By Nicole Rodriguez-Robbins
One of my favorite parts of the recent NACHC Community Health Institute (CHI) in Orlando was actress Anna Deavere Smith’s opening session performance from her work “Let Me Down Easy,” a series of monologues based on interviews with people about their experiences with the health care system. Smith gives voice to stories of individuals who have been abandoned and neglected by the traditional medical system. In one particularly heart-wrenching monologue, she plays a doctor at Charity Hospital in New Orleans, who recounts being trapped in the hospital during Hurricane Katrina while awaiting evacuation. As a self-identified privileged white outsider in the community, this physician is initially optimistic that she and the patients at Charity will be rescued quickly. In contrast to her optimism, her patients, virtually all poor and black, instinctively predict that they will be the last group to be evacuated. As the hours and days tick by with no FEMA rescue at hand, the doctor battles conflicting emotions of helplessness and rage. She has an epiphany about what it feels like to be abandoned by one’s government, because their hospital, located in the poor and black section of the city, is not a priority for rescue services.
In another piece, Smith plays a woman who explains why, despite doctor’s orders, she refuses to go on dialysis. With hardened posture she describes the painful story of her daughter’s experience with dialysis and death from AIDS, and how the callous treatment her daughter received from hospital staff led to her own bitterness and mistrust of the medical system. A pervading theme throughout these two works is the trauma and injustice these patients suffer, due both to poverty and discrimination and later directly at the hands of the very medical facilities where they sought help and care. In between her performances, Smith brought up Carl Jung’s concept of “the wounded healer.” She quotes Jung, who wrote that “it is [the healer’s] own hurt that gives a measure of his power to heal.” Smith issues a call to arms, imploring us to recognize each patient’s humanity. She stresses that empathy is necessary in order to be a good healer and must play a vital role in health care reform. I was moved by her performance and wondered how her message about empathy translated into the practical and clinical aspects of the work of community health providers.
This theme – empathy in practice – especially in working with patients who have suffered traumatic events, was underscored in an educational session called “Exposure to Traumatic Events : What You Need to Know to Improve Patient Care. ” This session featured clinicians who work with victims to address physical, sexual and emotional trauma. One of the presenters, Dr. Melanie Perez, of James A. Haley Veterans Hospital in Tampa, FL, who works with veterans suffering from PTSD and Sexual Military Trauma, discussed the vulnerabilities of trauma survivors and the distress that traditional healthcare settings can trigger. Alarmingly, according to the National Center for PTSD, 61% of U.S. men and 51% of U.S. women have experienced at least one traumatic event in their lifetime. Dr. Perez explained how even routine physical examinations can re-traumatize a victim and she outlined ways that medical staff can be conscious of signs of trauma and avoid triggering painful memories. Another presenter at the session was Dr. Kimberly Chang, Site Director of the Frank Kiang Medical Center at Asian Health Services in Oakland, CA, who works with teen victims of sexual trafficking. AHS’ Chinatown center provides treatment to the Southeast Asian immigrant population in Oakland, CA. Through their work in the community, they encountered growing numbers of young girls and boys who were coming to the clinic with sexually transmitted diseases and showing signs of physical, sexual and emotional abuse. AHS staff realized that many of these youth were being trafficked in underground prostitution rings, and among the estimated 100,000 to 300,000 American-born children are sold for sex each year. In response, the center established a number of programs to provide culturally appropriate primary and sexual health services to southeast Asian youth and also began providing counseling and social work services to patients they identified as victims of sexual trafficking. All AHS staff receive special training to learn to recognize signs of abuse and the special needs of these patients. In particular, Dr. Chang talked about the importance of showing respect, compassion, and sensitivity and of avoiding stigmatizing language. The Teen Clinic at Asian Health Services has become a safe space for Southeast Asian youth to seek out services and community support when many experience abuse and shame in their home lives. While these are examples of specific programs, targeted at providing care and assistance to especially marginalized or victimized persons, they clearly reflect the values and commitment of the providers and their health center organizations. Amidst the countless stories of neglect and unjust treatment in the medical system, so poignantly captured by Ms. Deavare Smith, there are compassionate and committed health care providers, in health centers and communities across the country, working to change our health care experience. This gives me enormous hope for the future of health care, for health centers,and for the communities they serve.