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Category: Diversity, Inclusion, & Accessibility

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Empty hospital beds in a poorly lit room
Empty Hospital Beds
Pixabay, 2016

In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post highlights transgender healthcare equity.

Author notes 

The topics presented in this article may be difficult and/or retraumatizing for some readers. Subject matter includes medical neglect, transphobic harassment, usage of slurs, medical misdiagnosis, death of a Black transgender women by medical neglect, and cancer. 

While some of the sources cited in this article are from over a decade ago and may use outdated terminology and may misgender the individuals discussed in them, this article was written by a transgender member of Himmelfarb staff, who has used appropriate language in the article itself.

August 7th, 1995. Washington, DC. 

A 24 year old woman named Tyra Hunter was critically wounded in a car accident when another driver ran a stop sign (Bowles, 1995). Once first responders came on the scene and assessed the situation, instead of treating her properly, they mocked and degraded her (Remembering Our Dead, 2019). When she was finally brought to the emergency room at DC General Hospital, she was given a paralytic and slowly bled out (Fox, 1998). The delay in treatment and degrading comments took place because she was a black transgender woman.

Tyra Hunter’s case is, perhaps, one of the more extreme instances of medical transphobia and healthcare inequity. That said, Tyra Hunter is one of many transgender people who have been victimized by anti-transgender prejudice – both personal and systemic – in healthcare. 

From avoidance of medical care due to fear, to biased diagnoses from prejudiced professionals, to even the blatant transphobia that first responders directed at Tyra Hunter, transgender people – particularly for Black transgender women – frequently lack access to quality healthcare. In this post, we will review the most common ways prejudice and cultural incompetency impact transgender patients, and we will consider ways medical professionals can provide equitable healthcare to transgender individuals.

Medical transphobia can take many forms, and not all of them are as blatant as what Tyra Hunter experienced on the day of her death in 1995. Even microaggressions, when experienced over long periods of time, can cause transgender patients to avoid or delay seeking treatment. A study by Seelman et al. in the journal Transgender Health found that among transgender participants, “those reporting a noninclusive PCP or who delayed needed medical care because of fear of discrimination were less likely to have had a routine checkup in the past 2 years” (Seelman et al., 2017, p. 25). This is supported by a study by Jaffee et al., which found that “1 in 3 transgender respondents delayed needed medical care for an illness or injury due to discrimination” (Jaffee et al., 2016, p. 1012), and that “the odds of delaying needed care was approximately 4 times greater for those who reported having to teach their provider about transgender people” (Jaffee et al., 2016, p. 1012).

This fear of medical discrimination is by no means irrational. A study by Rodriguez et al. analyzing data from the National Transgender Discrimination Survey which included over 6000 participants, found that “more than one-third of transgender participants reporting having experienced discrimination in health-care settings” (Rodriguez et al., 2017, p. 980), wherein discrimination was defined as, “physical abuse, verbal harassment, and/or denied equal treatment” (Rodriguez et al., 2017, p. 975). Of note here is that this number parallels Jaffee et al.’s reported 1 in 3 transgender respondents delaying treatment.

Transgender patients’ lack of trust is also attributed to “Transgender Broken Arm Syndrome,” which occurs when healthcare providers attribute unrelated medical issues to a patient’s transgender identity or transition-related care. The colloquial term comes from the scenario where a transgender patient might go into the doctor for a broken arm, but the healthcare provider questions to the patient about their gender instead. Jennifer Kelley describes this kind of scenario with a patient named Cam in the article, Stigma and Human Rights: Transgender Discrimination and Its Influence on Patient Health. Cam wanted to see the doctor about a chronic issue unrelated to her transness, and perhaps discuss hormone replacement therapy, but the provider instead questioned her about her identity, gave her a pamphlet on HIV, and told her to find a specialist (Kelley, 2021). 

Another example of a transgender patient who was not able to access appropriate quality healthcare occured when Jay Kallio, a transgender man in his 50s living in New York, was discovered to have an aggressive form of breast cancer (Buxton, 2015). After receiving a mammogram and a biopsy, Kallio did not hear from his physician for many weeks. When he finally heard about his diagnosis, it was from the medical professional who performed the biopsy, who was shocked to hear that Kallio’s physician, a surgeon at a major New York hospital, had not informed him of the swiftly-worsening cancer. Kallio struggled to get in contact with this physician, and when he did, the surgeon began the conversation by stating that he wanted to send Kallio to a psychiatrist for his identity. Eventually, Kallio was thankfully able to transfer his case to another surgeon, and even beat the cancer in 2008, though he later succumbed to lung cancer in 2016. (Jay Kallio, n.d.) Ultimately, Kallio’s case is one that serves as a reminder of the very real potential consequences for medical transphobia.

There are, however, some of the most wretched instances of transphobia that involve harassment and blatant cruelty, such as what happened to Tyra Hunter. Another such case is that of Robert Eads, a transgender man who was taken to the emergency room in Georgia in 1996 after passing out. When he was diagnosed with ovarian cancer, he was refused treatment by more than a dozen medical practitioners. By the time he was accepted by the hospital of the Medical College of Georgia in 1997, the cancer had metastasized, and no treatment would have been able to save his life (Ravishankar, 2013). He died in 1999, and his story is told in the 2001 documentary, Southern Comfort, named after a popular transgender gathering that he spoke at after his prognosis (“Robert Eads”, 2007). His case is more similar to that of Jay Kallio than Tyra Hunter’s, but Eads’ slow and painful death was the result of medical transphobia in action.

Even the late transgender activist and author of the well-revered Stone Butch Blues, Leslie Feinberg (who used the neopronouns ze/hir), has discussed the transphobia ze faced after seeking treatment. In zir 2001 work, “Trans Health Crisis: For Us It’s Life or Death”, ze detailed how hospital staff gathered around zir, calling Feinberg “it” and “martian”. Feinberg chose to leave the hospital in question without being treated, and thankfully the illness ze had was not life-threatening, as it had been for Tyra Hunter and Robert Eads (Feinberg, 2001).

Knowing what we do about medical transphobia, how can healthcare professionals enact change within the healthcare system, ensure that transgender patients are treated equitably and ethically, and rebuild trust with the transgender community? 

Leslie Feinberg urges in zir aforementioned work that decisions related to transgender patients involve transgender and gender variant people of all kinds. Ze made recommendations large and small, some of which have been implemented already. One of the simplest, which has been picked up by quite a few healthcare professionals, is to “refer to patients by their first and last names, not Mr. or Ms., sir or ma'am.” Another is a call for institutional standards (Feinberg, 2001), such as the Standards of Care developed by the World Professional Association for Transgender Health (WPATH). This comprehensive document acts as a guideline for health care professionals “to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment.” (Standards of Care, 2012, p. 1)

Medical education has also been shown to have significant gaps in coverage of transgender healthcare. Fung et al. performed a qualitative review of Toronto medical residents’ knowledge and confidence in transgender care in 2016. The results indicated that residents had limited exposure to formal training in transgender medicine, as well as few mentors within their specializations who had enough knowledge to confidently educate or advise on such topics (Fung et al., 2020). If you’d like to learn more about the gaps in transgender health education, Korpaisarn et al.’s Gaps in transgender medical education among healthcare providers reviews a number of studies on the subject and follows with a section on effective interventions, including the use of WPATH’s Global Education Initiative (GEI), which offers training and certification courses on transgender healthcare (Kopaisarn et al., 2018).

Healthcare professionals should stay up to date on legislative matters. Our previous article for Transgender Day of Visibility discussed this at length and included a number of resources for education and for action. If you would like to learn more about the legal side of transgender health, that piece would be a good starting point. Likewise, if you would like to learn more about some terminology related to transgender individuals in a healthcare setting or about how to build rapport with transgender patients or otherwise equitably treat transgender patients, Klein et al.’s Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know, is another useful resource.

Unfortunately, transphobia may persist in society and healthcare. It is unfortunately not enough to educate ourselves alone on matters of inequity and bias; the best way to support transgender patients is to speak out against transphobia when you see it. There will be times when speaking out is difficult, but when those moments happen, please remember that if even a single person had taken action, Tyra Hunter may have survived.

