Categories
disability Disability Issues Empathy Healthcare Disparities Medical Humanities Patient-Centered Care

Why as a society is difference viewed as unattractive?

Why as a society is difference viewed as unattractive?

By Lauren Higgins

 

Cherri (2022) The Adoration of the Golden Calf

 

The artefact I have selected is a lamb taxidermy called, ‘The Adoration of the Golden Calf, after Poussin’, which was created in 2022 by Ali Cherri and finished using wood, jesmonite and gold leaf.

The piece was commissioned in 2021 as part of the National Gallery Artist in Residence programme and sat within the Sainsbury wing of the art museum as part of the ‘If you prick us, do we not bleed?’ project.  This exhibition focused on historical pieces which had been vandalised when displayed, with Cherri assembling individual artworks to reflect the trauma of the original. This taxidermy of a lamb that died due to severe birth abnormalities, specifically relates to the Golden Calf depicted in the work of Poussin, which was destroyed with spray paint in 2011 (Wilson, 2011).

This unusual, alien-like figure immediately captured my interest, as it stood in high contrast to the beautifully depicted biblical scenes of the Renaissance paintings which surrounded it. Centred within the gallery, I also noticed that this artefact had caught the attention of large crowds, with many recoiling in disgust and horror at the physical appearance of the lamb. It has often been deemed human nature to be captivated and intrigued by the unknown or different, however the pure hatred that was directed towards this piece simply due to its distorted appearance shocked and outraged me. I, therefore, began to consider the animosity that individuals who suffer from noticeable deformities face, and the challenges of living in a society that doesn’t fully accept those who are atypical.

The distinct characteristics of the lamb also reminded me of the infamous Siamese conjoined twins. I thought about the struggles they must have encountered not only due to the disability itself, but also the unwanted views and opinions of society at the time.  I wondered whether after 100 years since their death if they would receive a similar reaction of repulsion which I witnessed being directed towards the abnormalities of this figure (Bahjat, 2018). Moreover, this sculpture encouraged me to reflect upon my own disability; the impact it has had on my life and the additional challenges I shall encounter as a medical student.

Throughout history, individuals deemed to be ‘medical oddities’, have been subject to curiosity from the public audience and even used as forms of entertainment for the so-called freak shows (Grande, 2010).  The exhibition of extraordinary bodies occurred across Europe and America during the Victorian period, whereby physical difference was seen as a profitable market (Durbach, 2012). Chang and Eng Bunker, credited as the original Siamese twins, were examples of individuals showcased around the world for paying audiences (Bahjat, 2018). The Bunker brothers were attached at the breastbone via a ‘small piece of cartilage’, but each had their own set of organs and body, allowing them to carry out the activities of a normal man (Bahjat, 2018).

At just the age of 17, the brothers’ peculiarities were identified as having ‘commercial potential’ by Robert Hunter, who proceeded to buy the boys from their mother in Thailand and exhibit them across the globe (Leonard, 2014). The idea that the Bunker brothers, and so many other individuals with physical deformities, were used as amusement for others is deeply saddening (Kattel, 2018). The humiliating and dehumanising nature of freak shows makes me consider the psychological implications patients with physical disabilities must endure due to the strain of unsolicited comments and community opinions.

Alongside the link to the Siamese twins, the structural deformity of the artefact reminded me of my own physical anomaly. I have an idiopathic form of scoliosis, which is the lateral deviation of the vertebral column without a known cause (Martin and Law, 2020, p.692). As a result, I have uneven hips and shoulders, poor posture, severe back pain/ discomfort, and lowered self-esteem due to an obvious hump-like structure caused by the posterior raising of my ribcage (kyphosis). Similarly, to the ‘freaks’ of the 19th century, I have personally been subject to wondering eyes, judgmental expressions, and hurtful remarks about my appearance when out in public (Grande, 2010). I, therefore, have experienced first-hand the damaging mental health consequences indirectly connected to my disability.

Although my scoliosis has posed many additional challenges in my life, I believe that having a disability as a medical professional may be advantageous in being able to effectively empathise with patients suffering from other long-term health issues. With disabled people aged between 16-64 reporting lowered well-being ratings on happiness; worthwhile and life satisfaction scores; and increased anxiety levels than non-disabled counterparts, the NHS is currently failing to provide adequate support to those with continuing health problems (Office for National Statistics, 2021). Hence, as a training doctor, I recognise that I will be in a privileged position to raise awareness about the psychological burden of lasting illness among my able-bodied colleagues and the general public. In doing so, I hope that healthcare workers will begin to take a holistic approach in viewing disability and think further than treating the body and look also to healing the mind.

The introduction of the Equality Act 2010, was a positive step into protecting people with disabilities from discrimination within the workplace and wider population, demonstrating the unquestionable progression society has made in accepting disability from the brazen Victorian freak shows. Such legislation introduced by the government has had an instrumental influence in encouraging people with disabilities into employment and societal activities (i.e., sports, community groups and higher education). For example, between 2013 – 2020, there was an increase of 8.1% in the proportion of disabled people in employment, with 2.6 million disabled women and 1.8 million disabled men working, demonstrating the constructive role of such parliamentary bills (Powell, 2021). Although the apparent improvements, the uneducated reactions I witnessed towards the lamb’s defects, along with my own experiences, would suggest that even in the 21st century, disabled people are inevitably going to be made to feel unsafe by the minority who still view difference as ugly.

 

In conclusion, the artefact identifies and represents the exploitation of vulnerable individuals with deformities and highlights the dangerous way humans react to things that they are unfamiliar with. I observed how most of the responses to this piece within the gallery, were profoundly negative, and I have come to believe that this reaction of repugnance is reflective of the poor treatment of disabled people within today’s society. This piece has led to me uncovering the failures of the healthcare system in the past to protect individuals most at risk from mistreatment and has opened my eyes to the challenges I may encounter during my medical career in terms of counteracting negative public perception of disabilities.

Although legislation introduced by the government aims to pave the way for a more optimistic future whereby disabled people are not faced with judgment and prejudice, such discrimination is rooted within British history, and thus I appreciate it will take time to fully shift public opinion. I, therefore, hope in the future as a medical student, I can educate those around me about the damaging consequences of ignorance towards difference, and support those who face maltreatment because they do not fit into the idealistic prototype pushed by society.

Reference list-

Bahjat, M. (2018) Chang and Eng Bunker (1811-1874). Available at: https://embryo.asu.edu/pages/chang-and-eng-bunker-1811-1874 (Accessed: 13 April 2022).

Cherri, A. (2022) The Adoration of the Golden Calf, after Poussin [taxidermy] The National Gallery, London (Viewed: 11 April 2022).

Durbach, N. (2012) ‘Skin Wonders’: Body Worlds and the Victorian Freak Show’, Journal of the History of Medicine and Allied Sciences, 69(1), pp. 38-67. Available at: https://doi.org/10.1093/jhmas/jrs035

Equality Act 2010, c. 1. Available at: https://www.legislation.gov.uk/ukpga/2010/15/part/11/chapter/1 (Accessed: 13 April 2022).

Grande, L. (2010) ‘Strange and Bizarre: The History of Freak Shows’, Things said
and done. Available at: https://thingssaidanddone.wordpress.com/2010/09/26/strange-and-bizarre-the-history-of-freak-shows/ (Accessed: 12 April 2022).

