Category Archives: Guest Posts

BGDMedS: Learning More Than Medicine

by Kayla Holston

“Kayla, you choose the music. You’re the most urban.” As a medical student at a PWI (Predominantly White Institution), I’ve become comfortable with being the only Black person in the room. From the engineering undergrad at the University of Virginia to the Master of Public Health at Emory University to now medical school at Thomas Jefferson University, PWIs have become quite familiar. But, whenever I forget just where I am and what assumptions I’m surrounded with, comments like this remind me.

My journey as a graduate student has been about finding out who I am when the security of undergrad has been torn away—who I am outside of school. Am I a yoga enthusiast, a family girl, or a travel fanatic? As it turns out, I am all of those. What I have discovered, though, is that I am also a pensive Black woman who can be disloyal to herself when it comes to confronting racism. And here’s how realized that:

At Thomas Jefferson University, our curriculum is divided into blocks, and each block focuses on a system (e.g., cardiology, pulmonology, neurology). During each block, we spend a few weeks dissecting Sally, our group’s human gift. One afternoon, two lab mates and I decided to go to the dissection lab while it was empty to re-dissect Sally as a form of studying. Since we were alone in the room, we decided it would be nice to play some music. That’s when it happened: “Kayla, you choose the music. You’re the most urban.”

All I could do was laugh. More of a crying laugh, but you know. I thought to myself, if Sally wasn’t here, I’d let you have it. Out of respect for her, I’ll shut up. That’s what I told myself but, honestly, I laughed because I wanted to make him feel more comfortable in a moment he had made uncomfortable. He laughed with me, and I became the “cool Black girl” who didn’t get upset over “silly jokes.’” Now he “jokes” whenever he sees me.

Being a Black medical student puts me in a weird place—I don’t want to be the difficult Black girl. Team learning is even more important here than in my past curricula, and I don’t want to ruin relationships with my assigned team members and then find myself struggling to group study with them. The comment my lab mate made illuminated a quality in myself that I am now grappling with. In academic situations, I tend to be conflict-averse at the expense of my mental health. I believe the reason is a combination of not wanting to hinder my learning (obviously) and not wanting to make situations awkward for myself and others.

I wish I could say, after this realization, I cut off every prejudiced person and clapped back to every racist remark. Still a work in progress. What I can say, though, is that I have become intentional about my mental health and the company I keep. I have embraced therapy for all facets of my life, began regularly engaging in mindfulness through yoga, and, most importantly, allowed God to be my center of peace. (Quick pause: Different approaches work for different people but, if you have not tried it yet, I highly recommend hot yoga as a healthy way to relieve stress and stay fit. But first, try God. Nothing will give you peace until that part is handled.)

Anyway, I have also become okay with the idea of a close, small circle. It is kind of crazy how we feel obligated to spend time with people just because we have in the past. I finally asked myself, why do you let this white girl (excuse me, white passing) keep talking to you like you’re stupid? Why do you voluntarily do Friday dinners with her? So, guess what? I. Just. Stopped. Not groundbreaking, but for me it was. I thought I needed to keep every friend I had because, if I didn’t, I wouldn’t have anymore friends and medical school is tough without camaraderie. Well, medical school is challenging either way, so may as well do it with woke people, even if there are only three.

So, what advice would I give to a future BGDMedS?

  1. Spend some time figuring out who you are because your identity will be illuminated and tested during this trying but exciting time of your life.
  2. Make a plan for caring for yourself before you get here. If you don’t, it probably won’t happen.
  3. Surround yourself with love and truth, nothing more and nothing less.

There are plenty of people who decide who I am before I open my mouth. But, even when I don’t know who I am, God is certain of my identity. So, I abide in him, embrace what He says of me, and care for myself. I hope you will too.


micahkaylagrad-23copuKayla Holston is pursuing an MD at the Sidney Kimmel Medical College of Thomas Jefferson University. Kayla earned a Master of Public Health in Health Care Management at Emory University and a Bachelor of Science in Biomedical Engineering & Cognitive Science at the University of Virginia. She is particularly interested in utilizing her educational background to improve patient flow and healthcare staff workflow in order to improve efficiency in understaffed health systems. Kayla’s current research focuses on improving quality and staff workflow in a Malawian health center in collaboration with Malawian medical providers and architecture professionals. Her second research focus is in orthopedic surgery, particularly with regard to how psychosocial factors affect hip pathology and postoperative outcomes. Professionally, Kayla hopes to blend the roles of a physician and healthcare administrator to continue projects like this, serving patients on both an individual and organizational policy level.

Deferred Maintenance

By Enjoli Hall

How and why I made healthcare my top priority in my first semester

Twenty-nine. The number of visits I made to a doctor’s office during my first semester as a PhD student. In any given week, my Google calendar was a fall-themed collage of classes, advising meetings, on-campus events, and doctor’s visits. Scheduling my doctor’s appointments was akin to a research assistantship—I mapped the locations of Black female primary care physicians. I analyzed what combination of dental procedures I could afford with my insurance benefits. I reviewed literature on the antidepressants recommended by a counselor. I wrote reports detailing my medical history on intake forms. I presented my life story to the six therapists I was forced to meet with in order to evaluate my request for an emotional support animal in university housing. While I couldn’t add these lines to my CV, perhaps I could add a few years to my life.

