JSNMA FALL 2018 Filling the Gaps with Socially Conscious Physicians Vol. 24 Is. 1 Preview

1 

IN THIS ISSUE 

As a Black woman, 

Serena Williams 

was up to six times 

more likely to die 

from... p. 13 

U.S. government 

took 65 years to 

apologize for the... 

p. 24 

Minority children 

have a lower 

response to lifesaving... 

p. 60 

Volume XXIV Issue I October 2018 

O C T O B E R 2018

JOIN 

PUBLICATIONS! 

Get in touch! publications@snma.org 

"Social media is the ultimate equalizer. It gives a 

voice and a platform to anyone willing to engage." 

~ A M Y J O M A R T I N ~

 

3 

SENIOR EDITOR 

COPY EDITORS 

OLIVIA NEWAN EDITOR IN CHIEF TAIWO AJUMOBI 

SERGEINE T. LEZEAU 

CAROL HARDEN 

ASSOCIATE EDITOR 

FRANCESS ODIBO 

ALECIA STEWART 

SHARANAH RIDORE 

DESIGN / ART 

ABNER A. MURRAY, PHD | OLIVIA NEWAN | SHAMON GUMBS, SNMA DESIGN INTERN 

ADVERTISING, CIRCULATION, MARKETING, & PRODUCTION 

ABNER A. MURRAY, PHD 

CONTRIBUTING AUTHORS 

SARAH AYAD | KETHELYNE BEAUVAIS | CHERRISSE BUTLER | KIA BYRD | LEAH CARTER 

ANNYELLA DOUGLAS | EZINWANNEAMAKA EJIOFOR | BRITTANY FLEMMING | DARREN GORDON 

CHARLES GRANT III | SARAH GREWAL | PRESTON IGWE | KELSEY MCLEOD | JENIFFER OKUNGBOWA- 

IKPONMWOSA | KRISTINA REDD | RACHELLE RIGAUD | KRYSTAL SAVICE | MILAN SHETH | JACOB USKAVITCH 

CONTRIBUTING ARTISTS 

MARTIN BROSY | MATHEUS FERRERO | TOA HEFTIBA | MATTHEW HENRY 

NICOLE DE KHORS | HONEY YANIBEL MINAYA CRUZ | JOSHUA NESS 

ILMICROFONO OGGIONO | WATOKER DERRICK OKELLO | RAWPIXEL 

LEO SERRAT | SHELLY SHELL | ALI YAHYA 

INQUIRIES 

ADVERTISING | PUBLICATIONS@SNMA.ORG 

OTHER | JSNMA@SNMA.ORG 

DISTRIBUTION 

THE JOURNAL OF THE STUDENT NATIONAL MEDICAL ASSOCIATION IS PUBLISHED 

QUARTERLY BY THE SNMA. IT IS AVAILABLE ONLINE, DIGITALLY, AND IN PRINT. FOR 

SUBSCRIPTION INFORMATION, PLEASE VISIT OUR WEBSITE, WWW.SNMA.ORG, OR SEND 

AN E-MAIL TO PUBLICATIONS@SNMA.ORG. 

REPRINTING 

NO ARTICLES, ILLUSTRATIONS, PHOTOGRAPHS, AND ANY OTHER EDITORIAL MATTER 

HEREIN MAY BE REPRODUCED WITHOUT WRITTEN PERMISSION OF THE JSNMA. TO 

REPRINT ARTICLES APPEARING IN THIS ISSUE, REFERENCE THE ARTICLE USING THE 

FOLLOWING TEXT: “THIS ARTICLE WAS RE-PRINTED FROM THE FALL 2018 ISSUE OF 

THE JOURNAL OF THE STUDENT NATIONAL MEDICAL ASSOCIATION, FIRST PUBLISHED 

OCTOBER 31, 2018 BY [AUTHOR]. 

COPYRIGHT 

THIS JSNMA ISSUE IS COPYRIGHTED BY THE STUDENT NATIONAL MEDICAL ASSOCIATION. 

ALL RIGHTS RESERVED. © 2018 

Journal of the Student National Medical Association 

5113 Georgia Avenue, NW | Washington, DC 2001 

T: 202-882-2881 | F: 202-882-2886 | www.JSNMA.org | JSNMA@snma.org 

ON THE COVER a depiction 

of unity, teamwork, and diversity 

̶ qualities that are all essential 

aspects of healthcare. In unity 

there is strength, and strength lies 

in differences. The journey to fill 

the gaps with socially conscious 

physicians is better appreciated 

as the interlocking pieces of 

a puzzle. The components of 

improvement are certainly not linear 

or independent of each other. 


4 

Table of Contents 

»» 

p.54 

6 Meet The Team 

7 Letter from the 

Editor-In-Chief 

By: Sergeine Lezeau 

8 Upcoming 

Opportunities 

11 Reaching beyond 

the healthcare 

sector to address 

social determinants 

of health 

Commentary identifying 

the different factors outside 

of medicine that can affect 

healthcare. 

By: Milan K. Sheth, MA 

12 Student-run, 

free clinics: 

A problematic 

necessity 

Explore the pros and cons of 

student-run, free clinics and 

the role of medical students. 

By: Preston Igwe 

13 A reflection on 

social determinants 

of health and 

the influence on 

maternal care for 

women of colour 

Reflections on when social 

determinants reach even 

the rich and famous of our 

community. The Serena Williams 

story. 

By: Cherrisse Butler 

15 A review of Medicine In 

Translation: Journeys 

with My Patients 

A physician attempts to serve 

both the medical and sociocultural 

needs of patients who are not 

only minorities, but many of whom 

are also recent immigrants from 

poverty-stricken and war-ravaged 

countries with unfortunate or 

traumatic life stories. 

By: Kelsey McLeod 

18 A 1000 Words 

20 Upcoming Events & 

Deadlines 

22 A personal reflection: 

Ignorance in the 

portrayal of Africa 

Although Africa is a continent 

commonly recognized for its 

suffering, rather than dwell in pity, 

let’s develop an appreciation for 

Africa’s beautiful truth. 

By: Jeniffer Okungbowa- 

Ikponmwosa, MPH 

24 Lift ev'ry voice: 

Tuskegee, stained and 

silenced 

History of the Tuskegee 

experiments within the context of 

its ramifications and the President’s 

apology. Could this matter 

have been handled better? 

By: Kristina Redd 

26 Just like art 

Oppression of people of color 

through artistic metaphors 

painting an image of resilience. 

By: Brittany Flemming 

28 Not your grandpa's 

medical education: 

A call to action 

on medical policy 

self-education 

Highlighting why physicians 

must make themselves 

educated regarding health 

policy changes as patient 

advocates. Times have 

changed dramatically, and 

governmental policies are not 

always in the best interest of 

patients. 

By: Darren M. Gordon 

29 Morality in the 

context of social 

consciousness 

A medical student reflects on 

the necessities of medical 

social engagement while 

preparing for the Step 1 exam. 

By: Leah Carter 

31 Splenomegaly and 

chronic pain in an 

adult female with 

sickle cell disease 

Case report discussing the 

J o u r n a l o f t h e S t u d e n t N a t i o n a l M e d i c a l A s s o c i a t i o n

5 

By: Charles G. Grant III, MD 

»» 

p.22 

»» 

p.35 

»» 

p.40 

uncommon incidence of an adult sickle 

cell patient with splenomegaly. 

By: Sarah Ayad et al. 

35 Wilbert C. Jordan Forum 

2018 Award winning 

abstracts 

40 The U.S. Opioid 

Commission's final 

recommendations: A 

summary and consideration 

for the impact on racial 

minority communities 

Learn how the new policies passed by 

the current administration affect minority 

populations, and how the opioid epidemic 

was addressed differently when it affected 

dissimilar communities. 

By: Kethelyne Beauvais et al. 

46 Another leaky pipeline: 

Increasing the number 

of minority physicians in 

executive leadership 

There is a need for more minority medical 

professionals in administrative positions. 

Find out what you can do to acquire the 

skills to become a successful leader! 

48 Could minority student organizations be the 

solution to increasing underrepresented 

minorities in medical schools? 

Analysis of student-led, minority organizations, like a SNMA chapter, 

implementing institutional change at a medical school with promising 

results for the future acceptance rates of underrepresented 

minorities at this school. 

By: Annyella Douglas et al. 

54 AMEC 2018 Recap 

59 Hippocratic coates 

Poem expressing the lack of healthcare access and the historical 

mistrust in healthcare by African Americans with birds at the center 

of the metaphor. 

By: Krystal Savice, MS 

60 Making #UnderservedPatientsMatter in 

healthcare: A proposed public relations 

initiative 

Discover how to harness social media to mobilize a more 

representative population when it comes to clinical trials. 

By: Jacob Uskavitch 

62 Osteopathic medicine as an avenue to 

address the medical needs of underserved 

populations 

The principles of osteopathic medicine and providing incentives for 

rural applicants may be an effective solution to treating underserved 

populations. 

By: Sarah K. Grewal 

64 Chile: A model for U.S. recruitment and 

retention of a rural physician workforce 

There's a declining number of physicians practicing in rural areas 

of the U.S. Are there any solutions to this problem? Chile’s medical 

system may have the answers. 

By: Kia Byrd 

70 Black History Month 2018 

»» 

p.13 

»» 

p.26 

»» 

p.70 


6 Meet the Team 

The Journal of the Student National Medical Association is published by the SNMA’s Publications Committee. 

Special thanks to our 2018-2019 Editorial Team!! 

SERGEINE T. LEZEAU is serving in her second year with SNMA as a Chairperson 

for the National Publications Committee. She received her Bachelor’s degree 

in Anthropology from the University of Florida before completing the Biology 

Honors Research Program at Florida Atlantic University. She is now a medical 

student at Edward Via College of Osteopathic Medicine in Auburn, AL currently 

completing her third-year clinical clerkships in Wellington, FL. 

ABNER A. MURRAY, PHD is a MD Candidate at Case Western Reserve University 

School of Medicine in Cleveland, Ohio. He rejoins the National Publications 

Committee as a Chair after serving for three years as a Co-Chair of the National 

Diversity Research Committee. He previously served on the SNMA’s Publications 

Committee as a collaborator during his tenure as the National Publication Chair 

for the Latino Medical Student Association (LMSA). 

OLIVIA NEWAN is the Senior Editor for the JSNMA. She graduated summa cum 

laude with a degree in Philosophy and a minor in Communication Studies from 

the University of Florida in 2014. Instead of going to law school, she decided 

to take the undergraduate prerequisites for medical school. She is studying for 

the MCAT while working part-time and freelance copywriting, copyediting, and 

writing for her own blog. 

ALECIA STEWART is serving as Vice Chair for the SNMA’s National Publications 

Committee. She graduated with a Bachelor's degree in Biochemistry from 

Christian Brothers University in Memphis, TN. Following graduation, she 

conducted research as a post-baccalaureate student at the Mayo Clinic and 

received authorship on several publications. She is now a fourth-year medical 

student at Marian University College of Osteopathic Medicine in Indianapolis, 

IN. 

TAIWO AJUMOBI is currently serving in her second year as a JSNMA Copy Editor. 

She graduated from DePauw University in 2012 with a major in Biochemistry 

and double minor in English Literature and Biology. Both her major and 

minors have benefited her in the medical school classroom and in her writings. 

Taiwo frequently participates in community service projects organized by the 

SNMA chapter at her school, Rowan University School of Osteopathic Medicine 

in Stratford, NJ. She has been a very active SNMA member at her school, and 

served in an executive position there during the 2016-2017 school year. 

SHARANAH G. RIDORE joined the SNMA’s National Publications Committee 

this year as a Copy Editor. She graduated from the University of Central Florida 

with a Bachelor of Science in Molecular Biology & Microbiology and a Bachelor 

of Arts in English Literature. Sharanah is currently a D.O. Candidate at the 

Rowan University School of Osteopathic Medicine in Stratford, NJ, where she 

served as SNMA Chapter President during the 2015-2016 academic year. 


Letter from the Editor 

7 

Dear Reader, 

On behalf of the SNMA Publications 

Committee, it is my upmost pleasure 

to present to you the Fall 2018 

JSNMA Issue: Filling the Gaps with 

Socially Conscious Physicians. 

This is the second of our journal 

publications since my appointment 

as JSNMA Editor-in-Chief, and I am 

truly humbled by this opportunity to 

once again feature the strong voices 

of SNMA’s membership. From poems 

to research articles, the creativity 

and diligence of the authors and 

my team members have taken my 

vision for both issues to unexpected 

heights. If you have yet to indulge 

in our first publication, Addressing 

Racial Bias in Medicine, then take 

a moment to witness how your fellow 

SNMA members boldly undertook 

this controversial yet delicate topic 

snma.me/getmyJSNMA. 

Filling the Gaps with Socially 

Conscious Physicians is a collection 

of unique perspectives regarding the 

dire need to seal prominent gaps 

within medical education, patient 

care, and medical research. Whether 

promoting a hashtag to increase 

minority involvement in clinical trials 

or sharing socio-cultural challenges 

experienced with patients, I 

commend the authors for exuding 

SNMA’s mission: (1) to support 

underrepresented minority medical 

and pre-medical students, (2) to 

address the needs of underserved 

communities, and (3) to increase 

the number of clinically excellent, 

culturally competent, and socially 

conscious physicians. 

Disparities are still plaguing the 

experimental, educational, political, 

and healthcare aspects of medicine. 

Despite notable strides across this 

spectrum ranging from policies to 

programming, more progress must 

be achieved to further reduce the size 

and number of gaps while securing 

sustainability of those efforts 

which prove successful. Given the 

diversity of the patient population in 

the United States and the statistics 

for minority health outcomes, we 

need to improve how medicine is 

taught, practiced, researched, and 

less feasible for underrepresented 

minorities to be recruited. Each of 

which are highlighted throughout this 

issue with potential solutions as the 

authors explore underlying causes 

for such gaps from different angles. 

These causes include historical 

mistrust in our healthcare system, 

lack of socio-cultural awareness, and 

limited underrepresented minorities 

in executive leadership, which have 

all hindered the health outcomes of 

minority patients and the success of 

aspiring minority physicians. 

When asked "How the JSNMA 

differs from other journals?", I 

proudly comment on the diversity 

of our writers, the variety of works 

accepted, the relevance of the 

themes to current times, and 

the opportunity to unreservedly 

express oneself at the scholarly 

level. Furthermore, we celebrate 

our members by highlighting their 

awards, scholarships, and winning 

abstracts. This JSNMA also features 

a special segment where SNMA 

chapters across the United States 

share how they celebrated Black 

History Month 2018 through unifying 

events, scholarship, and community 

service. 

It is my hope that this collection 

will open your mind and inspire you 

to become a part of the solution. 

We are all in this together and the 

JSNMA will continue to do its part by 

serving as a platform for you to be 

heard. When your unique opinions, 

scientific findings, or artistic skills 

are published in the JSNMA, you 

become a part of the powerful voice 

of the SNMA. We encourage you to 

take advantage of this opportunity 

by submitting to the JSNMA or 

joining the National Publications 

Committee! Visit www.jsnma.org for 

more information. 

Sincerely, 

Sergeine Lezeau, OMS III 

SEND ME YOUR THOUGHTS ABOUT THIS ISSUE OR SHARE WITH ME YOUR 

SOCIO-CULTURAL EXPERIENCES INVOLVING MEDICINE 

jsnma@snma.org with subject: Letter to the Editor 

Acknowledgements: Dr. Comfort Elumogo, Ms. Cynthia Bell, Dr. Gary Hill, SNMA Board of Directors 

"Our lives begin to end the day we become silent about things that matter." 

