Words for these times, a pandemic

From the 12/4/2020 issue


Poetry

Words for these times, a pandemic 

Julie Arthur



Could I write words for these times?
Arrange letters in some fashion
To make the distance bridged.
Writing is a powerful weapon, I am humanity’s soldier,
Words are an offering, a salve.


But nothing I write can unbreak my son’s literal broken heart.
Nothing I can write can sooth the figuratively shattered hearts I see on the floor all around me.


We are masked these days whether
we wear them or not,
and those masks hide the smiles
as well as the frowns, the fear
-that doesn’t just emote from the eyes you know-
and the recognition that these days, which are not for always, are at least for now.


I am not young nor old
And feel I should have wisdom to not feel so breathlessly scared every moment.
Steadfastness escapes me at every turn, I’m left chasing it, just as all are chasing answers
As to how things will end, how we’ll all get out
Of this ok.


These times are not for always.


Something I repeat as a hymn or a hum underneath the terror of the currents of my day.
An oar on this lonely lifeboat to white knuckle
And never let go of.
I wish I could give so many things to others,
Hope, or inspiration, or kindnesses,
Things to pack for the singular journeys we seem to all be on together.


Perhaps these words, these letters, can be
The salve then, used when the wounds are fresh,
When it’s night and things overwhelm,
To read and reread and in the silence to know:
I am there with you too.




Julie Arthur is an Education Program Coordinator II at MCW. “I have worked for MCW for almost 12 years, and have been writing poetry and fiction since first grade! I believe as much as medicine heals, words do too.”

Waiting in Lines

 From the 12/4/2020 newsletter

 
 
Waiting in Lines
 
 
Bruce H Campbell, MD – Transformational Times Editor
 
 
In recognition of MCW’s annual Global Health Week, Dr. Campbell shares some of what he has learned from his global humanitarian trips …
 
 

“At its best, medicine is a service much more than a science.”
- Paul Farmer, MD

Long lines form when the global health team show up. In El Salvador, people arrive in the backs of trucks and then wait hours for one of our provider groups to assess their stomach pains, headaches, or dental problems. The men, all in long pants despite the heat, talk while women in bright dresses tend the children. In rural Kenya, women in cotton print Kanga wraps and men in tattered clothes come from all directions by foot, bicycle, or “boda boda” (the ubiquitous motorcycle taxis), waiting on long benches in the equatorial sun. At the medical center in Eldoret, Kenya, the hallways adjacent to the ENT Clinic are packed with people wearing US-donated t-shirts bearing the names of sports teams, universities, and companies – shirts re-sold to them by roadside vendors.
 
There is no way we could ever operate on everyone who shows up. What could we possibly offer to so many people?
 
 “This is crazy!” I say to one of our hosts. “We’ll never get through them all.” During a typical workday at home, I see several patients, prepare Epic notes, check diagnoses and billing codes, click all of the boxes, and close the charts. If I am lucky, I can get through twenty people.
 
“We told them that the Americans would be here this week, so they showed up.” He shrugs. “No problem.”
 
The ENT Clinic in Eldoret, Kenya is an exercise in controlled bedlam. The handwritten records fall apart as I flip through them. The quality of the scans and ultrasounds remind me of those I saw in my training forty years ago. We jam two or three patients in the same exam room so the Kenyan and US doctors, nurses, and medical students can peer over one another’s shoulders; there is no HIPAA or pretense of privacy. Patients for whom we have something to offer nod and move to the nurse’s desk to schedule surgery. Patients for whom we have nothing nod and head home.
 
At the end of the day, I look down the hallway. There are still several people who have been waiting since early in the morning. “They’ll be back tomorrow,” says my Kenyan colleague. And they are.
 
I wonder how it feels to wait hours for an opportunity – maybe the only opportunity – to see a specialist and then be told to return the next day or, maybe, never at all.
 
