Advocacy

Current events in Afghanistan and the impending humanitarian crisis with the likelihood of increased number of displaced people

 

Facing crisis and emergency levels of needed humanitarian assistance, Afghanistan’s needs have risen sharply because of conflict and COVID-19. Since the end of May 2021, the number of people internally displaced because of conflict and in need of immediate humanitarian aid has increased by 550,000, adding to the already 3.5 million internally displaced people before this year (1).

As future medical professionals, we are deeply concerned about the people of Afghanistan and the threat posed to their rights, safety, and ability to access health care. We support the World Health Organization’s call to ensure access to health care during this turbulent time (2-3). 

Many members of the Asian Pacific American Medical Student Association are descendants of refugees that have fled past conflict, famine, and poverty. Southeast Asian refugees represent one of the largest refugee communities to resettle in the United States after being forcefully displaced by war and its aftermath in the 1970s. While there are differences regarding the context of what’s happening in Afghanistan vs. Southeast Asia, the desire to pursue safety and opportunity are shared between both groups regardless of time and place (4-7).

We urge our government to take swift action to ensure the safety of refugees, including but not limited to: keeping borders open to those fleeing from violence and persecution, permitting permanent resettlement in the United States, and ensuring refugees feel safe and supported by ending the ongoing deportations of all undocumented immigrants regardless of country of origin (8-9).

APAMSA has long supported providing culturally and linguistically relevant resources, including but not limited to financial assistance and mental health support. Government and nonprofit entities, especially those involved in healthcare, must commit to Afghanistan refugees for years to come.

Saturday marks the 20th anniversary of the horrific terrorist attacks on the World Trade Center. Nearly 3,000 people lost their lives on that fateful day. Let’s honor their memory by committing to being a country inclusive of diverse backgrounds committed toward building mutual respect and support that can resist hate and divisiveness in all of its forms.

On September 1, Texas law SB8 went into effect, outlawing virtually all abortions 1. By allowing third-party lawsuits against clinicians that provide abortions and restricting access to vital components of reproductive healthcare, SB8 creates a coercive environment for patients and clinicians. Additionally, it would escalate the financial and logistical barriers many abortion patients already have to confront regarding their care 2.

SD8 is an example of a “heartbeat bill 3.” In 2019, APAMSA opposed the passage of “heartbeat bills” in several states 4. We continue to oppose efforts to undermine patients’ ability to access a necessary component of their health care, recognizing that these discussions and decisions ought to remain at the discretion between patients and their health care providers without undue external interference.

SD8 will likely inspire attempts to pass similar restrictions in other states 5. APAMSA encourages its members to stay informed on local state laws, and to use accurate information from verified sources, such as the American College of Obstetricians and Gynecologists, to guide their patients 6.

On August 29th, Hurricane Ida made landfall on the Gulf Coast. Its impact was particularly felt in Louisiana, making it the second most intense hurricane to hit the state after Hurricane Katrina of August 2005. More than a million people in Louisiana currently have no power. There have been reports of infrastructural damage and heavy flooding in coastal areas. This is more apparent within healthcare, as local hospitals’ capacities to admit victims of Hurricane Ida are being pushed to near full capacity from the ongoing COVID-19 surge.

As the storm progressed north, devastation has also been felt throughout the East Coast, particularly New Jersey, New York, and Philadelphia. As of September 3rd, about 4.5 million people on the East Coast remain under flood warnings.

National APAMSA has been in contact with the local chapters to offer support to those impacted by the hurricane. In addition, we encourage everyone to support the local organizations in helping those affected. 

• Mutual Aid Louisiana https://www.gofundme.com/f/hurricane-ida-mutualaidlouisiana
• Imagine Water Works https://donorbox.org/imagine-water-works
• WC Kitchen https://donate.wck.org/give/355034/#!/donation/checkout?c_src=ida-homepage
• Cajun Navy Relief www.cajunnavyrelief.com
• Hands on New Orleans https://www.handsonneworleans.org/
• New Orleans Musician Clinic https://neworleansmusiciansclinic.org/
• Second Harvest Food Bank https://no-hunger.org/

On April 6th, 2021, Arkansas overrode a veto from the governor to pass Act 626–which banned gender-affirming treatments for transgender youth. Arkansas was only one of 33 states in 2021 that have altogether introduced over 100 bills intended to interfere with the rights of trans individuals. These bills aim to ban gender-affirming treatment, forbid trans students from participating in sports, require teachers to refer to students using their biological sex, and prohibit discussion of LGBTQ issues at school.

