S4E4: Radicalizing Health Care

Harjit: She was showing us her cute plant.

Bushra: My baby.

Harjit: She's a plant mom now. So cute.

Margaux: Does she have a name?

Bushra: Oh no, I should give her a name, huh? Okay. Hey everybody. Welcome back to the "Bundle of Hers." We are continuing our conversation about radicalism and we continue this conversation talking about radical moments in healthcare.

Harjit: So I really am excited about this episode because I think we are now going to bring it back to our home-base, right? Healthcare. And this is a place where we are currently in as interns all the time, all day long, but we're here. And I've been thinking a lot about how can I, as an intern, I can use this radical consciousness in all of my actions, right? One thing that I like to look at is radical moments in healthcare in our history. There's a lot you can learn from the past, and I think one of the strongest groups is black physicians that we can look to. And I think their stories are powerful because as Bushra had alluded in the past episode, a lot of the times out of necessity, we have to become radical thinkers, right? We need to imagine a world differently because the one that we exist in is killing us or our people.

I wanted to start talking about this doctor named Montague Cobb, right? He was this doctor, a black physician, and he was an anatomy educator at Howard University. And his story actually starts before him, okay? In 1947, Truman proposed something similar to universal healthcare. And at that time, the American Medical Association was exclusively white. They excluded black doctors from basically joining much of their chapters, and they were very for-profit. Insurance was becoming private at this time. They were also this organization that refused to protest the separate but equal clause that legalized hospital segregation, right, during this time.

So they hired this PR company and they have this slogan "Keep Politics out of Medicine," and they were giving newspaper ads, TV ads, newsletters, you know, sending things in the mail, blasting the American people that we shouldn't have this universal healthcare that Truman is proposing. And it worked. Whatever they did, that bill didn't pass and time moved forward.

So, in 1963, what Dr. Cobb did is he took leadership at the National Medical Association. So National Medical Association was this other chapter that was very similar to the American Medical Association, but it was inclusive of black physicians, right? And so he was like, "Okay, not only can I fight for universal healthcare, but I also want to fight for the desegregation of hospitals." And this culminated to a proposal of Medicare. And they basically targeted old people because I think they were like, "We need to get good traction on this."

Again, the American Medical Association came to fight against this bill, but this time, the black doctors organized, right? They organized. They got together. They were like, "We want to see this world, and we also want to see the desegregation of hospitals." So that's what we need to tackle. Their idea was they knew that hospitals would want Medicare because it's money, but the only way they would get that money is if they comply to federal law. And at that time, the Civil Rights Act of 1964 had passed, so not only would they get this money, but then they would also have to desegregate their hospitals, right? They saw this as a double whammy, basically.

So then they were fully supporting this, and in the end, the Medicare bill passed and 3,000 hospitals within 4 months desegregated. Who would have imagined that, right? That is radical thinking at its finest. There was this Dr. Cobb who was like, "I want to see a world where hospitals are desegregated," and within 4 months, 3,000 hospitals. That's, like, a lot, right? So that's a moment that really, really, really shows me what it means to be a radical thinker in healthcare, and that it can be done.

Bushra: Speaking of radical thinking and radical action, as most of you guys know, I'm doing my residency at Duke University, and that's in North Carolina. And as a lot of people know, there's a lot of voter suppression that goes on in majority African-American heavy areas, and so an initiative that was started by one of our ER docs, Dr. Haramol Gill and a few other people is that we have basically these little badges with QR codes to register patients that come into the ER to vote. And so we carry around these little badges and so people are able to click on it and get help, get registered to vote, which is very, very, very, like, important for people to be able to cast their vote. I think this, in and of itself, is very radical because we don't necessarily think about hospitals being a place where we can engage people in the political process as Harjit's story kind of mentioned. And so this is an amazing effort to kind of combat that.

Margaux: I just want to say really quick. We're also doing that too, and I didn't know that it started at Duke, but they gave us those same cards to put on our badges. And mostly we're helping our pediatric patients' parents register to vote. But that's really cool.

Bushra: I don't know that it actually started at Duke, but this is one of the things that we're kind of working towards.

Harjit: I think that's awesome, Bushra, because the American Medical Association built this slogan, "Keep Politics out of Medicine." And I think this is something we're going to explore further in this season, but how do you keep politics out of medicine if every single decision of yours is influenced by politics, right? And I think that this is another example of separating things and not understanding that things are complex and they're connected and they're interconnected. So I think it's beautiful that we can, in some way, have a direct action and see a world where we're having these conversations in the medical realm.

