Doctors Against Deportation

This week, federal immigration agents in Texas stalked a 10 year old girl with cerebral palsy to the hospital where she was receiving emergency gall bladder surgery for a life-threatening condition. Taking advantage of this moment of vulnerability, they captured this girl at the hospital and have now imprisoned her at one of their loosely regulated detention facilities. Federal guidance lists health care settings as “sensitive locations” which are supposed to be protected from immigration raids because discouraging people from seeking needed medical care out of fear of predatory immigration agents is an attack on their health and safety.

As a doctor who believes that the value of a human being’s health and safety is not contingent on their documentation status but rather on their inherent human worth, I am appalled by the work of U.S. immigration agents who seems to be eternally at odds with my work to keep my fellow human beings safe and healthy.

Because of this, I want to take a moment to outline how I think medical professionals should interact with U.S. immigration agents in healthcare settings and to highlight the work of some amazing organizations in the Seattle area who are working to uphold the dignity of all people, regardless of documentation status.

Interacting with immigration agents

  1. When immigration agents are in your medical facility, report them immediately. In Washington, you can report them to  1-844-724-3737. Elsewhere, you can report to 1-844-363-1423.
  2. Make sure the family being harassed by immigration agents are connected to local legal support. In Seattle, patients can call the Seattle-King County Immigrant Legal Defense Network at 206-816-3870.
  3. Do not comply with any request from an immigration agent, no matter how modest it may seem, without an explicit court order that has been verified by your hospital’s legal department or a local legal justice group like the Northwest Immigrant Rights Project.
  4. Even if there is a valid court order, consider public non-cooperation as a form of peaceful protest. If there is time, work with local activist groups to develop a optimal strategy for this action (such as alerting press in advance).

People doing good work

In Seattle, there are several prominent advocacy groups that are doing great work on behalf of the immigrant community.

El Centro de la Raza

  • El Centro de la Raza offers both direct aid to immigrant families and advocacy on their behalf. Among their many services is safety planning work where they help families make advanced plans in anticipation of immigration raids. This includes documentation of who is to have custody of children and financial arrangements to make a parents savings and assets available to their children should the parents be deported. These conversations are traumatizing in and of themselves, but they are a necessary evil in the face of the cruelty of Immigration and Customs Enforcement.
  • Donate to El Centro de la Raza here.

Washington Dream Coalition

  • Washington Dream coalition is a group led by undocumented youth in Washington. They do a great deal of advocacy on behalf of DACA (Deferred Action on Childhood Arrivals) recipients, which is especially important given the Trump administration’s attacks on this group who had some legal protections in the Obama administration. When ICE detained Daniel Ramirez Medina–a DACA recipient–this year,  the Washington Dream Coalition was on the front lines fighting for his release which was eventually won.
  • Donate here.

Northwest Immigrant Rights Project

  • NWIRP provides community education, litigation against unjust immigration law, and direct legal aid to immigrant families.
  • Donate here.

Colectiva Legal del Pueblo

  • Colectiva also provides legal education to communities and direct legal aid to immigrant families.
  • Donate here.

Washington Immigrant Solidarity Network

  • The Washington Immigrant Solidarity Network is a newer organization, established after Trump’s election, to organize solidarity actions with Washington’s immigrant community. A lot of their work involves developing rapid response networks to respond quickly and effectively to ICE raids. Additionally, they work to coordinate temporary housing, transportation, mental health support for families affected by raids.
  • Donate here.

 

What you can do today

  • Donate to or volunteer with any/all of the organizations above
  • If you see ICE, report the activity to 1-844-724-3737 and use your phone to record them.
  • Text “JOIN” to 253-201-2833 to receive alerts when there are immigration raids so that you can directly support the community being attacked. Also send an email to editor@thestranger.com so that they can send a reporter to to site.
  • Never cooperate with ICE agents.
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Innovations In Primary Care, Part 1

As part of my family medicine residency training, I’m taking a month-long elective called Innovations in Primary Care. This month is an opportunity for primary care doctors from family medicine and internal medicine residency programs in Seattle to explore some of the different primary care models being trialed in the Seattle area and to use those experiences to fuel discussion about how primary care (and really, all medical care) can be improved in the United States.

