Harborview Medical Center’s Dr. Ron Maier, Dr. Eileen Bulger, and UW Medicine’s Dr. Leo Morales await the days their jobs become obsolete –– the days when the cycle of poverty and disease is broken, all communities have access to high-quality care, and gunshot wounds are largely a thing of the past. They work every day with this larger goal in mind and hope to achieve it through social justice and activism in the hospital.
These health professionals work to improve care for soldiers and civilians with trauma, reduce firearm violence, promote healthcare access in rural areas, and increase cultural sensitivity in clinical settings.
Their work does not always resemble that of typical activists. While doctors sometimes meet with elected officials and attend rallies, activism can also involve providing new types of first aid skills training for the public or supporting diversity in hospital staff and students.
Doctors across Seattle and the country participate in this sort of activism, but the staff at UW Medicine do more than most. Morales believes this emphasis on social justice work is rooted in the hospitals’ missions.
According to Morales, most medical schools and major health entities have mission statements that focus on teaching medicine, conducting research, or a similarly narrow aspect of healthcare. In contrast, UW Medicine’s mission is quite broad: “to improve the health of the public.”
“When people talk about improving the health of the public, they include addressing the health disparities that exist in the population,” Morales said. “So that’s kind of an important guiding light for everyone’s work.”
This is what activism looks like in a hospital.
Bulger, a UW professor and the Harborview chief of trauma, has been an activist of sorts by spearheading an emergency first aid training program called Stop the Bleed. The program teaches ordinary citizens basic bleeding control skills, including how to apply a tourniquet and how to recognize if an injury is life-threatening. The training was developed through the American College of Surgeons and introduced at Harborview, as well as locations in other states, before spreading to other hospitals throughout Washington state.
These skills can apply to a wide variety of situations, from someone falling off a roof to a mass shooting. According to Bulger, the program has trained roughly half a million people across the nation in two years.
“It’s a very popular program,” Bulger said. “People like to feel empowered to help in an emergency.”
Bulger is also involved with other forms of activism to prevent injuries, including injuries from firearms. Her philosophy is to focus on finding the “middle ground,” or strategies to prevent violence that both gun owners and gun control advocates can agree on.
Some of Bulger’s recent projects have involved researchers from Forefront's Safer Homes, Suicide Aware program going to gun shops and gun shows. The researchers hand out free safety equipment, such as trigger locks and gun safes, in exchange for filling out surveys about firearm storage practices and beliefs. This helps researchers find out what strategies are most likely to work and where the “middle ground” is.
When asked how she felt about the recent #StayInYourLane and #ThisIsOurLane Twitter controversy, Bulger said she felt that it “helped bring the medical community together and raised awareness,” but that there is now a need to “get past the political piece of it.”
“If we keep it at the level of words of fight between the medical community and the NRA, which is the way the media tried to depict it … we stay polarized,” Bulger said. “But if we say, ‘OK, we’ve raised awareness now, we need to bring everybody together and work on the problem,’ then it becomes a solution.”
She said that the staff at Harborview have generally been involved in studying a wide variety of injury prevention strategies and implementing those that prove effective. Their work includes raising awareness of the dangers of distracted driving and promoting safe firearm storage.
“We treat injuries, but we’d like to prevent them,” Bulger said. “We’d love to put ourselves out of business.”
Much of the trauma work at Harborview focuses on civilians, but Harborview surgeon-in-chief Ron Maier has also worked extensively with military trauma. During the war in Afghanistan, he volunteered at the Landstuhl Regional Medical Center, an American hospital in Germany where soldiers would come 24 to 48 hours after suffering injuries that often required multiple operations.
“To help in their care as a trauma surgeon was an amazingly positive, heart-warming experience,” Maier said. “It’s truly an amazing experience to treat these dedicated young people with really horrendous injuries … to recover as much as they can and pay them back [for their service.]”
Now that he’s back in the United States, Maier is an informal activist for injured soldiers and other trauma patients. He has visited with elected officials in Washington, D.C., to discuss ways that military and civilian surgeons can pool their knowledge to improve care for all patients.
“I’ve provided my insights and experiences … so that future patients get the best care possible,” Maier said.
