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.
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.
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.
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.
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.
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.
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.
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
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:
A provider assuming something about them without asking (1).
A provider implying or suggesting they were to blame for a health problem (1).
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.
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.
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.
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.
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.
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.”
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.
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
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.
Elizabeth Ware Packard - Packard, born in Massachusetts in 1816, was needlessly committed to asylums twice in her life. At 19 her father sent her to an asylum in Worcester when she suffered from what was called “brain fever”. She believed the treatment she received made her symptoms worse. At the time asylums were “a quasi-prison, ruled by a psychiatric director”(Himelhoch, 1979). Patients had no rights to know their diagnosis, refuse treatment, or leave. As a middle-aged woman with six children, her husband committed her a second time when their religious beliefs diverged and she began to practice missionary and religious work outside the home. Though due process was required to institutionalize a man, husbands could commit wives without any evidence of mental illness. After three years at the Illinois Hospital for the Insane and a court case where she sued her husband for imprisoning her in their home after her release, Packard devoted the rest of her life to advocate for the rights of married women and the mentally ill through lectures, lobbying, and publications. Thanks to her work Illinois repealed the law that allowed women and children to be committed without due process safeguards; Iowa, Maine, and Massachusetts allowed visiting teams to assess conditions in their asylums; and, in Iowa, “Packard’s Law” made it illegal for asylum patients’ mail to be interfered with.
Learn more about Elizabeth Ware Packard at:
Brandman, Marianna. (2021). Elizabeth Packard. National Women’s History Museum.
Himelhoch, Myra Samuels, and Arthur H. Shaffer. (1979). Elizabeth Packard: Nineteenth-Century Crusader for the Rights of Mental Patients. Journal of American Studies 13.3, 343–375 https://www.jstor.org/stable/27553740
Agatha Tiegel Hanson - Hanson was born in Pittsburgh in 1867 and became deaf and blind in one eye at 7 years of age after a case of spinal meningitis. She attended the Western Pennsylvania School for the Deaf and was one of the first women enrolled in the National Deaf-Mute College which became Gallaudet University. The success of her women’s debate group pushed the college president to lift his ban on women’s organizations on campus and she helped establish the Phi Kappa Zeta Society. She was the only woman to graduate in 1893 and the first woman valedictorian at the college. In her commencement address, “The Intellect of Women”, she argued against the structural inequalities women faced. After graduation, she taught, wrote poetry and newspaper articles, and was a community activist in Seattle with her deaf husband Olof. Gallaudet’s Hanson Plaza and Dining Hall are named in her honor.
Johnnie Lacy - Lacy was born in Louisiana in 1937 and moved to California when she was 10. She contracted polio during a practicum as a 19-year-old nursing student and became paralyzed. When she applied to a speech therapy program at San Francisco State as a wheelchair user in 1980, she was at first denied admission due to her disability. After asserting her rights under the Rehabilitation Act (the only federal protection for disabled persons at the time) she was admitted but was not allowed to participate in graduation ceremonies. She co-founded the Berkeley Center for Independent Living and was an early activist in the independent living movement. As a Black woman, Lacy advocated at the intersection of race and disability at a time when most who were prominent in the movement were white.
Barbara Faye Waxman Fiduccia - Waxman was born in Los Angeles in 1955. Both Barbara and her brother Michael were born with spinal muscular atrophy, a hereditary disorder that causes progressive muscular weakness. She used an external ventilation system most of her life. Waxman graduated from California State University, Northridge with a degree in psychology and worked for Planned Parenthood and the Los Angeles Regional Family Planning Council as a sexual health educator and counselor. She advocated for the reproductive rights of disabled persons, authoring many publications on the topic. She and her husband who was also disabled fought to protect their right to be married without losing their Medicaid and Medicare benefits and provided testimony to a congressional committee about it in 1994. Tragically, Waxman died a few days after her husband in 2001 when her ventilator malfunctioned. Disability rights advocates are still fighting to do away with “the marriage penalty”, most recently in the form of HR6405.
March 8th is International Women’s Day! What a fantastic time to appreciate not only the women dear to us, but also to applaud the many women who have made progress in the field of Medicine. To discover more about the timeline of Women who made history in medicine, AMA has a brief timeline to illuminate those who helped to make the field of medicine what it is today.
Today, women continue to excel in all areas of healthcare, from clinical practice to research and academia. Female physicians, surgeons, researchers, and educators continue to make significant contributions to their fields that drive innovation and the improvement of patient care. Their dedication and expertise inspire the next generation of medical professionals.
Unfortunately throughout the world, women continue to face bias, discrimination, workplace pay inequality, and a lack of protection. A recent study from the World Bank reveals that the gender gap between men and women is wider than ever before. Moreover, women of color and those from underprivileged backgrounds often encounter additional barriers to advancement and recognition.
Addressing these challenges requires concerted efforts from not only the community as a whole but also medical schools and hospitals. Consider encouraging Initiatives that promote diversity and equality and encourage a more supportive and inclusive environment for women in medicine. GW’s very own Clara Bliss Hinds Society is a powerful and inspirational task force that hosts workshops and events to promote Women in the industry.
Let us not forget that tomorrow matters. As educators and mentors, we have a responsibility to empower the next generation of Women in Medicine. It may be beneficial to study and highlight the achievements of female role models in medicine and sharing their stories can inspire students to pursue their passions and overcome obstacles. Representation matters, and by showcasing diverse role models, we can challenge stereotypes and broaden perceptions of who can succeed in medicine.