Today was our first meeting, during which we gathered to collectively write an H&P for our current medical system. For those reading this who are not in medicine, the History and Physical or H&P is a semi-standardized note-writing structure that doctors use to describe the subjective and objective information about a patient’s health, assess why  the patient is experiencing illness, and describe the next steps we need to take (diagnostic tests and/or treatments) going forward. It’s a structured way of thinking about a patient that helps us be rigorous and methodical.

It was a gratifying process because each of the doctors at the table shared a passion for making our health care system better, but brought a different set of experiences and priorities to the conversation.

Some of the take-aways I had from this conversation are as follows (in no particular order):

  1. The insurance framework for paying for health care, while originally conceived to improve access to surgical services which would otherwise be prohibitively expensive to most people, was quickly recognized by doctors as a way to extract larger fees for patient care. After all, when a third party (the insurance company) pays the bills, people tolerate much higher fees even if the end result is steady rise in out-of-pocket costs for everyone. Doctors, hospitals, and pharmaceutical companies have abused this system so greedily under the previous usual-and-customary payment system that increasingly rigid cost-containment measures have had to be implemented to control costs. We now live in a society where the average doctor makes $294,000 per year–more than 98.9% of Americans–while medical bills bankrupt patients and health insurance cost suppresses wage growth. Recognizing and holding ourselves accountable to how capitalism in medicine has brought out the worst in us is necessary before we can even begin to conceptualize a new system.
  2. The costs of most important and effective interventions to improve health, including primary care, are recurring and predictable costs that are best paid for through public health funding, NOT through health insurance. Access to clean water, nutritious food, safe housing, and preventive medical care is necessary for All People at All Times.
  3. America fails to invest in public welfare programs because of racism. The idea of the racialized-and-thus-undeserving Other benefiting from public welfare programs (e.g. the racist specter of the Welfare Queen that Reagan so infamously promoted) is fundamentally intolerable to White America. We are comfortable with 1 in 7 people in the United States facing food insecurity if it means we can prevent one person from buying steak with food stamps. There is no justice without racial justice.
  4. Many participants are needed to transform our medical care system into a true health care system. While there are only physicians in this particular group, the real work requires public health professionals, community health workers, housing experts, policy wonks, political activists, artists, chefs, personal trainers, behavioralists, and many others to both design an implement a better system.

I’m looking forward to the experiences and conversations this month will bring, and I hope to walk away with greater insight into how I can be a better advocate for effective and equitable health care in this country.

Critical Race Theory in Medicine: A Reading List

Inspired by this letter by Jennifer Tsai and Ann Crawford-Roberts, I’m working on putting together a reading list to jump start conversation about Critical Race Theory in medicine at my family medicine residency. The goal of such a conversation is to develop a more effective anti-racism praxis in our medical system and our lives more generally. I’ll update this list as I get more recommendations. Please let me know if you have recommendations to add.

Professor Adrienne Keene’s open-access course in Critical Race Theory at Brown: Introduction to Critical Race Theory 2017

Recommended by Michelle Munyikwa
Recommended by Jeremy Levenson

If you are having trouble accessing any of these articles, let me know!

In support of Professor Tommy Curry

Associate Professor Tommy Curry at Texas A&M (my alma mater) is the latest academic targeted by White Supremacists in their campaign to silence scholars of race and racism.

Four years ago, in a podcast conversation about the movie Django, he gave a brief summary of scholarly work about the role of anti-White violence in the path of Black liberation. White Supremacist groups have now taken quotes out of context from that interview and are claiming that he was inciting racial violence.

Texas A&M President, Michael K. Young, found these White Supremacists’ argument compelling and decried Mr. Curry’s words as “in stark contrast to Aggie core values.”