Kattel, P. (2018) ‘Conjoined Twins’, Journal of Nepal Medical Association, 56(211), pp.708-710. Available at: https://www.jnma.com.np/jnma/index.php/jnma/article/view/3526/2764 (Accessed: 12 April 2022).

Leonard, T. (2014) ‘How the original Siamese twins had 21 children by two sisters… while sharing one (reinforced) bed’, The Daily Mail, 7 November. Available at: https://www.dailymail.co.uk/news/article-2825888/How-original-Siamese-twins-21-children-two-sisters-sharing-one-reinforced-bed.html (Accessed: 13 April 2022).

Martin, E. and Law, J. (eds) (2020) Concise Medical Dictionary. 10th edn. Oxford: Oxford University Press.

Office for National Statistics (2021) Outcomes for disabled people in the UK: 2020. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/articles/outcomesfordisabledpeopleintheuk/2020 (Accessed: 27 April 2022).

Powell, A. (2021) Disabled people in employment. (House of Commons Library briefing paper 7540). Available at: https://researchbriefings.files.parliament.uk/documents/CBP-7540/CBP-7540.pdf (Accessed: 13 April 2022).

Wilson, C. (2011) ‘Man held after Poussin painting is vandalised at National Gallery’, The Guardian, 17 July. Available at: https://www.theguardian.com/uk/2011/jul/17/poussin-attack-national-gallery (Accessed: 12 April 2022).

Categories
Emotion Empathy General Reflection Women's Health

In the Face of Loss: A Medical Student’s Journey Through Devastation and Discovery

By Melissa Bonano

Amidst the flurry of activity in a busy emergency department, an urgent call cut through the chaos, leading me to a profound realization about my path in medicine. “There’s a patient actively miscarrying in the restroom,” the message crackled with urgency and distress. Instantly, my focus sharpened as I grasped the gravity of the situation. A nurse, visibly shaken, relayed that a woman, bleeding heavily at 14 weeks into her pregnancy, required immediate assistance. In that moment, a wave of recognition washed over me—I had encountered this patient during triage.

Racing to her side, I found her standing over the toilet, clutching a fetus in her hand, tears streaming uncontrollably down her face. With the nurse momentarily frozen in the doorway, I was alone. The reality of the situation crashed over me as I realized I was the only one there to provide immediate support. Her heart-wrenching plea, “Can you help him?” pierced through the chaos, and I knew I had to deliver the heartbreaking truth.

A storm of thoughts swirled in my mind. How do you convey the finality of such a profound loss when you are unprepared? Despite lectures and TV portrayals, nothing had truly prepared me for this moment. As a medical student, all my training and knowledge suddenly felt inadequate in the face of such raw grief. As I crouched beside her, my arm wrapped around her shoulders for support, I summoned every ounce of compassion and clarity I could muster. I gently conveyed the harsh reality that there was nothing more we could do for the baby, softly explaining that it was too early in her pregnancy for him to survive. She nodded in understanding, her breaths interspersed with sobs. I cradled her baby in my hand as I guided her into a wheelchair, engulfed by a wave of helplessness. Her cries, the most gut-wrenching I had ever heard, reverberated around me. Witnessing her grief was agonizing; my words felt feeble in the face of such profound loss.

After settling her into her room, I remained by her side, determined to offer whatever comfort and support I could in her darkest hour. Despite my reassurances, her pain was palpable, an all-consuming sorrow that left me feeling powerless. My aspiration to heal seemed futile against the magnitude of her suffering. A part of me longed to stay, to be her anchor through this harrowing ordeal, but another part of me, the novice, wanted to escape, to avoid ever facing something so heartbreaking again.

As she was eventually transferred to the labor and delivery floor, I made my way back to the bustling ER that seemed unchanged, indifferent to the storm I had just weathered at this mother’s side. I sat back at my computer, staring blankly at the list of patients waiting to be seen when a hand gently landed on my shoulder. My preceptor stood beside me, his presence a silent acknowledgment of my turmoil. Without looking me in the eye, without asking a single question, he said, “Take 5 minutes.”

Take 5 minutes. Take 5 minutes to reflect on what it means to be a doctor. Take 5 minutes to absorb this rude awakening of what can unfold on any given day. Take 5 minutes to understand that despite the overwhelming difficulty of what I had just experienced, it was precisely what I was here to do—to stand beside those in their moments of greatest need. As I walked out into the quiet of the ambulance bay, a profound realization dawned on me. Despite its unconventional and heart-wrenching nature, I felt a deep, undeniable call to be there for every mother who needed me. It was on that day, amidst the sorrow and the struggle, that I found my true calling—to be an obstetrician and gynecologist, dedicated to supporting and caring for those who need it most.

Categories
Healthcare Cost Healthcare Disparities Innovation Technology

The Transformative Power of Telehealth: A New Era in Modern Healthcare

By Dipti Shah

Introduction:

Telehealth has rapidly evolved from a supplementary healthcare service into a vital component of the modern healthcare system. Spurred by the COVID-19 pandemic, its adoption has skyrocketed, offering a glimpse into a future where healthcare is more accessible, efficient, and patient-centered. This article explores the profound impact of telehealth on expanding access to care, improving cost-effectiveness, and the challenges that remain for its widespread implementation.

Expanding Access to Care:

Telehealth’s most significant advantage lies in its ability to extend healthcare access to populations previously underserved. For rural communities, where access to specialized care is often limited, telehealth has marked improvements in health outcomes. A 2021 study published in The Journal of Rural Health found that telehealth reduced the need for travel to urban centers for specialist consultations by approximately 30%, bridging the gap in healthcare access for rural populations. Additionally, telehealth has been particularly beneficial for individuals with mobility challenges and chronic conditions.

For example, a study by Doraiswamy et al. (2022) highlighted a 30% increase in healthcare utilization among patients with mobility impairments, leading to better management of chronic conditions such as diabetes and COPD. Furthermore, telehealth’s convenience has significantly increased patient adherence to treatment plans. During the COVID-19 pandemic, the American Medical Association reported a 35% increase in telehealth visits for chronic disease management, underscoring its role in enhancing long-term health management and improving overall patient outcomes. These examples demonstrate how telehealth effectively bridges access gaps, supports diverse patient needs, and fosters improved health outcomes across various populations.

Cost-Effectiveness and Efficiency:

Telehealth is not only improving access but also contributing to cost savings within the healthcare system. By reducing the need for in-person visits, telehealth decreases transportation costs, time off work, and other associated expenses. Additionally, telehealth can help to alleviate the burden on emergency services by offering an alternative for non-emergency consultations, leading to a more efficient allocation of healthcare resources.

A 2022 study published in Health Affairs estimated that telehealth could save the U.S. healthcare system over $10 billion annually. These savings are primarily attributed to the reduction in unnecessary hospital visits and the optimization of care delivery processes. As healthcare costs continue to rise, telehealth presents a viable solution for enhancing efficiency while maintaining high-quality care.

Challenges and Considerations:

Despite its many benefits, telehealth faces challenges that must be addressed to ensure equitable access. The digital divide, characterized by disparities in access to technology and reliable internet, poses a significant barrier to widespread telehealth adoption. Low-income households, elderly populations, and those in remote areas are particularly vulnerable to this divide, limiting their ability to benefit from telehealth services.