References

Bowles, S. (1995, December 10) A Death Robbed of Dignity Mobilizes a Community, Washington Post. https://www.washingtonpost.com/archive/local/1995/12/10/a-death-robbed-of-dignity-mobilizes-a-community/2ca40566-9d67-47a2-80f2-e5756b2753a6/ 

Buxton, R. (2015, June 15) This Trans Man's Breast Cancer Nightmare Exemplifies The Problem With Transgender Health Care, HuffPost. https://www.huffpost.com/entry/transgender-health-care_n_7587506

Feinberg, L. (2001)  Trans health crisis: For us it's life or death, American Journal of Public Health, 91(6), p. 897-900. https://doi.org/10.2105/AJPH.91.6.897

Fox, S. D. (1998, December 12) Damages Awarded after Transsexual Woman's Death. Polare. Internet Archive. https://web.archive.org/web/20140324052938/http://www.gendercentre.org.au/resources/polare-archive/archived-articles/damages-awarded-after-transsexual-womans-death.htm

Fung, R., Gallibois, C., Coutin, A., & Wright, S. (2020) Learning by chance: Investigating gaps in transgender care education amongst family medicine, endocrinology, psychiatry and urology residents, Canadian Medical Education Journal, 11(4), p. e19-e28. https://doi.org/10.36834/cmej.53009

Jaffee, K. D., Shires, D. A., & Stroumsa, D. (2016) Discrimination and delayed health care among transgender women and men, Medical Care, 54(11), p. 1010-1016. https://doi.org/10.1097/MLR.0000000000000583

Jay Kallio. (n.d.) Compassion and Choices. https://compassionandchoices.org/stories/jay-kallio/

Kelley, J. (2021) Stigma and Human Rights: Transgender Discrimination and Its Influence on Patient Health, Professional Case Management. 26(6), p. 298-303. https://doi.org/10.1097/NCM.0000000000000506

Klein, D. A., Paradise, S. L., & Goodwin, E. T. (2018) Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know, American Family Physician, 98(11), p. 645-653.

Korpaisarn, S., Safer, J. D., & Tangpricha, V. (2020) Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons, Reviews in endocrine & metabolic disorders, 19(3), p. e271-275. https://doi.org/10.1007/s11154-018-9452-5

Main Page. (n.d.) Global Education Institute. WPATH. https://www.wpath.org/gei

National Center for Transgender Equality. (2007, January 16) Robert Eads, National Center for Transgender Equality. https://transequality.org/blog/robert-eads

Ravishankar, M. (2013, January 18) The Story About Robert Eads, The Journal of Global Health. https://archive.ph/20130914005716/http://www.ghjournal.org/jgh-online/the-story-about-robert-eads/

Rodriguez, A., Agardh, A., & Asamoah, B. O. (2017) Self-Reported Discrimination in Health-Care Settings Based on Recognizability as Transgender: A Cross-Sectional Study Among Transgender U.S. Citizens, Archives of Sexual Behavior, 47(4), p. 973-985. https://doi.org/10.1007/s10508-017-1028-z

Seelman, K. L., Colón-Diaz, M. J. P., LeCroix, R. H., Xavier-Brier, M, & Kattari, L. (2017) Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults, Transgender Health, 2(1), p. 17-28. https://doi.org/10.1089/trgh.2016.0024

Transgender Day of Rememberance. (2019, February 17) Remembering Our Dead: Tyra Hunter, https://tdor.translivesmatter.info/reports/1995/08/08/tyra-hunter_washington-dc-usa_04a01786

World Professional Association for Transgender Health. (2012) Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. 7th ed. https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf

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April 25 is  National DNA Day. It’s a day where researchers, teachers, students and the general public can learn more about the history of genomics and DNA, as well as learn about the advances researchers have made over the years as they seek to understand what DNA can reveal about our shared humanity and our individual traits. According to the National Human Genome Research Institute, “National DNA Day is a global movement to mobilize, energize and empower communities, educators and students to innovate, collaborate and discover the promise of our shared humanity and connection to the natural world.” National DNA Day commemorates two significant events in the history of DNA: the completion of the human genome project in 2003 and the discovery of the double helix in 1953. In recent years and with a deeper understanding of DNA, there has been a discrepancy between the general public’s perception of the usefulness of DNA and what this information actually means for humanity. By examining the rise in popularity of at-home ancestry testing kits, the role DNA plays in the legal system, and disease research and DNA, it’s clear that our understanding of the human genome will not provide simple answers to complex questions. Researchers and the public must balance our appreciation of DNA with the reality that this research only deepens ongoing conversations about humanity.

Over the past few years, there has been a significant increase in ancestry testing and companies such as 23 and Me or Ancestry.com allow individuals to map their genetic ancestry through a simple DNA test. Ancestry tests can connect long lost family members to one another. For people who do not have access to an extensive well-documented family history, such as many African-Americans, ancestry testing can shed light on people’s countries of origin. These testing kits can also encourage people to learn more about cultures and groups. Many of these tests provide people the opportunity to connect with each other in meaningful ways. But many researchers and critics point out the limitations of ancestry testing. Many testing companies rely on their own databases to compare and create user results. If these databases lack genetic information from certain populations or groups, then the ancestry testing results will not be an accurate representation of people’s family lineage. “Commercial ancestry testing is an unintended spin-off from basic research, but the basic research was designed to answer questions about population migration in a probabilistic manner and not to provide concrete and detailed genealogical information to individuals.” (Wailoo et al., 2013, p. 58) Ancestry testing can also lead people to believe our ethnicity or race can be segmented into neat and clear categories. Many scientists have stated there is no biological or scientific basis for race, yet these ancestry tests unintentionally suggest otherwise as they often use broad racial or ethnic categories that do not capture the true diversity across the world. 

Ancestry testing is a great way for people to connect with relatives they’ve lost contact with or for people to have some idea of where they may originate from. But it’s important these tests do not perfectly capture our family history and the initial results may change as ancestry testing companies expand their internal DNA databases.

One of the most popular ways in which DNA testing is used is in the realm of the legal system. Popularized by shows such as Law and Order or CSI, forensic science and DNA testing are often seen as pivotal aspects of any legal investigation. With the rise in DNA testing, many police investigators have successfully apprehended alleged suspects after a crime has been committed. Criminal cases that were opened for years were able to be closed once the collected DNA was analyzed in a lab. But there have been cases of innocent people being wrongfully accused and jailed when errors in DNA handling or testing caused investigators to chase alternative leads. “The problem, as a growing number of academics see it, is that science is only as reliable as the manner in which we use it—and in the case of DNA, the manner in which we use it is evolving rapidly.” (Shaer, 2009) DNA has a complex role in the legal system. It can provide a sense of certainty when law enforcement officers are investigating a case, but poor handling or lab standards can sometimes lead to wrongful convictions that are difficult to overturn. And there are cases where defense attorneys have relied on DNA analysis to free wrongfully convicted individuals. “Among them [ready to move beyond concerns of DNA use in criminal trials] were Dream Team members Barry Scheck and Peter Neufeld, who had founded the Innocence Project in 1992. Now convinced that DNA analysis, provided the evidence was collected cleanly, could expose the racism and prejudice endemic to the criminal-justice system, the two attorneys set about applying it to dozens of questionable felony convictions. They have since won 178 exonerations using DNA testing; in the majority of the cases, the wrongfully convicted were black.” (Shaer, 2009)

Advances in DNA and genetic research has allowed individuals to better track hereditary illnesses, thus giving them the opportunity to take early steps to address potential health concerns. Through genetic testing individuals can learn about potential inherited susceptibility to diseases such as certain types of cancers, certain blood disorders or respiratory diseases. In this realm, researchers have cautioned that this form of testing could potentially be misinterpreted by individuals seeking to link certain racial groups to certain inherited diseases. “It is in the area of disease studies that the relationship between race and genetics becomes the most susceptible to misinterpretation and distortion…Work carried out by geneticists Sara Tishkoff and others make it clear that sweeping conclusions about African Americans and disease-associated genetic variables are untenable.” (Wailoo et al., 2013, 59) While genetics can play a significant role in an individual’s susceptibility to a disease, other factors are just as significant and should be carefully studied and addressed. “For most diseases in the United States that differ in incidence by race, racial differences correspond to socio-economic or cultural differences. Most of the differences in incidence of asthma, hypertension, and heart disease by race can be explained by differences in income and environmental risk factors.” (Wailoo et al., 2013, 60) The role that genetics play in determining a person’s susceptibility to a disease is important, but should be considered alongside other variables and it’s important to avoid sweeping generalizations. 

The discovery of DNA and the gene sequencing process allows humanity to better understand our makeup and answer some questions about our origins. In the conversations on who we are, where we come from and where we can go, DNA has an important voice that provides a unique insight into our inner workings. For this National DNA Day the general public should continue to learn about and engage with DNA research, while also remaining aware that DNA research will raise as many questions as it does answers. “Science is technical and difficult to comprehend but that does not absolve scientists of the responsibility to inform the public about their work, explain their methods and their rigor, admit the limitations and areas of controversy and uncertainty, and examine its wider relevance. Conversely, the difficulty of understanding and digesting science does not absolve the general public from acknowledging its importance and its contributions.” (Wailoo et al., 2013, 62) To learn more about National DNA Day or the Human Genome Project, please explore the National Human Genome Research Institute website.