Proponents claim that gender-affirming treatments are dangerous and not evidenced-based. Alan Clark, the state senate sponsor of the Arkansas bill, criticized that puberty blockers and hormone treatments are “at best experimental and at worst a serious threat to a child’s welfare.”

However, medical expert groups and studies say otherwise. Most professional societies—the American Medical Association, the American Psychological Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Endocrine Society—espouse the efficacy of these treatments at improving the wellbeing of trans youth. A National Institute of Health (NIH) prospective study that began in 2015 found that earlier gender-affirming treatment leads to better overall mental health. Given that nearly 1 in 3 trans youth attempt suicide in a given year, this new wave of anti-trans legislation poses an increased threat to an already marginalized community.

Our AAPI communities would also be devastated by these laws. Research from the Trevor Project, a non-profit addressing suicide prevention in LGBTQ youth, demonstrates that AAPI trans and non-binary youth are at 3 times the risk for attempting suicide compared to their cisgender peers. In 2020 alone, the organization served around 9,000 AAPI LGBTQ individuals. Another study reported that 54.7% of AAPI LGBTQ students have experienced harassment or assault due to their gender expression, and 82.3% have heard negative remarks about transgender people at school.

These chilling statistics remind us that there is more work to be done. APAMSA opposes these discriminatory laws that would severely undermine the well-being of trans individuals and their loved ones in AAPI communities and beyond. In medical education, we can advocate to our school leaders for more curricular resources and educational events concerning the foundational importance of gender affirming care. At our various institutions, we can work to establish clear, confidential pathways for transgender individuals to report mistreatment and discrimination. On a policy level, we can fight for local, state, and federal governments to recognize trans rights as human rights. We stand with the trans and nonbinary members of APAMSA and urge all our members and allies to show solidarity and advocate for the trans community in this ongoing fight against injustice and discrimination.

In solidarity,

Your APAMSA National Board

APAMSA mourns the senseless murders of Amarjeet Johal, Jaswinder Kaur, Jaswinder Singh, and Amarjit Sekhon, alongside Matthew Alexander, Samaria Blackwell, Karlie Smith and John Weisert. This massacre in Indianapolis took place exactly one month after eight other lives, including those of six Asian women, were taken in Atlanta.

We cannot separate these events from the current climate of racial violence. 90% of the workers at the FedEx center in Indianapolis were members of the Sikh community – a community that has endured hatred from the days it first settled in America in the 19th century. From the Bellingham massacre of 1907, to attacks and discrimination post-9/11, to the Oak Creek gurdwara massacre in 2012, our Sikh American siblings have been targeted over and over again. To deny that this crime was racially motivated is to deny the historical and personal experiences of our colleagues, patients, and loved ones.

To our Sikh American family: we see your resilience, your dedication to justice, and most deeply in this moment, your grief. We stand with you. We fight for you. And we mourn with you.

On March 29th, Adam Toledo, a 13-year-old Latino boy, was brutally shot to death by a white policeman in Chicago, IL while he was trying to comply with the officer’s orders to raise his hands. A few days later on April 11th, Daunte Wright, a 20-year-old Black man, was fatally shot in Minneapolis, MN after being pulled over for driving with an expired license plate–only ten miles from where Derek Chauvin is on trial for the murder of George Floyd.

APAMSA mourns for these unnecessary deaths, and we condemn these acts of police brutality. As discussed in a previous statement, APAMSA stands firmly with the Black and Brown communities during these heartbreaking times. We will not forget the pain from the murders of George Floyd, Breonna Taylor, Tony McDade, and Ahmaud Arbery; from the murders of Angelo Quinto and Christian Hall from our own communities; and the suffering that white supremacy has caused us all. We recognize that systemic racism is a public health threat, pledge to learn more about these issues that threaten the well-being of marginalized communities, and will continue to fight against all forms of racism.