Regulatory and reimbursement challenges also hinder the full integration of telehealth into the healthcare system. While the pandemic prompted temporary regulatory relaxations, permanent solutions are needed to sustain telehealth’s growth. Policymakers are currently working to streamline these regulations and improve reimbursement policies, but continued efforts are essential for long-term success.

Conclusion:

Telehealth represents a transformative shift in healthcare, with the potential to make care more accessible, cost-effective, and patient-centered. As the evidence in favor of telehealth continues to grow, it is imperative that healthcare systems and policymakers work together to address the challenges and fully integrate telehealth into the continuum of care. By doing so, we can ensure that the progress made during the pandemic is not just temporary but forms the foundation of a more resilient and equitable healthcare system.

Bio:

Dipti Shah holds a master’s in physical therapy and has over 10 years of experience in the field. She is passionate about integrating innovative healthcare solutions, such as telehealth, to improve patient outcomes and accessibility. Dipti’s insights are informed by her extensive clinical experience and commitment to advancing modern healthcare practices.

References:

  1. The Journal of Rural Health. “Telehealth’s Role in Rural Healthcare Access.” 2021.
  2. American Medical Association. “The Rise of Telehealth During the COVID-19 Pandemic.” 2021.
  3. Health Affairs. “Telehealth and Its Potential for Cost Savings in U.S. Healthcare.” 2022.
  4. American Telemedicine Association. “Policy and Regulatory Considerations for Telehealth.” 2023.
  5. The Nielsen Company. “The Role of Telehealth in the Modern Healthcare Landscape.” 2022.
Categories
Clinical Mental Health

Why Should We Sleep Every Night?

By Mohamed Ahmed Abu Elainein

Sleep is a fundamental aspect of human life, often underestimated in its profound impact on our health and well-being.

In the midst of exams and busy schedules, the temptation to sacrifice sleep for extended work hours may arise, but understanding the inherent benefits of sleep is crucial to maintain a healthy and balanced lifestyle.

The Centers for Disease Control and Prevention (CDC) recommends that adults should aim for a minimum of 7 hours of sleep per night. [1]

This guideline is not arbitrary; it is rooted in extensive research that highlights the multifaceted advantages of adequate sleep.

Sleep serves as more than just a period of bodily rest; it is a vital process that contributes significantly to our physical, mental, and immune functions.

A cross-sectional study conducted from April 2013 to December 2014 examined the sleep patterns of night shift workers and found that those who slept fewer hours had a higher incidence of high body mass index (BMI) and weight gain. Remarkably, this association persisted independently of age and gender. [2]

This underscores the intricate link between sleep duration and metabolic health, shedding light on the importance of sleep in weight management.

Athletes, whose physical performance is paramount, also stand to benefit significantly from sufficient sleep.

A systematic review of the literature revealed that sleep extension positively influences athletes’ performance and enhances their recovery. [3]

This insight emphasizes that sleep is not only a recovery mechanism but also a proactive factor that can contribute to improved athletic outcomes.

A Review Article demonstrated the significant impact of sleep on enhancing athletic performance through various mechanisms. It helps the body restore its immune and endocrine systems, recover from the strain of waking hours, and supports cognitive development. Different stages of sleep, like REM and NREM, contribute to memory consolidation and physical recovery in their own ways. NREM helps save energy and recover the nervous system, releasing growth hormone and reducing oxygen consumption. REM is important for brain activation, localized recovery, and emotional regulation. Overall, quality sleep with its various stages is crucial for athletes, influencing memory consolidation and adapting to the cognitive demands of sports. [4]

Moving beyond the physical realm, the mental health implications of sleep cannot be overlooked. Studies consistently show that individuals who experience poor sleep quality are more likely to report mental distress and anxiety. [5]

The intricate relationship between sleep and mental well-being underscores the role of sleep in emotional regulation and cognitive functioning. Adequate sleep is not merely a luxury but a foundational element in maintaining optimal mental health.

Sleep is important for a healthy brain. Different sleep stages affect how we think and remember things. Research shows that sleep has a big impact on our emotions and mental well-being. Getting enough sleep, especially the type with rapid eye movement (REM), helps our brain process emotions. If we don’t get good sleep, especially the positive kind, it can affect our mood and emotional reactions. It’s not just that sleep problems can show up because of mental health issues; they can also be part of what causes these problems. [6]

Moreover, the influence of sleep extends to our immune system. Research demonstrates that insufficient sleep can compromise the immune system, making individuals more susceptible to infections. [7]

A study published on European Journal of Physiology demonstrated that Sleep and our body’s internal clock have a big impact on our immune system. When we sleep, certain immune factors peak, promoting inflammation and aiding in immune cell functions. Daytime wakefulness, on the other hand, is associated with different immune responses. Sleep seems to help immune cells move around and interact effectively. Research also shows that a good night’s sleep enhances our immune memory, especially during specific sleep stages. These effects are linked to the hormonal changes that occur during sleep, like increased growth hormone and prolactin, and decreased cortisol and catecholamine levels. [8]

The intricate interplay between sleep and immune function highlights the role of sleep as a protective factor against illnesses and underscores its significance in overall health maintenance.

In essence, sleep is a dynamic process that encompasses a myriad of benefits for both the body and mind.

The CDC’s recommendation of 7 hours per night is not arbitrary but a well-founded prescription for fostering a holistic state of health. Whether it’s the regulation of body weight, enhancement of athletic performance, or preservation of mental and immune functions, sleep plays a pivotal role.

Recognizing the importance of sleep not only dispels the notion that it is a form of time-wasting but prompts a reconsideration of its prioritization in our lives.

In the hustle and bustle of daily activities, acknowledging sleep as a non-negotiable element of self-care becomes imperative.

As we navigate the demands of modern life, ensuring that we allocate sufficient time for restorative sleep is a conscious investment in our long-term health and well-being.

References

1. How much sleep do I need? [Internet]. Centers for Disease Control and Prevention; 2022 [cited 2024 Feb 5]. Available from: https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html

2. Brum MC, Dantas Filho FF, Schnorr CC, Bertoletti OA, Bottega GB, da Costa Rodrigues T. Night shift work, short sleep and Obesity. Diabetology & Metabolic Syndrome. 2020 Feb 10;12(1). doi:10.1186/s13098-020-0524-9

3. Bonnar D, Bartel K, Kakoschke N, Lang C. Sleep interventions designed to improve athletic performance and recovery: A systematic review of current approaches. Sports Medicine. 2018 Jan 20;48(3):683–703. doi:10.1007/s40279-017-0832-x

4. Fullagar HH, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T. Sleep and athletic performance: The effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Medicine. 2014 Oct 15;45(2):161–86. Doi:10.1007/s40279-014-0260-0

5. Blackwelder, A., Hoskins, M., & Huber, L. (2021). Effect of inadequate sleep on frequent mental distress. Preventing Chronic Disease, 18.

https://www.cdc.gov/pcd/issues/2021/20_0573.htm

6. Mental health and sleep [Internet]. 2023 [cited 2024 Feb 14]. Available from: https://www.sleepfoundation.org/mental-health

7. 8 health benefits of sleep [Internet]. 2023 [cited 2024 Feb 5]. Available from: https://www.sleepfoundation.org/how-sleep-works/benefits-of-sleep#references-82908

8. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflügers Archiv – European Journal of Physiology. 2011 Nov 10;463(1):121–37. Doi:10.1007/s00424-011-1044-0

Categories
Emotion Empathy Law Public Health

Through the Green Lens

By Rana Moawad

When will we learn that children belong running around, not lying under the dirt?