-- Martin Luther King, Jr 


8 Academic Corner 

UPCOMING OPPORTUNITIES 

SUBSIDIZED 

VISITING ELECTIVE 

PROGRAMS 

Boston Medical 

Center 

The Subsidized Visiting 

Elective Program (SVEP) 

provides financial 

assistance and support 

for underrepresented 

minority medical students 

to perform a monthlong 

elective at Boston 

Medical Center. 

Johns Hopkins 

University School 

of Medicine 

Department of Medicine 

All 4th year medical 

students are encouraged 

to apply who intend 

to pursue a career in 

internal medicine or 

its subspecialties; and 

who are from underrepresented 

groups in 

medicine 

Department of 

Anesthesiology and 

Critical Care Medicine 

Visiting Student Program 

will provide financial 

support to 4th-year students 

attending a U.S. 

medical school who are 

from backgrounds that 

are underrepresented in 

medicine. 

University of 

Alabama School 

of Medicine 

Birmingham 

Recipients of the 

Underrepresented 

in Medicine Senior 

Scholarship Program 

will complete a 4-week 

rotation at Children’s 

of Alabama and will 

be assigned a faculty 

member who will serve as 

a liaison throughout the 

rotation with opportunity 

to foster a long-standing 

mentor relationship. 

Recipients will be invited 

to interview for residency 

in pediatrics at UAB. 

As a joint venture 

between the Division of 

Diversity and Division of 

Community Health and 

LSU Neurosurgery, we 

are pleased to sponsor a 

fourth year senior medical 

student who plans a 

career in Neurosurgery 

and wishes to experience 

a rotation in our department. 

Students must selfidentify 

as an under-represented 

minority (URM) 

and display genuine interest 

in exploring issues of 

social determinants of 

health, population medicine, 

access to care, and 

social justice. 

RESEARCH 

Minority Medical 

Student Award 

Program 

Minority Medical Student 

Award Program designed 

to introduce minority 

MORE OPPORTUNITIES... 

∆ For details, visit snma.me/scholarshipDB 

medical students 

to hematology and 

hematology research 

through one of the 

following research 

experiences. 

Deadline 11/15/18 

Advancing 

Cornell Career 

Experiences for 

Science Students 

(ACCESS) 

The ACCESS Summer 

Internship Program at 

Weill Cornell Graduate 

School is a 10-week 

summer program that 

provides hands-on 

experience in biomedical 

laboratory research for 

students interested in 

pursuing graduate study 

towards a PhD. 


ASTRO Minority 

Summer 

Fellowship Award 

The ASTRO Minority 

Summer Fellowship 

Award introduces 

medical students from 

backgrounds that are 

underrepresented in 

medicine to the discipline 

of radiation oncology 

early in their medical 

education. 


∆ For questions, contact academicaffairs@snma.org 


SCHOLARSHIPS & 

FELLOWSHIPS 

Sherry R. 

Arnstein 

Minority Student 

Scholarship 

This award recognizes 

underrepresented 

minority students 

attending one of the 

member colleges of the 

American Association of 

Colleges of Osteopathic 

Medicine. Check 

website for deadline 

Minority Resident 

Hematology Award 

Program 

Minority Resident 

Hematology Award 

Program was created 

to increase the number 

of underrepresented 

minorities in hematology. 


Jeanne Spurlock 

Congressional 

Fellowship 

The Jeanne Spurlock 

Congressional Fellowship 

is an opportunity for a 

psychiatry resident or 

early career psychiatrist 

with significant interest 

in child and/or minority 

mental health advocacy 

to work in a congressional 

office. Deadline 1/31/19 

AMA Physicians of 

Tomorrow Award 

Medical students eligible 

for this award must 

be nominated by their 

medical school dean 

or dean’s designate. 

If you’re a medical 

student interested in 

being nominated, please 

contact your school. 

Check website for 

deadline 

PREMEDICAL/ 

POSTBACCALAUREATE 

American 

Medical Women’s 

Association 

(AMWA) 

Premedical Education 

Scholarship sponsored 

by the American Medical 

Women’s Association 

(AMWA). AMWA 

understands that your 

journey in medicine 

begins before medical 

school, and that this 

journey can be expensive. 


Travelers Summer 

Research 

Fellowship 

Program 

Travelers Summer 

Research Fellowship 

Program at Weill Cornell 

School of Medicine for 

students with interest in 

serving the underserved. 


Summer Health 

Professions 

Education 

Program 

The Summer Health 

Professions Education 

Program is a free summer 

enrichment program for 

students interested in 

the health professions. 


Chairman of the Board 

President 

President-Elect 

Vice President 

Pre-Medical Board Member 

Treasurer 

Secretary 

Speaker of the House 

Parliamentarian 

Immediate Past Chair 

Immediate Past President 

Region I Director 

Region II Director 

Region III Director 

Region IV Director 

Region V Director 

Region VI Director 

Region VII Director 

Region VIII Director 

Region IX Director 

Region X Director 

Academic Affairs 

Community Service 

Convention Planning 

Diversity Research 

External Affairs 

Health Policy and 

Legislative Affairs 

Internal Affairs 

International Affairs 

Membership 

Osteopathic 

Publications 

PBM to Executive Comm. 

Professional Board 

Members (PBM) 

2018-2019 Board of Directors 

Tiffani Houston, PhD 

Gabriel Felix 

Omonivie Agboghidi 

Joyce Jones 

Toddchelle Young, MPH 

Damilola Olatunji, MS 

Amma Boakye 

DaShawn Hickman, PhD MS 

Marika V. Tate 

Jason Powell, MD MBA 

Danielle M. Ward, DO MS 

Janee Murray 

Autefeh Sajjadi 

Sasha Ray 

Justice Echols 

Darren Gordon 

Adebusola Awosanya 

Brittany Flemming 

Sahlia Joseph-Pauline 

Elise Mike, PhD MS 

Petria Thompson 

Taylor Carter 

Shihyun Kim 

Kethelyne Beauvais 

Chidimma Acholonu 

Rita Akumuo 

Kiara Smith 

Jerome Arceneaux 

Boya Abudu 

Osose Oboh, MPH 

Christel Wekon-Kemeni 

Veronica Wright 

Jeniffer Okungbowa-Ikponmwosa 

Oluwabukola (Bukky) Ajagbe, MS 

Johnothan Smileye, Jr 

Janet Nwaukoni 

Brittany Fields 

Brittanie Hazzard Bigby 

Chetachi Odelugo 

Arielle Scott Turner 

Sergeine Lezeau 

Abner A. Murray, PhD 

Brooke Mobley, DO MBA 

Nana Yaw Adu-Sarkodie, MD MPH 

Marian Yvette Willams-Brown, MD 

MMS FACOG 

Christy Valentine, O C T O BMD 

E R 2018 

9

Shorts 

11 

R e a c h i n g b e y o n d t h e 

h e a l t h c a r e s e c t o r 

t o a d d r e s s s o c i a l 

d e t e r m i n a n t s o f h e a l t h 

MILAN SHETH, MA in Biomedicine - Eastern Mennonite University 

An individual’s health is 

impacted not only by 

factors such as genetics 

and lifestyle, but also by a group 

of factors collectively referred 

to as “social determinants of 

health”. These factors, which are 

responsible for the majority of 

health disparities, include the social 

and physical environment such as 

housing, income, education, and 

access to health services. These 

Efforts to eliminate health 

inequities due to social 

determinants of health must be 

collaborative.... 

determinants of health are shaped 

by the distribution of power and 

wealth at the local, national, and 

global levels. 1,2 Since these factors 

are largely beyond the control 

of individuals and since they can 

significantly impact health, there 

is a need for careful monitoring 

of both the conditions related to 

social determinants and the actions 

taken by community leaders and 

policymakers to address them. 

“Intersectoral actions” refer to those 

taken from a collaboration among 

leaders in two or more policy sectors 

aimed at achieving a common goal. 

These actions should be subject to 

scrutiny since they may be beyond 

the control of the healthcare sector. 

However, they may positively influence 

healthcare. For example, multiple 

policy sectors may develop initiatives 

to address air quality in relation to 

transportation. 3 These initiatives may 

ultimately improve healthcare and the 

quality of life for residents due to the 

relationship 

between poor 

air quality and 

respiratory 

problems. 

In spite of 

recognition 

by healthcare 

providers, 

policymakers, and community leaders 

that both social and environmental 

factors can significantly impact health, 

healthcare providers do not routinely 

screen for such determinants in their 

patients. 2 One reason for the lack 

of standardized screening efforts 

by healthcare providers may be the 

inability or difficulty to create positive 

change given the lack of control over 

such factors either by the patient or 

healthcare provider. One possible 

solution is that if an issue related to 

a social determinant of health cannot 

be appropriately handled by a primary 

care provider or social worker, then 

the patient could be referred to a legal 

expert for representation to address 

their problem and hopefully resolve it 

through legal means. 

Efforts to eliminate health inequities 

due to social determinants of health 

must be collaborative—involving 

not only healthcare providers and 

patient advocates, but also members 

representative of all major institutional 

sectors throughout society. ■ 

REFERENCES 

1. Centers for Disease Control and 

Prevention. (2014). Definitions. 

Retrieved from https://www.cdc. 

gov/nchhstp/socialdeterminants/ 

definitions.html. 

2. Theiss, J., & Regenstein, M. 

(2017). Facing the need: 

Screening practices for the 

social determinants of health. 

Journal of Law, Medicine 

& Ethics, 45(3), 431-441. 

doi:10.1177/1073110517737543 

3. Pega, F., Valentine, N. B., 

Rasanathan, K., Hosseinpoor, A. 

R., Torgersen, T. P., Ramanathan, 

V., &Neira, M. P. (2017). The 

need to monitor actions on the 

social determinants of health. 

Bulletin of the World Health 

Organization, 95(11), 784-787. 

doi:10.2471/BLT.16.184622 


12 Opinion 

Student-run, Free Clinics: A 

Problematic Necessity 

PRESTON IGWE, MS III 

Student-run free clinics (SRFCs) 

are an important resource 

for medical students to learn 

and apply clinical skills, but without 

adequate training in cultural humility 

and empathy, these clinics may instead 

be harmful to the most vulnerable 

populations in our communities. 

When I was applying to medical 

school, I noticed that almost every 

school I researched had one thing in 

common, the presence of a SRFC for 

the uninsured. A 2014 study stated 

that “SRFCs are now present at more 

than 75% of medical schools. Despite 

the lack of academic credit at many 

institutions, most medical students 

are volunteering in this setting”. 1 

These clinics have thereby become 

a staple for medical students across 

the country to hone their clinical skills 

and gain experience working with real 

patients. 

they help prepare us for our third- and 

fourth-year clerkships. 

Although I can see the benefits of 

free clinics for both students and 

community members, I cannot shake 

the thought that these clinics could 

pose a threat to the very people they 

seek to help. 

As a society, we are still struggling with racism, 

sexism, classism, and a host of other social 

ills designed to perpetuate inequality. 

At my institution, students must 

attend an orientation before they 

can volunteer at the clinic. In the 

orientation, we covered the logistics 

behind volunteering and what 

students should expect. However, 

we only spent a small portion 

of that orientation talking about 

cultural awareness, respect, and 

empathy. After discussing SRFCs 

with colleagues at other medical 

schools, I learned that insufficient 

cultural competency training for SRFC 

volunteers is also an issue at other 

institutions. 

healthcare system. If medical schools 

are sending students and physicians 

into underserved areas without first 

educating them on this history, they 

are running the risk of increasing the 

distrust between the African American 

community and healthcare providers. 

I remember having a conversation 

with one of my classmates about why 

many Black and Latinx Americans 

avoid going to the doctor. He told me 

that by avoiding family practitioners 

and ending up in the emergency 

department, they are putting a strain 

on the entire medical system. I saw 

this as a critical teaching moment. I 

did not want to generalize an entire 

race’s experience, so I decided to 

tell him about my own experiences. 

I explained that growing up, I did not 

see physicians regularly because my 

family did not always have medical 

Continued on page 67 

At the clinic affiliated with my medical 

school, I gain experience interviewing 

patients and obtaining a full medical 

history. It was at this clinic where I first 

learned how to write a prescription 

and patient note. I was able to do 

all of these things with the safety 

net of having fully trained physicians 

there in case I needed help. For firstand 

second-year students, these 

experiences are invaluable in that 

As a society, we are still struggling 

with racism, sexism, classism, and 

a host of other social ills designed 

to perpetuate inequality. The same 

is true in the field of medicine. I 

fear that many students enter these 

clinics without first acknowledging and 

checking their biases. In the case of 

African Americans, there is a deeplyrooted 

history of discrimination and 

exploitation on the part of the American 


Commentary 

13 

A Reflection on 

Social Determinants 

of Health and the 

Influence on Maternal Care 

for Women of Colour 

CHERRISSE BUTLER, MD CANDIDATE 2020, 

AMERICAN UNIVERSITY OF INTEGRATIVE SCIENCES 

As I was browsing through the latest edition 

of Vogue Magazine, I came across an article 

where international tennis superstar Serena 

Williams was sharing her childbirth experience. 1 

She recounted details about being diagnosed 

with a pulmonary embolism, a well-documented 

complication of childbirth especially for women 

who have recently undergone a Caesarean section 

delivery. A pulmonary embolism is a blood clot that 

usually forms in the lower extremities and migrates 

to the vessels in the lungs. This is a serious 

condition that may cause vessel occlusion which 

can lead to hypoxia, potentially resulting in death. 

Williams painted a picture of experiencing 

shortness of breath, which is a common indication 

of pulmonary embolism. She went on to detail how 

she had to convince her healthcare team that she 

was experiencing symptoms likely indicative of this 

life-threatening condition. She did so by recounting 

her past medical history of blood clots for which 

she was on daily anticoagulants. Williams, taking 

her own medical history into consideration, came 

to the conclusion that her shortness of breath could 

likely be due to a pulmonary embolism, as her 

anticoagulants had been recently discontinued by 

her physician as standard protocol for surgery. This 

recommendation was made in case Williams would 

have to undergo a Cesarean section delivery. 

However, her healthcare team was still hesitant. 

After many attempts by Williams, a computed 

tomography (CT) scan was finally ordered and 

her suspicions were confirmed—she was indeed 

suffering from a pulmonary embolism. 

In a time where medical care has become 

increasingly litigious and so-called “ambulancechasers” 

seem to be around every corner, it 

boggles the mind that Williams’ symptoms were not 

quickly addressed. On the other hand, healthcare 

providers are obligated to ensure that they are 

acting in their patients’ best interests, and this may 

mean foregoing unnecessary testing, which in itself 

can be harmful. However, with Williams’ symptoms 

and past medical history taken into account, this 

“Williams painted a 

picture of experiencing 

shortness of breath, which 

is a common indication of 

pulmonary embolism.” 


14 Commentary 

SERENA 

WILLIAMS AT 

THE US OPEN 

2013 

Photo by Boss 

Tweed (CC BY 

2.0) 

What was the 

barrier obstructing 

her quality of 

healthcare? 

was definitely not the case. An investigation for her hypercoagulable 

state was warranted and should have been quickly addressed. 

As I reflected on this story, there was a burning question in the 

back of my mind. “What was the barrier obstructing her quality of 

healthcare?” In medical school, we are taught what are known as 

the “social determinants of health”. These are factors beyond the 

biomedical scope that influence healthcare delivery and patient 

outcomes. 

Given the multiple dimensions addressed by the “social determinants 

of health”, Williams is considered to be in a position of great privilege. 

She has abundant wealth, excellent physical health, a high social 

status, and an extensive support system. Such factors should 

positively impact her healthcare outcomes. Somehow, however, 

these determinants of health failed Williams in this situation. As 

both a woman and a person of colour, if Williams had not been 

persistently adamant about undergoing the appropriate medical 

testing for pulmonary embolism, she probably would not be here 

today! It is difficult to pinpoint the exact factor that precipitated 

this near-miss episode. One can only speculate that maybe race 

intentionally or unintentionally influenced her substandard care as 

a patient. 

Unfortunately, Williams’ case is not an isolated incident. In an 

article, from the Journal of Perinatal Education, titled Alarming 

Racial Differences in Maternal Mortality, the author explains how 

African American women are two to six times more likely to die 

from complications of pregnancy than White women...depending 

on where they live. 2 The implication that race, an uncontrollable 

factor, can have a greater influence upon 

healthcare in comparison to those factors 

which one can potentially manipulate, 

needs to be weighted and accounted for 

when applying the social determinants of 

health to persons of colour. 

As future physicians and health care 

professionals, we need to not only 

advocate for our patients, but also listen 

to their concerns. No woman should ever 

have to bear the additional stress of trying 

to convince healthcare providers that she 

is indeed experiencing life-threatening 

complications following a major event 

like childbirth, especially when her clinical 

history is clearly telling the story. ■ 

Cherrisse Butler is a 3rd year medical student 

at the American University of Integrative 

Sciences. She is an aspiring Family Medicine 

physician interested in women’s, community, 

and global health. In addition to medicine, 

Cherrisse is also pursuing a degree in 

International Development at The University 

of London, and aspires to be an influencer on 

global health and development. 

REFERENCES 

1. https://www.vogue.com/article/ 

serena-williams-vogue-coverinterview-february-2018 

2. Flanders-Stepans, M. B. (2000). 

Alarming Racial Differences in Maternal 

Mortality. The Journal of Perinatal 

Education, 9(2), 50–51. http://doi. 

org/10.1624/105812400X87653 


Review 

15 

A Review of Medicine 

in Translation: 

Journeys with 

My Patients 

KELSEY MCLEOD, MS IV 

MD CANDIDATE AT DONALD AND BARBARA ZUCKER SCHOOL OF 

MEDICINE AT HOFSTRA/NORTHWELL 

Kelsey received her Bachelor’s degree from Columbia University, where she served as the 2016- 

2017 MAPS Liaison. She is currently in the process of applying for Pediatrics residency programs. 

even if some 

humans seemed 

solely to offer pain 

and destruction... 

there were others 

who existed only to 

create beauty. The 

chance to feel the 

hem of that beauty 

graze the cheek, was 

sometimes the only 

thing that kept the 

last straw at bay. 

Ofri, Danielle. Medicine in Translation: 

Journeys with My Patients. Boston: Beacon 

Press Books. 2010. Print. 


16 Review 

What does it mean to be 

a socially conscious 

physician? In her book, 

Medicine in Translation: Journeys 

with My Patients 1 , Dr. Danielle Ofri 

grapples with this very question. As 

a practicing internist at Bellevue 

Hospital in the heart of New York 

City, Dr. Ofri often treats patients 

where issues of language, 

interpretation, and immigration 

are major concerns of the patient 

encounter. 

In the first few chapters, she 

introduces her audience to the 

story of a young, political refugee 

and student from Nigeria who 

was in Bellevue’s Survivors of 

Torture (SOT) program. SOT was 

designed to provide survivors with 

medical, social, mental, and legal 

assistance. The young survivor 

was seeking help from SOT with 

finding specialized surgeons to 

heal his eyesight and remaining 

burns after an attack in his home 

country left him on the cusp of 

death. Despite his traumatic past, 

he went to Dr. Ofri still motivated 

to continue his engineering studies 

and to seek her help with finding 

career training. As much as she 

wanted to assist him, she felt lost 

with how to even begin addressing 

this patient’s needs, especially 

those needs far exceeding the 

traditional chief complaints. 

This young, perseverant man is 

just one of the many individuals 

that Dr. Ofri gives a voice to in 

her book, as she chronicles the 

unique stories of those whose 

bodies are as vulnerable as her 

own. Each one arrived at Bellevue 

Hospital with high expectations, 

then was taken under the care of 

an especially devoted physician 

who strived to provide them with 

exceptional medical care. Such 

patients were often individuals 

without documentation, lacking 

financial stability, and non- 

English speaking. Thus, none of 

the answers came easily to their 

physicians, including Dr. Ofri, or 

to the individuals themselves. Dr. 

Ofri was also often stifled by the 

governmental regulations that 

control the allocation of needed 

aid. This is especially highlighted in 

her story of a young, Guatemalan 

woman who was working several 

jobs and was in desperate need of 

a cardiac transplant for her failing 

heart, but could not attain medical 

assistance due to her lack of U.S. 

citizenship. The young woman was 

ultimately longing to be reunited 

with the child she had to leave 

behind in Guatemala. 

The discovery of the truth about 

the effective treatment of disease 

is a journey through which culture 

and language can sometimes 

serve as barriers. Dr. Ofri also 

recounts a Haitian woman with 

breast cancer who had difficulties 

accepting that she was sick and in 

need of chemotherapy since the 

affected breast was not painful. 

Instead, through the lens of this 

woman’s culture, simply ointment 

and tea would have been adequate 

as a cure. In reading this, I thought 

back to my own Guyanese mother 

The discovery of the truth about the effective 

treatment of disease is a journey through which 

culture and language sometimes serve as barriers 

and grandmother who, growing up, 

had always relied on vapor rub to 

treat any ailment whether internal 

or external. 

Dr. Ofri, who has a basic functional 

understanding of Spanish, narrates 

the many times she had patients 

reveal the most intimate details of 

their pain through impersonal, third 

party means. While necessary to 

the encounter to reduce medical 

errors, she still feels unsettled about 

how a service designed to enhance 

communication can simultaneously 

serve as a roadblock to genuine 

human connection. Even during 

times when some of her Spanishspeaking 

patients opted out of 

using an interpreter, she felt 

frustration with not knowing how 

to navigate complex conversations 

about their health without having 

a sophisticated grasp of the 

language, an ability that she often 

took for granted with English. In 

particular, she writes about an 

instance where she was able to 

communicate in Spanish with the 

young, Guatemalan woman about 

the dosing for her heart failure 

treatment. Dr. Ofri, however, 

was unable to provide a more 

nuanced response to the patient’s 

concerns about whether the 

medications would ultimately cure 


McLeod 

17 

her heart failure. By the halfway 

point of the book, she attempted 

to confront this dilemma by taking 

a sabbatical in Costa Rica for a 

year with her family to immerse 

herself in the Spanish language 

in hopes of becoming more fluent. 

While there, she also recharged 

spiritually through her writing and 

taking cello lessons. Music and 

writing have a continuous pulse that 

permeates throughout the book and 

have essentially become outlets 

for this dedicated physician. When 

she returned, she felt refreshed 

to continue the mission she had 

started and shows the reader how 

she used her experiences from 

Costa Rica to directly influence and 

assist more patients. 

While there is no doubt that she 

makes great strides on behalf of her 

patients, she still employs candor 

when discussing moments in which 

she has experienced tension with 

some of her patients’ opposing 

belief systems. For example, she 

was meeting with one of her elderly 

91-year-old patients to discuss his 

plan to return to China alone for 

the remaining years of his life, 

despite his wife’s recent diagnosis 

of Alzheimer’s. Upon first hearing 

of his decision, Dr. Ofri thought that 

it was selfish and questioned what 

personal values would condone 

leaving one’s wife who soon would 

not even be able to recognize 

him. She began to reevaluate her 

impression of his character, one 

that she thought she knew very 

well from over the years. Instead 

of leaving her evaluation just at 

that, she pushed herself to try and 

understand the decision from his 

point of view. She then integrated 

his views with that of her own 

family and realized how close, yet 

so far, their problems were from 

those that her patients grapple 

with. It is in these moments of Dr. 

Ofri’s cognitive dissonance and 

resolution that the reader has an 

opportunity to reflect on their own 

distance or proximity to the matter. 

This awareness and privilege 

are humbling for her, and do not 

hinder her from inching closer to 

understanding their values and 

beliefs every time—for that, I 

commend her. 

In a similar vein, she maintains 

this candor when discussing her 

own biases in the story of a patient 

from the Republic of Cameroon. 

She initially became frustrated 

with their first encounter when 

he could not remember details of 

his medical history surrounding 

prior cholesterol checks, prostatespecific 

antigen (PSA) levels, 

hepatitis C screening, and 

colonoscopy results. This led to 

her spending extra time to order 

potentially unnecessary tests, 

causing her to be late for child-care 

pick up. The reader senses some 

of her frustration as the balance 

between medicine and home life 

conflict with one another. A couple 

months later, when the two met for 

a second visit, the patient revealed 

to Dr. Ofri that he had no prior 

history of hypertension, but that his 

blood pressure elevated whenever 

he thought about his daughter. She 

had been murdered a few months 

ago after being sexually assaulted 

back in Cameroon. This tragedy 

was still fresh in his mind during 

their initial clinical encounter. 

Dr. Ofri expresses the guilt she 

feels for being more concerned 

at the prior visit with efficiency 

rather than thoroughly seeking to 

gather details about this patient’s 

past. She declares this patient 

encounter a failure on her part but 

vows to use the experience to do 

better in the future. 

The vivid language that Dr. 

Ofri utilizes to encapsulate 

such important themes further 

underscores this essential read for 

any medical student or practitioner. 

As mentioned earlier, she tries to 

balance home life, medicine, and 

music throughout the book. As 

an emerging cellist, Dr. Ofri often 

expresses her medical thoughts in 

terms of music, which underlines 

the surface of her thinking. For 

instance, one patient was advised 

to have a pacemaker implanted 

in his body even after an initial 

implant had failed. Despite 

his initial reluctance to having 

another one implanted, he agreed 

to follow the recommendations 

of his trusted doctor, based 

on a long relationship with her 

since the days of internship, and 

therefore, it was implanted. Very 

much aware of her role in his 

wellness, she listened to his heart 

some weeks after the procedure 



PHOTO OF THE WEEK

Regional Medical Education 

Conference (RMEC) Season is in full 

swing. Congrats to all the regions on 

their successful events!! 

Photo from the Region X RMEC

20 

UPCOMING 

EVENTS & 

DEADLINES 

CALENDAR 

11/10 

Region II Conference 

Chicago, IL 

11/16 

Region I Conference 

Los Angeles, CA 

Region VI Conference 

Richmond, VA 

Region VII Conference 

Boston, MA 

Region III Conference 

Shreveport, LA 

11/30 

Region VIII Conference 

Philadelphia, PA 

Region IX Conference 

New York, NY 


Events 

21 

11/30 AMEC 

2019 Early 

Bird Registration Ends 

Don’t miss out on the best rates 

for AMEC 2019. Early Bird registration 

ends on November 30, 

2018. Register Today! snma.me/ 

amec2019 

12/16 JSNMA 

Call for 

Submissions Submit your work for 

the next JSNMA Issue -- Defending 

Diversity in Medicine: Why this 

Matters in the Trump Era? 

Deadline: Dec 16, 2018, 11:59 PM 

EST 

snma.me/write4jsnma 

4/1 

AMEC 2019 

Regular 

Registration Ends The last day 

for regular rates for AMEC 2019 

is April 1, 2019. Register Today! 

snma.me/amec2019 

12/15 

Community Service Fall 

Service Grants due! The purpose 

of the SNMA Community Service 

Grant Program is to encourage local 

chapters to develop student-initiated 

service projects. Apply today, snma. 

me/service 

1/18-20 NLI 

National Leadership Institute 

The Winter National Leadership 

Institute (NLI) and Board of Directors 

Meeting will be the 18-20th of 

January 2019 in Nashville, TN. 

Registration will be available 

soon. The January NLI serves 

to not only develop our current 

leaders, but future SNMA 

leaders as well. Visit www.snma. 

org for more information. 

4/17 

AMEC 2019 

Join us for 

AMEC 2019 in Philadelphia, PA 

from April 17 - 21, 2019! 


A Personal Reflection: 

Ignorance in the Portrayal of Africa 

JENIFFER OKUNGBOWA-IKPONMWOSA, MPH 

OAKLAND UNIVERSITY WILLIAM BEAUMONT SCHOOL OF MEDICINE 

The continent that gave rise 

to me and my 

forefathers 

was once fruitful. 

It was home 

to boisterous 

individuals who 

prided themselves 

on a surplus amount 

of liquid and solid 

gold. A continent 

once rich in culture 

and history...left 

naked in the midst 

of colonialism. It 

is now a land that 

serves as the 

final resting place for beggars. 

It thrives on international aid to 

remove the pains of hunger and 

the shame of poverty from those 

who experience it. We surmise 

that it will come to an end soon, 

but when will soon ever come? 

Feelings of disgust consume 

my essence because we are 

citizens of a world so cruel that 

it allows billions to starve to 

death. Many are defeated by 

curable ailments as a result of 

the human-mandated standard 

that they do not deserve to 

live. How can human beings 

determine who lives and 

who dies? The land is now 

stained with crimson because 

it is where innocent lives have 

been taken away in a quest for 

global supremacy. 

I, alone, cannot weep for Africa. 

When will that miraculous day 

come where Africans will take on 

feelings of jubilation as we will have 

won the battle? That day will come 

when poverty will be no more and 

Africa will be re-established as the 

superpower of the world. That day 

...the story of a continent filled with emptiness and 

hopelessness. This view offers people the opportunity to regard 

Africans as subhuman, thus concealing the true reality of Africa. 

will come when all nations will pay 

homage to the land from which 

all of humanity was conceived. 

Luminescent smiles are 

borne on the faces of 

new generations because 

they maintain hope that 

Africa will one day be 

restored. As generations 

begin to age, that hope 

first disintegrates into a 

dream then gradually into 

a neglected thought. Yet, 

their souls are left captive 

in an internal battle as to 

where the fate of Africa lies. 

Homes unfit for even animals have 

become staple dwelling places 

inhabited by deprived men and 

their kin. Their homes symbolize 

the only structure they have in life. 

Nevertheless, one cannot disregard 

the fact that the stability of their 

homes can become compromised 

at anytime. Food is meagre and 

communities are forced to live from 

hand-to-mouth. Feelings of sorrow, 

anguish, and pain linger in the air 

and are inhaled by those who dare 

to breathe it. Children are stripped 

of their innocence and youth at 

ripe and tender ages. The water 

is overflowing with contaminants 

that provide the people with the 

only cure to their suffering: death. 

I, alone, cannot weep for Africa. 

Once upon a time… long, long ago… 

Africa possessed precious jewels 

coveted by all nations. The land that 

once flowed with milk and honey 

has since been raped by the White 

man, and its nations overtaken 

by genocide. Now, Africans have 

been left to fend for themselves. 

Wars against the undisciplined 

have developed into the customary 

way of life. A land that once had 

bounties of cocoa, groundnuts, 


Opinion 

23 

maize, and sugar no longer exists 

and has been replaced with 

emptiness instead. That emptiness 

sits heavy in the hearts of Africans 

everywhere. It is accompanied by a 

feeling of loathing towards all those 

who contributed to the neglect of 

Africa. Many are dying and many 

are suffering, yet they still offer all 

their thanks to the gods. They grip 

onto the hope that all that they are 

going through is not in vain. They 

remain optimistic that Africa will 

ascend to regain her dominion and 

that her banner will reign overall. 

Poverty has become an overbearing 

pandemic. I cringe at the thought 

of human beings surviving on 

unwanted crumbs, while others 

are privileged with having an 

abundant supply. The unwarranted 

parsimony of the flourishing class 

“...when poverty will be no more and Africa will be 

re-established as the superpower of the world.” 

offers people the opportunity to 

regard Africans as subhuman, 

thus concealing the true reality 

of Africa. Those of us who have 

lived in or visited Africa know that 

this narrative is untrue and that it 

is ignorant. When this ignorance is 

abandoned, then, and only then, will 

we all realize that Africa is a continent 

filled with so much joy and passion. 

are not everything. They want 

you to perceive us as wretched 

because they want you to detach 

us from reality and relegate us to 

a place worthy of disdain. Now, 

the time has come for the truth 

to be whispered in your ear—this 

is still the land of milk and honey 

and eternal happiness. The land 

of Africa cultivates feelings of 

elation in its people because we 

are not consumed by the vanities 

of the world. When you take away 

your house, wealth, and other 

possessions you are left with 

what? Nothing, nothing material 

that is. However, we would still 

hold our pride and delight because 

what is of importance to Africans is 

immaterial. Africa’s long-standing 

smile has been untouchable despite 

all of its hardships because it has 

overcome them time and time again. 

pierces my heart. I yearn for a 

beacon of hope to arise from this 

destruction and liberate Africa 

from this malicious oppression. 

Above is the view of Africa that is 

often portrayed. It is the story of 

a continent filled with emptiness 

and hopelessness. This view 

Welcome to the real Africa! 

Some of us are the daughters 

and sons of kings, politicians, 

physicians, teachers, business 

people, and cooks alike. We 

have a culture rich in unity 

and love. We have a land 

impregnated with natural 

resources coveted by all nations. 

Though we may not have all of 

the luxuries in life, we are proud 

of where we come from. Riches 

Do not weep for Africa because 

Africa is weeping for you. ■ 


24 Commentary 

A 

discussion of the 

mishandling of the 

research in a rural and 

poor Black town that forces 

us to ask, “Who owns the 

narrative?” 

LIFT EV’RY VOICE: 

TUSKEGEE, STAINED AND 

SILENCED 

KRISTINA REDD, PIPELINE MENTORING INSTITUTE FELLOW 

Sitting in the White House’s 

East Room, Herman Shaw, 

94, Charlie Pollard, 91, Carter 

Howard, 93, Frederick Moss, 

age undisclosed, and Fred 

Simmons, who reported an 

age of 110 at the time, traveled 

almost 800 miles to hear the 

apology that they had rightfully 

expected for decades. 1 

On May 16, 1997, President Bill 

Clinton acknowledged and, most 

importantly, apologized for the 

government’s gross mishandling 

of medical research known as the 

“Tuskegee Study of Untreated 

Syphilis in the Negro Male.” 2 In 

his statement, President 

Clinton called for moving 

forward—“to put the curse 

[of the Tuskegee syphilis 

study] behind [the 

victims]”—by offering an 

apology to the victims 

and their families 

on behalf of the U.S. 

government. 3 President 

Clinton also made it clear 

that it was up to the victims to forgive 

the government’s wrongdoings. 

On the 20th anniversary of the 

Tuskegee apology, I was shocked 

to learn that it had taken the U.S. 

government 65 years to apologize to 

the citizens of Tuskegee, Alabama. 

The impoverished sharecroppers 

and low-paid factory workers had 

long sought the promised benefits 

of participating in research: free 

healthcare, free meals, burial 

insurance, and treatment for 

“bad blood” (i.e., the colloquial 

term used at the time to describe 

illnesses such as anemia, syphilis, 

and fatigue). Of the 600 Black 

male study participants, a total of 

399 had syphilis and 201 did not 

have the disease when 

Roughly one third 

of Tuskegeans 

live below the 

poverty line 

they enrolled in the study. Hoping 

for the gift of healthcare that was 

made unavailable to them by an 

unaffordable system, the men 

were, instead, burdened with the 

persistence of a disease having 

deadly consequences despite 

the availability of penicillin to treat 

them. 

Growing up, I was accustomed to 

hearing the rich, vibrant tales of 

Tuskegee’s history. The town was 

a place where my family’s roots 

were planted. Black hands molded 

the small, rural town into a fruitful 

one. The wealth of its lands and, 

more importantly, the courage of its 

people stemmed from these efforts. 

The first stories I heard were at 

the feet of my great-grandmother, 

a farmer and nurse 

midwife during the most 

brutal times of the Jim 

Crow Era in the Union 

Springs/Tuskegee 

area. Her stories were 

riddled with Black strife, 

but they never ended 

with failure or despair. 

Each and every story 

shared ended with a sense of 

confidence, pride, and triumph. 

When most students become 

acquainted with the word 

“Tuskegee” in a medical context, 

it is not to share the rich histories 

that the small town contributed 

to the larger American narrative 

economically, culturally, or 


25 

medically. Discoveries about the 

establishment of the first Veterans 

Administration Medical Center for 

over 300,000 Black World War I 

veterans in the South fall to the 

wayside as a lost trivia fact to be 

researched solely out of curiosity, 

instead of being an essential part 

of the historical discourse covering 

the national progress of healthcare 

that predominantly Black towns 

have made. 

On the contrary, what reverberates 

from the Tuskegee Syphilis 

Experiment continues to resound 

loudly for the central Alabama town 

and its citizens. This narrative 

overshadows the illustrious history 

that Tuskegee, Alabama has 

loomed within its seams. Now, 

Tuskegee appears to be, and is 

often described as, a ghost town. 

Dilapidated community centers 

and rusted homes wrapped in 

kudzu vines offset the junctions of 

county roads and highways. 

According to the 2010 census, 

the racial makeup of the town is 

95.8% Black or African American. 4 

Roughly one third of Tuskegeans 

live below the poverty line. Forty 

percent of these civilians are under 

the age of 18. The median income 

for households is around $24,000 

and $43,000 for families. What is 

also surprising is that the per capita 

income for Tuskegee is $15,471. 

From these facts and figures, 

we should all be left to question: 

after the government’s apology, 

was pragmatism and equitable 

distribution of resources to rebuild 

Tuskegee even a part of the plan? 

Or, is this what health exploitation 

looks like on American soil? 

We should press on further to 

ask: What were the means of the 

government’s plans to rebuild 

trust in a healthcare system for 

Tuskegeans—if there were any 

means to do so at all? Could 

patient-provider relationships 

be repaired? Were the citizens 

equipped to be agents of their own 

health? Could they be made ready 

to take ownership of their lives— 

the same lives that had been once 

before assaulted? 

Monetary reparations were made 

available to the victims and their 

descendants. The Participants 

Health Benefits Program, 

formerly known as The Tuskegee 

Health Benefits Program, sought 

to provide free medical and 

burial services to all surviving 

participants, including 22 wives, 17 

children, and 2 grandchildren with 

syphilis to remedy the possible 

contraction of the disease during 

the study. 5 In my 

opinion, and from 

the imperative 

questioning of a 

civilized society, 

it is clear that 

reparations in 

the form of free 

healthcare were positive, but was 

it not “free healthcare” that had 

condemned the Black citizens of 

Tuskegee into their predicaments 

in the first place? This question 

is one a person who takes into 

consideration the collective, 

cultural, and psychological abuse 

REFERENCES 

carried out by that same government 

would understand. 

Whether the reparations were 

meaningful and effective is not 

something that current and future 

medical students can ameliorate. 

However, what we can do is improve 

the language that continues to 

describe the exact events of Tuskegee. 

Alabama is not a place foreign to the 

battering of Black bodies. As future 

competent and socially conscious 

physicians, our duties and professional 

moral imperatives are to provide 

a space that allows patients from 

vulnerable populations to describe 

exactly how they are feeling about 

past wrongdoings whether they be 

personal or ones that have impacted 

their friends or family. It is our duty 

to listen to our patients’ problems 

of today, but to also be mindful and 

educated of their socio-historical 

pasts. It is our responsibility to carve 

out a space for unheard voices—those 

who have been historically oppressed, 

...is this what health exploitation 

looks like on American soil? 

silenced, and told that they instead 

must forgive. 

I am jarred by the idea of placing 

the ownership of forgiveness within 

the victims’ hands. Why should they 

need permission to say, “I forgive 

you,” rather than, “Can I tell you 


1. Ross S. AP WAS THERE, Tuskegee Syphilis Study: Clinton apologized. The Seattle 

Times. https://www.seattletimes.com/nation-world/ap-was-there-tuskegeesyphilis-study-clinton-apologized 

Published May 10, 2017. 

2. U.S. Public Health Service Syphilis Study at Tuskegee. Centers for Disease Control 

and Prevention. https://www.cdc.gov/tuskegee/timeline.htm. Published August 

30, 2017. 

3. Bill Clinton Tuskegee Apology. C-SPAN. https://www.c-span.org/video/?c4488794/ 

bill-clinton-tuskegee-apology. 

4. U.S. Census Bureau. Community Facts. American FactFinder. https://factfinder. 

census.gov/faces/nav/jsf/pages/community_facts.xhtml. Published October 5, 

2010. 

5. Whorley T. The Tuskegee Syphilis Study and the Politics of Memory. Cox RJ, Wallace 

D, eds. Archives and the Public Good: Accountability and Records in Modern Society. 

2002;14(2):165-175. doi:10.1108/09565690410546163. 


26 Poem 

Just like Art 

BRITTANY FLEMMING REGION 7 DIRECTOR 

Just like art 

Painting streets 

Strokes of hatred with our blood 

Just like art 

Our skin 

Has a shine their darkness can’t dim 

Just like art 

Sculpting lies 

Chiseling away at the truth 

Just like art 

Our family 

Has a history brighter than their future 

Just like art 

Drawing lines 

We fight like our ancestors to cross 

And then… 

Just like art 

Our voices 

Carry notes their shackles can’t 

hold 

Just like art 

The truth 

On the canvas for all to see 

A truth that can’t be covered by 

strokes of hatred 

A truth that withstands the sculptor’s 

tools 

A truth that crosses lines drawn by 

hatred 

Just like art 


 

27 

HAVEN'T READ 

OUR LAST 

EDITION? 

G E T I T T O D A Y 

O N L I N E , I N P R I N T , 

O R D I G I T A L L Y 


28 Opinion 

Not Your Grandpa’s Medical 

Education: A call to Action on 

Medical Policy Self-Education 

DARREN MIKAEL GORDON, REGION V DIRECTOR 

University of Toledo College of Medicine and Life Sciences 

In 2010, Dr. Susan Skochelak, the 

American Medical Association’s 

Vice President for Medical 

Education, released a review of 

15 reports that summarized the 

problematic areas to be addressed 

concerning medical education. 

One of those areas included an 

increased emphasis on social 

accountability. 1 

The culture and climate 

of healthcare have 

changed drastically over 

the last few decades. 

With increases in 

healthcare spending and 

advances in healthcare 

outcomes, the way 

society understands 

and perceives medical 

education has radically 

evolved and continues 

to do so at an exponential rate. 

Thus, as medical students, we 

are standing at the forefront of 

such change in medicine and it is 

important that we be vigilant with 

what is and what was regarding the 

changes in both healthcare and the 

standards of practice in medicine. 

As a medical student, understanding 

healthcare policy may not 

necessarily seem integral to the 

role of a student, but it is indeed 

necessary. As government and 

policy change, their impacts on 

"Despite ...we [must] be vigilant with 

what is and what was regarding the 

changes in both healthcare." 

medical education are sure to ensue 

changes in educational standards and 

medical practice. More importantly, as 

a student of medicine, health policy 

is most relevant to the quality of care 

physicians are able to provide patients 

and to the opportunities available 

for patients as their own healthcare 

advocates. With policy reform affecting 

Medicare coverage by having such 

coverage determined on a state-bystate 

basis, for example, and changes 

in other insurance-related policies, us 

medical students must be mindful of 

how such changes impact our future 

patients. The opportunities once 

afforded to patients may change due 

to alterations in the ability of individuals 

to not only obtain healthcare, but also 

to navigate the healthcare system. As 

some of the most effective advocates 

for our patients, it is important that we 

educate ourselves in order to inform 

our future patients how healthcare 

changes could affect their healthcare 

status and opportunities for care. 

J o u r n a l o f t h e S t u d e n t N a t i o n a l M e d i c a l A s s o c i a t i o n 

At the end of the day, this is no 

longer your grandpa’s medical 

education. It is essential that we as 

medical students become active in 

uncovering the reality of policies as 

they can impact our future abilities to 

practice. We should also keep abreast 

of the changes to better serve as 

healthcare advocates for our future 

patients—arguably an obligation of 

our profession as future physicians. ■ 

Darren Gordon is an MD/PhD 

student at the University of 

Toledo College of Medicine 

and Life Sciences. He studies 

the impact of several nuclear 

factors and their role in the 

attenuation of obesity and 

diabetes. Aside from research, 

Darren has an invested role 

in educating and guiding 

students in the pipeline to 

medicine, serving in capacities as a 

mentor, camp counselor, and tutor. 

REFERENCES 

1. Acad Med. 2010 Sep;85(9 

Suppl):S26-33. doi: 10.1097/ 

ACM.0b013e3181f1323f

Commentary 

29 

M o r a l i t y i n t h e c o n t e x t 

o f S o c i a l C o n s c i o u s n e s s 

LEAH CARTER, MD CANDIDATE 

TRINITY SCHOOL OF MEDICINE 

Navigating my own 

preparation for the Step 

1 exam (a U.S. Medical 

Licensing Examination) 

while attempting to maintain a 

level head during this current 

presidential administration has 

been more of a daunting task 

than I had previously anticipated. 

With the flood of information 

arising from both mass media 

and social media, what used to 

be a break from microbiology 

or physiology, usually ends up 

being a frustrating glimpse into 

the present and potential future 

of American society. 

I recently revisited the book 

Science is Culture, an anthology 

of conversations about the 

interdependence of science 

and society, as transcribed 

and edited by Adam Bly. The 

conversations cover a myriad of 

topics that took place amongst 

a panel of noted scientific and 

non-scientific professionals 

in various fields. The aim of 

these discussions was to 

acknowledge and briefly assess 

how technological and scientific 

progression have influenced 

Western society and vice versa. 

Many of the discussants reflected 

on aspects of civilization which 

some deemed as being inherent 

to human nature in regards to: 

morality, ethical behavior, free 

will, communitarianism, etc. 

One discussion that piqued my 

interest is titled “The Problems of 

Consciousness”. This exchange 

took place between Rebecca 

Goldstein and Steven Pinker. 

They discussed how a particular 

level of awareness of one’s own 

identity and that of those around 

you can influence your behaviors 

and decisions. Early on, Pinker 

went so far as to say “morality… 

is the idea that one’s own 

perspective is not privileged— 

that the only coherent code of 

behavior takes a disinterested 

perspective that applies equally 

to oneself and to others.” 1 I find 

this as both an ignorant and 

ironically privileged viewpoint 

on morality. This conception of 

morality assumes that individuals 

exist in a vacuum. However, 

this is by no means the case. 

