What The MPH Experience Taught Me [and What It Didn’t] – Part 1

freevectoroftheday114lightbulbI have been trying to think of an appropriate metaphor for what I have learned over the last two years. The best I could come up with is that we (current and budding public health professionals) have all been meandering in a dark room, feeling around for the one light switch that will completely illuminate the room. Once illuminated, all questions and answers will be clear, problems simple, and solutions actionable. As our hands explore the surfaces around us, we each feel what we think is *THE* light switch; so we get really excited, try to flip the switch and… the lights don’t come on. It turns out that there are actually a million different light switches in the room and there is a magic combination of on-switches and off-switches that will fully illuminate this room. As we all work on the switches around us – getting closer and closer to that magic combination – the room gets marginally brighter. From moment to moment the changes may seem imperceptible, but, over the long-term, the room gets brighter. Some switches add more brightness than others, some actually make the room darker, some require an impressive amount of time, energy, and resources to flip, and some switches affect other switches in unpredictable ways, but with everyone’s sustained effort the room continues to brighten.

The fact of the matter is this:  after all these decades, the room is still somewhat dark, and there is no single switch that will fully illuminate the room, but, the net effect is such that our collective efforts have made the room a little less gloomy. And that, to me, means it is worth it and necessary to stay in the fight to illuminate the room, to keep working at it (to the degree that is possible while also maintaining wellness because #selfcareisimportant).

This was not what I expected to learn during my MPH. When applying, I was convinced that the MPH experience would equip me with all the skills necessary to be a part of the “team” to solve systemic issues contributing to the health inequities with which I am primarily concerned and result in a long fruitful career after which I would leave this world a little teeny tiny bit better than when I came into it. I was convinced that the faculty of my program had all the answers and for the low low price of tens of thousands of dollars they would share with me all of their secret solutions. I was convinced that I was entering a magical fairy land of public health amazingness and it was going to be the most intellectually-stimulating and passion-driven two years of my life.

Forgive my youthful naivete, if you will. As you may have guessed, things did not turn out quite as expected. In my first year, it quickly became clear that I was not going to learn how to solve the problems that consumed my thoughts. We frequently discussed the usual newsworthy contemporary public health problems (such as obesity, obesity, and more obesity, e-cigarettes, and [eventually] Ebola). We reviewed the historic successes of sanitation and vaccines, but learned little about how to “fix” some of today’s most tenuous public health issues – the ones that lay at the intersection of social norms, political leanings, and economic forces, and are further complicated by people’s multi-faceted identities (of which gender, sexuality, race, ethnicity, immigration status, English proficiency, and geography, are only but a few pieces).

Part of the reason we didn’t learn about the “right solution” or the “right answer” is that: (1) there is no one “right answer”, (2) we are still trying to figure out which problems are ours to solve – I lean towards an inclusive definition of what is “within scope” for public health, but not everyone agrees with that,  (3) even the problems we have decided are within our purview are exceptionally complex and difficult to “solve”, and (4) we are never going to solve them if only those within the public health bubble are focused on and paying attention to these issues.

My social epidemiology professor made it most clear when she explained that the tools, resources, and knowledge we need to solve these problems exist in sectors outside public health. I took this to mean that until we fully acknowledge that fact and act in accordance with it (i.e. we disperse and work in other sectors to give them a health lens with which to frame their work and/or act as expert conveners who can collectively leverage the knowledge, power, and resources of other sectors) we are not going to get very far in cracking the really tough problems, especially the socially determined ones with which I am most concerned.