School days are interrupted by loud bangs of shots and dead bodies hitting the hard ground. Only 150 days in 2023, and we had 263 mass shootings, but who is counting anyway? Mass shootings are becoming the new norm; we scroll past the news reports like we are scrolling through ads. I refuse to be negligent of our children’s plight. Wearing my medical student white coat means I have a duty to serve my community. I joined Promise Neighborhoods of the Lehigh Valley (PNLV) to end gun violence.

While interviewing community members at PNLV on their views of healthcare, I met “Green.” She embodies the story of many women before and after her. A daughter of an immigrant woman trapped in an abusive relationship, Green ran away from home when she was 11 years old. She survived the streets and bore two boys.  It was not long until the violence outside made its way into their home.  No mother should have to say a final goodbye to her 17-year-old son, gone too soon from the bullets. A child is gone and another is in prison. Yet still, guns here and there.

How much more can the fragile heart take before it shatters? They say they care about people like us, but all they see is a paycheck waiting to come. Never taking the time to listen, but they call themselves healers and changers. Listen to our pain and our hardships, and maybe then you will make a difference. Do this, do that, take this, take that; medicine is nothing but a to-do list, with practitioners needing to take the time to listen. They tell me I have this disease and that, but do they even know my name? If they took the time to listen, they would see the Green I embody. 

Inside her green eyes lie the stories of those before her and those to come: a warrior, a grandmother, a mother, and an activist. She stands for all those who do not have a voice.

When will we fight together to prevent gun violence? Gun violence is killing our youth, waiting for the next victim…would that be me or you?

Bullets are flying. Children are dying. We need to change this broken system. We need gun regulations. We need more robust background checks and decrease easy access to dangerous weapons. Green stands up for all mothers so they can hug their children to bed rather than their pillows, soaked with tears and what-ifs.

Green embodies the story of many women before and after her. She taught me the true meaning of medicine. We must advocate for our community to heal our children and invest in our future.

My time at PNLV taught me that just like Green’s life, our communities have the potential to be like newly green-cut grass with hope and potential waiting to flourish where our children can safely play instead of lying seven feet under.

Categories
Emotion Empathy Medical Humanities Visual Art

The Healing Touch

By Shruti Mahale

Earlier this year, I started my clinical rotations. In addition to seeing many of the things we learned about in the classroom, I have been able to witness patient-physician interaction and the important role physicians have in empowering, supporting, and providing hope for their patients who may be suffering from severe medical issues. I have seen many physicians comforting their patients by holding their hands and have tried to capture this through my painting.

You need to add a widget, row, or prebuilt layout before you’ll see anything here. 🙂
Categories
Empathy General Mental Health Narrative Psychiatry

From Her Mind to Mine

By Jessica D Simon

Walking down the familiar dead-end hall of Psych 2, I nearly walked right past the thin woman almost drowning in her hospital gown as she calmly allowed the nurse to take her vitals. I stopped to confirm her identity and introduce myself. “Oh hello, how are you?” came the polite response. Stories of Betty had wafted down from the consult-liaison team for the past week with a macabre fascination. Her image was contradictory; it seemed implausible that the frail, proper lady sitting in front of me, hair pulled neatly back into a graying ponytail, had just a few days prior made the desperate decision to violently shoot herself in the chest with the intention of ending her life.

I held my breath in anticipation, unable to deny my excitement at being assigned to this case followed immediately by the familiar sensation of guilt. How can I be fascinated by someone’s dark tragedy? I would soon learn that this dissonance, walking the line between compassion and self-gratification, lies at the heart of providing effective psychiatric care.

We exchanged pleasantries as together we made our way to the optimistically named “comfort room,” home to one large battered upholstered chair, a modest wooden table, and a window with an AC unit, culminating in a poor excuse for a respite on Psych 2. Betty shuffled slowly, still healing physically from her wounds, until finally making it to the red armchair where she would spend much of her time over the coming weeks. She looked at us expectantly with a hollow stare. She had a defeated yet pleasant energy about her, and the gentle wrinkles surrounding her dead-set gaze told me that I was sitting in front of a woman whose life I knew nothing about.

Betty met her husband Steve in high school, forming an immediate infatuation that continued to blossom into 45 years of loving marriage. They had no children and spent their days attending church, going for long walks with their dogs, and volunteering together in the community. Their lives were filled with a beautiful simplicity that bestowed long-lasting contentment, a sentiment for which many spend their whole lives searching. When Steve was diagnosed with an aggressive glioblastoma on September 1, 2021, Betty’s life quickly evolved into an endless cycle of hospital appointments, research, and clinical trial investigation. Yet she helplessly watched as Steve’s condition steadily worsened, his movements slowing and memory fading. In May 2022, when Steve failed multiple clinical trials, Betty fell into a deep despair that ultimately pushed her past the precarious edge of desperation.

Betty’s hopelessness was palpable, leaving an icy chill hanging in the room. I was alarmed to find myself feeling her agony to the extent that I almost wished for her sake that she had fulfilled her wish to die. I knew I could not promise this woman that she would have a happy future, devoid of the comfort and love that she had shared with a now dying man for the greater portion of her life. I took a deep breath. Working with Betty, I would slowly realize the therapeutic power of carrying the hope that individuals have lost in the flooding sea of mental illness until they again emerge and attempt to swim.

On Monday, Betty’s third day of admission, we received news that Steve had passed away in hospice earlier that morning. I hesitantly approached her for our usual session, preparing myself for an explosive encounter. I was shocked to find her eerily calm, her tone level, her response rational, her composure unscathed. She stared at me with the same dead eyes and motionless face that seem to challenge me, now what?

Betty guarded her true emotions with years of protective layers built from privacy and stoicism, speaking slowly with stiff unmoving facial features. I spent hours sitting across from her, watching her sip her two vanilla ensures that she ordered for lunch and racking my brain for how to engage her in a therapeutic relationship. A two-hour session with her felt equivalent to about twenty minutes of meaningful conversation, and for days it felt like we were getting nowhere. One day she said, “No one actually cares. You come and talk to me, but you don’t think about me once you go home.” Remembering the numerous times I had neurotically checked Epic late at night, my immediate unfiltered reply came, “actually I do think about you when I go home.” I saw her face soften ever so slightly, yet immediately regretted responding with my own emotional response rather than creating a space for self-reflection.

This moment brought me face-to-face with my own humanity and its effect on my patients. My response had centered myself in her healing, needing her to see my goodness and selfishly wanting our relationship to be special to her. The real question was why had she made that statement in the first place? The grief of losing her husband had clearly left her in the depths of an extreme loneliness, and this statement had unveiled a desperate longing to be held. An opportunity to guide her towards conscious awareness of her deepest desires became instead a chance for me to prove my compassion, a band-aid for her depression. I began questioning my habit of spending two hours daily speaking with her. What expectations was I setting? Was I doing it for her or for me? Doctors of course are all human, affected by the accumulation of past life experiences with flaws and strengths alike. I now realized the extreme importance of having self-awareness and acknowledging my own emotional needs as a future psychiatrist.