By Pinker’s definition, a morally 

When attempting to understand another’s 

perspective, we often put ourselves “in someone 

else’s shoes”. Even in doing so, many of our own 

personal biases remain. 

good physician-in-training ought 

to be completely devoid of 

interest in others’ identities and 

sociocultural factors in order to 

act in a morally permissible way 

with respect to patient care. 

Luckily, there are certain policies 

that act as fail-safes to prevent 

the endorsement of educating 

future physicians who have 

principles consistent with morally 

impermissible practices. 

As a Black woman, I benefit 

neither from White privilege 

nor male privilege, but my 

awareness of such benefits 

bestowed upon others has 

helped me acknowledge some 

aspects of my own privilege: I 

have never been homeless, no 

one has questioned or denied 

my sexuality, my parents are 

not divorced, etc. Remaining 

cognizant of such factors 

allows us to develop a more 

comprehensive picture of each 

patient in order to provide the 

best care possible. As people 

of color in America, we have the 

unarticulated benefit of living 

a distinct culture within our 

homes while simultaneously 

being exposed to a society that 

does not fully acknowledge 

diversity and is still rather 

homogenous. 

The media images which 

most frequently bombard us 

represent a nation far more 

unidimensional than most of 

our own lived experiences. 

Until fairly recently, on-screen 

representations of people 

that we visually identify with 


30 Commentary 

"It is not our responsibility 

as people of color to 

change the minds of 

racists, but we do have a 

moral obligation to remain 

aware of how the words 

and actions of racists can 

silence those patients 

who are among the 

disenfranchised." 

could be categorized into a few 

stereotypical constructions that 

were oftentimes not reflective of 

what we knew to be accurate. Our 

upbringings often involved sifting 

through characters not necessarily 

meant for our consumption. Those 

characters’ stories resonated with 

us in spite of that. This kind of 

upbringing has fostered a skill for 

recognizing, appreciating, and 

respecting differences in others 

without classifying such differences 

as those characteristic of someone 

who must be subhuman. 

Many would agree that, in addition 

to being able to recall and apply 

scientific concepts to individual 

patient cases, a great physician 

consistently and sincerely displays 

empathy. During the course of 

our medical education, feedback 

from preceptors and colleagues 

alike enables many of us to 

further cultivate a demonstrably 

empathetic bedside manner. 

However, many of us do not consider 

that both cognitive and emotional 

empathy have inherent biases. 

When attempting to understand 

another’s perspective, we often 

put ourselves “in someone else’s 

shoes”. Even in doing so, many of 

our own personal biases remain. 

We may see a patient suffering 

and view them as strong because 

we feel we would not have handled 

the situation as gracefully. We may 

notice a mistake that a colleague 

has repeatedly made and think 

they might not be cut out for a 

certain specialty because we feel 

we would have “gotten it right” by 

now, had we been given the same 

opportunities. Such biases follow 

us as future physicians because of 

how we have cultivated our social 

groups and curated our social 

media timelines, and therefore 

they often go unchallenged. 

The current executive 

administration has resurfaced the 

bigoted voices of a faction of the 

American Public that some falsely 

believed was near extinction. The 

same bigoted sentiments regaining 

visibility are similar to those which 

dominated American media when 

public lynching and segregation 

were not only legal, but also 

perceived as morally permissible. 

It is not our responsibility as people 

of color to change the minds of 

racists, but we do have a moral 

obligation to remain aware of how 

the words and actions of racists 

can silence those patients who 

are among the disenfranchised. In 

pursuing a career in medicine, it is 

evident that as future physicians 

we already have the intense desire 

to help those who are vulnerable. 

However, we must not forget that 

one of our duties is to further 

cultivate both cultural and social 

consciousness. 

American society, along with our 

health care system, is experiencing 

continuous change. However, through 

this flux, socially conscious physicians 

can provide solace for an increasingly 

anxious and distrustful patient 

population. Being a socially conscious 

physician goes beyond understanding 

that a Jehovah’s Witness will likely 

reject a blood transfusion, or that a 

recently immigrated female patient 

may defer to her husband to provide 

her medical history in the presence 

of a male physician. Being socially 

conscious involves acknowledging how 

societal landscapes are ever-evolving 

and understanding our roles as future 

physicians within those landscapes. 

Analogous to Step 1 exam preparation, 

knowing the high-yield topics will only 

help us in “getting by”, but a solid grasp 

of the understated details will help 

us to achieve excellence as socially 

conscious physicians. ■ 

REFERENCES 

1. Pinker, Steven, and Rebecca 

Goldstein. “The Problems of 

Consciousness.” Science is 

Culture: Conversations at the New 

Intersection of Science + Society, 

edited by Adam Bly, Harper 

Perennial, 2010, pp.25-42. 


Scientific Focus 

31 

Splenomegaly and Chronic Pain in 

an Adult Female with Sickle Cell 

Disease: A Case Report 

Sarah Ayad BSc 1 , Ezinwanneamaka Morayo Ejiofor BSc 1‡ , 

Kirolos Gergis MD, Alice Higdon DO, Sergio Baerga MD 2 , Barry 

Levinson MD 2 

1 

St. George’s University, Grenada W.I 2 Trinitas Regional Medical Center, Elizabeth, New 

Jersey. 

Abstract 

Sickle Cell Disease (SCD) is an autosomal 

recessive disease that causes a distinctive 

abnormality in the hemoglobin molecules of red 

blood cells (RBCs). The repeated polymerization 

and sickling of the RBCs cause the characteristic 

vaso-occlusive crisis (VOC) observed in persons 

with SCD. The hallmark symptom of SCD is pain. 

Acute pain is experienced frequently during VOCs, 

but chronic pain is more common. These recurrent 

episodes of pain contribute to an overall reduced 

quality of life. Multiple vaso-occlusive events lead 

to thrombosis, infarction, and atrophy of the spleen 

which results in complete autosplenectomy by, on 

average, eight years of age. In this paper, we will 

be presenting the case of a 43-year-old African 

American female with splenomegaly and SCD. 

She presented to the emergency department with 

debilitating and increasing left flank pain, which she 

reported had worsened from her chronic baseline 

of pain. An abdominal computed tomography 

(CT) scan revealed an enlarged spleen, and a 

therapeutic splenectomy was performed. The 

patient tolerated the surgery well, and her pain 

was relieved. This case is valuable because there 

is only a small number of reported cases regarding 

the relationship between splenomegaly and SCD 

in adults. 

Introduction 

Sickle Cell Disease (SCD) is one of the most 

severe and common genetic hemolytic disorders, 

characterized by a point mutation that causes a 

single amino acid substitution where valine replaces 

glutamic acid in the beta chain of hemoglobin. 

Deoxygenated conditions (e.g., high altitudes 

common with air travel, mountain climbing, or 

respiratory alkalosis) can cause hemoglobin 

molecules within the RBCs to polymerize and 

distort the RBCs into a sickle or crescent shape. 1 

SCD continues to be a major public health issue 

in the United States, most commonly affecting 

people of African, Mediterranean, Middle Eastern, 

and Indian descent. It is projected that more than 

two million Americans are carriers of the SCD 

trait. 2 There are different genotypes that have 

been shown to contribute to the development 

of SCD, but all of them are characterized by 

the presence of hemoglobin S. The different 

genotypes include both homozygous S (HbSS) 

and compound heterozygous forms of HbSC and 

beta thalassaemia. The most common genotype 

in patients of African descent is HbSS (65–70%). 

HbSC constitutes about 30% of cases, and beta 

thalassaemia is the least common among the 

relevant genotypic variations. 3 

SCD is associated with multiple organ damage. 

Complications of this disease include asthma, 

‡CORRESPONDING AUTHOR 

E-mail: eejiofor@sgu.edu 


32 Scientific Focus 

FIGURE 1 

Transverse CT of the abdomen 

showing an enlarged spleen 

with no evidence of splenic 

infarction, indicating 13x7x9 

cm dimensions. 

thromboembolism, acute chest syndrome, priapism, 

blindness, skin ulcers, and bacterial septicemia. 4 

These complications can be life-threatening, however, 

the hallmark of this disease is pain. 

The pain experienced by sickle cell patients may 

be acute or chronic and can range from mild or 

moderate to severe. Acute pain is due to VOCs 

which are commonly described as excruciatingly and 

unpredictably painful. Chronic pain is defined by the 

American Psychological Association as ‘‘pain that 

lasts longer than 6 months and affects how a person 

lives their daily life’’ and is experienced at a notably 

higher frequency than acute pain with VOCs. Chronic 

pain is associated with lower levels of physical 

and social activity, decreased food consumption, 

and negative emotions including worthlessness, 

helplessness, and anxiety. Persons living with SCD 

also experience an increased frequency and duration 

of pain thereby resulting in an overall, poorer quality 

of health. 5 

Studies have shown that painful episodes for those 

with SCD were among the most common causes of 

emergency department visits and hospitalizations, 

and 50% of readmissions were within just one month 

of discharge. 2 Despite compliance with daily pain 

medication, SCD patients continue to experience 

severe and debilitating pain crises. The most 

common cause of acute morbidity in persons with 

SCD is pain, which signals underlying necrosis and 

marrow ischemia. An increase in fetal hemoglobin 

(HbF) levels has been shown to relieve pain and 

increase survival. 6 The treatment of choice for acute 

and chronic pain in SCD has primarily been opioid 

medications. 5 Other treatment methods include the 

use of non-opioid analgesics or hydration for pain, 

antibiotics for infection, hydroxyurea to reduce the 

frequency of VOCs, and RBC exchange transfusion 

for active VOCs. 7 

The spleen is one of the most commonly damaged 

organs in SCD. Persons with SCD usually 

experience multiple vaso-occlusive events that lead 

to thrombosis, infarction, and atrophy of the spleen. 

These ischemic conditions often result in a complete 

autosplenectomy by eight years of age on average. 1 

Splenic infarction due to decreased blood supply 

to the spleen and sequestration is also a major 

complication in these patients. Splenic sequestration 

results from an entrapment of the majority of the 

RBC mass and thus enlargement of the spleen. This 

entrapment of RBCs causes a profound decrease 

in the hemoglobin levels and can become a lifethreatening 

event. 8 Literature has shown that the 

spleen undergoes fibrosis and atrophy due to the 

vaso-occlusion and infarcts which eventually lead to 

necessary, therapeutic splenectomy. 9 Splenomegaly 

and sickle sequestration crises are rare in adults with 

SCD. Higher levels of HbF and alpha thalassaemia 

appear to be significant etiologic factors for 

splenomegaly and the predisposition to splenic 

sequestration crises. 10 

This paper describes a 43-year-old African American 

female with HbSC SCD who presented with left upper 

quadrant (LUQ) and left flank pain. An abdominal CT 

scan revealed a 13x7x9 cm splenomegaly (Figure 

1). The clinical course and diagnostic measures are 

outlined below. 

Unlike patients with HbSS, who on average undergo 

autosplenectomy by age eight, 50% of patients with 

HbSC present with splenomegaly in adolescence 

and adulthood. 8 Although splenomegaly is more 

common in adolescent and adult patients with the 

HbSC genotype compared to patients with HbSS, 

this research is valuable due to the lack of SCD 

population-based studies in the United States. 


Ayad et al. 

33 

Case Report 

A 43-year-old African American female 

with a past medical history of SCD 

presented to the emergency department 

with a two-day history of persistent and 

progressively worsening abdominal pain 

localized to the LUQ and left flank after 

exhausting her opioid analgesics. She 

described a worsening pain that was 

present two weeks prior, seven out of 

ten in intensity, and characterized as 

constant, dull, and aching. She also 

complained of decreased appetite and 

early satiety. She denied any dyspnea, 

cough, or chest pain. There was no 

associated fever or trauma and no recent 

travel history. The patient stated that 

she had a total of three splenic infarcts 

over the last three years. Her past 

surgical history included a hysterectomy, 

Cesarean section, and right shoulder 

repair. 

On admission, the patient was afebrile 

with stable vital signs. Laboratory 

results revealed a normal reticulocyte 

count of 1.5%, hemoglobin of 11.7 g/dl 

(baseline unknown), and a moderately 

elevated lactate dehydrogenase (LDH) 

level. Due to the absence of significant 

anemia or pancytopenia, the LUQ pain 

was attributed to a spleen infarction or 

sequestration. The patient remained 

afebrile and without leukocytosis. There 

was no evidence of infection as a trigger 

of the pain crisis. 

Due to the severity of the pain, 

intravenous (IV) analgesia and fluids 

were administered after which her 

symptoms improved significantly. An 

abdominal CT scan was ordered and 

no evidence of splenic infarcts were 

found. The patient was later discharged 

three days after admission due to 

insignificant findings on her CT and 

proper management of her pain with 

opiates. The patient was instructed to 

take medications as directed and to 

return to the emergency department if 

symptoms recurred. 

One week following discharge, the patient 

returned to the emergency department. 

She presented with intolerable left flank 

pain that awoke her from her sleep. It was 

initially mild but had been increasing in 

severity until the day of her, now, second 

admission. The pain was associated 

with multiple episodes of non-bloody 

vomiting and watery diarrhea. She 

also reported dark-colored urine and 

a burning sensation with urination. In 

comparison to the first admission, the 

patient presented with an increase in 

creatinine from 2.0 mg/dl to 3.1 mg/ 

dl, an increase in hemoglobin from 

11.7 g/dl to 15.0 g/dl, and leukocytosis 

(16.5 x 10 9 per liter). Her Acute Kidney 

Injury (AKI) was due to poor oral intake 

and dehydration 

that resulted 

from vomiting 

and diarrhea. 

Consequently, a 

second contrast 

CT scan was not 

performed until 

the resolution of 

her AKI, which 

demonstrated stable 

splenomegaly 

measuring 13x7x9 

cm with the enlarged 

spleen abutting the 

stomach and no 

discrete lesions 

(Figure 1 and 2). 

A therapeutic, 

laparoscopic 

splenectomy 

was suggested 

as a means for 

pain control 

and improved 

quality of life. 

Vaccination against 

encapsulated 

organisms was 

given prior due 

to the planned 

splenectomy. 

A laparoscopic 

splenectomy was 

attempted but was 

converted and 

completed via an 

open approach, 

secondary to intraoperative 

hemorrhage controlled upon surgical 

opening. The patient tolerated the 

procedure well and was moved to 

the intensive care unit for monitoring 

overnight. Postoperatively, multiple 

pain modalities including Gabapentin, 

Fentanyl patch, and Dilaudid PCA 

were used to control her pain. 

On postoperative day four, the 

patient was discharged home 

in stable condition and provided 

with a prescription for Percocet 

for continued pain management. 

FIGURE 2 

Sagittal CT of the abdomen 

showing an enlarged spleen 

impinging upon abdominal 

organs. 



Discussion 

SCD is a common genetic disorder 

of hemoglobin molecules within 

the RBCs. This hemoglobinopathy 

results in the malshapening of 

RBCs and, consequently, vessel 

occlusion that contributes to many of 

the clinical symptoms of SCD. SCD 

affects around 100,000 Americans 

and accounts for over $450 million 

in healthcare expenses each year. 11 

It is genetically characterized by 

a point mutation in which valine 

is substituted for glutamic acid in 

the beta globin chain. The result 

is a grossly disabling syndrome 

characterized by painful crises, 

chronic anemia, infarction of organs, 

and a substantial decrease in quality 

of life and life expectancy. SCD is 

believed to have originated in tropical 

regions such as Sub-Saharan Africa 

where malaria is prevalent and 

carriers of the SCD trait are at an 

evolutionary advantage due to this 

genetic mutation which protects 

against morbidity and mortality 

from malaria. However, SCD has 

spread worldwide due to migration. 