Okay, so the MPH experience didn’t give me the solution to the problem set as I saw it, but what did it give me?  Stay Tuned for Part 2…


Incomplete thoughts on self-imposed guilt, taking action, and some related stuff

Why are we stopped? We should be moving soon. *looks around* I don’t see anyone I know. That’s a shame. *snap a few pictures* Okay, we should be moving soon. Aw, man, I am starting to get cold. We really need to get moving! Why did those cops just roll by on Vespas? When did the NYPD get Vespas? I wish I had a marching buddy. I hate being here by myself. I am not good with crowds and being here by myself is not helping. I have to stay. I have to stay. *text friends* I have to stay. We should be moving soon. Oh man, really starting to get cold. Ugh, but I am wearing multiple layers. What’s going on? We should be moving soon. I am so uncomfortable. I don’t like being here by myself. I wish I had a buddy. I hope nothing happens. We should be moving soon. I’m cold. I’m tired. Why aren’t we moving? *text friends* I have to stay. No, I can’t. Well, maybe I could just spectate and take pictures and help with documentation. No, then I’m going to be one of those people that marchers don’t like because I should be joining the cause actively and not just spectating. Ugh, don’t be a wimp. I have to stay. No, I … I don’t, but I should. NAH. EFF THIS. I’m going home.

So I leave after having stayed for a maximum of 30 minutes feeling a mix of immense shame for not staying the entirety of the march from Harlem to the UN (about 4 miles) and sweet relief knowing that I can go home to warmth and work on any number of the various other things competing for my attention at this moment.

I am so good at self-imposing guilt that stems from a nameless, faceless entity that believes there is only one way to care about an issue. This nameless, faceless entity has been created from: (1) jealousy of my friends and colleagues that are out there organizing, and marching, and taking action every weekend, and some times multiple days in a row; (2) utmost respect for my friends that are so up on it that every time there is ANY development regarding a cause they care about they are on social media sharing and [intelligently, eloquently, articulately] commenting on it – making sure this remains a movement and not a moment; (3) fear that when they call people out for remaining silent on issues until “the tension dies down” they are referring to me.

But then I have to dig around in my brain and remember the following about the aforementioned:

(1) I have been two marches, and both times, the experience was physically and emotionally grueling. After the first one I lost my voice and was hobbling around all of the next day. After the second one, which thankfully was on a Saturday, I spent the ENTIRETY of the next day (Sunday) glued to my bed. I could not move. While I feel it important to get out there and “take action” I quickly realized that I could never, realistically, be someone who goes out to marches all the time – I physically cannot do it. Furthermore, the emotional expenditure is more than I can afford on a weekly basis, particularly because I find large crowds anxiety-inducing and if I don’t have a buddy in the sea of people, forget it. I have spent a lot of time undervaluing the importance of self-preservation, occasionally to the point of risking my own health. Honestly there is no point in doing things because I think other people want me to do, or because I think some people, (but more likely a nameless, faceless entity), will think less of me if I don’t do the thing(s). I have to make sure that, for me, the cost is personally worth the benefit and I can still be around and fully present long enough to continue to do the work in the months and years following.

(2) Kudos to my friends that are up on their stuff, but honestly I do not owe my friends on Facebook or my followers on Twitter (believe me there are so few they would not notice if I never tweeted) anything. I post what I want to when I want to and I hope that others do the same. I firmly believe that everyone should take the “my Facebook, my stump” mantra to heart – this is why the “Unfollow” and “Unfriend” buttons exist. I am not required to only post about certain topics during certain periods of time for fear of derailing a important “conversation,” which may or may not be actually happening. The fact of the matter is that I am only me. I am not a new source, a professional blog, or a company twitter account. I am only me and share what I want, when I want and I need to stop feeling badly about not sharing enough news, or the right news at the right time, because quite frankly, I feel like I sufficiently overload news feeds with both silly and serious content.

(3) Look, whether I am or am not included in the people being called out about remaining silent during times of tension, doesn’t really matter. Their Facebook, their stump, they can call me out if they want to, but I don’t owe that person anything. There are no less than a zillion and half things competing for my attention at any given moment, and what I post has never been and will never be a comprehensive representation of what I care about and how salient certain issues are for me during certain times of the day, week, year, or my life. There is also the flip side where I need to calm the eff down and realize that it’s unlikely that many a passive aggressive post are meant for me, in specific, because, frankly, I’m not that special and don’t garner that much attention. I am not a public official or a celebrity… I am an individual who cares about stuff and until such time as I am held publicly accountable for my actions, the only person I am accountable to 100% of the time is myself.