Betty thanked me politely after each session, maintaining her image of a proper, well-brought up woman despite her circumstances. As we approached more difficult questions, her eyes would close tight with a wide grimace that displayed all her teeth, the veins in her face tensing with discomfort – a look as if she was about to break-down into heaving sobs. Yet I never saw her shed a tear. Over time, I slowly began to see changes in her as she learned to label her emotions, reflect on her self-isolating nature, and even display a forward-thinking attitude about what her future life may look like. Eventually, she entrusted me with the information that her suicide attempt had been a “joint act” with her husband, in a Romeo and Juliet moment where they had felt that life was not worth living without one another.

It is hard to know how to react to such information, and my mind swarmed with questions and wonder upon this disclosure. The juxtaposition of romance and violence was truly something out of a movie. I was struck by the commitment of their love, yet deeply saddened by the decision to which it had led. Is love dangerous? Is grief inescapable? Are parts of life worse than death? Betty’s story was a reminder to withhold assumptions, and in the world of psychiatry it is often better to ask questions than it is to demand answers.

On her day of discharge, I stared at the familiar phrase in Epic that I had copy and pasted many times: “Betty Wolff* is a 64-year-old female who presents after a self-inflicted gunshot wound to the chest s/p pulmonary wedge resection.” The brief summary evoked alarming images of the well-intentioned, loyal woman I had gotten to know intimately over the past couple of weeks. As I watched her walk out the door that day, neatly dressed in the button down and tennis shoes that her brother had brought, a wild mix of emotions swelled inside me. I felt proud to have played a role in her recovery process yet fearful of how she would respond to her new reality.

Psychiatry is wrought with uncertainty, with mistakes potentially resulting in devastating consequences that can keep you up at night. Yet I found solace in knowing that we had given Betty the potential to reclaim her life after unimaginable tragedy had left her in the dark sea of hopelessness. Everyone deserves that chance. I left my rotation with a deep appreciation for the complex nature of psychiatry with an increased comfort in relinquishing control over the unknown, acknowledgement of our shared humanity and limitations as clinicians, and an acceptance of the unpredictability of life and fellow humans.

And when Betty returned to the unit two days after her discharge having asked her brother to kill her, I learned to see this not as a failure but as a small stepping-stone in the complex journey to recovery.

* all names and identifiable information have been altered for patient privacy

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Categories
General Healthcare Disparities Mental Health Public Health

Let Me Be Brief: Addressing Health Disparities Among the AAPI Community

A series of briefs by Texas Medical Students

By: Jasmine Liu-Zarzuela, Emily Liu, and Justin McCormack

Asian Americans are the fastest-growing ethnic group in the United States, with Texas ranked 3rd in overall population and 2nd in an increase in population over the past 20 years.1 While this group is often referred to and perceived as a monolith, the label of Asian American and Pacific Islander (AAPI) encompasses over 50 ethnic groups speaking over 100 languages.2 With such a variety of ethnicities and language barriers within one group there also comes a variety of unique healthcare problems this population faces. AAPI individuals have been shown to face health disparities in cancer screening and mental healthcare, amongst many others, despite the population being relatively understudied compared to others.3 Thus, it is paramount for healthcare providers to be aware of AAPI health disparities to ensure access to adequate resources and outreach for proper screening, preventative care, necessary follow-ups, as well as proper research and study of this population to ensure disparities can be prevented. 

The AAPI community is composed of distinct ethnic subgroups which differ significantly by socioeconomic status, educational attainment, cultural background, amongst other major social determinants of health. For example, Asian Americans are the most economically divided racial group,4 and access to healthcare can depend on factors such as insurance coverage and interpreter access, which vary wildly based on subgroup.5 Thus, disaggregation of demographic data is paramount in order to identify within-group disparities in health outcomes and representation in medicine. The disaggregation of AAPI data will also aid in helping determine necessary initiatives to decrease disease burden in subgroups within the AAPI community. 

According to the National Alliance of Mental Health, AAPIs have the lowest rate of seeking mental help of any minority group, with just under a quarter of AAPI adults with mental illness receiving treatment.7 Several barriers contribute to difficulties seeking care, ranging from language barriers, stigma, the model minority myth, and alternative treatments, amongst others.8 The COVID-19 pandemic has increased xenophobia against Chinese Americans and the AAPI community as a whole, and these experiences have been associated with an increased level of depressive and anxiety symptoms.9  

In the US, incidence and death rates for liver cancer are second-highest in Asians compared to other ethnic groups (after Hispanic), reaching as high as twice the rates of other racial or ethnic groups.10 Liver cancers have been attributed to Hepatitis B (HBV) and C virus (HCV), which are often silent infections.11 Compared to other demographics, Asian Americans have the highest rates of HBV infection and are least aware of their HCV status.11,12 However, AAPIs with Hepatitis infection do not engage in established risk factors for HCV in other populations, and hence are often under-diagnosed.13

TMA Policy

Currently, TMA policy 260.126 supports the Texas Department of State Health Services efforts in addressing racial/ethnic healthcare disparities and the funding needed to lessen such disparities. However, there are no current TMA policies that acknowledge disparities in healthcare specifically among the AAPI population. TMA does support AMA policy H-350.954, which advocates for the restoration of web pages on AAPI initiatives that address disaggregation of health outcomes concerning AAPI data.

Recently, the medical student section (MSS) of the TMA have submitted several resolutions to address the health disparities within the AAPI population. One of the proposed policies calls for the TMA to support the disaggregation of demographic data regarding AAPIs to reveal the within-group disparities that exist in health outcomes and representation in medicine. A second proposed policy calls for the TMA to support legislation for the funding and promotion of HBV screening, treatment, and education among the Asian American and Pacific Islander population. Lastly, a third proposed policy urges the TMA to support raising awareness and educating providers about the discrepancies in mental health among AAPI populations. 

Advocacy Goals/MSS Perspectives

Advocacy goals on increasing HBV screening and education among the AAPI community would improve health outcomes, education, and treatment for HBV and HCV screening, while decreasing the prevalence of liver cancer among one of the most commonly impacted racial and ethnic groups in Texas and the United States. Similarly, advocacy goals on increasing mental health screening and education among this population would improve health outcomes and quality of life. By bringing awareness and policy to decreasing the prevalence of liver cancer, HBV, HCV, and mental illness among the AAPI community, the TMA-MSS has an intricate and influential role in building a stronger screening program and culturally specific interventions to improve the livelihoods and health outcomes in the AAPI community.

Current Bills

Stop Mental Health Stigma in Our Communities Act (H.R. 3573) (7) is a current bill that instructs the SAMHSA to provide outreach and education strategies for the Asian American, Native Hawaiian, and Pacific Islander (AAPI) community.14

Call to Action

It is imperative that medical professionals and students acknowledge the health disparities that exist within the AAPI community and further spread awareness and policy to ultimately improve the health outcomes of this community. 