Some of the appointments I scheduled might be considered “routine” check-ups: annual eye exam, seasonal flu shot, pap smear. But many of the appointments were for managing chronic pain and depression. Sometimes, these appointments were not planned, such as impromptu visits to the urgent care clinic on campus for frequent headaches or toothaches. What nearly all of these appointments have in common is that they were the result of deferred maintenance. In my field of urban planning, the term deferred maintenance is often used to describe the practice of postponing maintenance and repairs on essential infrastructure to save money, balance budgets, or reallocate resources to address more immediate needs. For example, a landlord might postpone fixing leaky pipes in an apartment to save money in the short term. Or a local government might delay replacement of lead pipes in its city’s water system due to budget shortfalls. The cumulative effects of deferred maintenance can be catastrophic—an apartment building that could have been rehabbed now needs to be demolished; a city’s population is poisoned by its water supply with lasting public health problems.

Prior to starting grad school, I deferred diagnostic tests, annual exams, small procedures, and mental health therapy for years. I was a first-generation, low-income college graduate barely making ends meet in an industry and city that people don’t choose to make money. While I am adept at understanding the functions of macro social systems such as racism and the economy, I often struggle to navigate individual institutions and bureaucracies to get my needs met. I could not afford the co-pays, the time off from work, or the transportation to get to doctor’s visits of all sorts. Sometimes I tried to schedule appointments, but would get discouraged when the closest doctor was located over an hour away, open during limited hours, not accepting new patients, or did not take my insurance. These challenges are common when you live in a poor, low-density region serviced by an inadequate public transit network. Or when you grow up in a community that discounts mental illness as laziness or a bad attitude: “You don’t need a doctor, you need discipline. Your problems will go away when you get a better job or a boyfriend.

I internalized my mental anguish as of my own making and normalized my physical discomfort as a fact of daily life. In effect, I deferred maintenance on the mental and physical systems that sustain my well-being. As a result, what were cavities became root canals. The situational depression I developed in college spiralled into clinical depression—a mighty vortex that seemed to grow more intense with each post-grad job, relationship, and life event. And what might have been managed with months of counseling sessions, probably requires several years of regular therapy. At times, it is very difficult to reconcile the access I’ve had to some of the most elite universities in the world with the barriers I’ve faced to accessing basic medical services. I don’t know how to describe the feeling of sitting in a class and knowing your lived experience is the outlying data point of educational success, the case example of why we need multifaceted definitions of “access” that consider affordability, availability, and awareness in addition to physical distance. When your GRE score is in the 99th percentile, and so is your cholesterol level.

I am sharing my story not because I think it is unique, but because I suspect it is quite common in some ways. Despite increasing awareness of the academic, financial, and sociocultural challenges experienced by minority, low-income and first-generation students, I have observed a persistent stigma and silence around health issues. I understand the disincentives and potential penalties that students—especially marginalized students—may encounter in sharing these stories. Or even just saying to someone “I have depression.” Our position in these programs is often marked by precarity and presumed incompetence. We’re constantly expected to prove our basic capabilities to handle the rigors of advanced research to our peers and professors. Our admission was not enough; at best it was a professional courtesy, at worst it was a statistical accounting. We should be so grateful. Talking about mental or physical illness—how it alters the way we process information, the way we move through space, the way we structure our schedule—carries tremendous risk in a profession that rewards intellectual acuity and constant productivity.

Grad school is hard. But for someone like me, it means improved access to care such as on-campus, free and subsidized providers, health screenings, and wellness services that I could not obtain for the last several years. The services are not comprehensive and my stipend is not enough, but it is more healthcare and more income than I’ve had for years. So, I am making my health my top priority. I cannot afford to defer maintenance of my mental and physical health any longer. Because the grim reality is, if I do not attend to these issues now, I might not survive to the end of my PhD program. I know this is only the very beginning of months and years of chronic pain, frequent appointments, and unforeseen consequences, but I am grateful for the opportunity to repair. My pain might not be my fault, but I am responsible for my healing.


Enjoli Hall is a PhD student in the Department of Urban Studies and Planning at the Massachusetts Institute of Technology (MIT). Enjoli’s research is focused on racism, social inequality, and urban policy, and the impact of these forces on local government planning, policy, and finance. Her work focuses on cities and counties facing chronic poverty related to deindustrialization. Enjoli’s research draws on over five years of experience working with non-profits, foundations, and research centers in her hometown of Buffalo, New York. She has worked in a variety of roles in community development, ranging from adult literacy tutor to youth advocate to program officer to regional planner.

 

Writing While Bilingual: English and Graduate School Writing

I am bilingual.