My very first humanitarian trip was to El Salvador where we saw dozens of unfailingly gracious patients. At the very end of the final day, there were still many people outside the clinic. My wife, Kathi, who had dusted off her nursing skills for the trip, accompanied an interpreter to talk to those in line. “Lo siento (I’m sorry),” the interpreter said. “We can see no more patients. The doctors and nurses must return to San Salvador before dark and they will not be back until next year.”
 
“That’s all right,” one of the women responded as she shook Kathi’s hand. “Thank you for coming to help us. We will return next year, as well.”
 
The next day, as we waited in Houston for our connecting flight, Kathi told our traveling companions about her encounter with the grateful woman. While she was speaking, the gate agent announced that our flight to Milwaukee would be delayed several hours because of a major storm disrupting air traffic all along the eastern seaboard.  
 
“This is outrageous!” A sunburned man near us angrily strode to the counter and berated the agent. “My family and I are heading back from vacation in Mexico and I must be at work for very important meetings tomorrow morning. I demandthat you re-route us now! We will not wait!”
 
The gate agent, in a remarkable display of self-control, apologized and said there were no options; every airline had been affected by the storm. The man paced the waiting area, yelling into his cell phone and circling back to the counter at intervals to loudly register his displeasure. Finally, he announced that he and his family were heading to a hotel and that the airline had better cover his expenses. “You’ll be hearing from me!” Off he stormed, family in tow.
 
“What a contrast!” Kathi noted. “Imagine if the Salvadorans who waited had reacted that way.” We were not blind to the grinding poverty in El Salvador and had heard stories about the people’s lack of opportunity, safety, services, and health care (a process Paul Farmer terms “structural violence”), but every one of us noted how grateful and gracious the Salvadorans had been during our one-on-one interactions.
 
Later that evening, a plane arrived. It was a long day, but we did sleep in our own beds that night. 
 
As Paul Farmer notes in his book, Pathologies of Power: Health, Human Rights, and the New War on the Poor, 
 

“The voices, the faces, the suffering of the sick and the poor are all around us. Can we see and hear them? Well-defended against troubling incursions of doubt, we the privileged are precisely the people most at risk of remaining oblivious, since this kind of suffering is not central to our own experience.”

Each global health opportunity has allowed me to view life through a brighter, sharper lens. The lines are always long and colorful. My memory is filled with people, each one hoping that they will hear a word of hope and healing when their time of waiting is finally done.
 
 
 
 
Acknowledgement: Thanks to the MCW Moving Pens and to my wife, Kathi, for valuable advice. A previous version of this essay first appeared in my blog, Reflections in a Head Mirror, in 2017.
 
 
Bruce H Campbell, MD FACS is a Professor of in the Department of Otolaryngology & Communication Sciences and in the Institute of Health and Equity (Bioethics and Medical Humanities) at MCW. He is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for Transformation of Medical Education. He serves as Editor of the Transformational Times. 
 

Learners and Justice: Our Present and Future

From the 12/4/2020 newsletter


Learners and Justice: Our Present and Future


Joseph Kerschner, MD – Dean, EVP, and Provost of the Medical College of Wisconsin



In a Leadership Plenary Address as the Chair of the Board of Directors of the Association of American Medical Colleges (AAMC), Dr. Kerschner explains the importance of listening to our learners, creating culture change, focusing on diversity, committing to being anti-racist, and transforming medical education.


Dr. Kerschner gave his address on November 17th, 2020 and the video of his full address is available here and the complete transcript is available here.

The AAMC is a unique organization with a unique position to influence medical education, research, and our nation’s health. I have always tried during my leadership year on the AAMC Board to put learner topics front and center, because at the very core of the AAMC, our organization needs to be about our medical students and residents who, after all, represent – not only our future – but our present. And, when given a voice, they provide important insights and identify solutions to our current challenges. Below are three topics students identified as the most important areas for emphasis by our medical schools, academic health systems, and the AAMC.



The first area we must tackle is learner well-being

This is at the top of my list. We simply cannot be satisfied with the state of our overall learner well-being. Although there are encouraging trends, the level of depression and distress for physicians (and other health care professionals) remains enormously high, and difficulties become manifest early in one’s journey to becoming a physician. There is not a single one of us who does not have a personal responsibility to actively reduce barriers to mental health access and to remove the stigma for those seeking healing as they struggle with mental health, addiction, and other related concerns.