So, I went to 110th and Lenox today and stood there for about 30 minutes, and instead of being excited about marching in solidarity with the people present I kept trying to ignore that nagging feeling in my gut and in my joints that was saying – not me, not today. I felt a self-imposed guilt to stay and to march only because I was afraid that not being there would give people fodder to say I don’t care or I don’t care enough. Which is totally B.S. because there is not now nor has there ever been only one way to care about an issue. Just because this what is meaningful and fulfilling for a lot of people doesn’t mean it is the only right way to take action. Everyone who cares will find a way to take part “in the movement” in their own way and no one needs to come at them for doing it in a way that doesn’t fit their personal definition of the “right way.”

Maybe this memory will help clarify what I am trying to get at – the first march I went to was a great experience, overall, but I am never going to forget the following three moments: The first was when a crowd of people wanted to rush a police barricade on the FDR. My thoughts? There is no way in hell I am doing that. Seemly, in response to my thoughts, a tall, attractive white gentleman, who appeared to be talking to no one in particular said,  “If you want change you have to be willing…” Willing to do what, exactly? Engage in reckless endangerment that could result in the death of several people? No thank you, sir. I will find other ways to act. The second was when an individual with a megaphone was screaming at people in their cars to honk their horns in support of us marching through the streets. Some people would comply, but if they didn’t he would cuss them out. Some other people marching in our section would say, “Hey, man, that’s not cool” or “That’s not necessary” to which the man with the megaphone would proceed to tell those people that they don’t know anything, that Eric Garner was his friend, and some other expletives I don’t remember. The people would try to confer with we’re all here to support, but he wasn’t having it. The third was a large, older, white gentleman who was in a red hat and a red sweater,  and who got red in the face when he started screaming at us – so much so that spit was flying out of his mouth – that we “need to get our heads out of asses” and that “no one cares about down there, that’s the ghetto” (he was pointing towards the Lower East Side…) adding that “we have to go where they don’t want us” pointing north. These instances are the antithesis of what these solidarity movements are supposed to be; insulting people that are in the crowd with you when we are all, theoretically, there for the same reason is counterproductive and alienates people like me who care deeply, but are offended by this vocal minority that don’t think we’re aggressive enough. I want to take a moment to add that the vast majority of marchers were just chanting and all about solidarity – I mean a stranger had offered me some of her food while we were marching along – the overwhelming majority were great.

I wish we were all better about meeting people where they are and being okay with whatever level of participation, no matter how small, they are willing to have. From those that just post a Facebook status or tweet (because everyone reaches some unique network of people), to those that directly make legislative changes happen, and everyone in between, we need them all, because a mix of methods and approaches will be more effective than only promoting one way of doing things and alienating those that can’t or don’t want to do things that way.

Originally posted on my tumblr.

Hi, my name is Lauren, and I’m ignorant

“How does she/he/they not know that?!”

“Some people JUST. DON’T. GET. IT.”

“Ugh, SOOOOO ignorant.”

Having either overheard or said some version of the above it has become increasingly clear, especially in my social and academic bubbles of highly educated, highly intellectual, opinionated and vocal activists, academics, future doctors, future lawyers, etc., that “ignorance” is NOT okay. Having internalized that social norm and jumped on the “let’s hate on ignorance” train, I have inadvertently worked to perpetuate my own ignorance by adopting the following as policies for dictating my behavior in social settings (and in meetings, when I was working, and in class, now that I am back in school):

1) “Don’t ask; don’t tell.”

Don’t ask stupid questions; don’t tell them you don’t know what they are talking about.

2) “Fake it until you make it.”

