We Belong to One Another: A Lesson from Dr. Martin Luther King, Jr.

From the January 21, 2022 issue of the Transformational Times (Urban and Community Helath)

We Belong to One Another: A Lesson from Dr. Martin Luther King, Jr.

Cassie Ferguson, MD

In his letter he wrote from a Birmingham jail—the letter that began in the margins of a smuggled newspaper and on found scraps of paper—Dr. Martin Luther King, Jr. shared this:

“Whatever affects one directly affects all indirectly. For some strange reason I can never be what I ought to be until you are what you ought to be. And you can never be what you ought to be until I am what I ought to be—this is the interrelatedness of life.”

The very same stardust

Dr. King suggests that if we would see how inextricably connected we are to one another—if we would see that we belong to one another not only by virtue of being born on the same planet, but also by virtue of the scientific and spiritual reality that we were made from the very same stardust—that then all of us could see how the systems that uphold and protect racism, health and wealth disparities, educational inequalities, and residential segregation dehumanize us all.

That if we understood our interdependence, we would move beyond empathy for those who are suffering the most under the weight of these systems and know in our hearts that when one teenager is murdered, we are all killed. That when a pregnant woman delivers a stillborn baby because her health concerns are dismissed, that we all lose a child. That when one of our students must repeat their first year of medical school because of inequities in medical education and in our learning environment that disproportionately impact students underrepresented in medicine (URiM), that we all fail.

Dangerous unselfishness

This kind of radical compassion is not for the faint of heart. Dr. King understood this. In his very last speech delivered in support of the striking sanitation workers in Memphis, Tennessee, Dr. King rallied the crowd declaring, “either we go up together, or we go down together. Let us develop a kind of dangerous unselfishness.”

At the Kern Institute, our mission has been to inspire and support this kind of unselfishness and this kind of compassion in our learners and educators, such that we might transform the system of medical education to ensure that every one of our patients feels seen and deeply cared for; such that every one of our patients is given the opportunity to flourish. This kind of systemic transformation requires tremendous courage, sacrifice, and love. It demands that we understand compassion not “as a relationship between the healer and the wounded…but as a relationship between equals.” (Pema Chödrön).

Despite these challenges, there are examples of how the MCW community is “showing up.” Here is one example. In the spring of 2020, student doctors British Fields, Jamal Jarrett, Morgan Lockhart, Enrique Avila, and Adriana Perez learned that the Apprenticeship in Medicine (AIM) enrichment program they had been chosen to lead that summer would not be funded because of the pandemic. Led by the incomparable Jean Mallet and supported by the Kern Institute, these students advocated for their program, pivoted, and in three weeks designed and stood up the Virtual Health Sciences (VHS) program. Over Zoom, they provided forty Milwaukee-area high school students from backgrounds historically underrepresented in medicine a meaningful and engaging look at careers in health care and showed them that there is a place in the profession of medicine for them. Our student doctors saw themselves in these high school students and this motivated and empowered them to take direct action.

“The Path of Joy is Connection”

What I have come to realize as a physician and, as someone who teaches medical students about well-being, is that when we become aware of our interrelatedness, we not only wake up to how we might design and redesign systems that assume the humanity of all peoples, but we also feel less alone, less fragile, less anxious; and, like these student doctors, we are empowered to become our best and truest selves. As the late South African anti-apartheid leader and Nobel Peace Prize Laureate Archbishop Desmond Tutu reminded us frequently, the path of sorrow is separation, and the path of joy is connection.

This week, as we celebrate the Reverend Dr. Martin Luther King, Jr., may we cultivate the awareness of our interrelatedness in our hearts, and find the courage to unselfishly redesign our world such that all of us may flourish. 

Catherine (Cassie) Ferguson, MD, is an Associate Professor in the  Department of Pediatrics (Emergency Medicine) at MCW. She is the innovator of the REACH Curriculum, and the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

A Reflection on the Impact of George Floyd at MCW

From the July 28, 2023 issue of the Transformational Times

Perspective/Opinion

Has Anything Changed? A Reflection on the Impact of George Floyd at MCW

Precious Anyanwu & Chiemerie Ogbonnaya, Class of 2026

Three years after the murder of George Floyd, medical students Anyanwu and Ogbonnaya offer their perspective on the shortcomings of the American healthcare system, and the racial and ethnic injustices that perpetuate them...

NOTE: Tear gas can be neutralized with about three tablespoons of baking soda mixed with eight ounces of water. It is important to have this mixture in hand before you arrive at a protest because when the gas hits, there will be no time to waste. Remember to carry enough to help wash the eyes of your peers. But most importantly, get out immediately.

This simple recipe has spread from crowds of protestors in Hong Kong to civil activists in Washington DC, all fighting for the preservation of their people.

In the wake of the unjust murder of George Floyd, protesters sought justice at the steps of our government. Instead, they were met with controlled violence in the form of tear gas and police batons. Even with the gas burning their throats, protesters continued to scream for justice. The pain they experienced in that moment was incomparable to the agony of watching yet another Black man lose his life to institutional injustice.