Bushra: I just wanted to touch upon the American Medical Association and how in its advent black physicians were not able to be a part of "The American Medical Association," simply because they were black. I think these are the kinds of things that we need to highlight within the historical context of this country and this medical system that it is inherently racist in that there are things that trickled down from then that affect people today. And so the fact that the National Medical Association needed to be created in order to be more inclusive is very telling. I think it's important for the American Medical Association to highlight its history to shed a light to its racist past because without investigating and righting their wrongs, I don't think that you can move forward as a progressive institution without it.

Harjit: I totally agree with that, Bushra. And you kind of were talking about the racist history of not only the American Medical Association but also just, you know, medicine in general. There was another really radical thinker that I wanted to talk about. Her name was Rebecca Lee Crumpler. She was basically a nurse who became a doctor, and she was the first black woman physician. And the year after she graduated medical school, she decided to work at the Freedmen's Bureau medical division. So this was the same time the Civil War had ended and 4 million people that were enslaved became free, but they became free with nothing. These people basically built the wealth of what the white people were living on, but they had nothing in their pockets. And that caused a huge public health crisis.

And you can just imagine that. Think of entire population of people having nothing and then having to go out into the world, conditions that they had to live through. And so that is why they created this Freedmen's Bureau. And so she started working there, but it was interesting because it was only housed by 100 doctors. And it was basically created to keep white communities "clean," right?

And I think a lot of people felt like we don't want to give free assistance to these people because it would create dependence, which is such an interesting concept because, you know, these enslaved individuals were basically giving people money for free. Their owners were taking their free . . . like, they were living off of them.

I think this also was the time where that whole narrative that black people are biologically inferior than whites and they're ill-suited for freedom and that's why they're dying at such high death rates, not acknowledging that America was what set them up to become that way, right?

And I think, Bushra, this is tied into what you just said because I think being a radical thinker is, yes, you're breaking out of that cycle, but you have to know what that cycle is.

Bushra: If you think about it, every catastrophe that happens in this country since the abolition of slavery affects the most vulnerable, the disenfranchised, and the poor, and those people are people of color. That, in and of itself, starts at the beginning of this country and how it was built. And it's not a coincidence that that's what it is. I mean, look at COVID-19, you know. Who does that affect the most? Who have the worst outcomes because of this pandemic?

Margaux: And like you said, Harjit, the part of being a radical thinker is recognizing and knowing the cycle and the factors and the history that have built it and influence it, and then working to change and disrupt it.

Harjit: Exactly that. I think one of the most important part of this story that I missed was what Dr. Crumpler did then is she wrote this book, not for doctors. She wrote this book for, like, black mothers, black fathers, and, like, how you could treat people within your own community. And that is one thing that I really love about, like organizing spaces that are productive is you take people's strengths and their skills, and you don't need to be educated.

Margaux: And one of the radical moments in medical history that I think about and that influences me, and I know it's not focused on BIPOC person but is Joseph Lister who was a surgeon in the mid to late 1800s. And this was before germ theory existed and they actually, you know, were operating on people, a), without anesthesia, but also b), without, like, gloves and sterile technique. And they actually thought that, like, pus was a normal part of healing. And so just imagine that, and then Joseph Lister had essentially the audacity to challenge his mentors and the revered leaders in surgery at that time to say, "Wait, wait, wait, wait. So many of our patients are dying from these, like, infections in post-surgical recovery. We must be doing something wrong."

And so he was able to challenge the leaders in that cycle that we were talking about. And he couldn't change at that level, you know, by talking to his mentors and stuff, but what he did was start by teaching his students his way of, like, "Maybe we should start thinking about germs theory," and he, you know, created antiseptic technique with carbolic acid and essentially had improved mortality rates than his peers.

And so I think about that all the time and it's like . . . and we talked about this in the last episode where our teachers and our academic system is not always correct, and we have to challenge and question it. And that means challenging and questioning the people who are considered leaders in healthcare or who are considered the experts. And right now thinking about, like you said, Bushra, confronting the racist history, which has led to how racism still infiltrates our healthcare system today and challenging people who think or say that, you know, only talking about it in a historical context. And so really stepping forward and being comfortable challenging those people who have taught us and, you know, done a great job, but also that's part of being a radical thinker is recognizing when you have your own deficits, right?