That sentence was one of the hardest to write. But harder still was coming to the realization that yes, I am indeed bilingual. See, I grew up in Uganda, a former British colony in East Africa. From the time I was three I spoke both English and Luganda. One way colonialism works is it destroys indigenous languages, by forcing the colonizer’s language onto the colonized. In the case of Uganda, the official language is English. And though I can fluently speak Luganda, I struggle with reading Luganda and writing it is even harder. But Luganda is such a huge and very important part of my life, and it affects the way I think and view the world.

But just as Luganda has been a part of me, so has English. My entire academic career has been in English; beginning in kindergarten and now in graduate school. Thus, I have written and spoken English, the Queen’s English, I’ll have you know, for the majority of my learning. But my introductory writing lessons in English were in Uganda. I was taught to write in English, specifically creative writing, but in a Luganda way. This meant much of my writing was telling, what I like to call wandering stories. When I think about the way I write and tell stories, Amos Tutuola’s novel, The Palm Wine Drinkard, comes to mind. Because the way I grew up involved hearing stories told with a lot of details, tangents, and with multiple characters, some of whom had a tendency to just disappear without having advanced the plot of the story much. So, I learned to write stories the way I heard them told, even though I was writing in a foreign language.

Graduate school writing, I believe, is a form of storytelling.

Graduate school writing, I believe, is a form of storytelling. And when I started my graduate school career, I had not written for over five years. I had been working and having a child. I quickly learned that writing is a muscle– one that if you do not exercise, will quickly atrophy. But never having been one that shies away from exercise, and because I am now a graduate student, I began to collect books on writing. And I learned some good tips such as write your introduction last, use simple English, write an outline, know your audience, and edit, edit, edit. The idea of simple English has always worried me. As a child who read Chinua Achebe’s No Longer at Ease, I am forever stuck on a particular scene in that book where Obi Okonkwo’s character returns home from studying English in the United Kingdom– a decision that had already disappointed the community that fundraised to send him to school. Upon his return he gives a speech which further disappoints his community because he uses “is” and “was” English instead of using big words. I have already disappointed my Ugandan family by not being a doctor, (though I am attempting that with a PhD, it is just two letters after all), a lawyer or an accountant. I am not going to disappoint them further by using “is” and “was” English too.

The writing advice was all good. But there was the messy case of the subject matter of my graduate work; sex and reproduction among women and girls from Africa living in America. Women and girls like me. I am well aware for whom the university was built for, and it was definitely not someone like me. I wanted to write for us; for women and girls that had taken that journey from Africa to settle on this “shining city on a hill.” I wanted this story, the story I was attempting to write during my qualifying exams, to be for us. And I found I couldn’t. Because to write it in the way I wanted to, English, I found, was inadequate. I knew the mechanics of putting together a sentence. I knew a first draft would always be terrible and that it would be the fifth maybe even sixth draft that I would finally send to my committee. But the content and the way I wanted to write that content; English wasn’t working out. In my head it was in Luganda, because Luganda allowed me to say what I wanted to say in the way I wanted to say it. But because I never learned to write it, but only to speak and think in it, English was all I had. And when I wrote in English attempting to fit Luganda into English, my paper was incoherent. I was frustrated and confused. How could I still be struggling with this god awful, clunky language, that I had been using for over twenty years?

While I in my own little world struggling with writing in English, Dr. Toni Morrison went home. And my literary world turned a little darker. A world that I had always found solace in when the real world got too much. I wanted to sit quietly in a corner for days and pore over her work. Read every novel and essay she had ever written word by word, sentence by sentence and turn it over and over again in my mind, and just glory in its beauty. I wanted to reach out to my black women friends and just talk to them about what she and her work meant to us as black women and as mothers. I wanted a month to collectively mourn her passing. But I couldn’t because deadlines.

So, I did the next best thing, I searched for audio and videos of her speaking. And I took a few minutes throughout my day to sit quietly and listen to her voice. And that is how I came across Dr. Morrison’s 1993 Nobel Prize in Literature lecture. That speech was exactly what I needed, and it made me furious. Because it spoke to everything I was struggling with and at the same time I felt there was no answer to my writing dilemma. I saw the whole of academia as those young people who set out to question what I was writing. But I was also the young men, holding language in my hand. A language that had been forced onto me before I was even born. But even though this language was forced onto me I still had all the responsibilities of that came with holding that bird, language in my hands. I wanted to ask Dr. Morrison what to do but she had gone home. But she had graciously left us a whole library of answers and so I went looking for an answer in her words. I picked up another of her books. I picked The Source of Self-Regard, though I prefer the visual painted by the European title, Mouth Full of Blood. And again, because every time I worry about writing, I return to Obi Okonkwo, I went straight to the essay on Chinua Achebe. And there, Dr. Morrison answered my question.

I am bilingual. I write in two languages but mostly I write for myself and those like me.


J. Nalubega Ross is a Ugandan American living in the dry dry desert of Arizona. She is currently pursuing a graduate degree at Arizona State University. Their graduate work is concerned with how people from Africa living in the United States look for information about sex and reproduction. And once they find that information how do they use it make decisions about having or not having sex and whether or not to reproduce. When not reading books for graduate work and avoiding writing, Nalubega spends time watching and commenting on cartoons with her toddler and ranting to her partner about sex and reproduction in the United States.