References

  1. Asian Americans are the fastest-growing racial or ethnic group in the U.S. (2021, April 9). Pew Research Center. https://www.pewresearch.org/fact-tank/2021/04/09/asian-americans-are-the-fastest-growing-racial-or-ethnic-group-in-the-u-s/
  2. Asian American and pacific islander. (n.d.). Nami.Org. Retrieved April 8, 2022, from https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Asian-American-and-Pacific-Islander
  3. The center for Asian health engages communities in research to reduce Asian American health disparities. (n.d.). Nih.Gov. Retrieved April 8, 2022, from https://www.nimhd.nih.gov/news-events/features/training-workforce-dev/center-asian-health.html
  4. Kochhar, R. (2018, July 12). Income inequality in the U.s. is rising most rapidly among Asians. Pew Research Center’s Social & Demographic Trends Project. https://www.pewresearch.org/social-trends/2018/07/12/income-inequality-in-the-u-s-is-rising-most-rapidly-among-asians/
  5. Lee, S., Martinez, G., Ma, G. X., Hsu, C. E., Robinson, E. S., Bawa, J., & Juon, H.-S. (2010). Barriers to health care access in 13 Asian American communities. American Journal of Health Behavior, 34(1), 21–30. https://doi.org/10.5993/ajhb.34.1.3
  6. Misra S, Le PD, Goldmann E, Yang LH. Psychological impact of anti-Asian stigma due to the COVID-19 pandemic: A call for research, practice, and policy responses. Psychol Trauma. 2020;12(5):461-464. doi:10.1037/tra0000821
  7. Duh-Leong C, Yin HS, Yi SS, et al. Material hardship and stress from COVID-19 in immigrant Chinese American families with infants. J Immigr Minor Health. Published online 2021:1. doi:10.1007/s10903-021-01267-8
  8. Why Asian Americans don’t seek help for mental illness. Mcleanhospital.org. Accessed December 20, 2021. https://www.mcleanhospital.org/essential/why-asian-americans-dont-seek-help-mental-illness
  9. Cheah CSL, Wang C, Ren H, Zong X, Cho HS, Xue X. COVID-19 racism and mental health in Chinese American families. Pediatrics. 2020;146(5):e2020021816. doi:10.1542/peds.2020-021816
  10. Products – data briefs – number 314 – July 2018. (2019, June 7). Cdc.Gov. https://www.cdc.gov/nchs/products/databriefs/db314.htm
  11. Ho, E. Y., Ha, N. B., Ahmed, A., Ayoub, W., Daugherty, T., Garcia, G., Cooper, A., Keeffe, E. B., & Nguyen, M. H. (2012). Prospective study of risk factors for hepatitis C virus acquisition by Caucasian, Hispanic, and Asian American patients: Ethnic differences in risk factors for HCV. Journal of Viral Hepatitis, 19(2), e105-11. https://doi.org/10.1111/j.1365-2893.2011.01513.x
  12. Kim, H.-S., Yang, J. D., El-Serag, H. B., & Kanwal, F. (2019). Awareness of chronic viral hepatitis in the United States: An update from the National Health and Nutrition Examination Survey. Journal of Viral Hepatitis, 26(5), 596–602. https://doi.org/10.1111/jvh.13060
  13. Products – data briefs – number 361 – march 2020. (2020, June 26). Cdc.Gov. https://www.cdc.gov/nchs/products/databriefs/db361.htm
  14. https://www.congress.gov/bill/117th-congress/house-bill/3573/text#:~:text=Introduced%20in%20House%20(05%2F28%2F2021)&text=To%20amend%20the%20Public%20Health,Hawaiian%2C%20and%20Pacific%20Islander%20 population. 
Categories
General Healthcare Disparities Public Health

Let Me Be Brief: LGBTQ+ Healthcare Under Attack Across Texas

A series of briefs by Texas Medical Students

By Amanda Block, Parminder Deo, and Zoe Davis

The onslaught of anti-LGBTQ+ legislative proposals continues to rise among Texas lawmakers amid already skyrocketing negative rhetoric and violence towards the LGBTQ+ community1. Some legislation calls for book bans in school libraries, questions the legality of gender-affirming care for transgender youths, and paints drag shows as grooming children for sex.

The United States Department of Health and Human Services defines gender-affirming care as a supportive form of health care which can include medical, surgical, mental health, and/or non-medical services for transgender and nonbinary people2. This early gender affirming care is essential to overall health for transgender or nonbinary children, allowing them to focus on social transitions which can increase their confidence while navigating the healthcare system. 

LGBTQ+ people are more visible in their communities than ever before. A Public Religion Research Institute (PPRI) survey found that 70% of Americans report that they have a close friend or family member who is gay or lesbian, while the number of Americans who say they personally know someone who is transgender has nearly doubled, from 11% to 21%3. Texas is home to approximately 7 million youth under 18, and holds the second largest LGBTQ youth population in the U.S., according to an analysis by Williams Institute at the UCLA School of Law and Gallup Daily4.

LGBTQ+ Demographics in Texas:

% of Adults (18+) who are LGBTQ+Total LGBTQ+Population (13+)% of Workforcethat is LGBTQ+Total LGBTQWorkers% of LGBTQ+ Adults (25+) Raising Children
4.1%1,053,0005%647,00029%

As of February 2023, the American Civil Liberties Union (ACLU) has identified 23 anti-LGBTQ bills in Texas– 10 of which directly target access to healthcare5. Many of the healthcare bills seek to limit or ban gender-affirming care for transgender youth by declaring gender-affirming care as “child abuse” and target medical providers with threats losing licensure and pressing criminal charges, and removing state funds for gender-affirming care. Other bills attempt to limit classroom instruction on sexuality and gender identity. Introduction of legislation like this affects the emotional and physical well-being of this historically marginalized patient population. 

Key Bills this Session:

  • Senate Bill 1029, filed by Texas Republican Bob Hall, would ban public funding for gender modifications and treatments, which includes castration, vasectomy, and hysterectomy regardless of age6. It would also bar some health plans from providing “gender modification procedure” and increase legal liability for medical professionals who offer the care.
  • Senate Bill 1082, filed by Texas Republican Bob Hall, relating to the definition and use of the terms “male” and “female” for purposes of certain government documents7. This would restrict all government-produced communications that request or provide information on someone’s sex to only use “male” and “female.”

The proposed Texas legislations are a direct insult to the mental-well being of LGBTQ+ people and their quality of life. Transgender and gender nonbinary adolescents are already at increased risk for mental health issues, substance use, and suicide. The Trevor Project, a suicide hotline for LGBTQ youth, reported that LGBTQ youth of color reported higher rates of attempting suicide than their white peers in 2022, and that for 86% of respondents in Texas, recent politics further negatively impacted theirwell-beings8.

A safe and affirming healthcare environment is critical in fostering better outcomes for transgender, nonbinary, and other gender diverse children and adolescents. Medical and psychosocial gender affirming healthcare practices have demonstrated lower rates of adverse mental health outcomes, increased self-esteem, and improvement in overall quality of life for transgender and gender diverse youth9.

As future healthcare professionals, it is our duty to ensure equitable healthcare for all individuals, regardless of gender identity. Furthermore, it is our duty to take actions of non-maleficence, avoiding doing any harm to individuals. If bills that restrict the healthcare for these individuals are put into place, this population will not have the same opportunity to advance their mental health and physical health as their non-transgender counterparts. Their mental health will undoubtedly undergo negative impacts as a consequenceThese pieces of legislation decry appreciation for LGBTQ community members and the autonomy and dignity these individuals deserve and are inappropriate for any policy, especially those pertaining to the healthcare legislature . 