Works Cited:

National Human Genome Research Institute. (n.d.). National DNA Day. Retrieved April 22, 2022. https://www.genome.gov/dna-day

Shaer, M. (2016, June). The False Promise of DNA Testing. The Atlantic. https://www.theatlantic.com/magazine/archive/2016/06/a-reasonable-doubt/480747/ 

Wailoo, K., Nelson, A., & Lee, C. (Eds.). (2012). Genetics and the Unsettled Past: The Collision of DNA, Race, and History. Rutgers University Press. http://www.jstor.org/stable/j.ctt5hj79f

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Did you know that April is National Autism Awareness month? Regardless of how much you understand about the Autism Spectrum Disorder, there are available resources that can help to expand your current perspective, which may be helpful in making appropriate treatment decisions for Autistic patients 

 For an introduction to the Autism Spectrum, Autism.org has a 30 minute 101 course designed to increase your knowledge on what it is and the early signs of Autism. Additionally, the CDC has resources available on their website appropriate for families of autistic children and others providing care for them. 

Over the past twenty years, Autism Spectrum Disorder (ASD) cases have been on the rise. According to the CDC, in 2000, it was estimated that 1 in 150 children developed ASD. By 2018, that number increased significantly to 1 in every 44.  As Autism Spectrum Disorder becomes more prevalent in the population, physicians will be more likely to provide medical care to Autistic patients during their medical career. 

Himmlefarb Library also has several resources on Autism: 

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In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post highlights transgender healthcare equity.

Visibility. What does it mean to you? Does it mean being seen or acknowledged? If something or someone is visible are they not only ‘seen’, but also understood? When someone is seen, is it the individual that is seen or is it a label ascribed to them that is seen? A fuller understanding of what it means to be transgender and the issues transgender people face within the current healthcare climate is the first step in changing the system towards a more equitable healthcare system for transgender people.

On March 31, 2022, International Transgender Day of Visibility, the United States is set to to break its all-time record for the introduction of anti-transgender legislation. While anti-transgender legislation covers a vast array of human activities – from using the restroom to participating in sports – the impact this kind of legislation has or may have on healthcare is not something to be ignored. Around the United States, transgender people, their families, and their healthcare providers are at risk of severe punishment for trans-affirming care. 

In Texas, transgender rights came into the spotlight recently when Gov. Greg Abbott instructed health-related agencies in the State of Texas to treat gender-affirming care provided to transgender minors as “child abuse” and that anyone could and should report transgender individuals, their families, and their healthcare providers under that definition (Ghorayshi, 2022; Goodman, 2022). Despite having no legally binding authority and being temporarily blocked by Judge Amy Clark Meachum, this order has already forced many families to face investigations that threaten to separate them from their transgender children. (Klibanoff & Dey, 2022)

In Idaho, HB675 seeks to group a variety of medical procedures under the definition of “genital mutilation” and was introduced in late February. Should this bill pass, medical service providers who administer medications or procedures in order “to change or affirm the child's perception of the child's sex if that perception is inconsistent with the child's biological sex, shall be guilty of a felony” (H.B. 675, 2022). This excludes procedures such as circumcision and controversial and often medically unnecessary surgeries performed on intersex children (Ejiogu, 2020), but includes the use of puberty blockers (also known as GnRHas) to delay puberty until a child comes of age and has the ability to consent to hormone replacement therapy if they so choose. A healthcare provider convicted of a felony under this proposed legislation would “be imprisoned in the state prison for a term of not more than life” (H.B. 675, 2022). This bill passed the House, but the Idaho Senate Majority Caucus released a statement against HB675, so it is unlikely that it will become law (Russell, 2022).

In Louisiana, bill HB570 functions similarly to Idaho’s HB675, with a few slight changes. Rather than a felony charge, healthcare providers would “be subject to discipline by the licensing entity with jurisdiction over the physician, mental health provider, or other medical healthcare professional” (H.B. 570, 2022). Healthcare providers might also be liable for compensation should the patient file a claim, or should their parents do so in the patient’s stead. In addition, HB570 includes sections that would restrict usage of public funds that might be used for gender affirming care (H.B. 570, 2022). This bill is currently awaiting review by the Louisiana House Committee on Health and Welfare.

In Tennessee, bill HB2835 is similarly structured. This bill includes restrictions regarding public fund usage, but medical service providers would be “subject to revocation of licensure and other appropriate discipline by the medical professional's licensing authority. The medical professional will be subject to a civil penalty of up to $1,000 per occurrence” (H.B. 2835, 2022). HB2835 also includes provisions that would require any individuals employed by the state to “immediately notify, in writing, each of the minor's parents, guardians, or custodians” of a minor’s transgender identity upon learning of it (H.B. 2835, 2022). The bill does not include any exceptions regarding this requirement should there be reason to believe that the parents, guardians, or custodians would react to the news violently. TN HB2835 was moved to the Tennessee House Health Committee for review on March 22, but was taken off notice and is unlikely to continue through any future voting procedures. (H.B. 2835, 2022)

These are only a few of the many parallel legislations raised in the last few months that have framed transgender-related care as abuse and mutilation. New Hampshire, Arizona, and Wisconsin have seen similar legislative proposals. That said, regardless of whether or not this kind of proposed legislation is passed, they raise a startling concern: how can healthcare providers care for their transgender patients should state laws subject those involved to harsh punishments? 

The truth is that visibility alone does not protect transgender individuals who would be impacted by such legislation. Healthcare providers can update their knowledge regarding legislation that targets gender affirming care. Freedomforallamericans.org features up to date information on all current anti-transgender bills, many of which are healthcare related. The Transgender Law Center’s National Equality map tracks legislation that impacts LGBTQIA+ individuals and includes healthcare as one of the major legislative categories. 

Healthcare providers can access resources to update their knowledge and to support high-quality care for transgender individuals via multiple resources available in Himmelfarb Library’s collections including:

The Whitman Walker clinic has a Cultural Competency toolkit that focuses on practices you can provide to all LGBTQIA+ patients. Other helpful associations include:

  • The DC Center for the LGBTQ Community aims “to promote health equity in our local LGBTQ Community'' with programs such as free at-home STI & HIV testing kits, the binder donation project, trauma-informed mental health support groups, and more. 
  • The DC Trans Coalition “is a volunteer, grassroots, community-based organization dedicated to fighting for human rights, dignity, and liberation for transgender, transsexual, and gender-diverse (hereafter: trans) people in the District of Columbia.” (“About DCTC”) The DC Trans Coalition has a transgender healthcare resource list, as well as a guide to educate transgender DC residents on their rights.
  • The Fenway Institute has a sub-organization known as The National LGBTQIA+ Health Education Center, which focuses on producing seminars and guides to educate health service providers. These resources cover gender-affirming surgeries, HIV and PrEP, research and data collection, and more.

Nationally, transgender individuals can find healthcare-related support through a variety of organizations. Healthcare providers can share the following resources with their transgender patients in order to improve patient education, particularly since generalized healthcare is often not suitable for transgender individuals:

  • The National Center for Transgender Equality (NCTE) aims “to change policies and society to increase understanding and acceptance of transgender people,” by way of legal support, news involving transgender rights, and guides for a variety of transgender-related topics”. (“About Us”, transequality.org) The topics of those transgender-specific guides include general healthcare, COVID-19, and health coverage. NCTE also has a page dedicated to mutual aid and emergency funds in the event that a transgender individual needs legal support when facing discrimination in a variety of spheres of life, including healthcare. 
  • In addition to legal support in defense of transgender individuals facing discrimination, Lambda Legal, which boasts “the oldest and largest national legal organization whose mission is to achieve full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and everyone living with HIV” (“About Us”, Lambda Legal) has a downloadable Transgender Rights Toolkit to support transgender individuals facing any number of discriminatory matters, including health care discrimination. Lambda Legal also has a LGBT rights by state tool to help find information about local legislation, including healthcare-related legislation.
  • The Transgender Law Center (TLC), a trans-led advocacy organization, hosts a page of health resources. This includes a guide for transgender patients on how to negotiate for more inclusive coverage, as well as a guide that explains nondiscrimination rights under the Affordable Care Act (ACA).
  • The Transgender Legal Defense and Education Fund, which offers legal services and public policy education, also manages the Trans Health Project. This program includes insurance tutorials, statements from major medical organizations in recognition of the medical necessity of treatments for gender dysphoria, literature reviews to support appeals that require proof of medical necessity, and more.
  • Anti-transgender discrimination can also be reported through the American Civil Liberties Union (ACLU), which has a page dedicated to transgender health. This page regularly updates with press releases and news analyses.

