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Category: Diversity, Inclusion, & Accessibility

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Background with a red, black, and green stripe. The word "Juneteenth" in the center.
Image by Wynn Pointaux from Pixabay

June 19th is Juneteenth, also known as “Black Independence Day,” “Freedom Day,” or “Emancipation Day.” Although President Abraham Lincoln issued the Emancipation Proclamation in 1863, enslaved people living in Confederate states, specifically Texas, would not learn of their freedom until two months after the Civil War ended in April of 1965. On June 19, 1865, Union General Gordon Granger and his soldiers arrived in Galveston, Texas, and informed the state’s residents that slavery had been abolished and that enslaved people were now free. Mary Elliot, Curator of American Slavery at the National Museum of African American History and Culture stated that “although there were enslavers who were aware of the implementation of the Emancipation Proclamation, it wasn’t until June 19th, 1865 that it was enforced with the Union Army” (Smithsonian Institution, n.d.).

While Juneteenth has long been a celebration of hope and freedom within the African American community, Juneteenth did not become a federally recognized holiday until 2021 when President Joe Biden signed the Juneteenth National Independence Day Act. If you’re interested in learning more about the history of Juneteenth, read our Understanding and Honoring Juneteenth post from last year.

Juneteenth and the Health Sciences

So how is Juneteenth related to medicine, the health sciences, and public health? In many ways, Juneteenth is more relevant than ever considering the focus in recent years on confronting health inequities and the structural racism that is at the root of those health inequities. In 2020, The American Medical Association (AMA) declared that racism threatens public health and created a strategic plan to advance health equity. The 2020 statement recognizes that “when race is described as a risk factor, it is more likely to be a proxy for influences including structural racism than a proxy for genetics” (O’Reilly, 2020). Race has long been considered a risk factor for many conditions and “is present in numerous clinical guidelines and algorithms” and “can impact medical decision-making that potentially worsens health disparities” (The Oregon Clinic, 2021). 

Juneteenth has many lessons that medical, nursing, and public health professionals and students can apply to further the cause of health equity and provide high-quality care to patients. Practicing critical reflection, “the process of identifying, questioning, and assessing deep-seated assumptions upon which our beliefs are built”  can help us “better recognize and arrest our biases that can manifest in our interpersonal encounters with patients, colleagues, and trainees” (Opara, et al., 2021). Participating in “transformational conversations” can help “raise the consciousness within the spaces we occupy” and bring important issues to light so they can be addressed (Opara, et al., 2021). 

Further Reading

Educating yourself on racial health disparities is always a great first step. Here are titles from our Diversity and Disparities in Health Care Collection that may be of interest:

References: 

Smithsonian Institution. (n.d.). What is Juneteenth? National Museum of African American History and Culture. https://nmaahc.si.edu/explore/stories/what-juneteenth

Opara, I.N., Lewis, C., Kasozi, R.N., Givens, R. (2021). Lessons from 1865: What clinicians can learn from Juneteenth. Passion in the Medical Profession. https://closler.org/passion-in-the-medical-profession/lessons-from-1865-what-clinicians-can-learn-from-juneteenth

O’Reilly, K.B. (November 16, 2020). AMA: Racism is a threat to public health. American Medical Association website. https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-health

The Oregon Clinic. (June 18, 2021). Juneteenth and healthcare. The Oregon Clinic Newsroom. https://www.oregonclinic.com/newsroom/juneteenth-and-healthcare/

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one person's hand holding another person's hand

June is Cancer Survivors Month. Any cancer diagnosis induces feelings of anxiety, uncertainty and fear in patients. While novel approaches to and treatments for cancer are improving survival rates, social determinants of health continue to exert significant impact on patients’ ability to experience positive outcomes to treatment. Let’s look at one of these determinants, economic stability, in the context of cancer survival.

The term “cancer-related financial toxicity” was introduced in 2013 by Zafar and Abernethy, and described as, “the patient-level impact of the cost of cancer care” (Zafar and Abernethy, 2013). Even those patients who are privately insured are not protected from financial toxicity, as a 2022 study published in the Journal of the National Cancer Institute found. Out-of-pocket expenditures by privately-insured cancer patients in the United States have increased, due to the rise in high-deductible insurance plans and greater expected patient contribution to medical expenses (Shih et al, 2022).

How best, then, to help patients navigate the potential financial burdens of a cancer diagnosis, and thereby improve their potential treatment outcomes? A 2023 scoping review in Critical Reviews in Oncology/Hematology examined interventions for financial toxicity among cancer survivors. The interventions discussed include: financial navigation, which includes identifying patients at high risk for financial toxicity, offering guidance on out-of-pocket costs, and facilitating access to programs to alleviate financial stress. Financial counseling helps patients access advice and guidance on managing financial toxicity caused by cancer treatment. Insurance education entails providing patients a structured way to develop insurance literacy and assistance in choosing a plan. Other types of interventions examined included multidisciplinary psychosocial supports, intensive symptom assessments, and supportive care (Yuan et al, 2023).

The effectiveness of the interventions, researchers found, were closely tied to the causes of the cancer-related financial toxicity, with socioeconomic and employment status, cancer stage, and type of treatment, type of insurance, as well as coping skills all having a direct impact on how effective financial interventions could be. Looking closely at just one of the interventions mentioned above, engaging with financial navigation helped cancer patients save significant dollar amounts annually by facilitating the procurement of free medication, and insurance premium and co-pay assistance.

The financial interventions described in the evidence reviewed differed greatly, but more generally, the recent focus in the literature on finding ways to alleviate financial toxicity frequently faced by cancer patients is one promising step towards improving outcomes for all patients dealing with cancer.

References

Debela, D. T., Muzazu, S. G., Heraro, K. D., Ndalama, M. T., Mesele, B. W., Haile, D. C., Kitui, S. K., & Manyazewal, T. (2021). New approaches and procedures for cancer treatment: Current perspectives. SAGE open medicine, 9, 20503121211034366. https://doi.org/10.1177/20503121211034366

Lau, L. M. S., Khuong-Quang, D. A., Mayoh, C., Wong, M., Barahona, P., Ajuyah, P., Senapati, A., Nagabushan, S., Sherstyuk, A., Altekoester, A. K., Fuentes-Bolanos, N. A., Yeung, V., Sullivan, A., Omer, N., Diamond, Y., Jessop, S., Battaglia, L., Zhukova, N., Cui, L., Lin, A., … Ziegler, D. S. (2024). Precision-guided treatment in high-risk pediatric cancers. Nature medicine, 10.1038/s41591-024-03044-0. Advance online publication. https://doi.org/10.1038/s41591-024-03044-0

Shih, Y. T., Xu, Y., Bradley, C., Giordano, S. H., Yao, J., & Yabroff, K. R. (2022). Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured. Journal of the National Cancer Institute, 114(10), 1392–1399. https://doi.org/10.1093/jnci/djac141

Yuan, X., Zhang, X., He, J., & Xing, W. (2023). Interventions for financial toxicity among cancer survivors: A scoping review. Critical reviews in oncology/hematology, 192, 104140. https://doi.org/10.1016/j.critrevonc.2023.104140

Zafar SY, Abernethy AP. Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park, NY). 2013;27(2):80-149.

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A piece of wrinkled shaded with the colors of the rainbow

Every person is different, and that diversity makes human beings so fascinating. In order to serve diverse populations, it’s important for us here at Himmelfarb Library to have a wide variety of materials for students to learn from. One of these populations is the LGBTQ+community. 

To help students locate material related to diverse populations, we have a Diversity and Disparities in Health Care collection. This collection covers a wide range of unrepresented groups, including queer people. Given the wide variety of content we offer, it would be impossible to cover everything in one blog post (which is a good thing). Instead, here are a few books from our collection to give readers a glimpse of what the library has to offer.


Global LGBTQ Health: Research, Policy, Practice, and Pathways.

By: Hwahng, Sel J. editor.; Kaufman, Michelle R. editor.

This book takes a look at the intersection of global and LBGTQ+health. Aiming to take a larger look at LGBTQ+health across the world, this text offers insight into issues on both a regional and global scale. 

The case against conversion "therapy": evidence, ethics, and alternatives

Haldeman, Douglas C., editor.

While many states have now banned the practice known as “conversion therapy” there are still places where it is used, often on LGBTQ+ youth. This text takes a look at the motivations behind the practice, the decades of evidence showing it to be actively harmful, and why LGBTQ+identities are not something to be “cured” but embraced. 

Trans medicine: The emergence and practice of treating gender

Shuster, Stef M., author.

This text covers both the history and contemporary practice of Trans medicine. Medicine for transgender people is often misunderstood due to both a lack of knowledge and misinformation. In this book, readers can not only learn that Trans medicine is not new, but is backed by decades of science.

Bodies and barriers: Queer activists on health

Shanker, Adrian, editor.; Levine, Rachel Leland, 1957- writer of foreword.; Kendell, Kate, writer of afterword.

Health disparities can exist for a variety of reasons. In this text, multiple queer activists explain some of the factors that lead to such disparities, what negative outcomes result, and ideas on how to fix them. 

The script - queer futures

Wortham, J., film producer.; Fryer, Brit, film director.; Schamus, Noah, film director.; Multitude Films, production company.; Good Docs (Firm), distributor

Our last resource for this post is a film. Using recreations of personal interviews, this film takes a look at how transgender and nonbinary people interact with the medical system, and how practitioners and patients interact with one another.

References:

Haldeman DC, ed. The Case against Conversion “Therapy”: Evidence, Ethics, and Alternatives. American Psychological Association; 2022.

Hwahng SJ, Kaufman MR, eds. Global LGBTQ Health: Research, Policy, Practice, and Pathways. First edition. Springer; 2024. doi:10.1007/978-3-031-36204-0

Shuster SM. Trans Medicine: The Emergence and Practice of Treating Gender. New York University Press; 2021.

Shanker A, ed. Bodies and Barriers: Queer Activists on Health. PM Press; 2020.

Wortham J, Fryer B, Schamus N. The Script - Queer Futures. [Distributed by] GOOD DOCS; 2023.

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Three male doctors in white coats in a black and white photo taken in 1892
Dr. William Coley (center), public domain photo from https://commons.wikimedia.org/wiki/File:William_Coley_1892.jpg

May is Melanoma Awareness Month, which serves as an annual reminder to visit a dermatologist regularly for a skin check. Melanoma affects every skin tone. Visit Himmelfarb's collection, Diversity in Dermatology, to explore our library resources on this topic.

This year, let’s go back in time to learn about the origin of one tremendous contemporary advance in the treatment of malignant melanoma -- immunotherapy -- and learn about a new development coming for patients diagnosed with melanoma.

Dr. William Coley (1862-1936) was a bone surgeon and cancer researcher who spent his career at the New York Cancer Hospital. At the time, cancers were commonly treated with amputation. Coley’s young patient, 17 year old Elizabeth Dashiell, presented with an aggressive sarcoma in her hand. Despite an amputation, her cancer had metastasized and she died ten weeks later. Coley began to comb through hospital records, and found a patient who had had four recurrences of an inoperable sarcoma, whose disease had gone into remission when he developed a superficial streptococcal infection of the skin. Coley managed to locate the patient, who did not present with any clinical evidence of malignancy. He also found a number of observational publications connecting this particular skin infection with positive outcomes for sarcoma patients.

Cover of a medical monograph from 1914
The Treatment of Malignant Inoperable Tumors, by William B. Coley, MD (1914)

Coley began intentionally inducing this skin infection in his cancer patients, despite the fact that antibiotics were not yet available to help control infections. His practice is of course shocking and unethical in the light of our contemporary understanding of medical ethics. Additionally, the specific infection, erysipelas, was difficult to induce in patients, some of whom never developed the infection, and some of whom were injected repeatedly in the attempt to induce it. Having achieved some results with his initial attempts, Coley began using a heat-killed version of the infection, combined with one other toxin (which is known to us today as Serratia marcescens) to increase the virulence, and in turn, patients’ immune responses. This combination came to be known as “Coley’s toxins.” A summary of the patients treated with Coley’s toxins prior to 1940 shows that 22 soft-tissue sarcoma patients and 8 lymphoma patients were found to be free of clinical evidence of disease for a period of at least 20 years. (Starnes, 1992). Results for other types of cancers varied, but were not nearly as dramatic. You can read Coley’s 1914 report on his treatment of patients with toxins in its entirety online.

The concept of inducing an immune response in patients to address malignancies also underlies the pioneering work done by contemporary researcher James Allison, for which he shared the 2018 Nobel prize with Tasuku Honjo, for their work on immunotherapy. Allison’s work is chronicled in the documentary Breakthrough, which is available to stream on a number of platforms. Immune checkpoint therapy stimulates the patient’s immune system by blocking inhibitory checkpoints, in order to enable T cells to attack the tumor. Currently, immune checkpoint inhibitors which target the molecules CTLA4, PD-1, and PD-L1 are approved. The very first immune checkpoint therapy, ipilimumab, was approved in 2011 for the treatment of melanoma; since then, seven additional immune checkpoint inhibitors have been approved for use in the treatment of an ever-increasing number of cancers.

Research is ongoing towards the development of melanoma vaccines, which also build on the basis of activating patients’ own immune systems. The April 2024 issue of Cancer Research contains a brief comment on the growing body of evidence for vaccines tailored to specific tumor mutations, noting that progress has accelerated and increased during the past five years. (Fritsch & Ott, 2024) 

While the ultimate goal is to prevent patients from developing melanoma in the first place, the results of research are leading to exciting and unprecedented outcomes for patients who have the disease. Dr. Coley’s early work with the immune system of cancer patients reminds us that pioneering ideas may come before their time and before the technology exists to support them, but may nonetheless lead to unimaginable and positive outcomes centuries later.

References

Coley, W. B. The Treatment of Malignant Inoperable Tumors with the Mixed Toxins of Erysipelas and Bacillus Prodigiosus : With a Brief Report of 80 Cases Successfully Treated with the Toxins from 1893 to 1914 / by William B. Coley. M. Weissenbruch, 1914; 1914.

Fritsch, E. F., & Ott, P. A. (2024). Personalized Cancer Vaccines Directed against Tumor Mutations: Building Evidence from Mice to Humans. Cancer research, 84(7), 953–955. https://doi.org/10.1158/0008-5472.CAN-24-0565

Starnes C. O. (1992). Coley's toxins in perspective. Nature, 357(6373), 11–12. https://doi.org/10.1038/357011a0

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Going to the doctor can be an anxiety-inducing experience. Regardless of how comfortable one is with their medical provider, the prospect of test results bearing bad news can make a routine visit understandably nerve-wracking. 

But what if one’s apprehension regarding medical care was due to other reasons? What if going to the doctor meant being called the wrong name and pronouns for the entire visit? What if your visit led to being grilled about your life and hobbies as if they’re to blame for whatever ails you? What if you had to change how you looked or dressed to get treatment?

Sadly, these experiences are not uncommon for adults who identify as LBGT. According to a new survey out of the Kaiser Family Foundation (KFF), one third of adults who identify as LBGT have experienced discrimination when they are treated by a health care provider. Negative experiences included but were not limited to:

  1. A provider assuming something about them without asking (1).
  2. A provider implying or suggesting they were to blame for a health problem (1).
  3. A provider ignoring or rejecting a request or question (1).

These negative experiences make patients less likely to seek care and can impact their health as a result. Even when LBGT adults continue to seek care despite these negative experiences, discrimination can lead to increased levels of anxiety or distress, which in turn can contribute to mental health conditions like depression or anxiety. Given that 46% of  LBGT adults report being unable to receive mental health services when they needed them in the last three years, this only worsens existing issues (1). 

LBGT patients are people, just like anyone else. Thankfully, there are things practitioners can do to provide a more welcoming attitude to  LBGT patients. 

  • Don’t assume one’s legal name and gender markers are what they use. Ask patients what they wish to be called by and what pronouns they want you to use. 
  • Don’t make assumptions: Never assume something about a patient just because they are LBGT. 
  • Have material in your office or medical facility that identifies your practice as a safe space. This can include patient materials about health concerns that disproportionately impact LBGT individuals, having a private policy on display, and showcasing rainbow stickers or signs that state the area is a safe space (4). 
  • Ensure your intake forms are inclusive. There are examples online one can use as templates like those available from Queering Medicine (3). 
  • Explicitly use inclusive language and images both in the office and on all social media. 

As pride month approaches, let’s work to ensure medicine is welcoming to all our patients, regardless of who they are. 

1.Survey: LGBT Adults Are Twice as Likely as Others to Say They’ve Been Treated Unfairly or with Disrespect by a Doctor or Other Health Care Provider. KFF. Published April 2, 2024. Accessed May 20, 2024. https://www.kff.org/racial-equity-and-health-policy/press-release/survey-lgbt-adults-are-twice-as-likely-as-others-to-say-theyve-been-treated-unfairly-or-with-disrespect-by-a-doctor-or-other-health-care-provider/

2. Queering Medicine - Intake Form Guidance for Providers. Queering Medicine. Published July 8, 2021. Accessed May 20, 2024. https://www.queeringmedicine.com/resources/intake-form-guidance-for-providers

3.  Daniel H, Butkus R. Lesbian, Gay, Bisexual, and Transgender Health Disparities: Executive Summary of a Policy Position Paper From the American College of Physicians. Ann Intern Med. 2015;163(2):135-137. doi:10.7326/M14-2482

4. Bourns A, Kucharski E, Peterkin A, Risdon C, eds. Caring for LGBTQ2S People : A Clinical Guide. Second edition. University of Toronto Press; 2022.

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Fingers with arthritis resting on a blue cushion
Fingertip arthritis - DIP joint, by handarmdoc on Flickr, licensed under Creative Commons

May was designated as Arthritis Awareness Month by Congress and the President in 1972. An estimated 53.2 million US adults (21.2%) reported being diagnosed with some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia, in response to the CDC’s National Health Interview Survey (Fallon et al., 2023). There are numerous types of arthritis. Because of its prevalence, as well as the financial impact of the various forms of arthritis – for the year 2017, the CDC estimated that osteoarthritis was the second most costly condition treated at US hospitals. Let’s look at a couple of recently published articles examining the impacts of arthritis on population health.

When we consider a condition that is as common within the population as arthritis, and as costly to treat, health disparities are a concern. In a brief report in the July 2023 issue of Arthritis Care & Research, researchers examined healthcare utilization by patients diagnosed with rheumatoid arthritis (RA) or osteoarthritis (OA), focusing on whether these patients live in rural/isolated, largely rural, or urban locations (Desilet et al., 2023) The study was based on questionnaires filled out by over 37,000 RA patients and over 8200 OA patients. A majority of the RA patients responding (74.5%) lived in a rural area, and this proportion was similar for OA patients. By analyzing questionnaire responses indicating healthcare utilization over six months, the research team found that among RA patients, urban residents were more likely to utilize healthcare provided by some type of professional than their rural counterparts. The same was true for OA patients. Patients with both types of arthritis fare better under the care of a rheumatologist, and in rural areas, access to this expertise is more limited. The findings of this study suggest the importance of extending access to rheumatology care in rural communities that are not currently well-served.

A forthcoming article in the journal Rheumatology (d'Elia et al, 2024) reports on a study of symptoms in a primary care database, which tracked prodromal (early) symptoms for the 24 months prior to diagnosis, in over 70,000 RA patients, over a period of 18 years. When analyzed demographically and socioeconomically, the findings were that symptoms were reported differently in new-onset RA across ethnic groups. While some of this may be accounted for due to the way symptoms are reported by patients, delayed diagnosis and treatment is another potential factor. 

Another interesting finding of this study was the fact that of the symptoms reported, there was a discrepancy between the most common symptoms of RA (e.g. painful small joints of the hands, present in over half of RA patients) and the percentage of patients in the database who were reporting this symptom (10.2%). This may point to under-coding of symptoms, which would have an impact on treatment. Future studies may build on these findings delving more deeply into the differences in RA symptoms among different ethnic groups, including their underlying causes and their clinical implications.

Arthritis affects a large proportion of the population in the US and worldwide, and the burden falls more heavily on those who struggle to access care, as well as those who are not served equitably within healthcare settings. This Arthritis Awareness Month, consider how you might be able to contribute to our understanding of these disparities and help to cure them.

References

Fallon, E. A., Boring, M. A., Foster, A. L., Stowe, E. W., Lites, T. D., Odom, E. L., & Seth, P. (2023). Prevalence of Diagnosed Arthritis - United States, 2019-2021. MMWR. Morbidity and mortality weekly report, 72(41), 1101–1107. https://doi.org/10.15585/mmwr.mm7241a1

Desilet, L. W., Pedro, S., Katz, P., & Michaud, K. (2023). Urban and Rural Patterns of Health Care Utilization Among People With Rheumatoid Arthritis and Osteoarthritis in a Large US Patient Registry. Arthritis Care & Research (2010). https://doi.org/10.1002/acr.25192

d'Elia, A., Baranskaya, A., Haroon, S., Hammond, B., Adderley, N. J., Nirantharakumar, K., Chandan, J. S., Falahee, M., & Raza, K. (2024). Prodromal symptoms of rheumatoid arthritis in a primary care database: variation by ethnicity and socioeconomic status. Rheumatology (Oxford, England). Advance online publication.

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An image from NAMI (the national alliance on mental illness) that says "small steps can lead to big progress in mental health"

When we talk about illnesses, one of the many things that might first come to mind is symptoms. A friend complains about a sore throat, a fever and white patches on the tonsils? We might advise them to go see a doctor about a strep test. A child complains of a headache and starts sporting a rash made of tiny red dots? It wouldn’t be outrageous to consider chicken pox the culprit. Of course, disease presentation can vary and many illnesses share symptoms, but at the end of the day, many illnesses provide a visible clue that something is wrong. 

Mental illness is far less visible to the naked eye. There is no rash that accompanies depression, nor is there a wheezing cough that comes with anxiety. The symptoms of mental illness, as the name implies, are often found in thought patterns and behaviors of those who have them. And while these thought patterns and behaviors can be observed, it often far more than a passing glance to properly diagnose someone. The average delay in treatment after a person starts showing symptoms of a mental illness is 11 years (1). 

Just because the symptoms of mental illness might not be as clear as other illnesses, they are just as debilitating. 

While mental illness may be hard to spot, that doesn’t mean it isn’t common. While one in five adults in the United States experience mental illness, only half of them receive treatment (1). The statistics for children are even more dire: nearly 70% don’t receive treatment (2).  

Treatment in itself is often difficult to access, with long wait lists to see a provider and spotty insurance coverage among other issues. 