The disease is diagnosed earlier in 

countries where newborn screenings 

and routine check ups lead to better 

clinical management and thus an 

increased life expectancy. 7 Our patient 

was diagnosed at birth with the HbSC 

variant of SCD which is less common 

than the HbSS variant. 

Pain is the major hallmark and the 

main reason for hospitalization 

of persons with SCD. The painful 

episodes may be caused by VOCs, 

during which adherence of sickled 

RBCs to blood vessels leads to 

blood flow obstruction. Endothelial 

activation occurs due to the interaction 

between the RBCs and the vessel wall 

producing inflammatory mediators 

that play a role in SCD pathology. 

The result is an acute, painful episode 

which is often severe enough to 

require an emergency department visit 

and IV opioids, as seen in this case 

report. Chronic pain is due to known 

causes including ischemia, nerve 

damage, and edema. 11 Such pain is 

often debilitating thus limiting physical 

activity and greatly affecting 

patients’ lifestyle. Our patient 

actually ceased her employment 

due to complications from her 

SCD and her dependence on 

opioid medications for pain 

management. 

Typically, the spleen in SCD 

patients becomes atrophied 

and fibrosed. However, in rare 

cases, splenomegaly persists 

well into adulthood. The process 

of autosplenectomy occurs due to 

multiple VOCs that consequently 

lead to splenic ischemia and 

infarction. 9 Persons in whom 

splenomegaly occurs are more 

likely to experience complications 

such as hypersplenism, splenic 

sequestration crises, and splenic 

abscesses. 12 These complications 

are linked with increased morbidity 

and mortality which prompt 

splenectomy. Hypersplenism 

is defined as splenomegaly 

associated with anemia. Patients 


REFERENCES 

1. Singh, Sompal, Singh, Deepak Kumar, Gupta, Ruchika, Nigam, Sonu, & Singh, Tejinder. (2006). Persistent splenomegaly 

in an adult female with homozygous sickle cell anemia. Hematology (Amsterdam, Netherlands),11(1), 63-5. 

2. Thompson, W., & Eriator, I. (2014). Pain Control in Sickle Cell Disease Patients: Use of Complementary and 

Alternative Medicine. Pain Medicine, 15(2), 241-246. 

3. Thein, Mya S., Igbineweka, Norris E., & Thein, Swee Lay. (2017). Sickle cell disease in the older adult. Pathology, 

49(1), 1-9. 

4. Samir K. Ballas, Muge R. Kesen, Morton F. Goldberg, Gerard A. Lutty, Carlton Dampier, Ifeyinwa Osunkwo, . . . 

Punam Malik. (2012). Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on 

Management. The Scientific World Journal, 2012, The Scientific World Journal, 01 January 2012, Vol.2012. 

5. Williams, & Tanabe. (2016). Sickle Cell Disease: A Review of Nonpharmacological Approaches for Pain. Journal of 

Pain and Symptom Management, 51(2), 163-177. 

6. Platt, O., Thorington, B., Brambilla, D., Milner, P., Rosse, W., Vichinsky, E., & Kinney, T. (1991). Pain in Sickle Cell 

Disease : Rates and Risk Factors. The New England Journal of Medicine, 325(1), 11-16. 

7. Chakravorty, S., & Williams, T. (2015). Sickle cell disease: A neglected chronic disease of increasing global health 

importance. Archives of Disease in Childhood, 100(1), 48. 

8. Orringer, Fowler, Owens, Johnson, Mauro, Dalldorf, & Croom. (1991). Case Report: Splenic Infarction and Acute 

Splenic Sequestration in Adults with Hemoglobin SC Disease. The American Journal of the Medical Sciences, 

302(6), 374-379. 

9. Jama, A., Salem, A., & Dabbous, I. (2002). Massive splenic infarction in Saudi patients with sickle cell anemia: A 

unique manifestation. American Journal of Hematology, 69(3), 205-209. 

10. Moll, S. P., & Orringer, E. (1996). Splenomegaly and Splenic Sequestration in an Adult With Sickle Cell Anemia. The 

American Journal of the Medical Sciences,312(6), 299-302. 

11. Lutz, B., Meiler, S. E., Bekker, A., & Tao, Y.-X. (2015). Updated Mechanisms of Sickle Cell Disease-Associated Chronic 

pain. Translational Perioperative and Pain Medicine, 2(2), 8–17. 

12. Al-Salem, A. (2011). Splenic Complications of Sickle Cell Anemia and the Role of Splenectomy. ISRN Hematology, 

2011, ISRN Hematology, 2011, Vol.2011. 


Abstracts 

35 

W i l b e r t C . 

J o r d a n F o r u m 

Award winning abstracts 

MRSA Colonization of the GI Tract Serves as a Reservoir for Surgical Site Infections: 

A Model of the “Trojan Horse Hypothesis” 

Emeka Okafor, MS; John C. Alverdy, MD, FACS; Monika A. Krezalek, MD; Sanjiv 

Hyoju, MD; Alexander Zaborin, PhD; Laxmi Chandrasekar, MD; Kristina Guyton, 

MD; Olga Zaborina, PhD; Susan Boyle-Vavra, PhD 

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of surgical site 

infections (SSIs). The mechanism in which the bacteria arrive at the surgical site focuses on inadequate sterilization 

techniques and poor surgical methods. The aim of this study is to explore an alternative mechanism by investigating 

whether MRSA colonization of the GI tract can serve as a source of postoperative infection. 

Hypothesis: In response to surgical injury and physiological stress, MRSA colonizing the GI tract is taken up by 

intestinal neutrophils, which then migrate to the area of surgical damage and release the intracellular bacteria in 

to the surrounding environment resulting in a SSI. 

Methods: In this study, a murine model of GI tract-derived MRSA SSI was developed. Mice were starved for 48 

hrs after administering antibiotics in order to interrupt the natural gut microbiota. The mice were then colonized 

with bioluminescent MRSA strain USA300 or GFP-tagged fluorescent MRSA strain via oral lavage. Next, the mice 

were subjected to rectus muscle ligation and disruption under aseptic surgical techniques to stimulate rectus 

ischemia and injury (RII). The surgical site was swabbed and cultured. Mice were imaged by photon camera on 

postoperative day (POD) 2, 7 and 14. Gut colonization status was assessed via culture. At sacrifice, the rectus 

muscle was examined for abscess formation and plated on selective media to detect MRSA. In order to assess 

the capability of neutrophils to harbor MRSA, mice blood was pooled, neutrophils were isolated via flow cytometry, 

and the presence of fluorescently tagged MRSA was analyzed using confocal microscopy. 

Results: All of the intraoperative swabs were negative for MRSA contamination. Additionally, no mouse appeared 

septic and all POD2 blood cultures were negative for postoperative bacteremia. Two mice (6.1%, n=33) subjected 

to rectus muscle ischemia/injury developed an abscess detected by gross rectus muscle examination and photon 

camera imaging. The abscesses occurred for the first mouse on POD7 and the second on POD14. The abscesses 

were confirmed via culture. Seven additional mice (21.2%) had MRSA present in the excised muscle based on 

culture only on POD7. However, none of these mice developed abscesses. 

Conclusion: MRSA colonization of the GI tract was successfully shown to be a potential reservoir of surgical site 

infections at distant areas of tissue injury via The Trojan Horse Hypothesis. 



Comparative Effectiveness of Psoriasis Treatments on Systemic Inflammation 

Appledene S. Osbourne, BA; Thomas S. McCormick, PhD; Kevin D. Cooper, MD 

Numerous cellular immune mediators are thought to initiate, as well as potentiate, the chronic inflammation 

characteristic of psoriasis. The progressive amplification of chronic inflammation also promotes co-morbidities such 

as atherogenesis, and thus patients with psoriasis have an increased risk of developing and dying of cardiovascular 

disease (CVD). Given that systemic treatments for psoriasis target shared inflammatory mechanisms observed 

in psoriasis as well as atherosclerotic cardiovascular disease (ASCVD), it is possible that effective suppression 

of skin inflammation could diminish distant pro-ASCVD effects. However, the parameters which best evaluate the 

potential for psoriasis treatments to reduce CVD event risk remains to be established. 

We performed a prospective longitudinal observational pilot study of the behavior of several biomarkers associated 

with an increased risk of CVD in psoriasis. Biomarkers including resistin, myeloperoxidase (MPO), and adiponectin 

were measured during and after one year of a continuous standard-of-care systemic therapies designed to achieve 

>75% psoriasis clearing based on validated measures of psoriasis severity in as many patients as possible. The 

average percent reduction in resistin from baseline to 1 year is 40.7% (n=26, 4.1 to 65.0%), and for MPO is 43.6% 

(n=26, -14.7 to 124.6%). The average percent increase for adiponectin from baseline to 1 year is 51.2% (n=26, 

-10.6 to 384%). To complement blood biomarkers, we quantified carotid artery inflammation using imaging via 

18fluorodeoxyglucose (18FDG)-position emission tomography (PET) with magnetic resonance (MR) at baseline 

and 1 year of therapy. For this cohort (n=15), the difference between the most diseased segment (MDS) of carotid 

artery at baseline versus the same segment a year later is statistically significant (p=0.000163) at p ≤ 0.05. On 

average, vascular inflammation in the MDS was reduced by 29.1%. 

Patient improvement is reflected in the multiparameter biomarker observations as well as PET-MR measures. 

Effects of Implementing American Diabetes Association (ADA) Guidelines on Patients 

Referred to a Diabetes Specialty Clinic 

Raveena Gandhi; Stephan Babirak; Jack Williams 

Introduction: Diabetes mellitus is a major risk factor for cardiovascular disease and it’s treatment has been shown 

to reduce the risk of cardiovascular diseases. In this study, patients who were referred to the diabetes clinic 

were treated aggressively per ADA guidelines for anticoagulation therapy, hypertension, lipid management and 

glycemic control. 

Hypothesis: The ADA standard of care is effective in improving several clinical outcomes in diabetic patients. 

Methods: Data of 1364 patients was collected. Variables recorded were hemoglobin A1c (HbA1c), systolic and 

diastolic blood pressure (SBP and DBP, respectively), low density lipoprotein (LDL) cholesterol, non-HDL (high 

density lipoprotein) cholesterol, and anticoagulant therapy. Measurements were recorded at baseline, 6 months, 

and annually for 6 years. One-way analysis of variance (ANOVA) followed by Tukey’s posthoc test was used for 

determination of statistically significant differences between the group means (p < 0.05). 

Results: HbA1c, SBP, and DBP levels dropped significantly at 6 months and remained decreased for 6 years. 

HbA1c decreased from 8.36% to 7.47% (p

Abstracts 

37 

Sublobar Resection and Video-Assisted Thoracic Surgery Are Associated With 

Decreased Postoperative Atrial Fibrillation and Flutter - A Nationwide Inpatient Sample 

Analysis 

Eduardo A. Bent Robinson, BS; David T. Cooke, MD; Miriam Nuño, PhD; Renee 

Bardini, BS; Kate Hanel, BS; Lisa M. Brown, MD, MAS; Habiba Hashimi, MD; 

Elizabeth A. David, MD, MAS; J. Nilas Young, MD 

Introduction: The incidence of postoperative atrial fibrillation/flutter (POAF) after lung surgery is as high as 19%, and 

leads to other postoperative morbidity. Small studies and published trends suggest that Video-Assisted Thoracic 

Surgery (VATS) and limited resection are protective. However, we do not understand the role, if any, VATS has in 

reducing POAF after lung cancer surgery. We test the hypotheses that sublobar resection and minimally invasive 

surgery reduce the risk of POAF after lung cancer surgery. 

Method: Querying the Healthcare and Utilization Project Nationwide Inpatient Sample from 2009-2013, we used ICD- 

9-CM codes to identify adult patients who underwent elective lobectomy and sublobar resection (segmentectomy 

or wedge) for lung cancer, via thoracotomy (OPEN) or VATS and Robotic Surgery (MIS). We estimate the rate of 

POAF and its effects on patient outcomes. We used multivariate analysis to study the occurrence of POAF and 

hospital mortality. A p value


Conclusion: Will be based on study results. Results will allow researchers to illuminate gaps in the literature 

regarding the potential for bias in student evaluations of minority faculty, allowing us to further explore potential 

barriers to retainment of minority faculty in academia. 

San Diego Racism and Heart Health Project (SD-RAHHP): Life Course Stressors 

among African Americans 

Naeemah Munir, MPH; Betial Asmerom, BA; Jessica Ramirez, BS; Giselle Nunez; 

Vince Garin, MS; Imani Howard, BS; Evelyn Ross, MS; Rodney Hood, MD; Anthony 

DeMaria, MD 

Background: Childhood abuses can leave individuals vulnerable to future stressors, such as racism. 

Aim: Our objective is to examine prevalence differences of lifetime racism exposure between African American 

(AA) adults, ≥ 40 years in San Diego County, with and without childhood abuse. 

Hypothesis: AA adults who experienced childhood abuses will have higher self-reported rates of lifetime racism, 

compared to AA adults who did not experience childhood abuses 

Methods: 211 (42% men) completed a questionnaire assessing childhood abuse and lifetime exposure to racism. 

We categorized lifetime racism exposure into low (never, rarely, or sometimes) and high (often or always), among 

3 categories: 1) treated unfairly by employers/bosses/supervisors (cat1); 2) treated unfairly people in service 

jobs (eg: serves, cashiers) (cat2); and 3) ‘treated unfairly by health professionals (cat3). Chi-square was used 

for statistical analysis. 

Results: Participant prevalence of verbal abuse (VA) was 31.9% (Men (M): 37.5% Women (W): 27.9%, p=0.16), 

sexual abuse (SA) was 30.2% (M: 15%, W- 41.3%, p=0.0001), and physical abuse (PA) was 29.84% (M: 36.25%, 

W: 25.2%, p=0.1). Prevalence of cat1 racism was 44.7%, cat2 racism 43.7%, and cat3 racism was 21.6% (M: 

11.9%, W: 28.7%, p=0.0045). Higher prevalence of high racism was present for every abuse category, compared 

to those with no abuse. Significant prevalence differences between those with no abuse compared to those with 

abuse, were VA and high cat3 (15.9% vs. 28.6%, p=0.038), and among men but not women (6% vs. 23.3%, 

p=0.023); PA and high cat2 (37.5% vs. 57.9%, p=0.0085) and high cat3 (14.6% vs. 33.3%, p=0.003), and among 

men only (5.9% vs. 24.1%, p=0.017) and women only (21.7% vs. 42.9%, p=0.029); and SA and cat3 (16.4% vs. 

28.8%, p=0.047). 

Conclusion: AA adults with history of VA, PA, or SA had significantly higher rates of experiences racism in healthcare 

sector. Childhood traumas may influence lifetime susceptibility to racism in various sectors. 

