PUBLISHED BY: SOPHIE ZHAO
NATIONAL NETWORK DIRECTOR
As part of our marrow awareness month, we would like to feature some of the incredible members of our API community who battled against leukemia and finding the perfect donor match. Meet Isabel Qi. Isabel is currently in her fourth year at UCLA studying Geography and Environmental Science. In August of 2016, she was diagnosed with leukemia and in February of 2017, she was discharged from the hospital after beating cancer.
AUTHOR: JIUN YIING HU
UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE email@example.com
PUBLISHED BY: SOPHIE ZHAO
NATIONAL NETWORK DIRECTOR
This is the inaugural post for our new monthly interview series, Faces of APAMSA, spearheaded by Jiun-Yiing Hu (Research Director), Janki Patel (Diversity Director), and Emilee Tu (Alumni Liaison), which aims to explore the diversity of experiences and passions of our student and alumni members. We hope you will enjoy these conversations as much as we do!
Saad is an M2 at the University of Maryland School of Medicine. He is a strong proponent for political engagement and Rutgers being the best university of all time. He grew up in New Jersey and is a recent Maryland transplant. He’s been actively engaged in politics since 2010. In his free time, he loves cooking (baking specifically, he makes an amazing chocolate pecan pie), photography, and co-parenting 2 kittens, Hiro and Tadashi.
We reached out to Saad as our first interviewee to share his experiences in growing a sociopolitical awareness and transforming his concerns as a citizen and student physician into positive action.
Give us a brief timeline of your life.
I’m 24, turning 25 this year—big year! I was born in Karachi, Pakistan. I came to the United States when I was five and I’ve been living in New Jersey pretty much ever since. I went to local schools there—public high school, Rutgers for undergrad, also a public school. I studied public health and cell biology neuroscience, then took a year off between college and medical school working at Deloitte Consulting. That’s when I came to Maryland and ended up here, and now I’m in my second year of medical school.
So you moved to the States when you were 5—what was that like?
I don’t remember too much about it, but I remember going back and forth a lot. My mom didn’t speak English, my dad was working pretty much full-time… he wouldn’t get home until 8 o’clock. From what I know, that’s really similar for many immigrant families where either one person is the breadwinner or they just don’t see their parents a lot. I was very fortunate to have my mom home all the time, but I didn’t speak English until first grade.
Have these experiences in any way shaped your focus in life?
I think I just see things from a different lens. A lot of my passion for global health and giving back to my community began early on. Part of my thought process was that I knew how poor my family was before coming to the United States. When my dad finally got a job, we started doing better financially, and now he sends money back to our family over [in Pakistan]. Though my family is doing well, I still have extended family living in very poor conditions… There’s just not a lot of strong support for our country. People aren’t going back to Pakistan to do work because, unfortunately, there are countries in that area that need even more help.
Are you thinking of going back to Pakistan in the future to do global health work?
I do want to spend a few weeks out of the year in my future career to go back and do whatever I can, but I have a different perspective on it now after speaking to our last course director. He’s Indian, and I asked him why he goes to Haiti, Zimbabwe, and other countries to serve, but not India. He explained that there’s a lot more people going [to India], and the places he goes to, they just need much more help because nobody goes there. So, I don’t know if I’d necessarily go back to Pakistan but if I do, it would be nice to give back to people I know.
So, you’re involved in a lot of things. Tell me about some of them.
I’m co-president with a good friend of mine, Owen Lee-Park, for Citizen Physicians, and co-president with Kaitlyn and John for the medical ethics club here. We just put on events and recently, we held a discussion about the ethics of end-of-life care, and how physicians and patients navigate that conversation when their beliefs are in conflict. It’s something I recently discovered I really enjoy doing.
I wanted to engage in both politics and medicine, and I found that health policy was good for that, but I just feel like that’s too broad a word, so now I’m just trying to hone in on what I really do enjoy about health policy. I think the intersection of law, medicine, and ethics, is where I want to be, so I’m actually taking a Critical Issues in Healthcare class this semester at the Carey Law School.
That’s great! Given that we’re going into a profession where we’ll be actively making ethical decisions all the time, I think students would really benefit from having medical ethics more emphasized in our curriculum.
I agree that it’d be good to have some more formal training so you have a framework to work with, or else you’d just be relying on the doctors you train with and that might not be ideal. Or you might not feel confident to speak up against your superiors if you have a different thought process about what’s being done. I believe we could always do more humanitarian training but, you know, med school in general, when you want to add something, they just add it. They don’t tend to take something else away, and we already complain about how much we have to do. [laughs]
How did you get started in politics?
I guess the start of my political activism was in high school. A friend of mine asked me, “Do you want to work at this guy’s office?” He was our local assemblyman in New Jersey, and his office was two streets down and he actually lived next door to my house. I never saw him but I worked with his staff on constituent relations for a year and a half, and did “Get out the Vote!”
Did you believe in all the parts of his platform?
Ah, no, I don’t think I really did. It was just something to do at that point. I didn’t really know who he was—he was a lawyer and his daughter was our age, so some of our classmates knew her, but at that point, I didn’t really critically think about what I was doing. It was just something I had the opportunity to do, and I wasn’t doing anything else besides applying to college. I met some really cool people though, so after my freshman year, I joined student government. I really, really liked that so I started working for Senator Frank Lautenberg—he passed away recently—of New Jersey and I got to meet a lot of cool people there too, and so that’s when I started considering politics as more of a career. I actually considered double majoring in politics, but all the reading and writing wasn’t really for me, and I didn’t really have time with the science major, so I found public health to be a good mixture of everything, where I got to learn some policy behind public health decision making. I was also a part of student government throughout college.
Did you stay engaged after college?
In my gap year, I worked at Deloitte in federal consulting at the Department of Defense. During this period, I had a lot of time to read so I started reading more and learning more about health policy. I read a book by Ezekiel Emanuel on why America doesn’t have a single-payer healthcare system, but Canada does, and how all these movements started. It’s really interesting if you understand how things were before the ACA, and how things are now, and we’re just having a completely different conversation about healthcare than they were when they were making that law. When they were making that law, these things weren’t taken for granted, because they didn’t even exist. For example, if someone had cancer, they couldn’t get insurance because they couldn’t get a job. Now, people are like that’s obviously ridiculous. So we’re having a very different conversation now.
And how are you continuing your involvement with politics today?
In my first year of med school, I attended a talk by Citizen Physicians regarding a bill about Death with Dignity in Maryland. Some of our classmates had a discussion about this: Do they support this bill? What restrictions should there be? Maryland’s [bill] is crafted so the patient has to be able to self-administer, but that brings to question, well paraplegics aren’t going to die in 6 months but some of them might be ready to end their life because of the quality of care they’re receiving or quality of life they have now. So there’s a lot of patients left out of this, and as a physician, would you feel comfortable doing [the procedure]. After that event, I was like, “I definitely want to be part of that org”, so here we are!
It’s been a tumultuous year, for all of us. What do you think are the greatest challenges America faces with healthcare in its current state and with our current administration?
I think our biggest challenge is how to move forward from where we are. I don’t think we’re in a bad place. The administration is currently trying to defund the individual markets where patients are able to buy insurance without their employer. They normally get help from the government, so if [the government] tries to reduce those payments, there’s just not going to be many options for people, and that’s hard. But I like to be more optimistic and hope that a more progressive party will win in 2018, and hopefully the mic will come back and we’ll be discussing something very different like how do we want to improve the Affordable Care Act? I think that’s a conversation we’re not well-equipped to have right now. People want to say “We just want Medicare for all” or “We want a single-payer healthcare system”, but that doesn’t really take into account how the reality of how America’s insurance marketplace is currently set up.
Part of what drives healthcare costs up so high is that insurance companies kind of bid for the lowest price from hospitals, but hospitals have multiple buyers, so there’s just this price-gouging where everyone’s just like “I’ll pay you more!”. So if Medicare sets a rate like say, we’ll pay $20 for this thing, a private insurance company who will want to save money will say that we don’t want to pay that low but we also want to make sure that our insured patients get really good care when they show up, so we’ll pay double what Medicare is offering you… also, one thing I don’t hear people talking much about is: what’s going to happen if we let the government be the sole insurance player? There’re a lot of jobs that are going to be lost. We don’t have a good social safety net here.
One thing politicians say is—and you can answer this—do Canadians come here all the time for healthcare since you have to “wait so long” in Canada? — I certainly don’t. — If you look, the only institute saying that is a very conservative institute in Canada, and they have issues in their sampling, it’s really bad data, studies, and a sample size of the richest people for elective procedures. People are coming here for elective procedures because they can get them done faster, but no one is coming here for life-threatening emergencies because of waiting time. Half the things we need care for, we don’t need urgently. So I don’t think America is ready for that conversation but I’m glad we’re having it here, now.
Do you think that by the next election, voters will better appreciate that it is a nuanced issue and be more open to discussing it?
Yeah! No Democrat is going to run on a platform of not expanding the ACA. That’s just not a feasible strategy anymore. There used to be talk about a “moderate liberal”, who’s anti-abortion but progressive in every other way. But if you look at Doug Jones in Alabama, he’s unapologetically pro-choice. So, you don’t have to pretend to be moderate anymore to win anywhere in this country. So you’re going to see a lot more progressives, and those people are going to support healthcare for all.
Medical professionals and scientists tend to shy away from politics. I overheard you the other day having a heated debate with a classmate about why he needs to vote. Do you have any suggestions on what med students can do to support or advocate for their communities, or be more civically engaged?
[laugh] Yeah, I was arguing with a classmate about getting him to vote and he was being facetious and saying things that might rile me up or saying that he supports fairly conservative policies, but the thing about Citizen Physicians is that we’re non-partisan. We just want to get you registered to vote and make sure you get out there. I mean, America doesn’t vote. 50% of the electorate votes for the president, but if you look at the drop-down ballot (who did you vote for Senator, Congressman, local offices, etc.), those numbers drop down to like 30-10% really quickly.
You don’t have to vote for everything, but I think at the very least we should get people registered and educated so they know where to go. So, for medical students, I think you need to make sure that medical school doesn’t take over your life. There’s still stuff going on in the world, and I know that we all feel very busy, but it doesn’t mean we have to shut everything out. We should still keep an eye on what’s going on. And if [health policy] isn’t your passion, you can still stay informed. There’s lots of great daily mailing lists and apps that give bullet points of what’s going on, and also provide a reference article you can read when you want, so I think it’s a combination of staying informed, and when you think there’s an issue we should be working on, you should call your congressman and ask them to support this. A couple of our friends just called for net neutrality a couple of weeks ago, and I know the FCC voted against it, but I think it’s really cool that a lot of us were calling… and for a lot of us, it was the first time.
Don’t just email your local representative or tweet them. I mean—do those too not only to spread awareness and to let other people know that you’re also supporting [a bill], but also make sure you call them because that’s what’s really going to most effective. The process for calling your state representatives has been made very simple and straightforward with websites like Call My Congress and 5 Calls, so anyone can do it! I’d highly encourage you take a brief moment to call and exercise your civic right!
Do you have some specific resources you can recommend to readers for staying informed?
I’d look at The Daily Skimm and I used to read Politico as well on healthcare and what specific agencies are doing. That might not be of interest to everybody [chortle], but I’d definitely recommend something like the Daily Skimm or a morning consult kinda thing.
If I could recommend some podcasts too, you have to listen to the New York Times The Daily every morning. It comes out at 6 am so if you want to get an early start to your day, you can listen to it on your walk to class. That’s when I listen to it. It’s like 20-30 minutes long, you can listen to it on 1.5x.
On a lighter note, what do you do for fun?
I like to bake, just like High School Musical, just like that guy [Zeke]. No, I’ve recently started baking. –Wait, who bakes in High School Musical?– One of the basketball players. He’s like, “I like to bake!” He just name drops a bunch of dishes and everyone’s like, “Dude, sit down!” because they’re singing this song Status Quo. [sings chorus of Status Quo] It’s a bad song. Anyway, besides baking pecan pie for our school’s annual chili and dessert cook-off, I’ve also baked Nutella lava cakes, tres leches for friends’ birthdays, pumpkin pie which didn’t come out well for Thanksgiving (Sorry to my brothers. They were home, and it was ok). I make this really good chocolate cake, and cheesecake too. I tried making matcha cheesecake. There was matcha in there but it didn’t turn green, and I recently learned how to fix that, thanks to my boy Makoto. Just kidding, I learned from a video online. You add matcha to water first. They don’t tell you that in the instructions or anywhere!
I’ve also been trying to read a lot more. I was only able to read one book last semester. Ah, I can’t remember the title —sounds like a memorable book— I read it in August and then moved onto my next book, If Disney ran your hospital. This guy worked at Disney but was also a hospital administrator. I was also reading this book Brain on Fire, where this journalist gets diagnosed with a psychiatric illness. I don’t know what her illness is yet because she’s just starting to experience symptoms. Anyway, those were two books I was reading and had to put down because, you know, school gets caught up with you. I like to read and go to the gym. I used to lift but now I’m looking for something more sustainable, something that doesn’t require as much equipment, for times when I don’t have time to go to the gym. I’m going to try to get back into running, although I didn’t love it.
Are there any truths that help keep you grounded in med school?
There’s one book I read after I graduated. It’s called The Defining Decade. It’s about how the 20s are such a critical time in your life. If you’re just going from relationship to relationship until your 30s, then you’re like why am I single, or if you just let go of all your dreams, and you’re wondering why can’t I accomplish anything? The book talks about how these are transformative years of your life where you’re setting habits and patterns that are going to define the rest of your life, because you know- they say your brain isn’t fully developed until you’re 25, so you’re still developing. So if you start thinking about good practices now and being more serious about your intentions when it comes to your relationships with other people or waking up early or exercising, these are really going to serve you down the line. The same goes for having good hobbies, so keep those!
If you had one piece of advice for M1s, what would it be?
[laugh] Honestly, there’s a feeling that you have to let all your passions die when you get [to medical school]. You don’t. You really don’t. If you’re letting your passions die because you want to do better in school, the few hours you spend studying instead of something stress-relieving or fun? Do that instead, whatever it is. Like we don’t study on Friday night, we all tend to do something and that’s always fun. I bring my camera whenever there’s an event (photograph above by Saad of the Mount Washington Monument lighting in Baltimore), and now I have a bunch of embarrassing photos of everybody and I really like doing that. If there’s something that makes you happy, you know, hold on to it and don’t let it die, because you’re not entering into something that’s going to be a short run, where you’ll have more free time later than you do now.
Thank you so much, Saad! Stay awesome.
(Photos courtesy of Saad Shamshair, Fatima Sallman, Owen Lee-Park. Interview by Jiun-Yiing Hu.)
AUTHOR: JUSTIN NGUYEN
TOURO UNIVERSITY CALIFORNIA COLLEGE OF OSTEOPATHIC MEDICINE
PUBLISHED BY: SOPHIE ZHAO
NATIONAL NETWORK DIRECTOR
Participate in APAMSA's first resolution cycle! Resolutions are member-initiated policy statements that, if supported by a majority of national membership, would be adopted as official APAMSA policy. This would make it easier for APAMSA to act quickly on issues affecting our communities, including immigration, mental health, and language barriers in health care.
Resolutions can be viewed in the link below. Any APAMSA member can submit testimony in support or opposition to a resolution from now through March 31. You can also view other people's testimonies here.
AUTHOR: JENNIFER QIN
AAPI ADVOCACY DIRECTOR
JOHNS HOPKINS SOM
PUBLISHED BY: SOPHIE ZHAO
NATIONAL NETWORK DIRECTOR
The model minority myth--the perception of success among Asian-Americans--is usually invoked to suggest that racism does not exist, that the success of AAPI communities is evidence that all people of color can succeed if they try hard enough. This myth is damaging not just to AAPI subcommunities and individuals that don't fit within this perception but also to other communities of colors whose experiences with racism are minimized by this comparison. Check out our infographic and read more here: http://n.pr/2F2DuiV
AUTHOR: VIVIEN XIE
REGION III DIRECTOR
University of Maryland SOM
PUBLISHED BY: SOPHIE ZHAO
NATIONAL NETWORK DIRECTOR
In my early experience becoming acquainted with the field of medicine, I heard the phrase "social determinants of health" repeatedly. It ended up being mentioned in an essay prompt or interview question for almost every single medical school to which I applied. Fast forward to the first weeks of UMSOM orientation, when we sat in on lectures detailing how the health of some Baltimore patients are so adversely affected by their lack of safe neighborhoods, healthy grocery options, and underfunded public school programs. My longtime awareness of these issues suddenly felt personal, as I saw my new white coat as a new responsibility to address these social determinants of health and ultimately act as each patient's advocate.
What I've come to find is that I think I've been trained well to identify a person's social determinants of health but feel relatively powerless in knowing how to make changes that would directly address them. As a student, I see my classmates putting amazing work into volunteering and community engagement efforts, but this is often unsustainable as a future clinician. I often observe physicians up to their neck seeing patients and dealing with documentation, which leaves so little time and resources to devote to helping a patient address real socioeconomic issues. "Oh, that no-show was because she couldn't catch the bus again? Just reschedule her and hope that she can make it next time." It's frustrating to feel like we will be trapped in a system that prevents us from acting upon the social mission we were taught so early on in our training.
The truth is the system has already recognized this need, and there are interdisciplinary patient care models out there that provide care AND address the social determinants of health. I have been so fortunate to shadow in a Federally Qualified Health Center (FQHC) each month as part of my school's primary care program and see firsthand how it provides comprehensive and holistic treatment. Wait, so what is that? I had no clue what a FQHC entailed when I first started, but I now feel that all future healthcare professionals should be aware. I sat down with my mentor, Dr. Tobie-Lynn Smith of Healthcare for the Homeless, to provide some fast facts on this paradigm shift in patient care.
So...what is it?
FQHCs, or Community Health Centers (CHCs), are community-based healthcare systems that provide medical care while directly listening to and addressing the community's needs. Essentially, they are by the community, for the community. FQHCs are meant to care for an underserved population and will provide care regardless of ability to pay (by using a sliding scale system). Any patient care center can be apply to become an FQHC if they fulfill certain other requirements:
Receive funding from the federal government (through the Health Resources and Services Administration (HRSA))
Provide holistic health and social services
Complete annual reporting requirements (the Uniform Data System (UDS))
Have a board of directors, with the majority of board members being patients themselves
They are all non-profit and tax-exempt organizations. Currently, FQHCs serve more than 27 million people in the United States. They are often crucial lifelines for communities by providing both care and employment.
What other services do FQHCs provide?
FQHCs are staffed by physicians, nurses, mental health counselors, social workers, and more, working in a team-based approach to care holistically for patients. If a center is not directly staffed by a service, FQHCs must have a connection to one, such as addiction counseling, transportation, and specialty care. In our clinic, they can go pick up the patient from home if he or she has no other means to get to the appointment. In addition, they work to meet community needs through initiatives like farmer's markets and community gardens. At the last board meeting, Dr. Smith was even discussing providing free laundry services to her homeless patients.
How do FQHCs provide care to uninsured/low income patients?
