One in Five

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By Vanessa Galli, MD

Nearly one in five women have reported experiencing rape in their lifetime according to the most recent data from the CDC. Statistics never mean as much to the reader as an “n of one” or a personal testimony. I myself am the one in five, a survivor of rape. That is not the point of this article, but rather serves as a context for a larger conversation.

I bring this all up at the beginning of this article because it shouldn’t be any different than talking about any other part of one’s life story. The shame and the embarrassment that these events are shrouded in stops us from having open conversations and prevents survivors from seeking the help that they need. I also bring this up to challenge your stereotypes about rape trauma survivors and for any of you reading this who share my experience to remind you that you are not alone in this journey. One in five means that many of you reading this unfortunately share this part of my life’s story.

Sexual assault can come in so many forms, both big and small. I have always been aware of gender biases in conversation, although have become increasingly aware of these throughout medical training. Each time I was called “Sweetie”, “Honey”, and “Angel” and told that I “looked like a Barbie Doll” by patients, it became harder to just shake it off and walk away. I attempted gentle correction, changing the subject and removing myself from the conversation. I never found a “good” solution and was left feeling guilty on some level. I found myself asking the question, “What did I do to bring this on?” I was experiencing some form of survivor’s guilt.

I also began see how often we do this to one another in the work environment. I began to notice that my female colleagues are frequently addressed collectively as “ladies” or automatically by their first name in conversation, while their male colleague sitting next to them may be addressed in the same breath as doctor. In the hospital setting, I have overheard staff complementing male providers for their “bluntness” and female providers with a similar communication style accused of being “harsh and unapproachable.” We live in a world of micro-assaults that are committed innocently in the work place every day.

So what exactly do we do about this? I do not believe in being overlying politically correct as that doesn’t further the conversation and leads only to frustration and tip-toeing around the true issues at hand. I believe in being direct and open in communication, a style that was born from my Northeast roots. So on that note, I challenge each person reading this to question your own preconceived notions and stereotypes. We are in a line of work that relies on solid skills in pattern recognition and judgement, although sometimes we need to leave that judgement at the door. We need to have open conversations with each other. We need to feel comfortable and safe correcting one another, whether it be a patient or a co-worker. Only then, will we create a work environment and a patient care environment that is safe for everyone.

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 Vanessa Galli, MD is a Chief Resident in the Family Medicine Residency Program in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.

 

Refugee Experience

By Patricia Avelar

I was shadowing Dr. Kirby as he conducted a refugee screening with a woman from Somali and two of her small children.  As he asked the woman general questions about her and her children’s health, she explained through an interpreter that she had three other children in addition to the two present with her.  She was also approximately 16 weeks pregnant and her husband was back in the refugee camp with his other wives.

 

I found my mind begin to wander in amazement of this woman and her situation: How would she manage in this foreign country without a partner to help her or any knowledge of English?  How would these children get by?  Did they understand the totality of their situation?  I felt humbled by her presence and life experiences thus far, but also worried for her and her children all at once.  In her young life she had already endured more conflict, responsibility and change than most do in an entire life. However, for all my amazement, all I could do was stand behind the attending and try to hide my emotions behind a smile and playful gestures towards the two children for fear that my reactions and thoughts may somehow transfer upon her.  So I tried to remain calm and used the attending’s behaviors to guide my own. He methodically went down his list of questions and remained somewhat reactionless as she continued to respond, which I attributed to his familiarity with refugee experiences as well as his desire to “normalize” the histories he heard in order to build a relationship with the patient.

 

As I shifted back from my own thoughts, the screening and the children’s laughter, the questions kept coming, and the doctor soon asked: “often when people live in camps, they experience trauma or physical injuries.  Has this ever happened to you?”  The mother stoically answered no but then proceeded to share that her daughter (now seven), however, had been raped at one-and-a-half-months of age.  I found myself become numb as I watched this same beautiful little girl laughing with her brother.  She continued to giggle carelessly with her brother unaware of the bomb of information her mother just unloaded. The mother and attending continued giving and obtaining the rest of the family history, respectively.

Suddenly, the interpreter mumbled her words and ran out of the room, the attending chasing after her. He returned moments later, alone, relaying to me that the interpreter was not expecting to hear about the rape.  She had no idea despite having worked with this family since their arrival to the US.