Varying Polyelectrolyte Multilayer Wrinkles for Successful Fibroblast Adhesion 

Miracle Rogers, BS; Ariel Ash-Shakoor, PhD; James H. Henderson, PhD 

Cell attachment and migration on a substrate is often affected by the shape, or topography, of the substrate’s 

surface. One method for creating substrate topography is to combine Shape Memory Polymers (SMPs) and 

Polyelectrolyte Multilayers (PEMs). SMPs are smart materials that can memorize a temporary shape and return 

to their original shape in the presence of a stimulus, such as heat. PEMs are thin material comprising alternating 

layers that can be deposited on surfaces, including those of SMPs. When the PEMs are applied to SMPs and 

then the composite PEM-SMP material is heated, the SMP contracts to its original shape, resulting in buckling of 

the PEM and formation of nano-topographic wrinkles. The relationship between magnitude of SMP contraction 

and resulting strength of cell attachment is unknown. The purpose of this study was to determine the cell's’ ability 

to attach to the PEM-treated SMPs strained to different extents. To achieve the goal of the study, SMPs were 

synthesized, strained, spin coated with PEMs, and heated in an isothermal oven. After the SMPs were heated, 

the SMPs returned to its original shape, buckled the PEM coating, and formed nano-wrinkles within the PEM 

coating. The contact angle of wrinkled polyelectrolyte topographies, a predictor of cell attachment, on three different 

compositions of SMP were analyzed. For each composition of SMP, the SMP was strained to 10%, 20% or 40%. 


Abstracts 

Abstracts 

39 

Each strained SMP group was spin coated with 10 or 15 PEM bilayers. Our results showed average contact 

angles of 80 degrees for 10% strain, 74 degrees for 20% strain and 75 degrees for 40% strain. The desired contact 

angle range for fibroblast adhesion is between 60 to 80 degrees. The results suggest, therefore, that this novel 

substrate is likely to support fibroblast adhesion for strains between 10% and 40%. 

Obesity & Family Meal Frequency across Race and Ethnicity 

Nabila Mohamed; Amanda Trofholz; Jerica Berge 

Obesity has been linked to chronic conditions such as diabetes, heart disease, high blood pressure, and cancer. 

Research has shown that obese children are more likely to be obese as adults, and are more likely to develop the 

aforementioned conditions. Although the national childhood obesity rate has begun to decline, obesity continues to 

disproportionately affect certain racial/ethnic groups, including African Americans, Latinos, and Native Americans. 

The main aim of this study was to identify the factors that contribute to obesity across race and ethnicity. One 

of the factors assessed was family meal frequency as it pertains to diet quality and BMI. We hypothesized that 

family meal frequency will vary across race and ethnicity and that it will not correlate with diet quality and BMI. 

Eligible participants were identified through primary care clinics. Families were eligible if they had a 5-7 yearold 

child, at least one additional child living in the home full-time, and the primary parent shared at least one 

meal per day with the child. Families (n=150) were stratified by race/ethnicity so there was an equal distribution 

(n=25 per group) of African American, White, Hmong, Hispanic, Somali, and Native American. Each racial/ethnic 

group was also stratified to ensure there was an equal distribution of weight status for nonoverweight (51%) and 

overweight/obese (49%) children. 

On average, families had a mean of 3.6 breakfasts, 2.5 lunches, and 5.7 dinners. Frequency of family breakfasts 

varied significantly by race/ethnicity: White families had the highest number of family breakfasts (4.8) together, 

which was significantly higher than African American (2.6) and Hmong (3.0) families. Participants reported lower 

amounts of family lunches. Frequency of family lunch and dinner did not significantly differ by race/ethnicity. All 

measures were adjusted by parent work status, household income, child weight status, number of household 

members, and household structure. 

There was no clear association between the frequency of family meals with child weight status; there were 

differences in the association of frequency of family meals and dietary intake by race/ethnicity. There are potentially 

other factors to consider when examining risk factors that contribute to childhood obesity across different races 

and ethnicities, such as socioeconomic status, culture, and family structure could contribute to the differences in 

BMI and diet quality across race and ethnicity. 



The U.S. Opioid 

Commission’s Final 

Recommendations: 

A Summary and Consideration 

for the Impact on Racial 

Minority Communities 

Kethelyne Beauvais 1‡ ; Mekbib Gemeda 2 ; Stephanie 

Peglow DO, MPH 3 

1 

EVMS MD Candidate 2019, 2 EVMS Vice President of Diversity and Inclusion, 3 Eastern 

Virginia Medical School 

‡ 

Corresponding author: beauvak@evms.edu; 4th-year medical student 


41 

he President’s Commission on Combating 

TDrug Addiction and the Opioid Crisis 

presented their final recommendations 

on Wednesday, November 1st, 2017. The 

report specifically mentions a call to action 

from primary care providers, psychiatrists, 

mental health organizations, and community 

organizations as it is common for substance 

use disorders (SUDs) and mental health 

disorders to act as comorbid diseases. 1,2 

Thus, it is important for current and future 

providers to become familiar with the 

forthcoming changes in the management of 

SUDs. The 138-page report begins with the 

Chairman’s letter summarizing the actions 

of the Trump administration regarding this 

topic and providing an overview of the 

committee’s recommendations, their goal 

being to: “help doctors, addiction treatment 

providers, parents, schools, patients, faithbased 

leaders, law enforcement, insurers, 

the medical industry, and researchers fight 

opioid abuse and misuse by reducing federal 

barriers and increasing support to 

effective programs and innovation”. 3 

The report then goes on to suggest 

measures aimed at standardizing and 

increasing accessibility to early SUD 

detection and treatment, removing 

pain management satisfaction from 

patient surveys, establishing “drug 

courts” for certain probation violations, 

improving provider and student 

education, preventing diversion, and 

increasing research. 

The organizations addressed in 

this report include but are not 

limited to: American Society of 

Addiction Medicine, Substance 

Abuse and Mental Health Services 

Administration, National Institute of 

Mental Health, National Institute of 

Drug Abuse, National Health Service 



Corps (NHSC), Health Resources 

and Services Administration, Drug 

Enforcement Administration, Centers 

for Medicare and Medicaid Services, 

National Institute on Corrections, 

and the Department of Justice. 

Some critics of the report have been 

frustrated with the lack of specific, 

increased funding appropriation and 

the lack of support for the expansion 

of syringe exchange programs. 4-6 The 

Chairman’s Letter, however, does 

mention early on that, “[i]t is not the 

Commission’s charge to quantify the 

amount of these resources, so we do 

not do so in this report”. He goes on 

to clarify that the letter emphasizes 

pooling various sources of federal 

funding for this crisis into simpler 

block grants for states. 7 

Other reports have also commented 

on the racial differences regarding 

those impacted the most by the 

current opioid epidemic. Racial and 

ethnic minority, especially Black, 

patients are often undertreated for 

their pain symptoms and less likely 

to be prescribed narcotics than 

White patients for reasons including 

increased (un)conscious provider 

bias of drug abuse and misuse. 

It was therefore suggested that 

because of this discriminatory factor, 

minorities may not have been as 

proportionally impacted by the recent 

opioid epidemic that infiltrated the 

suburbs. 8-11 

Although the recent opioid epidemic 

did not sweep through predominantly 

Black communities as strongly and 

quickly as it did through predominantly 

White communities, drug addiction 

continues to greatly impact minority 

and low-income neighborhoods. 12 

Many individuals from such 

neighborhoods, affected by a loved 

one’s or their own incarceration due 

to drug addiction, voiced concerns 

that politicians recently began taking 

interest in treating addiction as a 

disease instead of a crime only 

because addiction took a stronghold 

in non-minority, affluent areas. 13 Some 

question whether past sentences 

for similar crimes (e.g., possession 

of an illegal substance while on 

probation) would be decreased or 

even pardoned, but these talks have 

yet to result in any material action. 

However, there is hope that these 

policies will help communities 

across America who need it the 

most, regardless of color or income 

status. As a collective body that has 

taken, or will take care of, persons 

“Racial and ethnic minority, especially Black, 

patients are often undertreated for their pain 

symptoms and less likely to be prescribed narcotics 

than White patients.” 

with SUDs, current and aspiring 

medical professionals should hold 

the elected officials accountable to 

ensure that resources are equitably 

distributed. The President’s 

Commission on Combating Drug 

Addiction and the Opioid Crisis’s 

report recommends that the NHSC 

supply more healthcare workers in 

areas of higher opioid (ab)use. The 

NHSC has traditionally 

encouraged primary care 

physicians to deliver such 

healthcare in rural and 

underserved areas. Thus, 

the recommendation 

may be promising to 

populations who currently 

lack access to such care. 

LEFT 

Cartoon by Adam Zyglis, 

The Buffalo News, 2017 

with CC BY-NC-SA 2.0 

license 

RIGHT 

Cartoon by Dave Adam 

Zyglis, The Buffalo News, 

2016 with CC BY-NC-SA 2.0 

license 


Beauvais et al. 

43 

There is a gradual shift occurring 

in the view of treating addiction as 

a disease rather than a crime or 

character flaw. It is thereby the hope 

of many hurting communities and 

families across America that instead 

of being punished with a prison 

sentence, individuals suffering the 

most from the disease of addiction 

can get the medical and mental 

health care that they deserve. 

Below are brief excerpts/ 

paraphrases of the committee’s 

56 recommendations (acronyms 

defined at the end). To send a 

comment to the commission, email: 

commission@ondcp.eop.gov. For 

further details, the following is a 

link to the full report: https://www. 

whitehouse.gov/sites/whitehouse. 

gov/files/images/Final_Report_ 

Draft_11-3-2017.pdf 

Federal Funding and 

Programs 

1. Block grant federal funding for 

opioid-related and SUD-related 

activities to the states. 

2. Coordinated system for tracking 

all federally-funded initiatives. 

3. ONDCP to review a component 

of every federal program and 

necessary funding provided for 

implementation. 

Opioid Addiction 

Prevention 

4. Student assessment programs 

like SBIRT in middle school, high 

school and college levels. 

5. Wide-reaching, national multiplatform 

media campaign. 

Prescribing Guidelines, 

Regulations, Education 

6. Model regulations that ensure 

informed patient consent prior to 

an opioid prescription for chronic 

pain. 

7. National curriculum and standard 

of care for opioid prescribers. 

8. Collect data on prescribing 

patterns matched with 

participation in CME. 

9. Model training program for all 

levels of medical education on 

screening for substance use and 

mental health status. 

10. Prescribers desiring to be 

re-licensed to prescribe opioids 

must show participation in an 

approved CME program on opioid 

prescribing. 

11. Train pharmacists on best 

practices to evaluate legitimacy 

of opioid prescriptions, and not 

penalize pharmacists for denying 

inappropriate prescriptions. 

PDMP Enhancements 

12. States receiving grant funds must 

comply with PDMP requirements, 

including data sharing. 

13. Mandate PDMP checks. Consider 

amending EMTALA, which 

requires hospitals to screen/ 

stabilize patients in an ED, 

regardless of ability to pay. 

14. PDMP data integration with 

EHRs, overdose episodes, and 

SUD-related decision support 

tools for providers. 

15. Revise regulations and increase 

electronic prescribing, especially 

for controlled substances. 

16. PDMPs incorporate available 

overdose/naloxone deployment 

data. 

Supply Reduction and 

Enforcement Strategies 

17. Utilize Take Back Day to inform 

public. Encourage hospitals/clinics/ 

retail pharmacies to be year-round 

authorized collectors. 

18. Remove pain survey questions 

entirely on patient satisfaction 

surveys. 

19. Review/modify rate-setting policies 

that discourage the use of nonopioid 

treatments for pain. 

20. Strengthen data collection activities. 

21. Standardize drug testing procedures 

and forensic/toxicology methods in 

drug-related deaths. 

22. Reinstitute ADAM and DAWN 

programs. 

23. Enhance federal sentencing 

penalties for trafficking fentanyl and 

its analogues. 



24. Federal law enforcement to 

target those who produce/sell 

counterfeit pills. 

25. DEA to regulate the use of pill 

presses/tableting machines. 

26. CBP/ USPIS to use additional 

technologies/canines to intercept 

fentanyl/synthetic opioids. 

27. Use advanced electronic data 

on international shipments from 

high-risk areas. 

28. Support Synthetics Trafficking 

and Overdose Prevention (STOP) 

Act 

29. Prevent, monitor and detect the 

diversion of prescription opioids. 

30. Develop national outreach 

plan for Fentanyl Safety 

Recommendations for First 

Responders and standardize 

data collection related to first 

responder opioid-intoxication 

incidents. 

Opioid Addiction 

Treatment, Overdose 

Reversal, and Recovery 

31. Incorporate quality measures 

addressing addiction screenings 

and treatment referrals. Ensure 

health care providers are 

screening for SUDs and know 

how to counsel/refer a patient. 

32. Adopt process, outcome, and 

prognostic measures of treatment 

services as presented by the 

National Outcome Measurement 

and ASAM. 

33. HHS/CMS, IHS, Tricare, the DEA, 

and the VA remove reimbursement 

and policy barriers to SUD 

treatment, including patient limits, 

access limits to any forms of 

FDA-approved MAT, counseling, 

inpatient/residential treatment, 

and other treatment modalities, 

particularly fail-first protocols and 

frequent prior authorizations. All 

primary care providers employed 

by the above-mentioned health 

systems should screen for alcohol 

and drug use and, directly or 

through referral, provide treatment 

within 24 to 48 hours. 

34. Review/modify rate-setting 

to better cover the true costs 

of providing SUD treatment, 

including inpatient psychiatric 

facility rates and outpatient 

provider rates. 

35. Levy monetary penalties on 

insurers and funders, and launch 

investigations of health insurers 

independently for parity violations. 

36. Use a standardized tool that 

requires health plans to document 

and disclose their compliance 

strategies for NQTL parity. 

Private sector insurers, including 

employers, should review ratesetting 

strategies and revise rates 

when necessary to increase their 

network of addiction treatment 

professionals. 

37. NIC, BJA, SAMHSA, and other 

stakeholders use MAT with pretrial 

detainees and continuing 

treatment upon release. 

38. Establish federal drug courts in 

all 93 federal judicial districts. 

Government entities should apply 

for drug court grants. Individuals 

with an SUD who violate probation 

terms with substance use should 

be diverted into drug court, rather 

than prison. 

39. Expand the use of recovery 

coaches. Expand programs for 

hospital and primary case-based 

SUD treatment and referral 

services. 

40. HRSA to prioritize addiction 

treatment knowledge across all 

health disciplines. Recruit and 

increase the number of addictiontrained 

psychiatrists and other 

professionals 

41. Allow for SUD treatment via 

telemedicine. 

42. NHSC to supply health care 

workers to areas with higher 

opioid (ab)use 

43. EMTs to administer naloxone, 

including higher doses. 

44. Naloxone co-prescribing pilot 

programs to confirm initial 

research and identify best 

practices. 

45. Develop new guidance for 

EMTALA compliance with regard 

to treating/ stabilizing SUD 

patients. Provide resources 

to incentivize hospitals to hire 

appropriate staff for their ED. 

46. Implement guidelines/ 

reimbursement policies for 

Recovery Support Services. 

47. Disseminate strategies to keep 

families together. Research 

models for pregnant and 

postpartum women with SUDs 

and their newborns. 

48. Identify successful college 

recovery programs. Provide 

support and technical assistance 

to increase the number/capacity 

of high-quality programs. 

49. Develop best practices on SUDs 

and the workplace for both 

employers and employees. 

50. Develop model state legislation/ 

regulation to decouple felony 

convictions/ eligibility for business/ 

occupational licenses 

51. Develop quality standards/ best 

practices for recovery residences. 