Long before the shocking event that transpired on May 25, 2020, the lives of persons in Black and Brown communities were undervalued and endangered in America. The death of George Floyd, combined with the simultaneous COVID-19 pandemic, amplified how deeply ethnic discrimination and racial inequities are rooted in key American structures. The pandemic disproportionately impacted marginalized communities because of longstanding, systemic inequalities.

Numerous studies have proven that the American healthcare system does not prioritize cultural understanding for ethnic communities. This neglect contributes to an overall decrease in the standard of care and a notable increase in poor health outcomes. Justified mistrust of the healthcare system by these communities is ingrained in history. America’s past is riddled with medical exploitations of racially marginalized communities; recall the Tuskegee experiments and Henrietta Lacks.

The cycle of medical abuse and healthcare avoidance perpetuates chronic illness and shortened lifespans in Black and Brown communities. If American institutions continue to discriminate against marginalized populations under the guise of extenuating circumstances, they will never restore faith in the system and America will remain tainted by its sordid history.

Change starts at the grassroots

Although we have a substantial amount of progress to make as a country, it is important to acknowledge that change starts at the grassroots. In response to George Floyd’s death, the Medical College of Wisconsin implemented several changes to its surgery department centered around prioritizing the principles of diversity, equity, and inclusion.

These changes brought the opinions of marginalized groups to the forefront, introducing pertinent cultural topics that may not have been considered otherwise.

With this seemingly minor adjustment, disadvantaged communities now have advocates speaking on their behalf in spaces that can implement true change. Some cities also chose to pursue action after George Floyd’s passing. For example, Minneapolis reallocated $8 million from its police department to expand mental health crisis response services and Boston chose to invest $12 million into expanding public and social health services.

White Coats for Black Lives

White Coats for Black Lives originated from the national outcry for justice in response to the murder of George Floyd. We aim to safeguard the well-being of our future patients by advocating for the elimination of racialized medicine.

Our ultimate goal is for government officials and civilians across the country to recognize the need for restructuring how America operates fundamentally.

Tangible action against racial inequities is needed. History cannot be rewritten, and the lives lost from injustice cannot be resurrected, but the future can be changed. 

For further reading: 

1. MCW’s Department of Surgery’s response to George Floyd’s death. https://www.mcw.edu/- /media/MCW/Departments/Surgery/DOS-Statement-Racism-Disparities-DSiversity-6-12- 2020.pdf

2. Vasquez Reyes M. The Disproportional Impact of COVID-19 on African Americans. Health Hum Rights. 2020 Dec;22(2):299-307. PMID: 33390715; PMCID: PMC7762908. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762908/

3. Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror- 2021-reflecting- poorly#:~:text=The%20U.S.%20ranks%20last%20on,on%20measures%20of%20care%20process

Precious Anyanwu and Chiemerie Ogbonnaya are in their second year of medical school at the Medical College of Wisconsin. They are currently serving as Co-Presidents of the White Coats for Black Lives organization. Their work emphasizes the importance of outreach and intervention to provide a lifelong space for Black and Brown communities in healthcare.

The Right to Breathe

From the July 28, 2023 issue of the Transformational Times

The Right to Breathe

Michael N. Levas, MD, MS

A pediatric emergency medicine physician advocates for comprehensive and compassionate care in the broader context that health is more than biology – that it encompasses people’s lived experience, their trials, their strengths. As a leader of several diversity, equity, and inclusion initiatives at Medical College of Wisconsin, he also reflects on recent shifts he has observed in institutional culture, and reminds health care providers to be mindful of the social pressures that burden patients and colleagues...

“I can’t breathe.”

These were some of George Floyd’s final words, captured in a bystander video. Through this video, we as a nation also witnessed a dying man call out for his mother.

I often see youth who are scared, and some who feel like they are dying, as a pediatric emergency medicine physician who practices at Children’s Wisconsin. They say, “I can’t breathe” and they ask for their mothers. Watching the video of George Floyd, I felt powerless. But in the emergency room, there are situations where I can do something — I can help their difficulty breathing, we can find their mothers and get them to their bedside.

The risk of becoming numb to social injustices is real. It can lead to harmful health outcomes, even death. The continued traumas our nation experiences are seemingly endless.

Mobilization and hope

There has been a movement within MCW to increase advocacy addressing diversity, equity, and inclusion, including the development of DEI councils within residency programs and clinical departments.

For the first time since I was a medical student at MCW (many moons ago), I feel that it is okay to talk about biases, microaggressions, social determinants of health, and health equity.

In fact, health equity has become a theme of many clinical, educational, research and community efforts at MCW. More grand rounds across campus focus on racism’s impact on healthcare outcomes. Trainees are demanding health equity be woven into curricula. There is more acknowledgement that

health is much more than biology – that health encompasses people’s lived experience, their trials, their strengths.

