2015: A Year in Review

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As many of us begin the time-honored tradition of celebrating what lies ahead, I want to briefly look back and review a year that has meant so much to me. In true New Year’s Eve fashion, I thought a countdown would do the trick.

4. One Degree

For the past year and a half, I’ve coordinated a partnership between our regional American Academy of Pediatrics and One Degree, a SF-based tech non-profit. One Degree and their incredible staff are the brains behind an ambitious project to not just digitize social service referrals, but to do so in a way that strengthens the capacity of the safety net to understand and respond to social needs. By maintaining a platform that is freely available to the public, in English and Spanish, One Degree is also endeavoring to transform referral agencies, from gatekeepers whose staffing capacity determines access to bridges that open access to resource information. They also launched an affordable housing portal this year!

Together, in 2016, we are embarking on a multi-site clinical pilot, to test the feasibility and usability of One Degree’s technology in diverse clinical settings in the Bay Area. We are partnering with a mobile asthma clinic, a clinic for homeless families, a teen clinic, a primary care pediatric clinic, and a free clinic with a large immigrant population. With a team of faculty, providers, and research assistants we hope to refine this technology for use in the clinical setting and broaden the ways healthcare providers address social determinants of health. Here’s a picture of our fearless team!

3. Mentoring

This year, I was fortunate to meet Christine Chen, an inspiring undergraduate student at Stanford University who founded DiverseCity, a website where students “will find the stories advice, and reflections from a diverse range of inspirational people, to show [them] that no matter where [they] come from, or what [their] background, [they] can┬ádo incredible things.”

Through Christine’s work, I can hopefully encourage students and trainees to use their voice to make a space at the table for those of us with unconventional interests or underrepresented backgrounds.

To check out Christine’s feature on me, click here and to check out her blog post on Medium, click here. Here are the videos she made:

2. Teaching

In 2015, I had the opportunity to teach 1st and 2nd year Stanford medical students as well residents! When I was a medical student, I was eager to learn about the connections between health and inequality, but early in my education, I found few outlets for my curiosity. Since becoming an attending, introducing medical students to these topics has been a dream of mine. Through the work of students Jessica Steinberg and Brandon Turner, I got to participate in the development and execution of a seminar entitled “Clinical Excellence and Best Practices: Delivering Healthcare to Changing Populations.” This experience was a highlight of the year and something I won’t forget. Here’s my 1st class!

1. Police and Child Health

I, like many who share black skin, have watched, witnessed, black bodies killed without reason or hope for just retribution, by the very agents charged with our protection. And every time, it affects me. Like others, I know the actions of officers in Oakland, Ferguson, New York, Cleveland, Baltimore, Charleston, Chicago, and San Francisco upset more than sensibilities and implicate more than the random carelessness of a select few. It shakes my personal sense of safety and unearths an uncomfortable, non-random reality about being black in America.

But unlike many, whose fear for black lives is more personal than philosophical, I also know the physiology. I know that witnessing violence has important health implications and the impact of police encounters may not be limited to the transience of bruises. For survivors, far more may suffer incarceration, a sustained trauma that separates families, disrupts social networks, and generates new barriers to economic security. I know what is happening to black lives matters, but it isn’t simply an ethical supposition, it’s a biological one.

So I’ve been writing about it, first for my blog, then KQED radio and now Pediatrics (this piece is coming soon!). And I’ve been coordinating a local group of public health leaders, community advocates, and funders to help our public health infrastructure capture and address the health impact of police violence and other harmful police exposures.

More than any work I’ve done this year, this has been the most personal. Addressing social determinants of health is why I became a doctor but elevating the needs and priorities of communities of color within society’s trusted institutions is my life’s work. I feel overwhelming grateful and humbled to begin that work here and now.

Looking back, I never could have guessed the things that happened in 2015 (some that took me away from my blog for months at a time!). Though I hit the highlights here, know it was a year marked by challenges just as much as it was marked by opportunities – lost grants, extended paper revisions, and growing professional relationships. But I made it! I embraced the things that wake me up in the morning and light me up inside and I can’t wait to do it again in 2016.

Happy New Year blog family!

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Black Art

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Warning: This is not your typical physician blogger post. But, as you’ve hopefully figured out by now, I’m not your typical physician blogger.

There have been but few times in my life when the power of the written word has changed me.

When words, so delicately crafted, approximate both the splendor and the obscenity of human experience, and the light can overcome the shadows. When I was liberated because they spoke it so.

Those are sacred moments between me and Langston Hughes, W.E.B. DuBois, Zora Neale Hurston, James Baldwin, Maya Angelou, and Amiri Baraka.

When I read Amiri Baraka’s Black Art I was a sophomore in college and about 19 years old. I was living in a world dominated by the images, opinions, and interests of white people and trying to figure out what it meant to be a brown girl like me. He said:

Poems are bullshit unless they are teeth…

We want “poems that kill.” Assassin poems,

Poems that shoot guns…

Clean out the world for virtue and love,

Let there be no love poems written

until love can exist freely and

cleanly. Let Black People understand

that they are the lovers and the sons

of lovers and warriors and sons

of warriors Are poems & poets &

all the loveliness here in the world.

We want a black poem. And a

Black World.

Let the world be a Black Poem

And Let All Black People Speak This Poem

Silently

or LOUD

What a thought.

What if blackness was the perspective from which all other experiences are compared?

What does it mean to conceptualize blackness beyond a race card or a problem or a conversation about affirmative action, inner city violence, or health disparities?