I’ve signed this petition and am writing this now because I disagree with that assessment in the strongest terms. The Aggie honor code calls for us to “not lie, cheat, or steal, or tolerate those who do,” and yet the history of racial violence in America has been one of theft of Black people’s lives and livelihoods. If we are to live in this country as honorable Aggies, we must reject that path a form a new one. Doing so requires the thoughtful academic scholarship and leadership of people like Tommy Curry.

Why I wear a Black Lives Matter pin

 

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This is the badge where I choose to display a Black Lives Matter pin. I wear this pin to work each day because I believe that Black Lives Matter is a message that is essential for all Americans to see and hear on a daily basis. I’ve distributed almost a hundred of these pins to my co-workers and every month I order more. It was brought to my attention that my employer has received anonymous complaints about seeing medical staff wearing these pins, so I wanted to clarify why I as a doctor make the choice to wear this pin.

Black Lives Matter became a prominent slogan during nationwide protests against police violence.  According to the federal Bureau of Justice Statistics, between 2003 and 2009 4,813 Americans died at the hands of police. Black people are disproportionately the victims of these police homicides, accounting for 32% of these deaths despite constituting only 12.6% of the population.

In this context, #BlackLivesMatter was used to remind the White American public that Tamir Rice, Sandra Bland, Freddie Gray, and Walter Scott are precious souls to be grieved, not mere statistics. However, the slogan gained a life of its own as a push back against the myriad ways in which Black life is denigrated in our country. It is a pinprick to the conscience meant to call attention to the cynicism with which too many of us receive news of the deaths of our Black neighbors.

This is a message that we healthcare professionals need to hear as we are all too often oblivious or callous to the enormous health disparities that exist between Black and White people in this country. A 2013 CDC report showed that rate of deaths from heart disease and stroke is 20% greater for Black people than White. That’s 6,942 deaths every year that could be prevented if racial inequality was addressed. The same report showed that the infant death rate is 130% greater for Black children than White. That’s 4,576 Black babies that don’t live to see their first birthdays because of racial disparity.

When I say that racism kills, I am speaking to these thousands of deaths that occur every year because of the racial injustice that permeates our nation. When I wear that pin, it’s because the deaths of four thousand Black babies every year is a tragedy and an injustice and it matters.

As a profession that is committed to preserving health and prolonging life, we have a duty to push back against all things that threaten the well-being of our patients. That is why I wear this pin and will continue to do so.

If you wish to take a stand in your workplace as well, I encourage you to order your own Black Lives Matter pin here: http://www.radicaldreams.net/product/black-lives-matter-lapel-pin

 

EDIT 5/16/17: An earlier version of this post stated that “4,813 Americans died at the hands of police every year.” This has been corrected to state “between 2003 and 2009 4,813 Americans died at the hands of police.”

Holding Professional Societies Accountable

Shortly after Donald Trump nominated Dr. Tom Price to serve as Secretary of the Department of Health and Human Services, the American Medical Association, the Association of American Medical Colleges, and the American Academy of Family Physicians released statements supporting his nomination without reservation or qualification.

Many doctors were shocked to see these endorsements from their professional organizations knowing Dr. Price’s legislative track record as Representative from Georgia’s 6th district since 2005. As the New York Times editorial board describes in detail, Dr. Price has repeatedly acted against the interest of Americans’ health and well-being during his time in Congress. For example:

  • He repeatedly voted for legislation to dismantle the Affordable Care Act, threatening to eliminate the health insurance of tens of millions of Americans.
  • He introduced legislation to defund Medicaid for millions of low-income patients who rely on it for life saving medical care.
  • He voted against expansion of the SCHIP program which provides health insurance coverage for children.
  • He repeatedly voted for legislative interference in women’s medical decision-making around their reproductive health and is rated at 0% by the Planned Parenthood Action Fund.

In other words, although Dr. Price earned his MD from an accredited institution, his actions have demonstrated little respect for the Hippocratic oath.