A key distinction is that FQHCs qualify for enhanced reimbursement from Medicare and Medicaid and also receive grants from local/state governments, the private sector, and donations. This is how FQHCs have the financial power to have a sliding scale payment system and provide those extra services listed above.
How were FQHCs impacted by the Affordable Care Act?
With Medicaid expansion, more patients became insured and thus the FQHCs received increased revenue from treating essentially the same patient population. This extra income helped many FQHCs increase staffing, provide a greater breadth of services, move into larger facilities, and have the capability to see more patients within a day.
When did FQHCs begin?
In the 1940s, a physician named Dr. H. Jack Geiger traveled to South Africa and became inspired by a community-based health care model that was able to serve the most disadvantaged patients, even in the period of apartheid. Upon returning to the U.S., Dr. Geiger continued his work in the Civil Rights Movement and saw egregious health disparities that he believed could be addressed by similar community health centers. With a team of health care innovators, Dr. Geiger submitted proposals for funding from the Office of Economic Opportunity, and the first two community health care centers were born, followed by the Community Health Center program in 1975. In 1989, the term FQHC was coined and FQHCs were added as a Medicaid benefit in 1991.
What can I do to help?
Regardless of specialty, I think it's important to remember that FQHCs have a great chance of impacting your future patients. They are a safety net of care for all and act as an invaluable resource for socially/economically complex patients. What's within our power to help right now? Currently, Congress did not extend the Community Health Centers Fund, so many FQHCs are about to receive significantly reduced funding at the beginning of the next budget period. Call your Congress members and let them know that you support all community health centers and recognize their importance in the well-being of their constituents. In addition, you can continuously support with donations to your local FQHC and promote programs that help low-income families receive access to care, such as the Children's Health Insurance Program.
The American healthcare system is complex, confusing, and often frustrating, but it's inspiring to know that FQHCs are working to target health disparities and empower communities with diverse and high-quality care. I hope you all enjoyed reading and learning! Let me know if you enjoy these education-type posts or if you have any topics about which you are passionate or curious!
BY: SOPHIE ZHAO
NATIONAL NETWORK DIRECTOR
Members of the UC Riverside School of Medicine Asian Pacific American Medical Student Association (APAMSA) volunteered at the annual Reach Out Community Health Fair in Jurupa Valley on Saturday, October 14th. Over 80 patients were screened at the health fair, most of whom did not have health insurance. The patient population was primarily from minority groups. The medical students worked alongside physicians from Riverside University Health System and we assisted in taking patient histories and conducting physical exams. Services provided at the health fair included screening for blood glucose and hemoglobin A1c levels, physical exams, health insurance enrollment, and referrals to follow-up services.
AUTHOR: JANKI PATEL
PUBLISHED BY: SOPHIE ZHAO
NATIONAL NETWORK DIRECTOR
Type II Diabetes is rising globally, and can lead to many chronic consequences such as cardiovascular disease (CVD), including coronary heart disease and stroke. These diseases have had a particular impact on South Asian populations—studies show that South Asians are approximately 4 times more likely to have CVD or diabetes than other ethnic groups. Even further, CVD and Type II Diabetes have shown to develop at an earlier stage as well as progress at a faster rate leading to more severe complications in South Asian populations.
Projection data estimates that South Asians will contribute a dramatic 40% to the global cardiovascular disease rate by 2020. The reason for this disproportionate impact on South Asians isn’t completely clear but there are speculations that it could be related to increased insulin resistance within the ethnic genetic pool. Another large contributing factor could be lack of physical activity and high caloric diets which may be characteristic of South Asian ethnic lifestyle.
This is important for health care professionals to recognize in treating South Asian populations so that proper screening methods are established for early detection and appropriate management of risk factors assessed. It’s also important to empower South Asian populations to practice self-management and preventative factors to reduce the likelihood of developing disease. As such, attached below are links to exercise guidelines and Asian food healthy recipes that can serve as a resource to South Asian and all populations.