Within the Department of Pediatrics, over 500 faculty and staff have participated in Implicit Bias Training. Other departments have requested this training, including Psychiatry and Behavioral Medicine, Anesthesiology, Physical Medicine & Rehab, the Admissions Committee, the Joint Fellowship Council, among others.

The Comprehensive Injury Center and Department of Pediatrics recently adopted policies recognizing MLK and Juneteenth as holidays by not scheduling recruitment, training, or lectures during those days.

Barriers are real

But two things are clear: inertia is real, and not everyone is happy with such activism. For every stride we make fighting for equity in health outcomes and health education, a counter narrative is threatened by change.

While we are deliberating about what efforts to implement or back as institutions, youth are dying from firearms, families are losing their homes, and transgender youth are losing faith in the healthcare community.

Some changes that need to be made do not require repeated meetings or committees to implement. Unfortunately, our current healthcare environment has become accustomed to that approach, driven by fear of retribution rather than focus on doing what is right.

“The time is always right to do the right thing,” is my favorite quote from Dr. Martin Luther King Jr. We cannot become numb to the trials that our patients face. We cannot ignore the social pressures that burden our patients and colleagues.

Despite continued barriers and bureaucracy, as health care professionals we must continue to model comprehensive and compassionate care. We need to have the courage to use our privilege as health care providers to speak out against social injustices and our expertise to show the evidence-based approaches that lead to less disparities.

Every living human has the right to breathe.

We need to breathe to stay alive.

We need to breathe life into policies that strive for health equity.

We need to help others to pause and breathe before they are threatened by ideas that lean towards justice.

We need to breathe for those who no longer can.

Dr. Michael N. Levas, MD, MS, is a professor of Pediatric Emergency Medicine, Vice Chair of Diversity, Equity, and Inclusion for the Department of Pediatrics, Medical Director of Project Ujima, Associate Director of the Comprehensive Injury Center, Faculty Advisor for the Latino Medical Student Association, and MCW Faculty Advisor for White Coats for Black Lives.

On Inclusion, Diversity, and Why Black Lives Matter, Too

 From the July 21, 2023 issue of the Transformational Times - "A Look Back"

On Inclusion, Diversity, and Why Black Lives Matter, Too: What our MCW Community BLM Protests Mean to our Colleagues of Color

Leroy J. Seymour, MD, MS

Editor’s Note: Dr. Seymour, currently an incoming Chief Resident in Internal Medicine, was an intern at MCW when he wrote this essay for the Sept 11, 2020 issue of the Transformational Times following Black Lives Matter protests on campus in response to the shooting of Jacob Blake in Kenosha, WI. In giving permission for us to re-publish his essay today, he also shared reflections on what has changed, which are captured in a footnote.

On Wednesday, September 2, 2020 at 5:11pm, members of the Medical College of Wisconsin community held a Black Lives Matter protest to help shine a light on the frequent propensity for violence against people of color. This latest protest is one of hundreds of protests against police brutality and racial injustice that have been occurring in various cities, states, and countries, most recently triggered by the murder of George Floyd on May 25th 2020, in Minneapolis, MN.

So many people have demonstrated peacefully and expressed their voices, all vying for the same dream Martin Luther King Jr. expressed to the world. Almost every aspect of the world’s population has provided an overwhelming outpouring of support of the Black Lives Matter movement; taking the baton and relaying the message that “Black Lives Matter, too” to widespread media coverage and the political stage.

MCW faculty, residents, and medical students alike raised their voices in support of the Black Lives Matter movement. This stance informed the world that MCW and the Froedtert medical community will not tolerate racism, and that racism itself is a pandemic that needs to be eradicated. The Sept. 2nd protest involved holding seven minutes of sustained silence, each minute representing every bullet aimed at the back of Jacob Blake, an African-American man returning to his vehicle, by Rusten Sheskey, a Kenosha WI police officer.

Mere seconds after violence left a man paralyzed, the world responded with outrage and exhaustion, yet another example of the unfair mistreatment of people of color when interacting with those with a perceived position of authority.

Many of us have protested these injustices before. I've protested it before. Our parents protested it before. Our grandparents protested it before. Our ancestors survived and protested it. I’ve stood face to face with the Ku Klux Klan, neo-Nazis, and individuals who have all decided that racial slurs and anger were the best response when asked why they hate people of color or different sexual orientation.

Nobody should have to be afraid to walk outside or live in their own homes. People should not be judged by the color of their skin or their sexual orientation, but by the content of their character. People of every ethnicity, background, or creed, should not have to be afraid for their lives when interacting with police.

With the many communities, committees, social circles, and groups that I belong to, I can single-handedly attest to the importance of diversity, the inclusive nature of MCW, and why having people of varying backgrounds, experiences, and cultures is so critically important to both the health of a community and a medicine brain trust.

As a new internal medicine resident and as an African American, I have witnessed firsthand the most beautiful sides of humanity, and the darkest corners of vitriol. I have cared for patients who have been incredibly appreciative and receptive of my presence, feeling more at ease with talking about their privileged information because I am a person of color. I have also had patients turn me away for the exact same reason.