 

Hearing about the interpreter’s reaction made me instantaneously question my own as I stood there quietly and tried to communicate with the mother about how beautiful her children were. Had my previous work as a rape trauma counselor prior to coming to medical school and hearing all of those stories of rape and sexual assault made me numb to this new story?  Or was I simply not trying to stir emotion in the family by reacting?  Or was I able to separate myself from it given my very tertiary role as a medical student?  Should I have left the room shocked as the interpreter had?  Was I callous for not having done so?

 

I had heard women’s stories of survival and accompanied them through their own very painful healing, but I have never in my life encountered a story so brutal.  How could anyone commit such a violent horrific act on such a beautiful defenseless child?  Did she or would she remember?  How would her body respond later in life? And why was mom so calm as she shared? Had she already grieved this or was she remaining strong for her children?

 

This specific interaction introduced me to some cultural practices of Somali families, such as having multiple wives.  It also introduced me to the experiences faced by women living in UN refugee camps around the world.  Although we didn’t find out the specific details surrounding the rape, it still brought up the many issues faced by women when living in the camps.  Women are inherently more vulnerable, as were this mother and her daughter, just by virtue of being women.  This interaction also made me think of the movie “God Grew Tired of Us.”  It made me think of the daily struggles faced by the lost boys and how this Somali mother must have similarly struggled to find enough food and shelter for herself and her family.  This woman also made me think of the struggles faced by women in the documentary when John’s father writes to him that his sisters are sick and naked and need help.  In this one small line, it very poignantly and succinctly described the situation women face in camps because they are women.  Overall, this experience made me realize how complex working with refugees can be.  Even though we are their medical providers, we need be prepared to expect the unexpected and become aware of our own experiences, emotions and biases in order to build a relationship with this population.

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Patricia Avelar is a fourth year Medical Student at the University of Utah School of Medicine.

Why (not) Family Medicine? – Michael Magill, MD

Why (not) Family Medicine? is a series of posts from health care thought leaders, both inside and outside of Family Medicine. These will be posted every Friday. The participants were asked to focus on whatever they wanted in response to this question. We are glad that so many of these impressive leaders were willing to participate, and we hope that you enjoy their responses!

 

Imagine… helping a family through a difficult pregnancy, attending delivery of their healthy baby, “walking with” them through the amazing transitions of children and growing families, stresses of parenting, episodes of acute illnesses, and truly miraculous prevention we provide for the once-terrifying diseases of childhood.

 

Imagine… supporting hard working, aging immigrants as they negotiate the complex challenges of chronic illnesses like diabetes, hypertension, obesity, arthritis, asthma, and depression – sometimes all at once – despite burdens of poverty, pollution, and prejudice.

 

Imagine… leading an interdisciplinary team of excited health care colleagues, patients, families, public health, and communities, as you build trusting, healing relationships to improve the health of your neighbors and patients, all while reducing total cost of care.

 

You can do this and so much more as a Family Physician… care for patients and communities, conduct cutting edge research that matters, teach, lead health systems, advocate for your patients, tackle complex intellectual challenges.

 

But we are not the first to claim this amazing privilege. While I am in my 36th year as a Family Physician, I proudly claim deep roots in general practice through my grandfather, H.A. Moore, MD, who practiced 50 years (1915-1965) from a one-room home office in small town Ohio. He cared for neighbors throughout their lifetimes and without limit by social, emotional, or medical condition. He did not need to talk about continuing, comprehensive, accessible, compassionate, community-oriented care. It was simply good medicine: the expression of his values of service, commitment, and caring.

 

Diseases, tests, and treatments have changed enormously since “Grandpa Doc” left practice over 50 years ago. We now address multiple chronic conditions, implement complex treatment, wield powerful tools of prevention, manage infinitely more complex information, care systems, and payment. But we harness these in service of, not as substitutes for, the personal healing relationships embodied by the best of our general practice forebears.  And now we offer the kind of care, intellect, vision, and leadership most needed by our patients, communities, and American health care. Welcome to Family Medicine!

Michael Magill, MD

Michael Magill, MD is the Chairman of the Department of Family and Preventive Medicine at the University of Utah School of Medicine.