Another cause Maier advocates for is the need for rural surgeons. Rural hospitals have trouble recruiting and retaining physicians, especially surgeons, and in some cases, hospitals that serve large areas are closing.
“I think maintaining access to care in America should be what our elected officials are focusing on,” Maier said. “The bottom line is we’re losing access for patients, and we need to do something soon so that more people don’t have to suffer because they couldn’t get care in an efficient time frame.”
Maier also works to promote cultural understanding and sensitivity at Harborview. He said the main way Harborview addresses this challenge is by working to bring in more diverse medical staff with a variety of cultural backgrounds.
“If you want to provide optimal care, you need to recognize that diversity within individuals and populations and try and understand and learn of cultural issues,” Maier said. “[You need] individuals who can provide a liaison with a population, whether it’s language or religion … All of those things have an impact on how well somebody’s going to recover from their injuries.”
At Harborview, staff are also working to bring in more diverse research participants and volunteers. According to Maier, the Trauma Survivors Network at Harborview is recruiting recently injured patients from different cultures to team up with other patients and help them reintegrate into the community.
The hope is that patients from diverse parts of the community will be better equipped to provide each other with advice on where to get healthcare, how to improve living conditions, and how to gain employment.
Like Maier, Morales, chief diversity officer for the UW School of Medicine, is an activist for diversity in the medical profession due to the nature of his role. He works to recruit underrepresented populations to the medical profession and help future doctors learn how to optimally care for different communities.
Some medical schools, like the University of California, have five-year programs that allow medical students to complete an additional master’s degree in public health (MPH) and learn about diverse communities in depth. In contrast, UW medical students have the option to complete a certificate in one of five areas: Indian health, Hispanic health, LGBTQ health, global health, and the underserved.
According to Morales, the UW pathways are notable because they offer focused training on serving marginalized populations within the standard four years of medical school.
“I think the pathways as they are currently constructed is probably pretty unique to the UW,” Morales said. “You can’t go as in depth [as you would in a five-year joint MD-MPH program], but on the other hand, it doesn’t add another year of educational debt and time onto what is already a very long educational process.”
Morales also works on pipeline programs that encourage underrepresented minorities to consider medical school. These include the Summer Health Professions Education Program, a free six-week program that allows college students to shadow health professionals while taking relevant coursework; the Health Professions Academy, which provides professional development for UW undergraduates from disadvantaged backgrounds; and Doctor for a Day, which provides outreach events to Seattle students of color as early as eighth grade.
In addition to its mission statement, UW Medicine recently introduced the Healthcare Equity Blueprint, a multi-year plan for promoting high-quality healthcare access for all patients. The blueprint includes objectives and strategies for increasing inclusion among staff and reducing implicit bias, engaging diverse communities as partners, and collecting and acting on data about where disparities exist.
Harborview is arguably even more directly tied to social justice in its mission. The clinic’s website lists “to provide healthcare for the most vulnerable residents of King County” as the first of its four primary mission statements. According to Maier, Harborview exists as a safety net for patients who can’t easily find care elsewhere.
“They’re uninsured, they have trauma, they have social determinants that restrict their access to other care providers,” Maier said. “We don’t question their ability to pay, we respond to their needs, and it’s been that way forever.”
According to Maier, Harborview is currently working with the county to find ways to “not only treat [patients] well while they’re in the hospital, but to optimize their opportunities to recover fully and to keep from having recurrent challenges.” Maier cited inadequate social infrastructure, education, and housing as common reasons why patients struggle to recover fully after a hospital stay.
Doctors work on social justice not only because they care, but in many cases because they view it as part of their role.
Social justice “spans the entire work of medicine,” Maier said. “It’s providing care for patients who need medical intervention and care delivery. Sort of the entire premise of medicine is social justice for all.”
Ultimately, Maier, Morales, and Bulger do their work because they care. Someday, they hope people in every marginalized or rural community will have access to high-quality care, soldiers and civilians alike will get timely and effective care for their injuries, and people won’t regularly die from firearm wounds. Each step they take gets us a little closer.
Reach Science Editor Leslie Fisher at email@example.com. Twitter: @lesliefish3r
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