When I wanted to become a physician, I made a lifelong commitment to improving and protecting my community. I’ve vowed to provide a safe haven for those without a voice, to be a vanguard in the face of hatred, to be the lighthouse in someone else's storm. But when it is you, your family, your friends, or your community who is being harmed, harassed, and violently mistreated, it takes that community to heal the hurt.

It is hard to sustain a thriving and supportive community if that same community refuses to break bread with a particular subset of the population, even when everyone shares the same table.

I am proud to belong to a program and institution that takes a hard stance against institutionalized racism and is incrementally rolling out educational opportunities for those interested in, and in need of, anti-racism education. It is comforting to know that my colleagues and peers support the Black Lives Matter movement and understand the deeper inclusive meaning behind the statement.

However, supporting the movement is only the first step of a marathon many have been running for years. With many cities in various countries now protesting the same cause, only time will tell if our collective voices have resonated, and what changes will result from our collective stance against institutionalized racism and racist ideology.

Myself, my colleagues, and my peers at MCW have already decided which path we will walk, and that is hand in hand with our flourishing, diverse, and inclusive community.

July 21, 2023: I can look back at this essay with pride, as much as it saddens me that it came out of such intense anger for someone else’s suffering. It has been important to my healing to be part of many Diversity and Inclusion efforts at MCW since this was written. Much has been done, but our community isn’t perfect, and there is still much more to do. I am very proud to have been part of organizing events at the American Black Holocaust Museum in Milwaukee for incoming interns a few short weeks ago, and also attended and supported medical students there last fall, during programs that helped others better understand the experience of this historically under-represented population, and how this can frame our approach to providing better medical care. I think it is also remarkable that Juneteenth is now a National holiday, this is progress – Leroy J. Seymour, MD MS

Leroy J. Seymour, MD, MS, is a chief resident in the Department of Medicine at MCW. 

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

From the January 27, 2023 issue of the Transformational Times

Perspective/Opinion

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

By Michael Stout, Ed.D. – Master of Science in Anesthesia Program Director

The importance of diversity and equity in our organization is demonstrated by our values. But how we invest our time is where real change is cultivated… 

Diversity, Equity, and Inclusion goals are often easier to design than they are to achieve. We value their importance, yet gaps persist. These issues were seldom mentioned when I first entered graduate school. More recently, I would be hard-pressed to find a college leader who does not support DEI initiatives. It appears we renewed interest and enthusiasm for addressing gaps and inequality wherever they exist, including our college campuses. Creating a thriving community built on principles of respect and inclusion remains an institutional priority, but how can we make it imperative? The benefits of participation in DEI initiatives can extend beyond individual growth and development and promote positive change beyond our role. 

Admittedly, I have struggled to find time to participate in development programs. There are countless instances when I have received an email and thought, “That sounds interesting. I would really like to attend that event” only to be pulled immediately back into the consuming list of my daily tasks. Inevitably, the date passes without consequence. While missing an opportunity is usually disappointing, the explanation that other activities were more pressing suffices to allay my concern. However, the impact my non-participation has on my team, and the larger organization, is often missed. A person’s priorities can be discerned by where they spend their most precious resource, their time. How could my faculty, staff, and students understand my support of DEI initiatives, if they do not see me participate? 

These programs are designed to help move our organization

The resources dedicated to them aim to transform our campus community and achieve outcomes that align with our values. As an academic leader, I wish for everyone in my unit to attend these events. I welcome the transformational ideas they bring back to our team. But if I choose not to participate, why would I expect that anyone else will? Therefore, my decisions have expanding ripple effects. These decisions not only impact my own development, but can also impact my team, and the larger organizational culture. 

There is growing evidence that improving diversity yields benefits in both private and public institutions. To this end, I pledge to attend an IWILL event to broaden my views on gender. These programs present opportunities to demonstrate our commitment to improving organizational culture. I am grateful for all the hard work, generously provided, by those who organize and attend them. 

While the demands upon our time are likely to remain unchanged, investing in these initiatives can help close the gap between the aspiration for change and its achievement. 

Michael Stout, EdD, is an Assistant Professor in the Department of Anesthesiology at MCW, a Certified Anesthesiologist Assistant, and Program Director for the Master of Science in Anesthesia Program at MCW.

Reflecting on medical school and residency

 From the 6/11/2021 newsletter

Perspective

Reflecting on medical school and residency

By Buba Marong, MD

Dr. Marong reflects on his journey of gratitude through MCW as a student and resident.  

It has been quite the journey, these past seven years. As I conclude what I considered to be the most meaningful endeavor of my adult life, I am filled with a range of emotions, but perhaps the sentiment that overshadows them all is GRATITUDE. I am eternally grateful for the opportunity and privilege to realize this childhood goal of mine in this faraway land. A land so far away from where I grew up, yet it never quite feels foreign to me. America always feels like home to me because I consider myself so lucky to have crossed paths with some amazing human beings; human beings whose impact on my growth - both personally and professionally – has been immeasurable. 