Pretend you know what they are talking about (nod and say “mmhmm” at appropriate intervals), until you can run home to look it up on the interwebs.

By doing so I miss out on opportunities to learn and/or clarify understanding in what should be “safe spaces” only to avoid being on the receiving end of a pause, look around, raised eyebrow, and a “Really?!”

A worse consequence is the immediate devaluation of a contribution from the person (or people) on the receiving end of the scoff, eye-roll, or side-eye. There are numerous instances in which I have immediately stopped listening and felt their perspective invalid, which is a HORRIBLE thing to do, because that person, as a result of their life being different from mine will possess knowledge and experience that I do not and may need. I use my personal experience here as an example:

I remember having a conversation with some of my friends about being astonished that many of the colleagues in my MPH program were not familiar with the notion of a “microaggression.” I thought, “This is a public health program! How could you not know about microaggressions?! Or at least heard of them!” Then I thought of two things… 1) If someone is here for say, biostatistics, why would they be concerned with an academic conversation on microaggressions? Nowhere in the job description for a biostatistician does it say “must possess knowledge of microaggressions,” but just because I know the concept and they don’t, doesn’t make their perspective any less necessary in the field. 2) [Confession] I hadn’t heard the term “microaggression” before last year – although I had been on the receiving end of them for quite some time.

In trying to understand the circumstances of ignorance in others I had to come to terms with my own, particularly as I shifted my focus from engineering to public health. It wasn’t until I started this process that I became exposed to this whole realm of sociomedical science. In order for this to happen I had to be in an environment and part of a larger social network that cared about these issues, was vocal about these concerns, and readily shared information about them. As I was soaking up this knowledge I felt increasingly empowered to implement effective outcomes as a public health leader some day, but I began to realize that while I was empowered with information, I was not empowered with experience or a tangible understanding of the lives and needs of the populations I wanted to help and in some cases, I was not and still am not even in tune with popular opinion!

For instance, two weeks ago I was asked to address how a documentary challenged popular opinions about why people join gangs and I was dumbfounded, because I literally did not know what popular opinions on the topic were. Honest to goodness, I had to Google it, because I was so far removed, so entrenched in academic macro-level and systemic analysis of the reasoning behind gang involvement that I did not even know what most people or average people thought about it. That sounds so crazy, doesn’t it?!

But it was a wake-up call –

  • I may understand lofty academic ideas and models that hope to sort of explain the lives of people, but in most respects I am still ignorant of what daily life is like for the people in the marginalized communities I say I am committed to helping. Our lives differ so drastically that I am pretty sure I will never be able to fully understand and I frequently feel like this disqualifies me from pursuing the work I wish to, but I suppose I have to accept that pursuit of understanding is going to be a life-long endeavor.
  • In public health we frequently employ top-down, paternalistic interventions that rarely if ever involve the input of those that will be on the receiving end of such interventions and if we continue to do this I don’t think we are ever going to be able to shake the popular distrust.
  • Dismissing “ignorance,” if I continue to do it, is going to translate into patronizing and paternalistic behavior (whether intentional or not) that will alienate the very people I want to help (that, honestly, already don’t trust us – public health practitioners).
  • I need to embrace the bidirectional teachable moment. I have a lot to learn from others and there are things I can teach others (although I never feel like the latter is the case, but that is another post).
  • There is no core curriculum for life. Expecting that others know everything and/or expecting that I know everything, is… well… ridiculous.

Originally posted on my tumblr.

Health Disparities in Our Own Backyard

Aspiring Docs Diaries

It has been quite some time since my last post. Qualifiers (the only thing close to finals at my school) consumed some time, but it was actually my recent engagement ceremony that predominantly preoccupied me for the past month. Spring break served as a much needed respite and I’ve truly come back feeling rejuvenated. Being away from my classmates made me realize how close I have become with some of them. My class certainly feels more like a family now and the sentiment is reassuring as this is the community I was craving when I began medical school. I cannot stress this enough to other students who are currently in the process of choosing which school they will ultimately enroll in: take the time to talk to as many students as possible to see if the school is a place you see yourself being supported and happy throughout an inevitably…

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Bias in the Medical School Admissions Process

Aspiring Docs Diaries

The long and cumbersome process of applying to medical schools has finally come to a close this month for applicants starting medical school in the fall. Stressful years of hard work seem to boil down to one or two interviews at each school. Unfortunately, this process can be particularly toiling emotionally and psychologically.