Changes to curricula and assessment are making a difference. We must improve learning environments and assess how we provide instruction and evaluation. I personally believe that the recent change to pass/fail for the Step 1 exam will have a positive impact.

But we must do more to explore access to mental health resources, financial support, and milestone-based curricula that will provide more flexibility to our learners as they progress in their development. I believe we must provide the ability for a student to finish medical school and residency in less time – or more time – than the “standard number of years,” depending upon her or his previous experiences and aptitude.


Changing the culture to address well-being

We can change our cultures, in part, simply by bringing the conversations forward and highlighting the importance of engaging in this manner. The currency of leadership is time — and, as leaders, if we do not spend time on this issue, we will devalue the importance of well-being. Have we stressed the importance of taking time for oneself and one’s loved ones with the same passion that we have stressed completion of the latest research project or preparation for the next presentation on rounds? Do we intentionally “clear the deck” to talk to our struggling colleagues to provide guidance, resources, and support?

Well-being and mental health are broad topics that demand systemic approaches, yet I believe that the most critical systems change we need — throughout medicine and education — is a change in our culture. Until we enable our culture to truly see those who are suffering, remove all negative connotations, and offer what is needed to support our colleagues, we will continue to risk our own and our colleagues’ mental health and wellness.

A favorite saying of mine is, “Our attitudes influence our perceptions, which in turn create our realities.” The message here is that we can change our culture so that the health and well-being of our learners — and, really, all who pursue health and science careers — will improve!



The second area we must tackle is student debt and transition to residency

Often linked to well-being for our learners is overall debt and residency opportunities — or competitiveness. I will focus here mostly on the overall debt of our learners.

The US is an anomaly in the world, in which those who have chosen to dedicate their lives to the practice of medicine are often asked to take on an enormous debt burden before they even begin to see patients. We have resisted solutions, because, the thought process goes, physicians are well-compensated and can afford to pay back loans. In addition, many medical students come from relatively privileged backgrounds. There is some truth in these assertions. However, if we seek to encourage diversity among our medical workforce, how many potential students from less advantaged socioeconomic backgrounds never even consider medicine because, early on, they learn of the overwhelming cost and debt?

I believe that if medical school debt could be limited through means-based support of those with fewer economic advantages, we would see progress in well-being and a more diverse workforce. A legislative solution would require a realization that medical students are a national treasure that deserves our support.



The third area we must tackle is student diversity

Our students view medical school diversity as a critical area to strengthen education, improve health outcomes, and bring much needed racial and social justice to our society. As a nation, we simply have not made enough progress in this regard. For example, the matriculation rate for Black and African American men has not made any appreciable progress in fifty years!

Racial concordance between patients and providers can contribute to better patient communication, satisfaction, and trust — and that these attributes and others can provide at least a part of the solution to the lack of equity in health outcomes. We must construct our admissions processes, pipeline programs, and support systems to enable this reality. I believe that our medical schools and institutions must become truly anti-racist. We must establish institution-wide practices that address unconscious bias in all faculty, staff, and learners.



How I learned a diversity lesson

When I became Dean nearly a decade ago, there were many who were willing to work on equity, diversity, and inclusion; enhanced structures to measure pay equity; changes in policies influencing the manner in which inequities were handled; and institution-wide unconscious bias training for every leader, student, staff member, and faculty. We doubled the number of underrepresented in medicine matriculants. We enhanced our pipeline programs, and students of color specifically shared with me their heightened feelings of inclusion at MCW. Leadership diversity improved, thanks to conscious efforts in faculty hiring and leadership searches. On the financial side, an annual process was instituted to rectify gender-based and other inequities. And we were in the early stages of developing the Center for the Advancement of Women in Science and Medicine, which would soon become a reality. We were gaining momentum.