Visibility is important, and at Himmelfarb we believe that it is a human right to be acknowledged for who you are. While transgender healthcare has come a long way, there are still ways that we can improve our care and protect our patients, particularly those who live in states with anti-transgender legislation on the rise. We hope that the resources in this piece will help medical professionals, transgender patients, and allies to take action and defend transgender people so that they can be visible. 

References

“About DCTC.” DC Trans Coalition. https://dctranscoalition.wordpress.com/about-dctc/. Accessed March 30, 2022.

“About Us.” Lambda Legal. https://www.lambdalegal.org/about-us. Accessed March 30, 2022.

“About Us.” National Center for Transgender Equality. https://transequality.org/about. Accessed March 30, 2022.

Ejiogu, N. I. (2020). Conscientious Objection, Intersex Surgeries, and a Call for Perioperative Justice. Anesthesia and analgesia. Vol. 131 (5), 1626-1628. http://doi.org/10.1213/ANE.0000000000004946

Feinberg, L. (2013). Transgender liberation: A movement whose time has come (pp. 221-236). Routledge.

Ferrando, C. A. (2020). Comprehensive care of the transgender patient. Elsevier.

Forcier, M., Van Schalkwyk, G., & Turban, J. L. (2020). Pediatric gender identity : gender-affirming care for transgender & gender diverse youth. Springer.

Ghorayshi, A. (2022, February 23). Texas Governor Pushes to Investigate Medical Treatments for Trans Youth as ‘Child Abuse’. New York Times. https://www.nytimes.com/2022/02/23/science/texas-abbott-transgender-child-abuse.html

Goodman, J. D. (2022, March 11). How Medical Care for Transgender Youth Became ‘Child Abuse’ in Texas. New York Times. https://www.nytimes.com/2022/03/11/us/texas-transgender-youth-medical-care-abuse.html

Hardacker, C., Ducheny, K., & Houlberg, M. (2019). Transgender and Gender Nonconforming Health and Aging. Springer.

H.B. 570, House of Representatives, 2022 Reg. Sess. 397. (Louisiana 2022). https://www.legis.la.gov/legis/ViewDocument.aspx?d=1256678

H.B. 675, House of Representatives, 2022 2nd Reg. Sess. (Idaho 2022). https://legislature.idaho.gov/sessioninfo/billbookmark/?yr=2022&bn=H0675

H.B. 2835, House of Representatives, 2022 Health Subcommittee. (Tennessee 2022). https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB2835&ga=112

Keuroghlian, A. S., Potter, J., & Reisner, S. L. (2022). Transgender and gender diverse health care : the Fenway guide. McGraw Hill.

Klibanoff, E., & Dey, S. (2022, March 11). Judge temporarily blocks Texas investigations into families of trans kids. Texas Tribune. https://www.texastribune.org/2022/03/11/transgender-texas-court-hearing/

LGBTQ+ : support and care. Part 3, Caring for transgender children (2021). American Academy of Pediatrics.

Russell, B. (2022, March 15). Senate GOP releases statement on its opposition to HB 675 on trans youth care. Idaho Press. https://www.idahopress.com/eyeonboise/senate-gop-releases-statement-on-its-opposition-to-hb-675-on-trans-youth-care/article_5c5305d4-9854-568f-b27a-76865a04b75c.html

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Awareness. It is one thing to read about it and another to understand what it means. The beauty of awareness is that it often inspires change in our actions, thoughts and lives. March just so happens to be Developmental Disabilities Awareness month, and is a fantastic opportunity for the medical community to recognize the importance of educating ourselves and our patients when it comes to developmental disabilities. 

Children develop at their own pace, but there are important milestones that should be achieved by a certain point in a child’s development. These skills are not only fundamental to a child’s growth, but if not monitored closely, long term developmental disabilities can worsen such as ADHD, autism, cerebral palsy, learning disorders, or a loss of hearing or vision. Developmental disabilities may be physical or intellectual; Intellectual and Developmental Disabilities or IDDs is the term used to describe instances when an intellectual disability and other disabilities are present.. For further reading, see what the NIH has to say about IDDs. 

Ask yourself: “Is my patient developing at a rate they are supposed to?” Observation is key when it comes to treating children. Monitor your patients. If you notice an ongoing pattern, seek appropriate treatment for them.

For further information on Developmental Disabilities and what you can do to protect and prevent your patients’ symptoms from worsening, visit the CDC’s Developmental Disabilities homepage. 

Additional reading can be found at: 

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Images of Dr. Margaret Chung, Dr. Virginia Alexander, Henrieta Villaescusa, and Estelle Brodman.

In honor of Women’s History Month, Himmelfarb Library celebrates the lives of four influential women within the health sciences. Today, we honor: Dr. Margaret Chung, the first Chinese American woman to become a physician; Dr. Virginia Alexander, African American physician and public health expert who fought against racial discrimination in healthcare; Henrieta Villaescusa, the first Hispanic nurse appointed as Health Administrator of the Department of Health, Education and Welfare; and Estelle Brodman, a medical librarian who had a profound impact on the field of medical librarianship.

Dr. Margaret Chung: The First Chinese American Woman Physician

Image of Dr. Margaret Chung.
Public domain image retrieved from https://www.nps.gov/people/dr-margaret-mom-chung.htm

Margaret Jessie Chung, born in Santa Barbara, California in 1889 and the daughter of Chinese immigrants, dreamed of becoming a medical missionary to China from a young age. She graduated from the University of Southern California Medical School in 1916 as the first American-born Chinese female doctor (PBS, n.d.). As a medical student, Chung was the only woman in her class, and often wore masculine clothing and referred to herself as “Mike” (Wagner, 2021a). 

After graduating medical school, she was denied residencies and internships in local hospitals and was rejected from becoming a medical missionary based largely on her race (Stanford Libraries, n.d.). She moved to Chicago where she completed an internship and residency in surgery and psychiatry (Stanford Libraries, n.d.). She returned to California and accepted a staff physician position at the Santa Fe Railroad Hospital in Los Angeles where she specialized in emergency plastic surgery for victims of  railroad accidents (PBS, n.d.). She soon started a private practice that catered to the actors and musicians of Hollywood’s growing entertainment industry (Wagner, 2021a). In the early 1920s, she moved to San Francisco where she helped establish the first Western hospital in San Francisco’s Chinatown (PBS, n.d.). She led the OB/GYN and pediatrics units.

In the 1930s, during the Japanese invasion of China and the Sino-Japanese War, Dr. Chung became friends with a U.S. Navy Reserves officer, Steven G. Bancroft and his friends. The group saw her as a motherly figure and adopted her as “Mom” (Wagner, 2021a). Dr. Chung was instrumental in the creation of Women Accepted for Volunteer Emergency Service (WAVES), a reserve corps for women in the Navy (Wagner, 2021a). Although WAVES helped lay the groundwork for women’s integration into the U.S. armed forces, Chung was not permitted to serve, likely a result of her race and sexuality (PBS, n.d.) and she never received credit for her efforts in WAVES creation (Wagner, 2021a).  Judy Tzu-Chun Wu, the author of Chung’s biography, wrote that Chung “was not afraid to break barriers” (Stanford Libraries, n.d.). Chung’s fearlessness in breaking down barriers paved the way for other women and minority physicians to do the same!

Dr. Virginia Alexander: Pioneer of Public Health Equity 

Image of Dr. Virginia Alexander
Photo from https://files-profile.medicine.yale.edu/images/5e62b755-ac78-4a58-ba0b-b88675a5548d

 

Virginia Alexander was born in 1899 to formerly enslaved parents in Philadelphia, Pennsylvania. Her family faced financial hardships when she was a child. Her mother died when she was only four years old, and her father lost his livery stable when she was 13. The financial strain this placed on the family did not stop Alexander from pursuing her education, something her father was adamant that she continue. She was awarded a scholarship to the University of Pennsylvania and worked as a maid, a clerk and a waitress to pay her living expenses (NIH, 2015).

She went on to medical school at the Woman’s Medical College of Pennsylvania (Wagner 2021b). During medical school, Alexander experienced racism as one of the only Black students in her class (Wagner, 2021b). After finishing medical school, Alexander had trouble landing an internship because of her race and even her own medical school’s hospital did not accept Black doctors (Wagner, 2021b). She eventually landed a position at the Kansas City Colored Hospital. 