TMA Policy

The LGBTQ Health Section of the TMA is charged with addressing important issues of interest to LGBTQ medical students, residents and fellows, and physicians. The goal is to advance the association’s leadership role in providing physicians and patients with evidence-based, scientific information on care for lesbian, gay, bisexual, transexual, and queer/questioning individuals. TMA specifically wants to protect the patient-physician relationship. Below are policy examples.

60.008 Rejection of Discrimination: The Texas Medical Association does not discriminate, and opposes discrimination, based on race, religion, disability, ethnic origin, national origin, age, sexual orientation, sex, or gender identity. TMA supports physician efforts to encourage that the nondiscrimination policies in their practices, medical schools, hospitals, and clinics be broadened to include “race, religion, disability, ethnic origin, national origin, age, sexual orientation, sex, or gender identity” in relation to patients, health care workers, and employees. (CSPH Rep. 1-A-18)

60.010 Opposing Legislation that Mandates Physician Discrimination: The Texas Medical Association (1) supports the removal of “opposite sex” as a requirement for affirmative defense to prosecution within the Texas Penal Code, and (2) opposes legislation or regulation that mandates physicians and other health professionals discriminate against or limit access to health care for a specific patient population (Res. 111-A-19).

265.028 Improving LGBTQ Health Care Access: The Texas Medical Association recognizes that lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals have unique health care needs and suffer significant barriers in access to care that result in health care disparities. TMA will provide educational opportunities for physicians on LGBTQ health issues to increase physician awareness of the importance of building trust so LGBTQ patients feel comfortable voluntarily providing information on their sexual orientation and gender identity, thus improving their quality of care. TMA also will continue to study how best to reduce barriers to care and increase access to physicians and public health services to improve the health of the LGBTQ population. (CSPH Rep. 8-A-18)

For LGBTQ mental health support, call the Trevor Project’s 24/7 toll-free support line at 866-488-7386. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 98810.

Sources

  1. Legislative Bill Tracker 2023: Equality Texas. equalitytexas.org. https://www.equalitytexas.org/legislature/legislative-bill-tracker-2023/. Published March 13, 2023. Accessed March 31, 2023. 
  2. Lesbian, gay, bisexual, and Transgender Health. Centers for Disease Control and Prevention. https://www.cdc.gov/lgbthealth/index.htm. Published November 3, 2022. Accessed March 31, 2023. 
  3. How social contact with LGBT people impacts attitudes on policy. PRRI. https://www.prri.org/spotlight/lgbt-pride-month-social-contact-gay-lesbian-transgender-individuals/. Published October 13, 2021. Accessed March 31, 2023. 
  4. The Williams Institute. https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT&area=48#density. Accessed March 31, 2023. 
  5. Mapping attacks on LGBTQ rights in U.S. state legislatures. American Civil Liberties Union. https://www.aclu.org/legislative-attacks-on-lgbtq-rights. Published March 28, 2023. Accessed March 31, 2023. 
  6. Texas SB1029: 2023-2024: 88th legislature. LegiScan. https://legiscan.com/TX/bill/SB1029/2023. Accessed March 31, 2023. 
  7. Texas SB1082: 2023-2024: 88th legislature. LegiScan. https://legiscan.com/TX/sponsors/SB1082/2023. Accessed March 31, 2023. 
  8. 2022 National Survey on LGBTQ Youth Mental Health by State. The Trevor Project. https://www.thetrevorproject.org/wp-content/uploads/2022/12/The-Trevor-Project-2022-National-Survey-on-LGBTQ-Youth-Mental-Health-by-State-Texas.pdf. Accessed March 31, 2023.
  9. Tordoff DM;Wanta JW;Collin A;Stepney C;Inwards-Breland DJ;Ahrens K; Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA network open. https://pubmed.ncbi.nlm.nih.gov/35212746/. Accessed March 31, 2023. 
  10. For young LGBTQ LIVES. The Trevor Project. https://www.thetrevorproject.org/. Published February 27, 2023. Accessed March 31, 2023.
Categories
General Healthcare Costs Healthcare Disparities Mental Health Public Health Women's Health

Let Me Be Brief: Maternal Mortality

A series of briefs by Texas Medical Students

By: Radhika Patel and Sanika Rane

Maternal mortality continues to be one of the more pressing public health issues in Texas. In December 2022, Texas’ Maternal Mortality and Morbidity Review Committee released a report reviewing pregnancy-related deaths in Texas since 2019 1. The review found that despite policies implemented to prevent these cases, there has been little improvement in rates since 2013, with Texans continuing to experience above-average rates of pregnancy- & childbirth-related deaths – about 12 deaths per month with 89% of cases being preventable 1. The report also found that 19% of pregnancy related deaths were attributed to discrimination, with people of color, particularly Black patients being at the highest risk of pregnancy related discrimination and subsequently the highest risk for maternal mortality.

So what gaps remain to be addressed? In a recent issue of Texas Medicine, TMA announced that “women’s reproductive health” and “Medicaid coverage for women and children” amongst its priorities to address in the 2023 legislative agenda 2 . The federal administration has developed a Maternal Health Blueprint specifying policies on Extending Postpartum Medicaid Coverage; A Maternal Mental Health Hotline; Investments in Rural Maternal Care; No More Surprise Bills; and Better Trained Providers (addressing implicit bias), and in February, Dr. Jackson Griggs testified on behalf of TMA at the Texas Senate Finance meeting seeking adequate state funding for maternal & child health – the written testimony highlights similar issues regarding maternal mortality in Texas (more below) 3. Currently, there are a number of bills proposed this legislative session to address some
of these issues:

Medicaid coverage

  • In the last session, House Bill (HB) 133 requesting extension of coverage for 12 months postpartum was passed by Texas’ House of Representatives – but the Senate reduced this to 6 months, causing the expansion to be stuck requiring waiver approval by the federal government 4
  • Due to this, despite Medicaid covering half of births in Texas, insurance still only extends coverage to 2 months postpartum – with nearly one-third of maternal deaths in Texas occurring after this coverage ends 5
  • Medicaid will undergo further “unwinding” this year as Texas restarts disenrollments – currently, a pregnant woman earning up to 198% of the FPIL can be covered by Medicaid through 60 days after pregnancy 6; but on day 61, she must earn less than 17% to maintain her coverage ($3,733 for a family of three), leading to loss of coverage for many 7. In Texas, rates of delayed and foregone preventive care for children and adults have increased, resulting in potentially missed and delayed diagnoses.
  • Gregg Abbott has even stated that one of his budget priorities is to request funding for 12 months of Medicaid postpartum services 8.
  • Bills proposed this session to expand Medicaid coverage to 12 months postpartum include House Bill (HB) 56 (currently still in Health Care Reform committee) & Senate Bill (SB) 73 (currently still in Health & Human Services committee).