To help raise awareness about mental illness, May is Mental Health Awareness Month. The National Alliance on Mental Illness (NAMI) is celebrating with the campaign “Take the Moment” which aims to highlight programs NAMI provides for patients and their loved ones dealing with mental illness, as well as working to erase stigma around mental health. Here at GW, our Resiliency and Well-Being Center has its own list of topics it will be discussing both this month and the month of June.

  1. Mindfulness and Stress Management (May 8-21)
  2. Healthy Eating (May 22 - June 4)
  3. Restorative Sleep (June 5-18)
  4. Physical Activity: Improving Movement  and Exercise (June 19 - July 2)

The center will also be offering classes about practicing mindfulness both online and in person. 

Here are some ways you can decrease stigma around mental illness: 

  • Language really matters. Terms like “bipolar” and “OCD” can be thrown around as slang for being “moody” or “neat” respectively, despite being terms for serious mental conditions. Don’t perpetuate stigma and stereotypes about these conditions: use different words rather than conditions to describe what you mean. 
  • Reach out to others: It’s okay to need help. If you haven’t been feeling well, you can find help. The school’s Resiliency and Well-Being Center provides resources to support those who are coping. There are also plenty of national resources one can use: NAMI offers a variety of resources in-house and also curates outside resources for those who either need help or want to help someone else.
  • Know mental health is for everyone: stigma about mental health implies that those who have mental illness are simply “not trying hard enough” or “seeking attention.” This couldn’t be further from the truth: mental health conditions are caused by a variety of factors including genetics and environment.  

1. Mental Health Awareness Month. NAMI. Accessed May 6, 2024. https://www.nami.org/get-involved/awareness-events/mental-health-awareness-month/

2. House TW. A Proclamation on National Mental Health Awareness Month, 2024. The White House. Published April 30, 2024. Accessed May 6, 2024. https://www.whitehouse.gov/briefing-room/presidential-actions/2024/04/30/a-proclamation-on-national-mental-health-awareness-month-2024/

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Child in a wheelchair and child using an assistive walking device are on a running track with a coach encouraging them
2017 Special Olympics Spring Games Photo by Aaron Hines (public domain image)

Students at GW are doing great things both in the classroom and outside of it. For our ongoing series of spotlights on student organizations, I spoke with Arinze Okeke and Nikki Karri, both of whom are first-year med students, and also the co-presidents of KEEN at GW.

KEEN stands for Kids Enjoy Exercise Now, and the chapter at GW is part of a larger organization which has provided free programs for fitness and recreation for youth with disabilities since 1992.

Volunteers from GW, who are known as coaches, sign up on KEEN’s email list, and then volunteer one of three Saturdays a month to help out with the program. KEEN invites youth between the ages of approximately ten and 20 years old with all types of disabilities to come to a gym or pool and be paired with a coach or coaches. Students from GW’s KEEN chapter, as well as other area universities, serve as coaches for the activity selected by each young participant.

Arinze explained how participants join the KEEN program: “To get involved, kids fill out a profile stating their likes and dislikes, what activities calm them down, and what they like to do for fun. Sometimes their parents are involved in helping complete the profile.” 

Nikki explained how coordination occurs between the coaches and the participants in KEEN, who are known as athletes. “After we recruit our coaches, we work with the KEEN Greater DC area program director, who’s in charge of both us as coaches, and also the athletes.” KEEN provides a list of athlete abilities and activity preferences, based on the first-hand account collected in the athlete questionnaire. “Beth [KEEN’s program director] knows us and the athletes, so she’ll pair us up based on how well she thinks we’ll fit.” With newer coach volunteers, Nikki continued, “Beth will pair them with the athletes she thinks will be a good fit.” Each Saturday session lasts three hours, during which coaches cycle through working with different athletes and different age groups on an hourly basis.

The range of disabilities represented by KEEN athletes is wide, Nikki reported. “Some of them are nonverbal, and a lot of them have intellectual or physical disabilities.”

Once athletes have been matched with a coach, Arinze says, “We hang out with them, play sports with them – whatever they want to do for the hour we’re together.” Nikki elaborates, “Athletes are new to the activities, and they can try things out. While our involvement is solely with coordinating volunteers for the sport and swim activities, KEEN is not only sports. There are different activities offered throughout the week.” 

Before each session, the coaches gather, and Beth or one of her coordinators will hand coaches their papers. Arinze describes what happens next: “We have some time to read through the first-hand account of each athlete’s characteristics, and maybe talk to other coaches who’ve worked with them. Because typically there are people who have worked with them before, who know their likes and dislikes.” 