Black Lives Matter.

In solidarity,

National APAMSA

National APAMSA stands in solidarity with medical students and healthcare workers in Myanmar.

It has now been nearly two months since the Myanmar military executed a coup d’etat to overthrow the country’s democratically elected government, prompting widespread peaceful protests demanding a return to democracy and a civil disobedience movement (CDM).  CDM is a no recognition, no participation movement against the military junta consisting of nationwide protests and labor strikes.

Myanmar’s health workers and professionals in particular—many of whom have been leading CDM —have been systematically targeted by the military. Many health workers have been kidnapped in night raids, detained arbitrarily, or forced into hiding after the military has presented spurious charges against them. According to the World Medical Association, “private clinics, medical personnel carrying out emergency treatment and ambulances have been shot at without any reason.”

Even more concerning is the increasing and deliberate assaults on medical students by security forces. Young Myanmar medical students have marched relentlessly since February despite escalating crackdowns which have led to scores of students being detained at great risk to their wellbeing. Medical students are also dying at the hands of the military. March 14 saw the bloodiest assault on civilians to date with an estimated 94 individuals confirmed dead. Among those slain was Khant Nyar Hein, a 17-year-old first-year medical student from Mandalay who succumbed from a headshot wound.

National APAMSA has joined with our colleagues at White Coats for Myanmar Human Rights, co-signing a letter to the International Federation of Medical Students Association urging them to speak out against the human rights violations the Myanmar military is committing against the people of Myanmar, and in particular toward fellow healthcare workers and medical students.

How can you help?

1. Join White Coats for Myanmar Human Rights on April 19th for a webinar “Protecting the Right to Health in Myanmar.”
   Registration: https://jh.zoom.us/webinar/register/WN_xcbaCYD7R4i9zsX0PelF-A.

2. Directly support emergency medical needs by donating to: https://givebutter.com/JYXD52. There is over $200K worth of emergency medical supplies and services needed for wounded individuals across Myanmar.

3. As our fellow colleagues persist tirelessly on the frontlines, please join medical students across the globe on April 26th for #whitecoatstrike by posting a photo of you with a three finger hand “Hunger Games style” hand salute like so:

And using the following caption (with a personal twist!):

I stand with my fellow healthcare colleagues in Myanmar as they battle at the frontlines against the military junta. To support emergency medical needs on the ground, please consider donating to: https://givebutter.com/JYXD52.

#WhiteCoatStrike #CivilDisobedienceMovement #SaveMyanmar #WhatsHappeningInMyanmar #GM4MD

 

After April 26th, check @gm4md on Instagram for a photo album/collage of your photos!

Dear APAMSA community:

Less than 24 hours after the release of our Anti-Asian Racism Toolkit, we were horrified by the news out of Atlanta: 8 people were murdered by a white terrorist who deliberately targeted Asian-owned massage parlors. 6 of the victims were Asian women. The names we know so far:

Xiaojie Tan, 49

Daoyou Feng, 44

Julie Park, 70s

Hyeon Jeong Park, 50s

Delaina Ashley Yaun, 33

Paul Andre Michels, 54

Two yet unreleased

Today, we mourn these women who could be our sisters, mothers, aunts. We mourn the communities they represent: femme, low income/working class, the elderly, immigrant — the most vulnerable in our communities. We grieve the loss of their lives individually – wishing them peace as they join our ancestors. We also grieve the loss of their lives as our collective loss, tear drops added to the expanding pool of lives claimed by White supremacy and anti-Asian hate.

That hate did not end after it took these women’s lives. It continues with the denial that this crime was racially motivated, that the murderer deliberately and methodically targeted Asian businesses and Asian workers. It continues with the narrative that minimizes his motive by claiming he had a “bad day,” a “sex addiction,” by taking him at face value when he says he “isn’t racist” instead of judging him by his actions. It continues with our erasure from American history, the silence of our medical education leaders, our exclusion from curricula that claims to teach us how to care for all patients and initiatives that proclaim to center equity.