Racial disparities

  • Nationally, Black people giving birth are three times more likely to die than their white counterparts – and twice as likely in Texas.9
  • Bills proposed this session addressing racial disparities include:
    • HB 663: Creating an unbiased maternal mortality and morbidity data registry for Texas.
      • Passed vote in the House, now in the Health & Human Services committee in the Senate.
    • HB 1164: Obtaining funding to conduct a study specifically investigating maternal mortality and morbidity among Black women in Texas.
      • Passed vote in the House, now in the Health & Human Services committee in the Senate.
    • HB 1162 & 1165: Establishing requirements for medical provider licensing should include hours for cultural competency and implicit bias training.
      • Both still in the Public Health committee

Life-saving care

  • Maternal death rates have been found to be 62% higher in contraception-restriction states like Texas 10
  • In two Texas hospitals, 57% of patients were reported to have significant maternal morbidity as a result of state-mandated management of obstetrical complications (like access to life-saving medication) compared to 33% in states without such legislation. On average, patients were withheld life-saving care for 9 days, simply being observed instead as their conditions worsened – before they eventually developed complications severe enough to be qualified as an immediate threat to maternal life for physicians to legally take action under Texas law. 11
  • Bills proposed this session addressing life-saving care include:
    • SB 79 & HB 3000: Ensuring that current restrictions will not negatively impact pregnant patients requiring termination for their care, including not being susceptible to criminal penalties.
      • Both still in the State Affairs committee.
    • HB 1953: Establishing exceptions to current restrictions to ensure that physicians are able to provide life-saving care to high-risk patients in their third-trimester.
      • Currently still in the Public Health committee.

Mental health resources

  • 84% of pregnancy-related deaths were preventable – leading underlying issues varied by race & ethnicity, including: mental health conditions (23%) (suicide and overdose/poisoning) disproportionately affecting Hispanic & non-Hispanic White people. 12
  • In Texas, rising rates of drug abuse, suicide, and domestic violence reflect the mental anguish and distress so many patients face – suicide and homicide represented 27% of pregnancy-related deaths with homicides most often perpetuated by the individual’s partner 1
  • Establishing funding to allow PCPs to provide up to 4 postpartum depression screens in the year following delivery, especially given the current shortage of both adult & child psychiatrists, may help address these issues. 8
  • Bills proposed this session addressing mental health resources include:
    • HB 3724: Establishing a maternal mental health peer support pilot program for perinatal mood and anxiety disorder.
      • Currently still in the Health Care Reform committee.
    • HB 2873: A strategic plan for improving maternal health, including improving access to screening, referral, treatment, and support services for perinatal depression.
      • Passed vote in the House, now awaiting vote in the Senate.

Maternal health deserts

  • Texas leads the country in maternal health deserts – communities with limited or no local prenatal and maternity care services, even for insured women – jeopardizing the health of expectant mothers and their unborn babies.8
  • Bills proposed this session addressing maternal health deserts include:
    • HB 3626: Implementing a public outreach campaign to increase the number of maternal health care professionals in rural areas.
      • Currently still in the Health Care Reform committee.
    • HB 617 & SB 251: Establishing a pilot program for providing telemedicine and telehealth services in rural areas.
      • HB 617 passed & signed into law by Governor Abbott, effective 9/1/2023.
      • SB 251 passed vote in the House, now in the Jurisprudence committee in the Senate.
    • HB 1798 & SB 663: Developing a strategic plan for providing home and community-based services under Medicaid to children and mothers, especially in low-resource settings.
      • HB 1798 passed vote in the House, now in the Health & Human Services committee in the Senate.
      • SB 663 currently still in the Health & Human Services committee.

In summary, please consider the following goals for advocacy this session:

  • Ensuring safe access to life-saving procedures.
  • Extending Medicaid coverage to 12 months postpartum for all mothers in Texas.
  • Increasing access to evidence-based community and crisis mental health and substance abuse services.
  • Addressing gaps in medical education to prevent the impact of racial discrimination on maternal mortality, including cultural competency & implicit bias.
  • Improving access to comprehensive healthcare in rural settings and maternal health deserts.

Since most of these bills are still being discussed within committees, it is an especially pertinent time to speak with the representatives sitting on these committees and urge them to move the bills forward to be voted on and signed into law. Stay informed about issues pervading your communities, reach out to your local representative to ask for their support on proposed bills, and engage in this legislative session by joining physician advocates at the Capitol!

Resources

  1. Texas Maternal Mortality and Morbidity Review Committee and Department of State
    Health Services Joint Biennial Report 2022. Accessed January 26, 2023.
    https://www.dshs.texas.gov/sites/default/files/legislative/2022-Reports/Joint-Biennial-
    MMMRC-Report-2022.pdf
  2. Texas Medicine March 2023. www.qgdigitalpublishing.com. Accessed April 1, 2023.
    https://www.qgdigitalpublishing.com/publication/?m=55178&l=1
  3. House TW. FACT SHEET: President Biden’s and Vice President Harris’s Maternal Health
    Blueprint Delivers for Women, Mothers, and Families. The White House. Published June 24,
    2022.https://www.whitehouse.gov/briefing-room/statements-releases/2022/06/24/fact-sheet-
    president-bidens-maternal-health-blueprint-delivers-for-women-mothers-and-families/
  4. Klibanoff E. Texas health agency says its plan to extend maternal Medicaid coverage is “not
    approvable” by feds. The Texas Tribune. Published August 4, 2022. Accessed April 1, 2023.
    https://www.texastribune.org/2022/08/04/texas-medicaid-postpartum-application/
  5. Waller A. Maternal health care advocates applaud new state law to extend Medicaid coverage,
    but say it doesn’t go far enough. The Texas Tribune. Published August 27, 2021.
    https://www.texastribune.org/2021/08/27/texas-medicaid-maternal-mortality-health
  6. Comments on the Status of the Texas Maternal Health Coverage Bill. Texans Care for
    Children. Accessed April 1, 2023. https://txchildren.org/posts/2022/5/4/comments-on-the-
    status-of-the-texas-maternal-health-coverage-bill
  7. Maternal deaths are public health and health equity problems. They’re also preventable. |
    Kinder Institute for Urban Research. Kinder Institute for Urban Research | Rice University.
    https://kinder.rice.edu/urbanedge/maternal-deaths-are-public-health-and-health-equity-
    problems-theyre-also-preventable
  8. Texas Medical Association. Senate Finance Committee – Senate Bill 1, Article II Hearing
    Texas Health and Human Services Commission. TMA; 2023
  9. Salahuddin M, Patel DA, O’Neil M, Mandell DJ, Nehme E, Karimifar M, Elerian N, Byrd-
    Williams C, Oppenheimer D, Lakey DL. (2018) Severe Maternal Morbidity in Communities
    Across Texas. Austin, TX: University of Texas Health Science Center at Tyler/University of
    Texas System.
  10. Declercq, E., Barnard-Mayers, R., Zephyrin, L., & Johnson, K. (2022, December 14). The U.S.
    Maternal Health Divide: the Limited Maternal Health Services and Worse Outcomes of States
    Proposing New Abortion Restrictions. Www.commonwealthfund.org.
    https://www.commonwealthfund.org/publications/issue-briefs/2022/dec/us-maternal-health-
    divide-limited-services-worse-outcomes
  11. Nambiar, A., Patel, S., Santiago-Munoz, P., Spong, C. Y., & Nelson, D. B. (2022). Maternal
    morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with
    complications in 2 Texas hospitals after legislation on abortion. American Journal of Obstetrics
    & Gynecology, 0(0). https://doi.org/10.1016/j.ajog.2022.06.060
  12. CDC Newsroom. (2016, January 1). CDC. https://www.cdc.gov/media/releases/2022/p0919-
    pregnancy-related-deaths.html