Dr. Alexander soon returned to Philadelphia and opened up her own community health clinic out of her home, Aspiranto Health Home (NIH, 2015). The clinic focused on treating Black patients who were refused treatment from white staff in Philadelphia hospitals free of charge (Wagner, 2021b). She cared for pregnant women and young mothers, and also provided contraceptives to women free of charge (Finlay, 2020). Over five years, Dr. Alexander saw 2,000 patients and delivered 43 babies (Finlay, 2020). 

In 1935, she conducted a study on race and public health in North Philadelphia that found “shocking disparities in health outcomes among Black and white residents'' (Wagner, 2021b). Her data showed that Black babies died at more than twice the rate than that of white babies, and that Black people were dying of tuberculosis at a rate six times higher than the white population in the city (Wagner, 2021b). Her work also exposed racial discrimination in segregated wards at hospitals and linked this issue to the inequality of social conditions including inadequate sanitation in Black neighborhoods (Wagner, 2021b). 

Dr. Alexander later earned a Master’s of Public Health degree at Yale University and accepted a position at Howard University as the physician-in-charge of women students (NIH, n.d.). She advocated for the 1939 National Health Bill, an early attempt at a national health insurance system (Wagner, 2021b). During the 1940s, she served with the U.S. Public Health Service. During WWII, Alexander volunteered for the government and treated coal and iron miners who were living in extreme poverty in Birmingham, Alabama (NIH, n.d.). While there, she contracted lupus. She died in Philadelphia at the age of 49. She once said that “we will have to send physicians into sections which have no bright lights and … take public health across the railroad tracks, to serve those most in need of comfort and care” (NIH, n.d.). Dr. Alexander truly lived out this belief throughout the course of her life and incredible career!

Henrieta Villaescusa: The First Hispanic Nurse Appointed as Health Administrator

Image of Henrieta Villaescusa
Image from https://nahnnet.org/about/bios/Henrieta-Villaescusa

Henrieta Villaescusa was born in Tucson, Arizona in 1920. She attended Mercy College of Nursing in San Diego, received a Bachelor's degree from Immaculate Heart College, and a Masters Degree from UCLA (NAHN, n.d.). Villaescusa held a variety of nursing positions, and eventually worked for the Los Angeles City Health Department, where she became the only Hispanic supervising public health nurse (Pasadena Star-News, 2005). She later worked as part of the Center for Disease Control’s Hispanic/Latino subcommittee for the National Diabetic Education Program where she worked to address the needs diabetic patients in the Hispanic and Latino population (Pasadena Star-News, 2005). 

Villaescusa’s career was one of many firsts for Latino women. She became the first Hispanic nurse appointed as Health Administrator in the Department of Health, Education and Welfare (NAHN, n.d.). She was also the first Mexican American Chief Nurse Consultant in the Office of Maternal and Child Health within the Bureau of Community Health Services (HAHN, n.d.). In this capacity, she identified the needs, trends, and priorities in nursing research and training (Pasadena Star-News, 2005). 

Villaescusa was also the first Hispanic to serve as the Bureau of Community Health Services’ Federal Women’s Program Manager (Pasadena Star-News, 2005). In the 1960s, she was appointed to the Alliance for Progress, making her the highest ranking Mexican American in the Bureau (Pasadena Star-News, 2005). In this capacity, her impact reached beyond the United States. She worked to improve the health of people in Latin America by partnering with the academic and community health nursing leaders to “develop nursing education programs, curricula, and collaborative partnerships with local health professionals in Peru, Ecuador, Bolivia and Panama” (Pasadena Star-News, 2005). 

Throughout her career, Villaescusa worked closely with the National Coalition of Hispanic Health and Human Services Organization, and the Mexican American National Women's Association (NAHN, n.d.). She also served as the president of the National Association of Hispanic Nurses from 1984 to 1988 (NAHN, n.d.). Among her many other accomplishments, Villaescusa served as an advisor to director of health programs with the Office of Economic Opportunity, was the the only Hispanic member of the Board of Nurse Examiners in California, and was chief nurse with the Division of Maternal and Child Health where “she was responsible for all nursing aspects of the maternal and child health programs in the country” (Pasadena Star-News, 2005). Villaescusa was truly a trailblazer and her career left a lasting impact on the field of nursing, nursing education, and healthcare!

Estelle Brodman: “A Towering Figure” within Medical Librarianship!

Image of Estelle Brodman
NLM Digital Collections (1951?). Estelle Brodman [Digital image]. National Library of Medicine Digital Collections. http://resource.nlm.nih.gov/101410948

Estelle Brodman was born in New York City in 1914, and grew up in a Jewish household that placed a high value on education and learning. This love of learning served her well in her chosen field of medical librarianship. “I find learning a great joy and a great pleasure, …[others] think of learning as something they are required to do, and I think of learning as something I want to do” she stated in her oral history (Messerle, 2010). 

Brodman’s father was a physician and she and her brother both intended to follow in his footsteps. While her brother became a psychiatrist, she was not accepted to medical school despite having a bachelor’s degree from Cornell University in histology and embryology (Messerle, 2010). Determined to have a career in the medical field, she ultimately decided to become a medical librarian and received a master's degree in library science from Columbia University (Messerle, 2010). 

Over the course of twelve years, she held a number of librarian positions at the Columbia University College of Physicians and Surgeons Library. While serving as “Acting Librarian,” she was told that they would never make a women [head] librarian,” so she decided to get a Ph.D (MLA, 2016). She would go on to serve as the Chief of the Reference Division of the Army Medical Library, which would later become the National Library of Medicine (Messerle, 2010). 

In 1960, she was instrumental in developing and writing much of the Medical Library Assistance Act, which created regional resource libraries that were supported by the National Library of Medicine to improve medical library collections, upgrade facilities, and train medical librarians (Fee, 2015). Although the Medical Library Assistance Act was not passed until after Brodman had moved on, it had a “far-reaching impact” and contributed to the growth of medical librarianship and medical libraries (Messerle, 2010). 

Brodman later moved to Washington University in St. Louis. The position allowed her to teach, and she “was able to persuade them that just as any other department [the library] should do research and training” (MLA, 2016). Brodman developed the PHILSOM automation project, an automated serials control system, in the early 1960s (MLA, 2016). She was an early adopter of technology and later developed a training program in computer librarianship (Messerle, 2010). 

Brodman was active in professional associations including the a term as president of the Medical Library Association in 1964-65, the Special Library Association where she served as Director from 1949-1952, the NIH Biomedical Communication Study Section, History of Medicine Review Panel, the Council of the American Association for the History of Medicine, and the Presidential Commission on Libraries (MLA, 2016). She served as editor of the Bulletin of the Medical Library Association for ten years. In her work with the joint Medical Library Association/American Association of Medical Colleges Committee, she helped create guidelines for medical school libraries (MLA, 2016). When Brodman died in 2007, an article in The Journal of the Medical Library Association stated that we had lost “a towering figure of the profession” (Messerle, 2010). While she is no longer with us, her impact within the field of medical librarianship will not soon be forgotten!

 

References:

Fee, E. (October 22, 2015). The Medical Library Assistance Act of 1965. Circulating Now, National Library of Medicine website. https://circulatingnow.nlm.nih.gov/2015/10/22/the-medical-library-assistance-act-of-1965/

Finlay, M. (June 2020). “Guardian of the Health of Negro Women”: The Work and Legacy of Dr. Virgina Alexander. Drexel University College of Medicine Legacy Center Archives & Special Collections Blog. https://drexel.edu/legacy-center/blog/overview/2020/june/guardian-of-the-health-of-negro-women-the-work-and-legacy-of-dr-virginia-alexander/

Medical Library Association (MLA). (March 18, 2016). MLA Oral Histories: Brodman, Estelle (PhD, AHIP, FMLA)*. MLA website. https://www.mlanet.org/blog/brodman-estelle

Messerle J. (2010). Estelle Brodman, AHIP, FMLA, 1914–2007. Journal of the Medical Library Association : JMLA, 98(1), 6–8. https://doi.org/10.3163/1536-5050.98.1.004 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801987/pdf/mlab-98-01-6.pdf

National Association of Hispanic Nurses (NAHN). (n.d.). Henrieta Villaescusa, MPH, PN. NAHN website. https://nahnnet.org/about/bios/Henrieta-Villaescusa

National Institutes of Health. (June 3, 2015). Dr. Virginia M. Alexander Biography. https://cfmedicine.nlm.nih.gov/physicians/biography_5.html