In the face of this hatred, we send love to you all, our community grieving and in pain. It is absurd that we must bear these tragedies on top of the neverending parade of exams, clerkships, research applications, residency applications, and more. National APAMSA is here for you, and we want to emphasize that we will support you in asking your institutions for time off, for protection, for space to be human.

Sharing a post from @asiansformentalhealth on Instagram with the text:

“Dear AAPI family, As you hear the news of the attacks in Atlanta, please sit down. Please give your weary soul time to breathe and catch up. Please turn off your phones and turn inward toward those you love. Please grieve, cry, wail, and exhale. Give your body the space to acknowledge the pain that you have been carrying for so long.”

https://www.instagram.com/p/CMgTRVzDdU-/

In solidarity,

Your APAMSA family

On February 11th, 2021, Dr. Princess Dennar, the first Black female program director at Tulane University School of Medicine, was terminated from her position with Tulane’s Med-Peds residency without warning or clear cause. Since then, evidence has emerged that this termination may have been the culmination of years of racist and sexist mistreatment against Dr. Dennar and minoritized residents in the program; or, indeed, retaliation against Dr. Dennar for speaking out and filing complaints about this mistreatment.

National APAMSA stands in solidarity with Dr. Dennar, our Tulane chapter, the Tulane community, and our Black colleagues in medicine. Too often, healthcare is a hostile field for minoritized trainees and leaders – those who are best equipped to care for patients marginalized by that very same system. We cannot allow this insidious violence to continue.

We urge our members to educate themselves about what is happening in Tulane – a situation that could very well be happening in their home institutions – and to take the following actions in support of Dr. Dennar:

1. Sign and circulate Tulane’s letter to Tulane administration with specific demands for clarification, transparency, and accountability (signee identities remain private and protected);

2. Sign and circulate this national letter of support with specific demands for clarification, transparency, and accountability from Tulane and the ACGME (signatures displayed);

3. Customize and send this email to the ACGME (link automatically opens an email for you);

4. If in a position to do so, contribute to the GoFundMe for Dr. Dennar’s legal costs;

5. Follow @MedPeds21 and @TheTulane7 to stay updated

If you have questions or concerns, please contact the main organizers at Tulane University School of Medicine, the S.L.A.M Coalition (SNMA, LAMSA, APAMSA, MSPA) at slam.tusom@gmail.com.

In solidarity,

Your National APAMSA Board

February 19, 2021
Liz Richter
Acting Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244

Dear Acting Administrator Richter:

As the Biden Administration begins to take aggressive steps to deploy the COVID-19 vaccine across the nation, we are writing to seek your assistance with urgent Medicare and Medicaid vaccine reimbursement concerns that could significantly impact the ability to reach the people most in need of the vaccine.

Federally Qualified Health Centers (FQHCs or “health centers”) work tirelessly to ensure access to timely, affordable care for all individuals, regardless of ability to pay. We appreciate the confidence the Biden Administration has placed in health centers to deliver the COVID-19 vaccine to the most vulnerable communities. However, it is critical that health centers have the tools and resources they need to do their part. To ensure their continued ability to fulfill this commitment, we are writing with an important request.

In recognition of the critical role FQHCs are playing on the front lines of the pandemic, we request that CMS establish FQHC-specific COVID-19 vaccine administration reimbursement policiesfor Medicare and Medicaid, ensuring that health centers have the resources they need to keep their doors open. Existing federal regulations, including the COVID-19 Interim Final Rule that went into effect on November 2, 2020,

and other guidance will leave health centers severely challenged at the worst possible time. It is imperative that health center reimbursement rates account for the increased costs associated with the COVID-19 vaccine. Such costs may include factors such as hiring additional or temporary staff; training; outreach and vaccine hesitancy related activities; storage capacity; altered, temporary, or rented facilities; PPE and other equipment; IT systems interfacing; outdoor and overnight capacities; security; cleaning and disposal; patient transportation; and lost revenues for redeploying staff. Furthermore, the vaccine’s short shelf life requires health centers to strategically schedule appointments, perform additional outreach for both doses, and dedicate staff for patient monitoring while complying with social distancing and occupancy guidelines.