I asked Nikki whether there is a constant flow of new athletes joining KEEN. “Most are repeat athletes. Some of them even come with their siblings, so that’s very fun. And there are people who won’t come on a given week and then you see them later and say, ‘Oh my gosh, I missed you!’”  Occasionally new athletes also join the program.

In terms of coach volunteers, Nikki explained that a maximum of ten students can sign up for each weekend’s session, in order to ensure a correct ratio of coaches to athletes. “Depending on whether it’s a heavy week with tests and stuff, sometimes we’ll have six or eight people, but sometimes if it’s a test-heavy week it will be [fewer].” Arinze says that the ratio of coaches to athletes is either one on one, or sometimes more than one coach is assigned to an athlete.

Coaches participating in KEEN come from GW and other area universities. Arinze has met KEEN coaches from Howard University’s medical school. Additionally, coaches from area schools may come from undergraduate programs and disciplines other than medicine.

I asked Arinze and Nikki what drew them to becoming involved with KEEN. For Arinze, mentorship is something he has always been drawn to. During his gap year, he had a unique opportunity to be a second grade special education teacher in Southeast DC. He appreciated “being able to spend time with the kids I had on my caseload, day in, day out, [understanding] what each of them specifically learns, what each of them specifically needs to flourish, because it will look different from the full class, but it will also look different across each individual kid on the caseload.”

Arinze found it rewarding to learn “the small things that make a huge difference in the kids’ learning, their confidence, and their experience of school itself.” Having a disability of any type, he reflected, “can get really discouraging. You can get down on yourself. So I was really glad that I was able to encourage them through the process.”

The mentorship aspect is also one that drew Nikki to become involved with KEEN. Throughout high school and her undergraduate studies, she had volunteered working with the elderly at a nursing home. Eventually, she made the transition to working with children, “doing equine and hippotherapy – working with kids and horses.” She saw how their interactions helped make kids’ days better, and shaped and improved their overall well-being. 

In terms of their involvement with KEEN and its influence on their eventual choice of specialty, Nikki said that working with KEEN “pushed me towards pediatrics. I’m between peds and other fields, but I think KEEN really solidified my choice of peds as one of my top contenders.” Arinze is thinking about family medicine: “That would incorporate working with kids and adults. Just because I definitely feel drawn to the mentorship aspect, being a positive adult influence is important.” 

While some other KEEN coaches are interested in pediatrics, Nikki says, the activity is also a draw for students because it carves time out of the week to “do sports, do something completely different than medicine, but still being able to use your skills and build your people skills.”

In terms of what KEEN’s co-presidents are looking for in potential coaches, Arinze emphasizes, “Just being interested in helping the kids is what we need. Being interested and enthusiastic is what we’re looking for at KEEN.” Nikki adds, “All coach volunteers are provided training prior to their first session. We are open to everyone – be self-motivated and willing to help.”

Published on
On the White House lawn, a child high fives an adult at the 2024 White House Easter Egg roll.
Representatives from GW's OT, PT and Speech Language Hearing programs help make the 2024 White House Easter Egg Roll sensory friendly and accessible to all participants.

Let’s spend some time learning about occupational therapy, sensory friendly spaces, and learning about a recent initiative of GW’s Occupational Therapy program.

Occupational therapy is an allied health profession which helps people develop, recover, or maintain the occupations (or activities) of their everyday lives. Occupational therapists are found in a wide variety of settings, from hospitals to nursing homes, schools to mental health centers. OTs frequently work on an interprofessional basis, collaborating with doctors, psychologists, social workers and special education teachers to help their clients carry out their activities of daily living and increase their participation in activities. (Stein & Reed, 2020)

Occupational therapy as a discipline was officially recognized in the United States with the establishment of the National Society for the Promotion of Occupational Therapy in 1917. That organization is known today as the American Occupational Therapy Association (AOTA). The field of occupational therapy has transformed considerably since its inception just over a century ago, and its goal of achieving occupational justice has been made more concrete. AOTA included occupational justice in its Occupational Therapy Practice Framework beginning in 2014. “The framework states that occupational justice is a part of the domain of occupational therapy because environmental forces impact participation in occupation, the provision of occupational therapy services, and patient health outcomes.” (Bailliard et al., 2020) At GW, students within the OT program are trained to engage with the principles of occupational justice to support client empowerment.

One area in which GW’s OT program is engaged is the successful adaptation of environments and programs to be more sensory friendly. Program director Dr. Roger Ideishi explains, “‘Sensory friendly’ refers to creating a supportive and welcoming environment for children with disabilities. The term sensory friendly has been historically used for community programs aimed to support children with neurodevelopmental disabilities. Adaptations are made to the environment such as lessening the sound and lights to accommodate children who have sensory sensitivities.”