Pasadena Star-News. (2005, March 9). Henrietta Villaescusa Obituary. Pasadena Star-News. https://www.legacy.com/us/obituaries/pasadenastarnews/name/henrietta-villaescusa-obituary?id=26841230

PBS (May 27, 2020). The First American-Born Chinese Woman Doctor. PBS American Masters website. https://www.pbs.org/wnet/americanmasters/first-american-born-chinese-woman-doctor-ysk233/14464/

Stanford Libraries (n.d.). Dr. Margaret Chung. Rise Up for Asian Americans and Pacific Islanders. https://exhibits.stanford.edu/riseup/feature/dr-margaret-chung

Wagner, E. (December 9, 2021b). Dr. Virginia Alexander. National Park Service website. https://home.nps.gov/people/dr-virginia-alexander.htm

Wagner, E. (October 8, 2021a). Dr. Margaret “Mom” Chung. National Park Service website. https://www.nps.gov/people/dr-margaret-mom-chung.htm

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It is nearly impossible to pinpoint the exact start of Irish medical history as many sources, both primary and secondary, have been lost to time. Thankfully with the aid of historical town annals and medical manuscripts stored in either a private collection or at an institution, historians can peer into ancient times and learn more about professional medical practices in Ireland. Like many cultures, the medical traditions in Ireland were uniquely tailored to the lives and societal norms of the time period, often adapting to changes in the social hierarchy. There are books, articles and other scholarly sources that provide analysis and detailed overviews on Irish medical practices and we hope this article will encourage you to learn more. 

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Medicine & Religion: Pre-Christian Irish medical history is believed to be closely tied to the Druids and druidic practices. Due to a lack of firsthand knowledge about the Druids, their beliefs and practices, historians must separate facts from myths often ending up with inconclusive results. In Irish mythology, the Druid  “Diancecht' was known as the God of Healing and is said to have practiced hypnotism. He is said to have recognized fourteen disorders of the stomach.” (Woods, 1982 p. 35) Physicians and medical figures are woven into early Irish myths and legends, hinting at the importance of their profession during the ancient times when warfare was a common occurrence. “King Cormac who reigned in AD 227 made an order that all future monarchs of Ireland should at all times be accompanied by ten persons, a chief, a judge, a druid, a physician, a poet, a historian, a musician and three servants. This order apparently lasted until the death of Brian Boru in 1014 AD.” (Woods, 1982, p. 36) With the arrival of Christianity and the decline of the Druids, medical responsibilities shifted towards monasteries and Christian priests. 

Newly built Christian churches and monasteries contained separate wards and small hospitals that were dedicated to the care of sick or injured individuals. In these sick wards, the priests and nuns attended to their patients, often relying on prayer or herbal concoctions as remedies. Plagues were a common occurrence. There are documented cases of widespread sickness in 250 AD, 664-665 AD and the end of the sixth century when the bubonic plague reached Ireland. During these times, the Christian church grew in power as many in Ireland found comfort in Christian teachings. “The miracles of Christ, the miraculous power entrusted to his followers and the belief in the resurrection after death, gave hope to the sick and those living amidst a plague, while the Christian ethos of caring gave practical comfort.” (Woods, 1982, p. 37)  While secular physicians existed during these early times, for many years medical authority resided primarily with individuals and organizations tied to a religious background, starting with the ancient Druids before transitioning to the Christian priests once their faith reached Ireland. This union of medicine and religion lasted until the mid-twelfth century when medical authority once again shifted towards a new group of leaders and practitioners.

Hereditary Physician Families: The release of the ‘Papal Edict of 1163’ contributed to the downfall of the Christian church as a main source of medical authority. The edict prevented monks from performing surgery making it difficult for injured or sick people to rely on the church for care. As a result of this papal edict, hereditary physician lines grew in influence. Medical knowledge was usually passed from father to son even during the years when the Christian church was the primary healthcare provider. But from the mid-twelfth century to around the early seventeenth century, these hereditary lines established long-lasting connections with the Irish elites. These physicians were usually treated well and received fair compensation for their work. “The stipend usually consisted of a tract of land and a residence in the neighborhood, held free of all rent and tribute, together with certain allowances and perquisites: and the physician might practice for a fee outside his patron’s household” (Joyce, 1908, p. 267). Physicians were able to travel freely throughout the lands, even when they needed to travel into an unfriendly neighbor’s territory. These physicians typically possessed their own family medical book which contained medical treatises translated from other languages such as Greek or Latin as well as their own personal cures and recipes for common medicines. 

Despite the tremendous influence and respect these physicians earned, the Brehon Laws, Ireland’s main legal system for centuries, offered basic protections for patients if their physician intentionally or unintentionally harmed them during a procedure. Under the Brehon Laws a patient or their family could pursue litigation against a physician for any wrongdoing and in most cases the physician was forced to pay a fine in retribution. While physicians were well-respected members of the communities, these early patient protection legal codes point to the underlying danger of ancient and medieval medical practices. Even without the presence of a national medical board to issue medical licenses, early Irish physicians were held to a high standard and medical malpractice could lead to financial and legal consequences. 

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Collection & Preservation of Medical Manuscripts: Early Irish medical professionals relied on books to expand their understanding of medicine and how to treat the injured or infirmed. There was an active attempt at translating medical texts from other countries into Irish. Some of these medical manuscripts are stored in the Royal Irish Academy and they provide insight into the budding international medical community that existed during early and medieval times. For example, ‘The Book of O’Lees’ “contains a translation from Latin into Irish of a highly organised medical treatise, with 44 tables outlining details of diseases, each divided into 99 compartments, across, aslant, and vertical. These are coloured red and black, and comprise descriptions of different diseases, showing name, prognosis, stage, symptoms, cures, etc., of the disease in question. There are rough decorative drawings at the top left margin of many pages.” (The Book of O’Lees [“Book of Hy-Brasil”]: Medical treatise, 2015, para. 1) 

The Edward Worth Library is another prominent collection that contains many early Irish medical manuscripts and texts. Located in the Dr. Steeven’s Hospital in Dublin, this collection was donated to the hospital at Worth’s request after his death in 1733. “Edward Worth was a physician whose taste in books radiated outwards from his professional concern with medicine…Beside medical books, ancient and modern (ie. 18th century), one finds important contributions to the study of related sciences, then philosophy, the classics, history etc. Worth was particularly interested in the book as object: the collection not only holds fine examples of sixteenth-century typography but is also considered to be the best collection of early modern book bindings in Ireland.” (Edward Worth Library, n.d., para. 2)

The Edward Worth Library and the medical manuscripts in the Royal Irish Academy reveal an ancient medical community dedicated to learning not just from their fellow peers in Ireland, but from physicians and scientists abroad. The medical community did not work in isolation, but actively sought out other sources to improve their own craft and medical knowledge.

Understanding pre-Christian Irish medicine is difficult due to the lack of information about the Druids and their customs. We see that even during ancient times, the Irish had a growing community of physicians who were important figures in the community. These medical communities grew and flourished, often establishing hereditary physician lines that worked for the lords and kings with excellent compensation for their services. Thankfully there are ancient medical treatises and texts that show how Irish physicians actively pursued international sources that were translated into Irish. If you’re interested in learning more about Irish medical history then read some of the sources listed in the ‘References’ section below! 

References:

Cunningham, Cantor, D., & Waddington, K. (2019). Early Modern Ireland and the World of Medicine: Practitioners, Collectors and Contexts. Manchester University Press. https://doi.org/10.2307/j.ctv18b5h6b

 Joyce, P.W. (1908). A Smaller Social History of Ancient Ireland, Treating of the Government, Military System, and Law; Religion, Learning, and Art; Trades, Industries, and Commerce; Manners, Customs, and Domestic Life, of the Ancient Irish People. Longmans, Green, & Co., 1908.

Woods, J.O. (1982). The history of medicine in Ireland. Ulster Medical Journal, 51(1), 35–45.

The Book of O’Lees [“Book of Hy-Brasil”]: Medical treatise. (2015, August 31). Royal Irish Academy. https://www.ria.ie/library/catalogues/special-collections/medieval-and-early-modern-manuscripts/book-olees-book-hy

The Edward Worth Library. (n.d.). Edward Worth Library. Retrieved March 15, 2022, from https://edwardworthlibrary.ie/

Subtracting insult from injury: The medical judgements of the Brehon Law. (2013, March 7). History Ireland. https://www.historyireland.com/subtracting-insult-from-injury-he-medical-judgements-of-the-brehon-law/#:~:text=The%20Brehon%20Law%20was%20the

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In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post explores the ethics of using the results of Nazi experiments during WWII. This post is a follow-up to our International Holocaust Remembrance Day post from January 26, 2022.