“Buba! Very nice to meet you.” That was how Jennifer Haluzak, then the admission coordinator at the Medical College of Wisconsin (MCW), greeted me during our first encounter when interviewing for a position in the Class of 2018. I usually remark that it doesn’t bother me at all when folks butcher my name, and I mean that. But there was something about how perfectly she pronounced my name that made me feel right at home. That sentiment of feeling right home would stay with me throughout medical school. I am painfully cognizant of race relations in America, and I must admit that I mentally prepared myself to tackle both the overt and covert issues in medical school and residency. Fortunately, it was preparation that I never needed, for all my interactions have been filled with genuine and mutual respectful curiosity and admiration. 

It should be no surprise then that residency selection was an easy choice for me. Medical College of Wisconsin Affiliated Hospitals (MCWAH) was my number one and only choice. I knew if I was willing to put in the work and time, I could garner the requisite skillset necessary to become the kind of physician that I knew I wanted to be. I was lucky to be surrounded by colleagues and educators who are just as passionate about their craft as I am. There is something special about the Internal Medicine residency class of 2021. As a function of my family obligations, I didn’t get to interact with folks that much outside of work, but there is an indescribable warmth about this class and an eagerness to be there for each other. I will greatly miss listening to Curren’s quiet wisdom, catching up with Kam in the hallways about family, and Matt giving me a hard time about that one award that he thought I stole from him.

When I look back at my residency, though, perhaps the turning point for me was formative feedback I received from my favorite attending and mentor, Dr. Jayshil Patel. I had solicited feedback at the end of a rotation, and he told me to be “comfortable with being uncomfortable.” He went on to elaborate that true growth only comes about through putting oneself through intellectually uncomfortable situations. I took that to heart and read the entire Annals of Internal Medicine Clinic Series (for example) to shore up my foundational knowledge. I re-read basic biochemistry again (at least the components with pertinent clinical applicability). I was appreciative of that formative feedback. At the time, I didn’t understand it as being “called out” for becoming complacent, and there was a reason for that, which brings me to my final point and a challenge to all my fellow educators. 

Giving trainees formative feedback should be considered a privilege. A privilege that is only earned after establishing with said trainee that you genuinely care for their personal and professional growth. Take some time to get to know your trainees. What drives them to do what they do? What are their biggest fears? What makes them happy and/or sad? Have they lost someone close to them recently or in the past? Is their family doing okay?  I am fervent believer that if the very first time that you have any meaningful non-work-related conversation with a trainee is to give them feedback, the chance that those tips will land on a receptive ear is slim to none. Instead, the sentiment you expressed will merely serve as a fodder for venting to the next willing listener that the trainee can find. 

To the graduating class of 2021, I challenge you all (myself included) to please use your new-found status and privilege in society for the common good.  Start with the simple things: Be the best friend, partner, son, daughter, parent that you can be and let your north star always be DOING THE RIGHT THING! 

Buba Marong, MD is a PGY3 Internal Medicine resident at MCW. He founded the Marong Health Group with the goal of establishing quality and affordable primary health care clinics in Gambia.  He will be practicing hospital medicine in the Milwaukee area.

Minding our Mental Health

 From the 5/14/2021 newsletter

 

Perspective/Opinion

 

Minding our Mental Health

 

Toni Gray - Office of Diversity and Inclusion

 

Ms. Gray writes about her family’s experiences and how unconscious bias disproportionally affects communities of color …

 

I was nineteen when I got the call. My mom was in the hospital. She had swallowed several pills. She had attempted suicide. The emotions that filled my body included anger, sadness, shame, and back to anger. My mom, a mother of seven, felt that the best thing she could do to solve her anguish, her sadness, was to take her own life and leave the lives that she had help create; searching for answers and never getting them.

Fortunately, my mom survived, but she would continue to deal with depression and anxiety. It is something that runs in our family, and I would soon lose two cousins at early ages to suicide.

As I reflect on why I wanted to write about this painful subject, it was clear that my personal experience was important to me. One of my favorite quotes is: “Make your mess your message.” Isn't it true how so many of us suffer in silence because we are ashamed of the personal struggles that we face, the trauma that we hold, and the doubts that we cater to? They hold us in a guilty place where we do not often know who we can turn to and trust with our deepest, painful secrets.

However, mental health is becoming less of a stigma and I am so grateful for that. We are opening up the door for conversation and connection which allows compassion to reign. But we dare remind ourselves that part of the mental health stigma depends on the color of your skin and your culture.

In the African American/Black community, there is a strong spiritual basis that we hold to our hearts that is handed down in tradition by our great grandmothers and grandfathers, and our ancestors. That is the idea that a higher power can heal all our illnesses. And that if we have depression or anxiety, we are not relying on the higher power enough which compounds the feelings of guilt that we may already be holding. Our faith is called into question. This stigma has plagued the African American/Black community for many decades. Besides that, we still have the effects of systemic racism where African American/Blacks were denied access to health care and now even in the 21st century health care still remains an access and economic issue plagued with unconscious biases.