Sensory friendly adaptations increase opportunities for children with all types of disabilities to encounter a friendly and accepting environment. According to Ideishi, “a welcoming, non-judgmental environment makes a huge difference to children with disabilities and their families who constantly face discrimination and ridicule in public.” Ideishi has been at the forefront of the sensory friendly movement for two decades, and has advised cultural institutions including the Kennedy Center for the Performing Arts and the Smithsonian Institution.

The White House held its first sensory friendly Easter Egg Roll in 2023. In 2023, over 100 GW students and faculty from Occupational Therapy, Physical Therapy, and Speech, Language and Hearing supported the White House's efforts. This year again, over 100 OT, PT, and Speech students and faculty supported the accessibility and inclusion initiatives at the White House Easter Egg Roll. GW students and faculty contributed to the event in a number of ways, according to Dr. Ann Henshaw, Assistant Professor in the OT Program. GW affiliates assisted with sensory friendly activities; ensured wheelchairs were accessible to those in need; and, because the White House lawn is sloped, which is challenging for those with mobility deficits, they made recommendations around the location of events. Additionally, GW volunteers provided adaptive devices to allow participants with limited mobility to push the egg down the track. These devices were reachers and long handled sponges that were decorated as Peeps®, or hockey sticks with adaptive grips.

Two people stand in front of the White House with aprons that say White House Easter Egg Roll.
Two adults standing on a lawn looking on as children roll Easter eggs. One adult is applauding.
Two adults standing on a lawn looking during the 2024 White House Easter Egg Roll. One adult is applauding.
An adult looks on as a child rolls an Easter egg on the White House lawn.

For those interested in learning more about OT at GW, a student-led information session on the entry-level OTD program will be held on April 17.

References

Bailliard, A. L., Dallman, A. R., Carroll, A., Lee, B. D., & Szendrey, S. (2020). Doing Occupational Justice: A Central Dimension of Everyday Occupational Therapy Practice. Canadian journal of occupational therapy. Revue canadienne d'ergothérapie, 87(2), 144–152. https://doi.org/10.1177/0008417419898930

Stein, F., & Reed, K. L. (2020). Occupational therapy : A guide for prospective students, consumers and advocates. SLACK, Incorporated.

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Picture of a person holding a white board with the text "Hello My Pronouns are ___" written in rainbow color letters.

March 31st is the Transgender Day of Visibility. Here at GW we are proud to support our transgender community, and wanted to share the message that we are here for you. Today is not just about encouraging awareness of the transgender community, but it serves as a call to action for members of the medical community to foster a healthcare system that values and respects everyone’s gender identity. 

If you are new to the GW community and are looking for some resources, look no further than our very own Multicultural Student Services Center. They offer not only programming and ways to get involved, but also access to health and wellness resources. As aspiring professionals, or current practitioners within the medical community, it is important to appreciate the difference between gender identity and sexual identity in order to provide appropriate care for transgender patients. 

Visibility matters in Healthcare. Transgender patients face unique challenges and barriers, including limited access to gender-affirming care. It is important to know that visibility plays an impactful role in addressing those changes, visibility helps to break down stereotypes and misconceptions about transgender people, which may lead to more empathetic and affirming care. If your practice has transgender-specific treatments or quality of care, be sure to publicize them.

When transgender individuals see themselves represented in healthcare settings, they are more likely to seek out and engage with healthcare services. Remember to acknowledge your patients. Visibility goes a long way toward eliminating stereotypes and misconceptions about transgendered individuals. Doing so can lead to more empathetic and affirming care. 

As future healthcare providers, medical students have a unique opportunity to champion transgender visibility and inclusivity. If you are not sure where to begin, a good place to start is to educate yourself: seek out opportunities to learn about transgender health during your medical studies. Attend workshops and lectures, or join student-led initiatives focused on LGBTQ+ health.

 Advocate for inclusive policies and practices such as those described by GW’s LGBTQIA+ Community Support, a resource for all members of the GW community. 

As always, offer support to those in need. Continued allyship with your transgender peers and patients will foster understanding and a more connected patient community. Listen to their experience, validate their identities, and advocate for their needs within healthcare settings in your school, including the introduction of gender-neutral facilities, the use of inclusive language on patient forms, and training on transgender health for faculty and staff. 

Let us commit to creating a healthcare environment where transgender individuals feel seen, heard, and valued. By promoting visibility, fostering inclusivity, and advocating for gender-affirming care, medical students, staff, and faculty can make a meaningful difference in the lives of our transgender patients and contribute to a more diverse and inclusive healthcare system for all. 

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