Recent accounts from my peers about encountering prejudice in the application process triggered reflections on my own experiences of encountering racism and sexism as a Muslim woman of color applying to medical schools in this country. I was in the fortunate position of being offered fifteen interviews across the nation. As a Women’s & Gender Studies major at Columbia University, I was excited to talk about my health justice activism, my desire to work with underserved populations in inner-cities, and my hope to expand reproductive rights for women of color in the US. The night before my…

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How my doctor and I failed each other

When I walked out of my primary care physician’s (PCP’s) office last Thursday I was fuming, “I can’t believe it. There were so many things she didn’t check! How dare she?! I didn’t travel several hours and across multiple state lines to have a sham of a physical!” When I got home I launched into a tirade about how she did this, but not thoroughly enough, and didn’t do this, this, that, and the other thing. I had literally gotten so heated by the end of it that I was sweating.

Three days later I had brought up the visit, yet again, with one my friends and animatedly shared my frustration, “I couldn’t believe that no one checked my BP! I am predisposed! It’s in my chart!” My friend politely interjected, “Did you ask her to take it?”

I paused and mentally replayed the visit in my mind. The answer? No.

It was then I realized that my doctor and I were both at fault for making that a less than productive visit.

How she failed –

Before she started the exam she asked me a series of questions to update my chart. Totally standard. However, she asked the laundry list of questions in rapid-fire succession, which did not provide me with much time to think about my answers or whether they were complete. Furthermore, some questions, like this one, were asked rather indelicately—

PCP: How is your mood? Is it stable? Are you depressed?

This is a loaded question. Actually it is three questions, but how do I completely answer any of them? My mood, I don’t know, it comes up and down given life circumstances. What do you define as “stable” and for how long is that term supposed to apply? Am I depressed this very moment? No, not really. Have I felt that I may have been in the past, yeah, maybe, I’m not sure. Do I feel comfortable having a conversation with you about it right now? Nope, you’re not very welcoming and I have about had all of the vulnerability I can take today.

I would have preferred if she treaded a bit more lightly. Had the tone been conversational rather than an air of I-am-just-trying-to-get-information-down-on-this-paper-so-I-can-go-see-more-interesting-patients I would have been slightly more open to a conversation about it.

And her flippant remark in this instance was completely unnecessary—

PCP: Do you exercise?

Me: Occasionally. I know I should exercise more regularly, but I don’t.

PCP: It’s because you’re skinny; you’re not motivated.

Me: O________O

WOW! Because people are only ever motivated to exercise when they want to lose weight, right?! Yeah, okay. Instead of that remark a better follow-up would have included questions about why I am not exercising, for example: Is it painful when you exercise? Are you too tired? Do you feel like you don’t have time to exercise? Do you have access to a park or another area (that doesn’t require payment/membership) where you can work out? Is it safe to exercise in your neighborhood? She also could have suggested ways to work in physical activity during my workday like taking the stairs or taking a walk during my lunch break.

The physical exam itself was *actually* sub-par. She only checked my mouth, lungs, and breasts (although she only checked them with my arms down at my sides). My temperature, blood pressure, ears, eyes, abdomen, and joints all went unchecked – which I found exceptionally strange because those were all things she checked during my last physical with her.

How I failed –

I didn’t come prepared to discuss any of the mildly abnormal aches, pains, popping sounds, and migraines I had experienced over the last year mostly because I forgot about them. Unless I am feeling the pain when I am at the doctor’s office I completely forget to bring it up with her. To combat this I am thinking of trying to set reminders about things to bring up with my doctor with alarms that go off about 15-20 minutes before the appointment to help jog my memory.