When you are trying to open up your heart with innermost thoughts, you want someone that you can trust and someone who may relate to you. Compounded by the economic restraints and access to therapist is that often you cannot find a therapist that looks like you if you are a person of color. They say representation matters. I second that and elevate that it is imperative. People feel connected to people who look like them in a society that villainizes you for looking a certain way. We need to find people who can relate to the unique societal struggles that people of color face.

As an institution, I believe we are truly committed to creating equity in healthcare. We are committed to building awareness with intentionality around intersectionalities that people come in with and finding ways to address unconscious biases that impact health care outcomes for people of color. That includes the mental strain of poverty, police brutality and profiling, the killing of Black and Brown bodies by police officers, on top of the ongoing effects of this pandemic. We have much work to do in the mental health space, but I am grateful that we are now understanding that our mental health matters just like any other health concerns we may have.

As I reflect on my mom’s journey of resilience, I am comforted by her story. She realized the need to see a therapist to get the tools she needed to deal with her depression and anxiety. Hearing stories like this makes us feel not so alone in our pain. We are human; we bend but we do not have to break. However, we need the resources accompanied by compassion so that we can stand up straight again and embrace a full life we all deserve to live.

 

Toni Gray serves as the Learning and Growth Program Coordinator in the Office of Diversity and Inclusion at the Medical College of Wisconsin. She’s been with MCW for 10 years. She oversees, leads, and creates learning and growth experiences in the equity, diversity, and inclusion space.

 

 

Poetry by Rhea Martin - Dear America

From the 4/16/2021 newsletter

Poetry

Rhea Martin

Dear America

I wish I felt loved by you.
I wish I felt safe being with you.
I wish I could trust the promises of hope and progress you keep saying will come.

Like any love
It is not perfect 
There is beauty as well as sorrow 
To give unconditional love means to have trust
I wish I could trust you America
But I can’t 

and what’s worse 
Is that it breaks my heart to see that people are trying
beautiful, strong, devoted people fight for you
And maybe I’m not strong enough to give 
That trust

That doesn’t mean you are hopeless
Or less beautiful and vibrant and passionate 
Nor is anywhere else going to be perfect
I’m not naive to expect more than what can be given within the current climate 
But maybe we just don’t fit 
and that’s ok
I wish nothing but the best for you

To the man who almost ran me over today
Who didn’t stop
Who didn’t look back 
To the witnesses who walked away 
To the police that drove around my neighborhood pretending to look out for the community

How dare you have the audacity to put the words “Black Lives Matter” in your yards
and in your windows 
and bumper stickers on your cars

To the one POC who witnessed what happened and gave me a ride home and said
Thank you for doing the decent, human thing

“Thank god you had good reflexes”

I know it is not a crime to be 
A women
Queer
Or Black

But America

Stop gaslighting me 

America

Being with you it’s like being with an alcoholic
I don’t know whether to be pessimistic or optimistic that recovery is in your future
There are so many programs and so many resources
Your casual slurs and liveliness at parties used to be fun
And I know I can be easily accused of not being virtuous enough to see you through and see you get better
I feel like it is on my back to make it my responsibility for you to get better

You have made it so many people's responsibility to call you out on your history and your lack of transparency of your habits habits you keep and how you destroy communities
But you are like my family
I would not be who I am without you
To have criticism does not mean I don’t see you for who you are
More
So much more than a simple word 
A moment 
A feeling 
I get so mad when others treat me better
Because I want to feel that love and acceptance 
from you

Show me I can believe in you
I want to trust you 

I want to walk down the street and feel safe
As a queer
Black 
Women
I google, safest places to live In America
Then I remember 
Back space 
Safest places for black queer women to live in America
Because there is a difference

Am I the problem
And I the problem in this relationship?
You shrug your shoulders
And I guess it depends

What am I wearing 
Where are you from
Did I say what I said the right way
Do I care too much?
Are you on your period?
Are my standards a little bit too high

I don’t know
But I’ll keeping working on things that are in my control
I am still standing today
I know about us right now, let’s take a break

Rhea Martin is a Public Ally with Public Allies MKE and an Intern with the MCW Office of Diversity and Inclusion. Rhea reflects on their relationship with America as a queer person of color. This work was shared during the Spring 2021 MedMoth event at MCW. 

The news from Atlanta this week is horrifying

From the 3/19/2021 newsletter

The news from Atlanta this week is horrifying.

A gunman took the lives of eight people, six of whom were Asian women. This has been one among many recent hateful crimes that have terrorized the Asian American community. Every one of us at The Kern Institute expresses our unconditional support for this community, and we want to express our love and concern for MCW’s Asian students, trainees, faculty and staff during this acutely difficult time. We continue to invite dialogue about racism, discrimination, character, caring, compassion and medical education because we understand that it is only in bringing these discussions into the light that we might learn from one another and be a part of changing our profession and our world for the better. 