Harjit: Margaux, I think that's a great segue into how do we create radical frameworks of thinking, and how do we create action in them as well, right? I always say that I think what is kind of the beginning or foundational of a radical framework is that internal reflection. So you gave this example of Dr. Lister and how he had to work with his students to kind of push this antiseptic movement forward, right? And it required him to know that he can get education from every place, right? And work together with people from, you know, different levels of education to make something happen. And I think you can't build a radical framework until you are okay with collaborating and working with people. And I think that goes back to that definition we gave in the first episode on this topic about how action is done when you're engaging with others.

Margaux: I definitely agree. And that's something I'm trying to incorporate as a resident now is what can I learn from med students, and what can I learn from the environmental services staff, and what can I learn from the dietician? And can I be more open to having conversations with these people about their experience in this system, and how can we work together to change it?

Harjit: Right. And I think the first step is working with people. The second step is developing your voice, right? I think that is a really important key is when you talk to others you develop knowledge, in that knowledge, then you develop your own thinking, right?

Bushra: And just in the scheme of working in a collaborative environment, I just wanted to bring up one quick thing. There's this idea of professionalism and what it means to be professional. And I think that a lot of times that stifles the collaborative environment. I think there's a difference between mutual respect for people. And then professionalism has been used as a tool to kind of stifle you and to . . .

Margaux: A tactic.

Bushra: Yeah, exactly. That's exactly what it is, Margaux. It's a tactic that's been used pretty well to say that the way that you dress and the way that you look and the way that your hair is and the way that X, Y, and Z is unprofessional, and therefore not invited into this space of collaboration, especially in healthcare. And I just want to call bullshit on that real quick, because I think what should be thought as of "professional" is, should be, and I want to underline this and highlight it is mutual respect for one another, and anything regardless of that should not have anything to do with professionalism at all because the way that someone looks and dresses should not deter you from listening to them, taking in their opinion as valuable. That's just me.

Harjit: When I have a thought that's way out there, and I introduce it, it's been an academic space and people are saying, "Oh, that's such a radical thought." And this goes back to our very first episode on this topic that it's such a negative thinking to have a radical thought, but you know what I think the problem is it's oppression cannot be perpetuated if we start thinking radically and start doing things radically every single person. And I think that's what's the core at it. The system is benefiting the people that want to stay benefiting, and so that's why all of these tactics are used. So our radical thinking is also oppressed. We're not allowed to be imaginative people. We're not allowed to question things. We're not allowed to say, "This needs to change," but I think a lot of us are sick of it.

Bushra: I think that it's interesting because it's like it's almost thought of as you're supposed to change who you are once you walk into that kind of environment because you don't want to be perceived as unprofessional, but I want to stay true to who I am and what my values are and the way that I speak and the way that I talk. And I don't want to change my personality to make someone else feel comfortable.

Harjit: Period.

Margaux: Done. Mic drop.

Harjit: Underline. And that's it. I think to create a radical framework in healthcare we need to first change the way we think about things, and then actually try to investigate and work with people with different experiences and then come together and utilize your voice, first, develop it, and then utilize it, and share your ideas with others because this is something that we've been saying since season one that our voice is important, it's powerful, and we should never be afraid to let people know how we feel about things. That I think is kind of the biggest takeaway that I have from having a radical framework is a lot of the work starts by internal reflection and within oneself, and then it's engaging with your community. And I think that happens at the same time. It's not like one after another. That happens together, and then it's actually developing into action.

Margaux: Agreed.

Harjit: I hope everyone is imagining a new world for themselves and dreaming that there is the possibility for change. Because like I said before, I often, you know, fall into this pattern that things are going to stay the way they're going to stay, so why should I do anything? And I'm not going to lie. I have those moments, and there are those moments of exhaustion, but that doesn't mean we ever stop doing what we need to do.

Bushra: Absolutely.

Harjit: And so I think with that, thanks for listening. Please check us out on our social media platforms @bundleofhers. If there's anything you want to share or any thoughts that came up, please leave a comment on our social media pages. You can also call in to the listener hotline at (601) 557-2673. Again, that's (601) 557-2673. Also "Bundle of Hers" is part of "The Scope Presents," and there are a bunch of other great podcasts that you can check out on this network.

Bushra: Until next time, folks, stay radical and bye-bye.