I should have asked questions when I was confused or curious about something instead of just letting the question sit in my mind and remain unanswered until I forget I had the question in the first place.

I should have asserted myself and asked for what I wanted (in reference to the BP check) instead of sitting there after the doctor left and getting angrier by the minute. It wouldn’t be putting her out and it takes no time. It’s my health; we both have to take responsibility for maintaining it.

But saying I should have done these things and doing them are two totally different things. I know why I didn’t do them. It’s usually because the following things are frantically running through my mind:

– I don’t want her to think I am a hypochondriac…

– I don’t want to bother her with unimportant things because she is busy…

– She probably thinks this is a waste of time…

– It’s probably nothing…

While also knowing that I am not a hypochondriac, this isn’t a waste time, and it could be nothing, but it could be something. Furthermore, how can she know that something is wrong and address if I don’t tell her? She is not omniscient.

I think, if anything, this visit reminded me that the person sitting across from me on the rolling stool is a human. There is a lot of power that comes with that M.D. She has undergone extensive training, has years upon years of experience, and is highly regarded among her peers and patients. Regardless, she is still human and is as imperfect as the rest of us. My health is not best served by expecting her to know and do it all, it is best served by the two of us working together; it has to be a partnership.

Maybe we’ll work together a little better next time.

Originally posted May 15, 2014 on my tumblr.

It’s all okay, you’re skinny; you can take it.

Something I wasn’t expecting when I entered the “real world” was the frequency with which my co-workers were going to make comments about my body. It was and still is completely unnerving.

“I will never understand how you people can eat whatever you want and stay so skinny.”

“I used to look like you, enjoy it while you can.”

“Ugh! Just look at her little body, don’t you just want to hit her?!”

Co-worker: “You’re stopping, Lauren?”
Me: “I’m full.”
Co-worker: “I thought you always eat 10 slices. Come on, eat more, you can afford it.”

Just because you think I “can afford it” doesn’t mean that I should binge eat. I am still capable of having an extremely unhealthy relationship with food and while it may not manifest itself in weight gain it does manifest itself in equally damaging ways, but because you cannot see the damage, it doesn’t exist.

There are jokes and memes about “eating feelings” which is something I often did in college and occasionally still do. I used to frequently find myself needing to chew something, I needed to have food in my mouth and I would eat and eat and eat, well past the point of being full, because food was the only thing that made me feel better, until it didn’t anymore. At which point I was so sick of food that I craved nothing, and every time I tried to eat, even when I was very hungry, I wouldn’t find it all satisfying and would end up eating very little, if anything at all. This in the midst of constant exertion and little/no sleep once led to me to faint on a subway platform. I would eventually “even out,” eat normally, and be okay for a while but once things got overwhelming difficult the cycle would restart.

We talk about the perils of body shaming and I agree it is terrible; we should not do it TO ANYONE and we should not condone it AT ALL. But, for some reason, at least at work, I feel like “No body-shaming!” became, “No body-shaming [anyone over a size 6]!” Size 6 or smaller, we can make jokes about what you eat and how much you eat. We can bring up that one time you “ate a lot” over and over and over and over again, hoping you’ll repeat the spectacle so we can get some new material. We can playfully say, “don’t you just want to hit her?!” whenever you wear your favorite dress and it’s no big deal. It’s all okay, you’re skinny; you can take it.

What if I can’t take it? Maybe your constant commentary drives me completely nuts. Maybe I walk into the office every day hoping that this will be that miraculous day when you don’t say a thing about my body or eating habits. Look, I’ll be the first to admit that I have all kinds of privilege, “skinny privilege” being one of them, but I am still human under my clothes and I don’t find your harassment cute, funny, or flattering.

Originally posted 4.17.14 on my tumblr.