Teaching About Implicit Bias in the Classroom

 From the 3/5/2021 newsletter

Perspective/Opinion

Teaching About Implicit Bias in the Classroom

 

by Sandra Pfister, PhD, and Kerrie Quirk, MEd

 

Dr. Pfister and Ms. Quirk describe the course they co-lead in the KINETIC3 program which helps faculty recognize and mitigate their implicit bias when teaching...

 

The definition of implicit bias is: “the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.” Let's use a True/False question to see what you think: True or False? I have no implicit bias.  Correct answer: FALSE. Every one of us has implicit bias because that's a function of how our brains work. What happens when implicit bias takes over when we are teaching? Maybe you say that women don't have heart disease. Not said with intention, but isn't heart disease a man's disease? Or when teaching about skin disease, maybe you only show images from white patients. Not done with intention, but maybe because those were the same images used when you were a student.

Using a combination of didactics and active learning, our KINETIC3 course is structured to allow participants to explore their own implicit bias. Prework is to take the Implicit Association Test (IAT). IAT begins to connect learners with attitudes and beliefs they may not know they have (unconscious or implicit bias). The IAT website gives this example: "You may believe that women and men should be equally associated with science, but your automatic associations could show that you (like many others) associate men with science more than you associate women with science." Each KINETIC3 learner is given the opportunity to discuss their own experience with the IAT. 

This course also offers a more in-depth discussion on the meaning of implicit bias, and we delve into the role of the brain. Think FAST. Think SLOW. Think FAST involves those parts of our brain outside of conscious awareness. For example, let's say you stop your car at a red light. When the light turns green, you know to go. This mental association requires no conscious or effortful thought. In contrast, Think SLOW is the brain's conscious processing. It's what we use for mental tasks that require concentration, such as a taking an exam. Together, Think FAST and Think SLOW parts of the brain help us make sense of the world. But it is also the Think FAST parts of our brain that contribute to unconscious bias. This session looks at times when unconscious bias is activated in our brains and shows up in our teaching (when we are rushed, when we are fatigued, or when we are unprepared) and offers strategies to help. We also show a video clip from a PBS special to highlight how medical education has contributed to systemic racism and the role of institutions in contributing to implicit bias. Through small group break-out rooms, learners are given the chance to reflect on their own role as medical educators to ensure a diverse and inclusive representation in clinical case-based material.

This KINETIC3 course aligns with a Kern Institute Transformational Ideas Initiative (TI2) project led by Kerrie Quirk to design a reflection check list for faculty to assess the clinical cases currently being used in the preclinical curriculum. The project is called Identifying Bias in Classroom Clinical Cases: A Structured Approach to Make Clinical Cases More Diverse and Inclusive. Since no KINETIC3 course is complete without a chance to spin the Character Wheel, we end the session with discussion on how specific character traits can play a role in mitigating our own implicit bias. 

Sandra Pfister, PhD, is a Professor in the Department of Pharmacology & Toxicology at MCW. She is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Kerrie Quirk, MEd, is a Program Manager in MCW’s Office of Educational Improvement.

The Patient Told Me “You cannot take care of me. You’re black and I don’t like black people.” How Do You Respond?

 From the 12/18/2020 newsletter

 

Perspective                       

 

 

The Patient Told Me “You cannot take care of me.  You’re black and I don’t like black people.” How Do You Respond?

 

 

Victor Redmon, MD

 

 

Dr. Redmon, a resident in the Med/Peds Program, shares what he has learned about speaking up when experiencing or witnessing moments of injustice …

 

 

My name is Victor Redmon.  I am a fourth-year internal medicine and pediatrics resident here at the Medical College of Wisconsin Affiliate Hospitals (MCWAH).  I have served on the MCWAH Diversity and Inclusion (D/I) Committee since my intern year.  Given the current political landscape and the ever-present pandemic, we felt it necessary to put out a narrative centered around “accountability,” both for yourself and your colleagues around you. 

 

The year of 2020 has been one for the ages. I have been more cognizant of reading articles addressing intolerance, injustice, and micro-aggressions this year, more so than in years past.  A student of mine recently asked me particularly good questions about accountability and when to speak up for yourself and others, when either your colleagues or patients make insensitive remarks.  I do not know if I gave him the best answer at the time, partly because I do not know if there is one right answer give.  

 

 

A patient care story

 

In medical school, I was taking care of a woman during my third-year internal medicine clerkship.  She was Caucasian and in her 60s.  We were treating her for a pneumonia, UTI and encephalopathy.  She was admitted overnight and the next morning I decided to follow her as one of my primary patients.  I walked in the room alone and introduced myself along with my role on the team.  She took one look at me and said, “You cannot take care of me.  You’re black and I don’t like black people.” I paused and then she went ahead to ramble on about other things that didn’t make much sense.  I asked permission to examine her and she stopped talking and let me perform my examination.  Once I was done, I thanked her and told her I would see her later in the day.  She said “Okay, but I don’t like black people.”  As we continued to treat her infections, she became more coherent and "with it.”  

 

The next day when I went to see her, she greeted me with a “Good morning,” 

 

I replied back, “Good morning. It looks like you are feeling better today.” 

 

She said, “Yes, I am. Who are you?”  

 

I realized that she did not remember our first encounter, so I re-introduced myself.  She thanked me and the team for our treatments.  The rest of the encounter with her was very pleasant and we discharged her home eventually.   

 

I keep thinking about how and why I handled this encounter the way I did.  I knew the patient was delirious from her active infections and hospitalization.  Does that give her a pass for what she said to me?  How much truth was in her words?  I never told anyone on my team about what she said to me.  Not my fellow third-year student colleague, not my intern, not my senior resident and not my attending.  Why did I choose not to?   

 

 

Another patient care story

 

During my second year of residency, I was senior resident of one the medical ward teams at the VA.  We had a patient who was notorious for his abuse of the health system, bigotry, and sexism.   He was homeless, and every time he was admitted to the hospital, it was a saga to get him discharged.  If you worked at the VA long enough, you knew this guy by name alone.  You were either on his good side or his bad side.  I had taken care of him several times in the past, starting when I was still a medical student.  The patient and I had a good doctor-patient relationship, and he was never disrespectful to me.  I wish I could say that for others.   

 

My third day on the team, my intern following this particular patient came back to the room laughing.  I chuckled and asked him what was so funny.  “Oh Mr. So-and-So being Mr. So-and-So,” he replied, “he’s not so bad if you’re on his good side.”  The patient had been medically ready for discharge for weeks and we had been working with social work and case management to find him a place to stay since he required home oxygen therapy.   After rounds, my attending went to speak with the patient alone to basically tell him that he will be discharged the following day, and he could not stay in the hospital any longer.  My intern, who was of East Asian descent, was now very nervous about how this will affect his relationship with the patient.  I told him that the patient would be more likely to be mad at the attending, but I offered to be there for him if he needed me.  My intern declined and said, “I’ll just see how it goes.”  

 

The next day, my intern came in laughing again: “Mr. So-and-So being Mr. So-and-So.”  I took it as a positive sign and moved on.   During rounds, my attending asked how Mr. So-and-So was doing today.  My intern said “He’s fine, nothing has changed medically.  But he hates you,” referring to my attending.   My intern then said, “He says he never wants to see ‘that brown, Jihad *********** again’.”  

 

This statement is wrong on so many levels.  My intern then laughed it off.  My attending, of Indian descent, was silent for a moment, but then said, “Well unfortunately, he doesn’t have a choice.”  I looked around and the rest of the team (the other intern and two medical students) was dead silent.  As a team we moved on and finished rounds.   The patient was discharged without much drama.  

 

Internally, I was an emotional wreck.  I felt anger, remorse, shock and regret all at once.  I didn’t know how to respond in that moment.  I was with people I had not grown comfortable with yet, so I froze and didn’t respond at all.  

 

The following day was switch day for both the interns and the attending, so I had a whole new team.   Approaching the patient about what he said would have not been a battle worth fighting.  However, I never approached anyone else on the team about what was said, how they felt and how we could have done things differently.  I missed an opportunity to point out intolerance and injustice and to take a stance on a perpetuated culture that needs to end.  I feel like I failed my team.  I feel like I failed as a leader.  

 

 

What I have realized

 

I could continue to write about countless stories that are similar and worse than which I discussed above.  

 

Whatever personal accounts or stories that my friends and colleagues have experienced, these types of encounters happen every single day.  Often, we are silent and decide not to say anything so we can keep the peace.  I no longer regret being timid in those moments. I felt I was doing what was necessary to “survive” and progress to where I want to be in life.  I imagine that others have taken similar stances for similar reasons.  

 

I do not think there one “right or wrong” way to handle these situations, but I do think it is a reflection on how little improvement we have made as a society in addressing these issues. 

 

I realize now that it is not about me or one person at a given time.  It’s about all of us as a society.  As a medical society, we have a significant impact on our communities, especially the marginalized communities.  It does not matter if you are a medical student, a physician, nurse practitioner, physician assistant, a nurse, a medical assistant, a physical therapist, or a speech therapist.  You have a voice.  You have a platform to use to speak out against injustice, intolerance, and micro-aggressions that we too often meet in our work environment.  

 

I am far from perfect and I do not pretend to be free of my own implicit biases.  I hope to further an inclusive culture.  I want to be called out if I am being insensitive or have a moment of intolerance -- because that’s how we grow as humans.  I hope that I can learn from my failures and successes.  At the same time, I hope others can learn from my experiences and their own experiences as well.  

 

 

A challenge to all of us

 

We can no longer stay silent about these issues.  There is a lot of work to be done, but small simple steps eventually lead to larger ones.  I intend to start speaking up for my colleagues; especially for my trainees and students, who are in a particularly vulnerable period in their life.  I hope I am not alone.  For MCWAH D/I, we hope that we are not alone. 

 

 

 

Victor Redmon, MD is a fourth-year resident in the MCW combined medicine and pediatrics (Med/Peds) residency program.