The reaction of physicians was swift and fierce. Thousands of doctors publicly denounced the AMA. An equal contingent of medical students condemned the AAMC. The National Physicians Alliance joined the fray. In response, the AMA and AAFP privately sent emails to their members reassuring them that these organizations’ values remained unchanged, but without public advocacy for those values, what meaning do they have?

As physicians, doing everything in our power to promote the health and well-being of our patients is not a corny mission statement to copy-and-paste onto a website and ignore when it’s inconvenient. It is the driving force of our clinical, academic, and political practice.

In 2016, when there is so much at stake for our most vulnerable patients, it is a time for personal and professional courage. It is time to call upon our professional societies to stand with us in the fight to ensure that all Americans have access to high quality medical care without legislative interference in the doctor-patient relationship. It is time for these organizations to state clearly the patient-centered principles that they believe in most strongly, and to advocate for these principles on every level.

Opportunities for action (list will be updated)

  1. Call your congressional representatives and voice your support for the greater access to healthcare services and opposition to Tom Price’s nomination. 
  2. Open letter to the AAFP from family doctors
  3. Open letter to the AMA from physicians
  4. Open letter to the AAMC from medical students

 

Subverting Whiteness

This article on John Brown and White people’s anti-racism is really thought provoking and I strongly recommend reading it, especially if you identify or are identified as White.

In the essay, the author argues:

“The “white” subject position is formed by and predicated on an assumed superiority over “non-white”. The entire history of whiteness is produced towards this end. More specifically “white” was/is produced, originally, in counterposition to “Black” and “Native” providing the ethical basis for African Slavery and Indian Removal. Alternately put, white supremacy is inhered in whiteness and there is no articulation of whiteness that is not also an articulation of white supremacy. This is to say that whiteness is defined by its subject position, not cultural production; it is the product of the colonization of Turtle Island and enslavement of Africans rather than an accumulation of traditions and influences. Whiteness’ only real tradition is white supremacy.”

[…]

“If, as white people committed to ending white supremacy in all its manifestations, we are serious, then we must consider our subject position forfeit. This is not the same as pretending positionality doesn’t exist and must not be carefully navigated. We must continue to undertake anti-oppression practices that somewhat mitigate our subject position’s power while doing the work to abolish it.”

I agree with the author that it’s not possible to subvert Whiteness by ignoring it. This “colorblindness” was the strategy of my own upbringing. There was never any explicit mention of my family’s Whiteness. Yet, it was also clearly demonstrated that non-Whites were an Other to be avoided. We were moved out of integrated public schools into segregated Catholic schools. We lived in segregated neighborhoods. Each action was done with good intentions, always with the pretext of “safety.” But by never discussing or asking why Black neighborhoods were unsafe or Black schools were inferior, I was taught that this is just the natural order of the universe. This silence taught its own lesson.

Rather than colorblindness, I think it is important for White people to be attuned to how Whiteness plays out in their lives, and utilizing this awareness take active efforts to dismantle the White subject position and cultivate an alternative subject position in its place.

This means speaking openly and honestly about the sociopolitical structures that privilege the position of Whiteness, particularly as they play out in our own lives. The purpose of this exercise is not cultivating guilt or shame, but to achieve a clarity of vision about how race works in the world.

Once we have gained some clarity on how Whiteness plays out in our lives, then we can work to subvert and sabotage the sociopolitical structures that privilege our Whiteness. This means calling attention to and actively resisting any space that we occupy that is disproportionately White. This means recognizing when we are offered credibility, congratulations, or promotions over peers of color and rejecting those benefits.

And if one feels that an alternative subject position must replace that of Whiteness, let that subject position be that of the anti-racist. Identity as action and action as identity. Such action will get you labeled as Race Traitor and likely care with it financial and interpersonal penalties. However, if one’s resistance to racism is only to the point of discomfort, then one is not resisting racism at all.

If you’re a White-identifying person interested in subverting Whiteness, here are some resources to start with: