an Autism case that the office had been struggling to resolve. This case involved an adolescent male diagnosed with severe Autism. His family did not have much success getting therapeutic services for him because of language barriers, inconsistent reporting, and because the mother is cognitively-limited. All of this information was revealed to the office by the older son in the family who reached out and pleaded for help for his autistic brother. Hearing the circumstances of this family was honestly shocking as I thought about the numerous Boston families who may be struggling with similar issues. Furthermore, this case was extremely challenging due to conflicting family involvement in this adolescent’s autism. The older son is not of age and the mother strongly refused ABA support possibly due to mistrust. This raised tough questions of how the office should ethically intervene knowing that there must be clear consent from the parents and not from the older brother who is not old enough to coordinate his brother’s health. Even as a single case, this family’s story helped me recognize that accessible care is not the only external barrier to helping communities, but that internal barriers can affect one’s ability to ethically receive support.

Considering systemic aspects, I attended a Pediatric Grand Rounds talk that sent me and Sahithi, another intern, on an exciting journey to discover Boston’s legislative role in healthcare. This talk was presented by Dr. David Duong who shared with us this method of creating a “communities of opportunity” to holistically support the life course of immigrants and their health. As an immigrant myself, I connected deeply with David’s immigration story and his dedication to supporting numerous immigrants through health policy. Throughout his talk, he described this system as a multifaceted approach that provides immigrants with safe neighborhoods, economic security, social mobility, and mentors. Though this structure is not necessarily government-based, David explained that effective results have been made with the involvement of government support services such as departments of health, education, etc. Seeing this impressive work that he has already done globally to implement this comprehensive healthcare really inspired me and all the physicians in the room. It was quite amazing to see everyone ask engaging questions of how BMC could better serve its immigrant population and possibly encourage more involvement from the government. At the end of the hour, David encouraged us all to attend the Safe Communities Act public hearing at the State House happening the next day. Excited to experience legislative action, Sahithi and I attended this event not knowing what to expect.

We sat in the audience watching testimonies and were both shocked to hear very extreme opinions from hate groups. Many of them were incorrectly stating the sanctuary city act and had irrational arguments with the moderators. However, later when we heard advocates testifying, there seemed to be no consideration for their opinions. Several immigrants hysterically shared their stories as their hands shook and their voices cracked. But there were no questions asked and the moderator simply told the next testimony to come up. Seeing this made me really upset because I know how difficult it is to be vulnerable about your identity, especially in front of others who don’t share the same story. Watching the advocates go one after the other without any conversations from the moderators made it seem as if they weren’t listening. What’s the point of having the ability to speak if you aren’t willing to have a conversation to understand one’s view point, especially in a political circumstance? After a few hours, Sahithi and I left the state house feeling a mixture of emotions but I mostly felt discouraged at the inability of two perspectives to simply have a conversation with each other as a very important aspect of understanding.  

Overall, these experiences have been eye-opening for me in recognizing many health issues that are right next door in Boston. Furthermore, I realized that the core of many of these issues stem from incomplete interactions of different groups. Whether it is between patients and doctors or advocates and opposers, there is an intersection of worlds that always occurs in healthcare and the biggest challenge is knowing how to communicate effectively and fully. From my IAP experience, I’ve found BMC to be a ‘common place’ where these different communities can share understanding and a desire for better health. Though there is still much work to be done, I have seen great efforts to address social determinants of health and improve patient and doctor collaboration. In the future, I would like to be apart of this mission of creating, improving, and growing these common places. Going back to MIT, I hope to attend more state house hearings and explore public health issues more deeply as I want to pursue a MPH/MD and possibly health policy work. I am eager to learn more about how professionals are collaborating with the underserved population to tackle Boston’s prevalent health issues.

Thank you PKG and BMC for this transformative experience. It’s incredible how much I’ve learned about my community, my values, and my interests in only a month. Surely, these realizations will last much longer and have already influenced my journey into healthcare.

Tags: IAP Health 2020

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