It is no secret that during the Holocaust, Nazi’s performed brutal and inhumane experiments on prisoners in concentration camps. These experiments were not only painful, they were often deadly. It was not uncommon for prisoners who had survived these experiments to be put to death afterwards “in order to facilitate postmortem examination” (USHMM, n.d.). However, questions surrounding the ethics of using the data and results of these experiments remain unsettled.

In 1984, Kristine Moe attempted to tackle some of these questions in her seminal article titled Should the Nazi Research Data be Cited? In this article, Moe poses some interesting questions that are still worth considering today: 

“If the experiments were conducted in an unethical manner, can the results be considered reliable? If the results are useful, can we afford to ignore them? Does the use of the data imply an endorsement of the methods by which they were gathered, and provide a justification for further unethical research?”

(Moe, 1984)

At the time this article was written, many scientists viewed Nazi data as both useful and “necessary to their work” (Moe, 1984). Take for example Eduard Pernkopf’s Atlas of Topographical and Applied Human Anatomy, sometimes referred to as the “atlas of the Shoah” (Mackinnon, 2020). Nerve surgeon Susan Mackinnon writes about the ethical dilemma she faced upon realizing that the “old but precise textbook” she’d relied on for so long was the product of “a Viennese anatomist who had dissected Hitler’s victims to produce his detailed illustrations'' (Mackinnon, 2020). The accuracy and detail of the images in this textbook were a direct result of the “cadaveric nature of the emaciated bodies, a product of torture and great suffering” (Mackinnon, 2020).

In the late 1980s, Robert Pozos, a physiologist and expert on hypothermia, and Arthur Caplan, a professor of medical ethics, held a conference at the University of Minnesota to discuss if and how to “use hypothermia information gathered at Dachau” (Caplan, 2021). During this conference, some attendees expressed their view that “using immorally acquired information” is justifiable if it is the only way to save a life (Caplan, 2021). Caplan argues that the use of “tainted information” adds legitimacy to this information, thus requiring the need for “good teaching about the horrific history of this information’s creation and careful deliberation about how it is referenced and cited in journals, books, exhibitions, clinical practice guidelines, award presentations, talks, and other sources” (Caplan, 2021).

Some researchers find the Nazi data to be weak, but still use the data to affirm more reliable experimental results. Still others are wholly opposed to the use of this data. Arnold Relman, a former editor of the New England Journal of Medicine, stated that the Nazi experiments were “such a gross violation of human standards that they are not to be trusted at all” (Moe, 1984). Allen Buchanan, a former philosopher at the University of Arizona who reviewed work on human subjects observed that “experiments that are ethically unsound are also scientifically unsound. Very rarely have I seen an experiment that is very good and valuable that had serious ethical problems” (Moe, 1984). This statement makes a strong case against the scientific soundness of Nazi experiments.

A 1990 article entitled Nazi Science: The Dachau Hypothermia Experiments exposed the lack of credibility and scientific vigor of the Nazi experiments. These experiments were found to have been “conducted without an orderly experimental protocol, with inadequate methods and an erratic execution,” and reports were “riddled with inconsistencies” (Berger, 1990). Additionally, there was evidence of data falsification and fabrication (Berger, 1990). Berger makes a strong case for abandoning future citations of Nazi data based on “scientific grounds” (Berger, 1990).

Others find the issue to be more nuanced. Caplan argued that “tainted” information could be used “if, at the same time, non-maleficence can be achieved and the physician acknowledges and discloses the immoral origins of the work, in a manner that honors the victims but not its perpetrators” (Mackinnon, 2020). Mackinnon presented a four-step framework to consider when use of the Pernkopf Atlas is deemed to be potentially helpful. This framework includes taking a timeout to reassess planning, consult a colleague for help, and consult other educational resources or textbooks. As a last resort, the atlas can be consulted, but only if it is done with “disclosure, respect, gratitude, and solemnity” (Mackinnon, 2020). 

The dialog around this issue is an important one. The topic has experienced a resurgence in recent years and discussion of the topic has been renewed. Mackinnon eloquently states that “as physicians and educators, we have an enduring moral duty to recount history, share knowledge with generations that follow, and protect against new versions of the atrocities of the past” (Mackinnon, 2020). 

References:

Berger, R. L. (1990). Nazi science: The Dachau hypothermia experiments. New England Journal of Medicine, 322(20), 1435-1440. Retrieved from https://proxygw.wrlc.org/login?url=https://www.nejm.org/doi/full/10.1056/NEJM199005173222006

Caplan. (2021). How Should We Regard Information Gathered in Nazi Experiments? AMA Journal of Ethics, 23(1), E55–E58. https://doi.org/10.1001/amajethics.2021.55 Retrieved from https://proxygw.wrlc.org/login?url=https://journalofethics.ama-assn.org/article/how-should-we-regard-information-gathered-nazi-experiments/2021-01

Mackinnon S. (2020). When medical information comes from Nazi atrocities. BMJ (Clinical research ed.), 368, l7075. https://doi.org/10.1136/bmj.l7075 Retrieved from https://proxygw.wrlc.org/login?url=https://www.bmj.com/content/368/bmj.l7075

Moe, K. (1984). Should the Nazi Research Data Be Cited? The Hastings Center Report, 14(6), 5–7. https://doi.org/10.2307/3561733 Retrieved from https://proxygw.wrlc.org/login?url=https://www.jstor.org/stable/3561733

United States Holocaust Memorial Museum. (n.d.) United States Holocaust Memorial Museum Website. https://www.ushmm.org/

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(Picture provided via Markus Spikse on Pexels)

The United Nations first celebrated International Women’s Day on March 8, 1975 and two years later, the international organization designated March 8 as an annual day of observation for International Women’s Day. This awareness day is celebrated in a variety of ways depending on the country. Many people use the day to honor the successes of women and various gender equality movements, while also raising awareness on the issues that continue to impact women such as pay inequality and the disproportionate impact of climate change on women and children. 

Though the UN didn’t designate March 8 as International Women’s Day until 1977, the day originated in the early 1900s during labor rights protests and the suffrage movement. “The impetus for establishing an International Women’s Day can be traced back to New York City in February 1908, when thousands of women who were garment workers went on strike and marched through the city to protest against their working conditions.” (Haynes, 2018). To honor the anniversary of these labor strikes, the first National Women’s Day was celebrated in the United States on February 28, 1909. The celebration was led by Clara Zetkin, a German organizer and socialist, who was instrumental in spreading the awareness day in Europe. Russia celebrated its first International Women’s Day in 1913, but in 1917, after suffering from poor economic and social conditions, many used the day to protest and express their outrage over the mistreatment they faced. Their strikes and protests led to Russian women gaining the right to vote that same year. Suffragists in other nations learned from the experience of the women in Russia and used similar tactics to eventually gain the ability to vote. The collaboration and solidarity of women across the world continued throughout the 1900s and their activism paved the way for International Women’s Day to become a globally recognized holiday. 

The International Women’s Day website offers resources and events to help you learn more about the day and connect with others who are invested in advocating for women’s equality. On March 8 at 2:00 pm, the National Cancer Institute will hold an event titled ‘Breaking Bias: Women in Healthcare and Science Leadership.’  On March 11 the ‘Reimagined in America: Advance Gender Equity’ event will discuss building gender equity policies and gender inclusive communities in the United States. The United Nations will also hold a virtual event on March 8 from 10:00 am- 11:30 am in celebration of International Women’s Day. The event will focus on climate change and its impact on women and children and will feature appearances from prominent international leaders and figures such as Jane Goodall and UN Leaders. Click here to register for this UN event! If you're interested in attending a local event, GWU's American Medical Women's Association (AMWA) will be holding a potluck to celebrate International Women's Day on March 8, 2022 from 12:00 pm- 1:00 pm in the Ross Hall Courtyard. Dean Bass will be a guest speaker! If you'd like to sign up to bring a dish to the potluck, use this Google Sheet.

There are many ways to observe International Women’s Day. It’s a time to reflect on the significant achievements of women around the world and the perfect time to commit to and work towards a more gender inclusive world. We hope you’ll learn more about the history of International Women’s Day or attend one of the many events that honor this holiday!