Then, six years ago, a group of MCW medical students raised their concerns about police brutality, the Black Lives Matter movement, and racial injustice. They requested support from my office for a local “White Coat Die-In” — a national initiative in 2014 that many listening today will remember. My office was supportive and helped arrange for the most prominent location at MCW’s Milwaukee campus for this to occur — the entrance to our Medical Education Building.

The event took place and received some local media coverage. Although I was well aware that MCW still had a great distance to travel, I remember believing that this student-led “die-in” was yet another example of MCW’s progress on its journey to becoming an anti-racist institution.


Fast-forward to 2020: Like the rest of the world, we watched the coverage of George Floyd’s senseless, horrific, and tragic death and read about the ongoing issues of police accountability. We convened a Town Hall meeting and panel, including expert opinions on racial justice and steps to move forward. The conversation was honest and, at times, raw, but action-oriented — qualities that I believe embody a maturing, questioning, and vibrant organization.

One of the panelists, a person of color who had been a student at MCW during the 2014 “die-in,” provided her impressions of the event. She stated that she felt the event was an enormous disappointment. Why? Because of low turnout; the overall lack of dialogue about the event by leaders and the broader MCW community; and a general sense that this issue was not important at MCW.

And she was right.

Hers was the true story — not the one I had told to myself six years before. It was not the “comfortable” narrative which I had constructed at the time of the die-in that rewarded my need to see progress.

I logged off the Town Hall and reflected on the “uncomfortable” place where I now was — and what I should have done differently. I cannot say it any better than did Bryan Stevenson, author of Just Mercy, when he suggested that we must “get proximate” to the issues at hand. My own misinterpretations of student reactions following the “die-in” in 2014 were partly a result of my lack of proximity. I needed to acknowledge the former student’s story and engage in additional dialogue. But, more importantly, I needed to take concrete and meaningful steps forward to make MCW an anti-racist institution.



My challenges to you

My ask of you is threefold:

• First, if you are in an educational leader, always ask, “How will this decision impact our learners?” but, before answering, actually listen to some students to ensure that you have it right. 
• Second, if you are a learner who is worried about not being heard, find faculty allies. It might be hard, and might seem “risky,” but it is important. 
• Third, if you are neither a major decision-maker nor a learner, ask how you can be a better ally for our learners, because they do matter. 

How we listen and provide this support has the potential to change everything in medicine.

Every institution is trying to enhance social and racial justice. We still have a long way to go, and we have made far too little progress, but it is critical that we seize the moment now and not lose this momentum. If we hope to more rapidly “bend the arc of the moral universe toward justice,” as the Rev. Martin Luther King, Jr. so eloquently told us, we must all continue to engage in dialogue, thought, and action.


I would encourage us all to work to elevate the voices of others. We must increasingly see how the judgments we impart, the ways we consciously or unconsciously behave, and the decisions we make, will move us to make progress toward an inclusive, equitable, and healthy environment for all.







Joseph E Kerschner, MD is Dean, Executive Vice President, and Provost of the Medical College of Wisconsin. He is a Professor in the Departments of Otolaryngology & Communication Sciences and Microbiology & Immunology at MCW. These remarks are excerpted from a longer address delivered on November 17, 2020 at the 131st Association of American Medical Colleges (AAMC) meeting in his role as outgoing Chair of the Board of Directors.

Fact: Malaria in pregnancy causes 200,000 stillbirths per year in Africa

A poem for Global Health Week

Fact:
Malaria in pregnancy causes 200,000 stillbirths per year in Africa 
 

 
As the shadow attaches to her toes
so the mother slings the still
born over her shoulder until night
when her birthed treasure is buried
with the others under the blankets.
At cock’s crow she presses the pink
of his unformed lips to her breast.
Soon the dead will have another
Birthday, and she will tell him stories.
 
 

Cameron Conaway
From “Malaria Poems” (Michigan State University Press, 2014)
 
 

Cameron Conaway is an adjunct professor in the Professional Communication Program at the University of California-San Francisco. He was the first poet-in-residence at Bangkok’s Mahidol Oxford Tropical Medicine Research Unit (MORU).