Below you will find our specific policy recommendations:

Medicare

Serving over 2 million Medicare beneficiaries a year, health centers are positioned to meet the goal of vaccinating the 65 and older population as quickly as possible. Under current Medicare regulations, health centers are reimbursed for vaccine administration through their Medicare Cost Report, which takes 12 to 18 months for processing and payment. We request that the agency establish the following:

• An interim payment for COVID-19 vaccine administration based on the Medicare Part B Physician Fee Schedule to ensure they receive reimbursement in a timely manner — and before 2022. • A revised reimbursement rate for FQHCs at 100 percent of reasonable costs for the COVID-19 vaccine administration given the additional costs to administer the COVID-19 vaccine.

Medicaid

Health centers serve 1 in 5 Medicaid beneficiaries nationwide and need adequate compensation for the additional resources required to meet the demand for vaccinations. In recognition of the critical role health centers play for Medicaid patients, Congress established a specific payment methodology for health centers,

the FQHC Prospective Payment System (PPS). This payment system is central to the ability of health centers to provide a broad range of primary care services to Medicaid beneficiaries while serving other low income patients. Currently in some states, vaccine-only visits do not trigger a Medicaid billable visit for FQHCs, which means they do not receive the PPS reimbursement rate and, in some cases, receive a very low or no additional administration fee at all for administering the COVID-19 vaccine. As a result, we request that the agency do the following:

• Require states to cover COVID-19 vaccine administration and specimen collection as a mandatory service for FQHCs under Medicaid state plans. This would require a state to either: (a) increase the PPS rate to account for the “new” mandatory service or (b) create an alternative payment methodology (APM) to pay for vaccine administration outside of the PPS rate.

• Encourage states to propose APMs that provide additional payments for vaccine administration to compensate for the additional resources required to meet the demand for vaccinations related outreach and general administration.

• Provide flexibility for more health care professionals employed, or under contract, with health centers to trigger a “billable visit” for vaccine administration.

• Require states retroactively reimburse health centers for additional costs of COVID-19 vaccine administration should new payment policies be adopted.

We appreciate the administration’s attention to this important issue and look forward to working together to ensure our nation’s most vulnerable are able to access the COVID-19 vaccination.

Sincerely,

National Association of Community Health Centers(NACHC)

AIDS Foundation Chicago

The AIDS Institute

AIDS United

AMDA – The Society for Post-Acute and Long Term Care Medicine

American Academy of Family Physicians American Immunization Registry Association American Kidney Fund

American Muslim Health Professionals American Network of Community Options & Resources (ANCOR)

Asian & Pacific Islander American Health Forum

Asian Pacific American Medical Student Association (APAMSA)

Association of Asian Pacific Community Health Organizations

Association of Black Cardiologists

Association of Nurses in AIDS Care

Autistic Self Advocacy Network

Cascade AIDS Project

Casting for Recovery

Center for Disability Rights

The Center for Law and Social Policy (CLASP)

Christ Health Center

CommonSpirit Health

Disability Rights Education and Defense Fund (DREDF)

Empowering Pacific Islander Communities (EPIC)

Equality California

Familia Unida

Hep B United

Hepatitis B Foundation

Hispanic Federation

HIV Medicine Association

Howard Brown Health

Immunization Action Coalition

Immunize Nevada

Infectious Diseases Society of America International Association of Providers of AIDS Care (IAPAC)

International Community Health Services Justice in Aging

Los Angeles LGBT Center

Multi-State Partnership for Prevention National Alliance for Hispanic Health National Alliance of State and Territorial AIDS Directors

National Association of Pediatric Nurse Practitioners

National Association of Social Workers National Black Nurses Association

National Consumers League

National Council of Asian Pacific Americans (NCAPA)

National Council for Behavioral Health National Council of Jewish Women National Health Care for the Homeless Council National Organization of Black Elected Legislative Women

National Viral Hepatitis Roundtable

Nevada State Medical Association Nurses Who Vaccinate

Prism Health

RESULTS

Shriver Center on Poverty Law Sickweather

Silver State Equality-Nevada

South Dakota Public Health Association UnidosUS

Vaccinate Your Family

VaxCare

The Well Project