Is it possible that black people could be “all the loveliness here in the world?”

If it is possible, then how can I embody that pride effortlessly or “say it loud?” Both, of course, being equally acceptable.

Historically, this poem framed a time of anger and unrest at the centuries of injustice suffered by black people in America. It was the 60s. It was the beginning of the movement for civil rights. It was the birth of the Black Arts Movement, the contribution of black artists, writers, philosophers, and activists to not only chronicle the emotion and the intentionality of the movement, but take the greatest weapon at their disposal – the written word – and BE the movement.

Amiri Baraka was the movement. He was bold. He was fiery. He was unabashedly committed to re-claiming blackness and the beauty it embodies. As a young black woman who found my passion for social justice in medicine through the ethnic pride I discovered in college, I can only hope my writing will do justice to the beauty of the people I seek to serve. For the overlooked, vulnerable, and marginalized among us, thank you Amiri Baraka for fiercely embracing our power and showing us how to live in the beauty in us all.

RIP.

Hunger Matters

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I thought that point was obvious. But apparently, there remains some debate because on November 1, 2013, the federal government effectively cut 5 billion dollars from the most powerful anti-hunger program in our country – food stamps (or SNAP as it is now called, which stands for Supplemental Nutrition and Assistance Program).

Here’s the quick history on the issue: During the recession, unemployment rates spiked. As family incomes fell, more families were at once eligible for food stamps and in need of extra money to put food on the table at the end of the month. To account for this increased need, the federal government issued a “stimulus package,” technically called the 2009 American Recovery and Reinvestment Act. The Act did a number of things, one of which was to boost food stamp benefits. That boost expired on November 1.

The problem is, usage of the program (read: hunger) remains at an all-time high. And, the program works.

So let’s break that 5 billion dollar cut down to real numbers. For a family of 4, it means they will lose $36 dollars per month to cover their food costs. That is equivalent to losing 21 meals per month OR if you try to stretch the money out, having about $1.40 per person per meal, each month.

$1.40.

To put that number in perspective, in case $1.40 seems reasonable to you, the USDA has actually calculated how much it costs to eat on a super tight budget. They call that estimated value the Thrifty Food Plan. According to this bare-bones estimation, the cheapest, nutritious meal in America costs at least $1.70-$2.50 (the exact value depends on age and gender). For millions of American families, that gap between $1.40 and $1.70 will be the difference between being fed and going hungry in 2014.

In medicine, we refer to “being fed” as food security, or access to sufficient, safe, and nutritious food to maintain a healthy life. It is estimated that 1 in 6 Americans are food insecure. In 2012, that was about 49 million people. As of November 8, 2013, SNAP provided food for more than 47 million people, nearly half of whom were children.

Imagine I said 1 in 6 people have swine flu or the plague or a terrible form of cancer. There would be outrage. Frankly, we’d call it an epidemic, a real problem that someone has to stop! And yet, when nearly 20% of Americans do not have enough food on their table, there is debate about what should be done.

The answer is simple, #saveSNAP.

In 2011, it was estimated that SNAP fed 1 in 4 children in the US. Children need healthy food to build bones, grow their brain, and control their behavior. Try hurdling the achievement gap without breakfast. The challenge is obvious. People need food to live and succeed. As a society, we simply cannot tackle the major problems ahead of us if we fail to provide for the most basic needs of our country.

In the coming months, I will re-address this issue as the House and the Senate consider bills that would eliminate food stamp benefits for millions of Americans.

In the meantime, check out what pediatricians, community advocates, and I are working on to tackle hunger in the Bay Area.

What an Oreo can Ad to Medicine

OreoHow do you prepare for something that doesn’t exist?

In medicine, what tools will be required to build a better future for providers, patients, and the many advocates who work to make health realized?

Like our predecessors before us, embracing an unknown future will likely require solutions that are part rigorous methodology and part instinctual art. I am confident that the rigorous methodology that makes science unique among fields of scholarship will continue to advance discovery in health and disease management. But how can modern-day physicians and health advocates use the art of our practice to increase health literacy, connect the dots between health and society, and optimize our relationships with complementary fields?

When I saw the Oreo Super Bowl ad, I knew. This is what medicine should be doing. Not pushing sugar sweetened products, but utilizing moments to capture national attention around a singular idea – health.

For those of us interested in the exciting opportunities new technology offers the field of medicine, Oreo taught us that capturing national attention may be as simple as fostering thoughtful application of new media; media that for all said purposes, is free (although the thoughtful application part definitely requires a significant investment…more on that in future posts).

It is clear that consumers are now making decisions in the context of an online network of peers where they collectively share cultural experiences and discuss trending topics in news and popular media. This is an incredible opportunity to key into consumers who are looking for health information, information that data suggests some are using to make health decisions. Interacting with patients on their timetable, moderated by their thoughts and comments, and based on their personal priorities, allows medicine to have a greater impact beyond the confines of our offices and medical centers. And I’m not just talking about e-visits (although this is an interesting and potentially great idea), I’m talking about engaging a national audience in a conversation about health, identifying partners in this work, and aligning all of our interests to reach a common goal – health.

Part of preparation for any unknown outcome is recognizing opportunities to take steps in the right direction. New technology, like that promoted by incubators like Rock Health and thought leaders like Wendy Sue Swanson, MD and Bryan Vartabedian, MD, will definitely define the future of our field; a future that I hope is rooted in simplicity, transparency, and good old customer service.

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