Work Cited:

Haynes, Suyin. (2018, March 8). The Radical Reason Why March 8 Is International Women’s Day. TIME Magazine. https://time.com/5187268/international-womens-day-history/

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Published on 1 Comment on African-Americans & Historical Washington D.C.
Black and white photo of the Lincoln Theater and other buildings on U Street.
(Photo from Lincoln Theater Website)

African-Americans have always been a significant portion of Washington D.C.’s population. Since the cultivation of the land and eventual creation of the capital city, African-Americans, both enslaved and free, steadily flowed into the city and planted roots in certain neighborhoods such as U Street, Georgetown and Barry’s Farm. They formed communities that often bridged class divisions to support each other through adversity and advocated for the expansion of their rights, from equitable access to the voting booth to safe and affordable housing, issues that are still relevant today. Scattered throughout the city are monuments and memorials dedicated to some of the figures, social-political movements and institutions that were pivotal in supporting the African-American community. As this year’s Black History Month comes to a close, we’d like to highlight some of the people, locations, landmark court cases and other historical moments that created the foundation that many Black Washingtonians stand on today.

Benjamin Banneker (1731-1806)- A native Marylander, Benjamin Banneker was a mathematician and amateur astronomer who helped survey the land and establish boundaries for the newly commissioned capital of the United States. Banneker received little formal education and taught himself many of the skills he frequently used. When Andrew Ellicott, a cousin of Banneker’s neighbor George Ellicott, was tapped to survey the land that eventually became Washington D.C., Andrew brought along Banneker to assist with the project. In the 1600s and 1700s the land around the future capital was primarily farm land, specifically tobacco plantations that heavily relied on slave labor. When the survey team arrived, they had to navigate a landscape that looked vastly different from the city of our time. Because of his age and the demands of the physical labor that the project required “Banneker…concentrated on the intellectual tasks of calibrating instruments, making mathematical projections, and calculating distances accurately.” (Asch & Musgrove, 2017, p. 27) Banneker also advocated for emancipation for enslaved Africans. In a letter to Thomas Jefferson, he expressed his desire to see enslaved people freed and argued that African-Americans could contribute to society if they were given the opportunities to govern themselves. Benjamin Banneker died in 1806 in Maryland and was buried in his family’s burial grounds. Overlooking L’Enfant Plaza in the southwest sector of D.C. is a park dedicated to Benjamin Banneker. This park is one of many sites in the country that pays tribute to Banneker’s work and legacy. 

Queen v. Hepburn (1813)- Slavery was a dominant function of Washington D.C’s society, much like other parts of the country. While enslaved people in Washington experienced some small forms of freedom and independence, unlike those who labored on Southern plantations, they still sought ways to experience full freedom. Freed African-Americans would often ‘purchase’ their enslaved relatives. But some enslaved individuals used the courts to gain their freedom. Mina Queen, an enslaved woman in Maryland, pursued this route in the 1810s when she argued for her freedom by insisting that her great-grandmother was a free woman and this freedom passed down to Mina. She hired Francis Scott Key to represent her and her case circulated through the legal system before eventually reaching the Supreme Court. Unfortunately the Supreme Court ruled against Mina and her eventual fate is unknown. Chief Justice John Marshall “dismissed the use of hearsay testimony to establish one’s legal status, ruling that in legal terms enslaved people were considered property. If the Court allowed such hearsay evidence, Marshall argued ‘no man could feel safe in any property.’” (Asch & Musgrove, 2017, pp.42-43) While the Queen v. Hepburn case was a setback for enslaved people seeking their freedom, it also points to the ways in which they resisted the institution of slavery. This decision did not deter enslaved people from using the courts to gain their freedom and shows the many avenues African-Americans pursued before the Emancipation Proclamation.

Barry Farms (established. 1867)- Located in Southeast Washington, Barry Farms was created by the Freedmen’s Bureau after the end of the Civil War. While the 1863 Emancipation Proclamation freed enslaved people in the South, enslaved Washingtonians were actually freed a year earlier in 1862 with the passage of “An Act for the Release of Certain Persons Held to Service or Labor in the District of Columbia” that President Lincoln signed into law on April 16, 1862. (This date is remembered as Emancipation Day in D.C.) African-Americans flocked to the capital, putting further strain on the already limited housing market. The Freedmen’s Bureau was tasked with assisting the freed men and women adjust to their new lives. To help resettle African-Americans, the bureau purchased 375 acres of land, divided the land into one-acre plots and sold them for $125-$300 per acre. The purchase also included lumber to construct homes and residents had two years to pay off the costs. Over the years, Barry Farms developed into a thriving community which included hundreds of homesteads, a church, a school and other community institutions. The Barry Farms community exists today, though many residents are actively working to keep the neighborhood listed as an affordable housing option. Barry Farms did not completely end the housing crisis many Washingtonians experienced, but with time it developed into a well-established neighborhood for African-Americans.

Photo of books on a shelf
(Photo by Element5 Digital from Pexels)

African-American Education in the District- Black Washingtonians saw access to education as a key feature that would benefit everyone. As more and more African-Americans migrated to the capital, individuals and charitable organizations worked to build public and private schools to teach reading, arithmetic and other subjects. Howard University, located near the popular U Street Corridor, was founded in 1867 and named after the Union general Oliver O. Howard. It was originally an integrated university, but primarily focused on educating black students. The Preparatory School for Colored Youth (later known as M Street High School and eventually Dunbar High School) was one of the first public high schools for African-American students. The high school was a well-respected and beloved institution for Black Washingtonians and it eventually became one of the top high schools in the country. Many of the schools wrestled with segregation and intense scrutiny from school board members or congressional leaders, but this didn’t dissuade individuals from seeking to educate themselves. Many African-Americans saw a formal education as their ticket to a better life.

Black and white photo of Mary Church Terrell
(Photo from National Women's History Museum website)

Mary Church Terrell (1863-1954)- Born in Tennessee, Mary Church Terrell was an educator, activist and one of the first Black women to earn a college degree. She was an influential figure in the community. She taught Latin at M Street High School and was eventually appointed to the Board of Education, making her the first Black woman to ever sit on a school board in the country. In 1896, she helped found the National Association of Colored Women. Terrell believed in “uplifting” the Black community and worked tirelessly with other organizations to fight against racial discrimination. When African-American women secured the right to vote with the passage of the 19th amendment, Terrell focused on other forms of discrimination such as inequitable access to education and racial discrimination by businesses. Her home, located in the LeDroit Park neighborhood, is considered a National Historic Landmark and in 2020 she was inducted into the National Women’s Hall of Fame.

“Black Broadway”/ U Street Corridor- With it’s close proximity to Howard University, the blocks of U Street are filled with restaurants, bars and clubs where many Washingtonians unwind after the work week. But from the early to mid 1900s, U Street was a hub of entertainment and commerce for African-Americans who were denied access to many theaters, businesses and other venues because of Jim Crow laws. Before the Harlem Renaissance, U Street was filled with nightclubs, theaters and restaurants that catered to middle-class and affluent African-Americans and was seen as a place of cultural significance. U Street “boasted more than three hundred black-owned businesses and organizations, including the Whitelaw Hotel and the Industrial Savings Bank, both established by a remarkable, unschooled black entrepreneur named John Whitelaw Lewis.” (Asch & Musgrove, 2017, p. 239) Edward Kennedy “Duke” Ellington, one of the most well-known composers and jazz musicians, grew up near the historic U Street Corridor and performed some of his earliest shows in the neighborhood’s theaters. Though the area experienced hardships in the 1960s to the 1990s, it has once again become a popular section of the District and is remembered for providing entertainment to African-Americans after the Great Depression.

It is difficult capturing every historical event that holds meaning to the African-American community in Washington D.C. While the capital was not immune to the racial tensions and divisions that impacted the rest of the country, many African-Americans believed Washington D.C. was a haven and people moved to the city in search of a better life. There are ongoing changes to the capital’s population, but it’s important to remember the history and experiences of the individuals and organizations that helped shape Washington D.C.

Work Cited:

  Asch, & Musgrove, G. D. (2017). Chocolate City : a history of race and democracy in the nation’s capital. The University of North Carolina Press.

McQuirter, M. A. (n.d.) A Brief History of African Americans in Washington, DC. Cultural Tourism DC. https://www.culturaltourismdc.org/portal/a-brief-history-of-african-americans-in-washington-dc

Biography.com Editors. (2014, April 2) Benjamin Banneker Biography. The Biography.com website. https://www.biography.com/scientist/benjamin-banneker

Black Broadway on U: A Transmedia Project. (n.d.) Blackbroadway on U. https://blackbroadwayonu.com/

Further Readings:

 Black Georgetown Remembered: A History of Its Black Community from the Founding of “The Town of George” in 1751 to the Present Day by Kathleen Menzie Lesko, Valerie Babb & Carroll R. Gibbs

Leading the Race: The Transformation of the Black elite in the nation’s capital, 1880-1920 by Jacqueline M. Moore (available through a CLS request)

The Black History of the White House by Clarence Lusane (available through a CSL request)

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