Research and 

Development 

52. Engage in a comprehensive 

review of existing research 

programs and establish goals for 

pain management and addiction 

research. 

53. Additional resources to NIDA, 

NIMH, and NIAAA to fund the 

research areas cited above, 

including long-acting injectables, 

more potent opioid antagonists 

to reverse overdose, drugs used 

for detoxification, and opioid 

vaccines. 


54. Further research of and fast-track 

review process for any new 

Technology-Assisted Monitoring 

and Treatment for high-risk and 

SUD patients and SUD patients. 

55. Commercial insurers and CMS 

fast-track creation of HCPCS 

codes for FDA-approved 

technology-based treatments, 

digital interventions, and 

biomarker-based interventions. 

56. FDA establish guidelines for postmarket 

surveillance. ■ 

Acronyms 

ADAM. Arrestee Drug Abuse 

Monitoring program 

ASAM. American Society of Addiction 

Medicine 

BJA. Bureau of Justice Assistance 

CBP. U.S. Customs and Border 

Protection 

CME. Continuing Medical Education 

CMS. Centers for Medicare and 

REFERENCES 

Medicaid Services 

DAWN. Drug Abuse Warning 

Network 

DEA. Drug Enforcement 

Administration 

HCPCS. Healthcare Common 

Procedure Coding System 

HHS. Health and Human Services 

HRSA. Health Resources and 

Services Administration 

IHS. Indian Health Service 

MAT. Medication-Assisted Treatment 

NHSC. National Health Service 

Corps 

NIAAA. National Institute on Alcohol 

Abuse and Alcoholism 

NIC. National Institute on Corrections 

NIDA. National Institute on Drug 

Abuse 

NIMH. National Institute of Mental 

Health 

NQTL. Non-quantitative Treatment 

Limitations 

ONDCP. Office of National Drug 

Control Policy 

PDMP. Prescription Drug Monitoring 

Program 

Beauvais et al. 

45 

SAMHSA. Substance Abuse 

and Mental Health Services 

Administration 

SBIRT. Screening, Brief Intervention 

and Referral to Treatment 

SUD. Substance Use Disorder 

USPIS. U.S. Postal Inspection 

Service 

VA. Veterans Affairs 

Kethelyne Beauvais is currently a fourthyear 

medical student at Eastern Virginia 

Medical School in the MD Class of 2019. 

As former SNMA National Speaker of 

the House of Delegates and one of the 

current National Community Service 

Chairpersons, she enjoys working 

with fellow SNMA members to help 

advance SNMA’s mission of addressing 

the needs of underserved communities 

and increasing the number of clinically 

excellent, culturally competent, and 

socially conscious physicians. She 

aspires to become a family physician and 

hopes to utilize her position to continue 

finding innovative ways to provide 

quality primary care to communities. 


1. Kelly, T.M. and Daley, D.C. (2013, Aug 26). Integrated Treatment of Substance Use and Psychiatric Disorders. Retrieved from 

. 

2. Herbeck, D.M., Fitek, D.J., Svikis, D.S., Montoya, I.D., Marcus, S.C., West, J.C. (2008, Dec 10). Treatment Compliance in Patients with 

Comorbid Psychiatric and Substance Use Disorders. Retrieved from . 

3. Christie, C., Baker, C., Cooper, R., Kennedy, P.J., Madras, B., Bondi, P. (2017, Nov 1). The President’s Commission on Combating Drug 

Addiction and the Opioid Crisis. Retrieved from . 

4. Goodnough, A. and Hoffman, J. (2017, Nov 1). Panel Recommends Opioid Solutions but Puts No Price Tag on Them. Retrieved from 

. 

5. Bernstein, L. (2017, Nov 1). White House Opioid Commission Calls for Wide-Ranging Changes to Anti-Drug Policies. Retrieved 

from . 

6. Johnson, C.K. (2017, Nov 1). Trump Opioid Panel Wants Drug Courts, Training for Doctors. Retrieved from . 

7. Christie, C., Baker, C., Cooper, R., Kennedy, P.J., Madras, B., Bondi, P. (2017, Nov 1). The President’s Commission on Combating Drug 

Addiction and the Opioid Crisis. Retrieved from . 

8. Mossey, J. (2011, Jan 20). Defining Racial and Ethnic Disparities in Pain Management. Retrieved from . 

9. Kolata, G. and Cohen, S. (2016, Jan 16). Drug Overdoses Propel Rise in Mortality Rates of Young Whites. Retrieved from . 

10. King, N. and Kolodny, A. (2017, Nov 4). Why Is The Opioid Epidemic Overwhelmingly White? Retrieved from . 

11. Lopez, G. (2016 Jan 25). Why Are Black Americans Less Affected by the Opioid epidemic? Racism, Probably. Retrieved from . 

12. Lopez, G. (2017, Dec 22). The Opioid Epidemic Has Now Reached Black America. Retrieved from . 

13. Windsor, L., Dunlap, E., and Armour, M. (2013, Oct 1). Surviving Oppression Under the Rock: The Intersection of New York’s Drug, 

Welfare, and Educational Policies in the Lived Experiences of Low-Income African Americans. Retrieved from . 


46 Opinion 

WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE 

CHARLES G. GRANT III, MD 

Another Leaky 

pipeline: Increasing 

the number of 

Minority Physicians in 

Executive Leadership 

One of the biggest gaps to have 

recently captured the attention 

of and inspired discussions by 

medical specialty organizations, and 

hospital systems alike, has been the lack 

of minority physician leadership within 

their very own ranks and administrations. 

These groups of leaders that have a 

paucity of minority representation are 

the same people that are making the 

crucial decisions regarding areas like our 

education, the health of our communities, 

and even our recruitment as minorities 

into medicine and executive leadership. 

As a fellow colleague once told me at 

the start of my journey into medicine, 

“Just being present in a white coat 

alone inspires our people to follow in 

your footsteps and to do great things.” 

I took this to heart and started my 

own journey into leadership, proudly 

accepting the responsibility of my image 

to our communities. My colleague’s 

words and my early leadership 

experience made me realize that just 

being present as a minority with any 

kind of professional standing has a 

bigger impact than one would think. 

This is especially the case when it 

comes to recruiting more minorities 

not only to positions where they can 

attain an outstanding professional 

education, but also to positions 

where they can become leaders in 

their professional communities. This 

is why we, ourselves, should strive 

to repair the current leaky pipeline by 

encouraging one another as minority 

medical and premedical students to 

seek out leadership opportunities 

in order to: (1) gain the experience 

needed to become excellent physician 

leaders, (2) play a hand in making 

those crucial executive decisions, 

and (3) become role models for future 

minority physician leaders. 

Now, not everyone in 

medical school gains 

the necessary skills or 

experience to navigate 

through the bureaucracy 

and political savvy of 

professional executive 

boards and/or committees 

that make these impactful 

decisions. These skills and 

experiences are not always 

taught or integrated into a 

medical school’s curriculum. 

This is why it is important 

for us, as the future minority 

physician workforce, to 

seek opportunities that 

make ourselves not only 

better physicians, but 

also better professional, 

executive leaders such 

that we, ourselves, can 

fill these gaps in minority 

executive leadership and 


47 

Ilmicrofono Oggiono with CC BY 2.0 

further the Student National Medical Association’s 

(SNMA’s) mission to increase the number of 

culturally competent, clinically excellent, and socially 

conscious physicians. 

One example that inspired me to write this article 

actually occurred during one of my fourth-year 

electives, when I had the pleasure of meeting a 

non-minority, neurointerventional surgeon who is 

the Chairman of the Clinical Neuroscience Institute 

at a Level 1 trauma and stroke center. Although he 

“only” had past leadership experience during his 

residency as President of the house staff and as 

Chief Resident under his belt, he was the one who 

his new job had counted on to build something that 

did not exist at the time in order to help expand the 

department’s neurologic subspecialty capabilities. 

He had no structure or framework to go by and only 

two people to help him out, who had just finished 

their own fellowships. By applying his “limited” 

executive leadership experience, he was able to 

build a structure from the ground up that currently 

delivers many forms of neurological care across the 

health system. This new program has hired over 50 

providers and administrators in the last eight years 

to get this accomplished and has shown significant 

growth since its inception. 

From creator to now Chairman of the Institute, he 

manages not only the continuing expansion of it, but 

also the intricacies and challenges of maintaining the 

varying components of each subspecialty under the 

Institute via committee and administrative work. It’s 

amazing to know that he was able to use just one or 

two of his past leadership experiences, along with 

the skill sets he acquired from them, to successfully 

navigate through the hospital system’s bureaucracy. 

He is now able to serve as a key pillar for mentorship 

amongst future neurologists and for repairing the 

diversity gap in the leaky neurology pipeline. 

When listening to his story and applying my own 

leadership experience, I began to ask, “Why aren’t 

we, as future and current minority physicians, 

doing more things like this too?” We have both the 

potential and tenacity of this man, and others like him, 

but somehow we fail to utilize or seek the opportunities in 

front of us that can prepare us to accomplish great goals 

and feats. We must develop the foresight to acknowledge 

that we, as the future of our communities' leadership, 

must continually improve our executive leadership 

experiences and skill sets to face future challenges 

successfully. Overcoming such challenges are necessary 

to create or mold systems that could improve not only our 

communities’ health outcomes, but also improve the leak 

in the minority physician leadership pipeline by taking 

“just being present in a white coat” to the next level as 

minority physician leaders. 

This is why I encourage anyone who is reading this 

article to consider becoming a leader within the SNMA 

whether that be at the chapter level, regional level, or 

even the national level. It is student organizations like 

the SNMA that will give you the leadership experience, 

unique skill sets, and executive competency needed for 

your career to successfully navigate through the vital 

executive and corporate decisions that have continually 

hurt our pipelines and communities’ health outcomes. We 

need to start grooming and encouraging each other to 

better ourselves in this respect so that we can participate 

in these decisions and start making real impacts on 

closing disparity gaps, and ultimately, the gap in minority 

physician-executive leadership. ■ 

Charles G. Grant, III was the SNMA National Vice President 

for the 2017-2018 administrative year. He graduated from 

Western Washington University with a Bachelor’s of Science 

degree in Chemistry in 2012 and matriculated into the MD 

program at Wright State University Boonshoft School of 

Medicine in 2014. He is an inducted member of the Gold 

Humanism Honor Society and has served in many leadership 

positions and executive boards within the chapter, regional, 

and national levels of SNMA throughout his medical school 

career. His main focus has been on the development of 

SNMA’s pipeline structure and outreach and the further 

development of SNMA’s Pipeline Mentoring Institute. He 

plans on practicing Emergency Medicine and continuing to 

engage in community advocacy and leadership. 



Could Minority 

Student 

Organizations 

be the Solution 

to Increasing 

Underrepresented 

Minorities in 

Medical Schools? 

Annyella Douglas MS4, 1‡ Rachelle Rigaud MS4, 1 

Nicole Williams, MD 2 

1 

The Pennsylvania State University College of Medicine, Hershey, Pennsylvania 

2 

Department of Pathology and Laboratory Medicine, Penn State Health, Milton S. 

Hershey Medical Center, Hershey, Pennsylvania 

‡ 

Corresponding author: Adouglas1@pennstatehealth.psu.edu 


49 

Abstract 

According to the Association 

of American Medical Colleges 

(AAMC), groups defined as 

underrepresented in medicine 

(UiM) are those who self-identify 

as African American/Black, 

Hispanic/Latino, American 

Indian/Alaska Native, or Native 

Hawaiian/Pacific Islander. Within 

the literature, it has been found 

that underrepresented minorities 

in medicine are more likely to 

practice in communities with 

higher proportions of their own 

ethnicity as well as have more 

patients who are uninsured 

and are covered by Medicaid. 1 

Therefore, UiM physicians play 

an essential role in improving 

health disparities. 

The recruitment of UiM students 

into medical schools continues 

to be limited by factors such 

as lack of faculty diversity, lack 

of minority role models as well 

as lower MCAT scores. 2 At the 

Pennsylvania State University 

College of Medicine (PSUCOM), 

there was an increased emphasis 

in recruiting underrepresented 

minorities with the resurgence 

of our Student National Medical 

Association (SNMA) chapter 

in 2015. This minority student 

organization, along with others, 

began actively developing 

strategies to increase minority 

student matriculation. During 

the same time period, there 

was an administrative transition 

from one Dean of Diversity to 

another at PSUCOM. Prior to 

2015, the Dean of Diversity 

was also a physician and 

thereby had limited availability 

due to clinical obligations, while 

the current Dean of Diversity’s 

only professional obligation has 

been the Office of Diversity & 

Inclusion, in order to enhance 

recruitment efforts for diverse 

students. This study focuses 

on these student-led strategies 

along with their successes and 



limitations in increasing UiM student recruitment. 

Background 

The AAMC reports that physicians from racial/ 

ethnic backgrounds underrepresented in 

medicine are more likely to become primary care 

physicians, practice in more impoverished areas, 

and improve the quality of healthcare in these 

areas. 3 Yet, the data shows that African American 

applicants have lower acceptance rates into 

medical schools relative to their peers. 4 Despite 

medical schools nationwide implementing 

programs to diversify the composition of their 

academic classes, the low rate of racial and 

ethnic minorities matriculating into medical 

schools has remained unchanged since 2012. 4 

The purpose of this study is to describe and evaluate 

the results of strategies implemented by the PSUCOM 

SNMA chapter along with the support of other minorityled 

organizations, the Office of Diversity & Inclusion, 

and the Office of Admissions. 

Methods 

Student-led strategies were implemented from Fall 2015 

to Fall 2016 (Table 1). We used data accumulated by 

the Office of Admissions at PSUCOM over the past four 

admission years (2014-2017) to assess the impact of 

these student-led recruitment strategies by analyzing 

student matriculation (Figure 1) and declined admission 

offers (Figure 2) for admission years 2014 to 2017. 

All data was de-identified prior to release from the 

Office of Admissions and was categorized into racial/ 

ethnic breakdown by academic year. PSUCOM data 

was compared to national trends in medical school 

admissions data provided by the AAMC. 5 

Table 1. Student-led Strategies Implemented from Fall 2015 to Fall 2016 

at PSUCOM 

Fall 2015 • Minority student organization members attend 

monthly, Diversity Day luncheons to speak with UiM 

interviewees and answer their questions 

• Minority students host UiM interviewees the night 

before their interview 

• White Coats 4 Black Lives initiative implemented as 

one of the Office of Diversity’s goals at PSUCOM 

Spring 2016 • Diversity Segment created for Second Look Day 

• Pre-Med Mentorship Program established with Lincoln 

University; year-long program 

Fall 2016 • Diversity Segment created for Primary Care Day 

• Expansion of Pre-Med Mentorship Program to UiM 

students of Penn State Harrisburg and Franklin & 

Marshall College 

J o u r n a l o f t h e S t u d e n t N a t i o n a l M e d i c a l A s s o c i a t i o n 

"Despite medical schools nationwide 

implementing programs to diversify the 

composition of their academic classes, the low 

rate of racial and ethnic minorities matriculating 

into medical schools has remained unchanged 

since 2012." 

Results 

When analyzing the AAMC matriculation rates by 

ethnicity for academic years 2014 through 2017, 

PSUCOM performed below the national average for 

matriculation of Hispanic students (Figure 1). From 2014 

to 2015, PSUCOM had significantly lower matriculation 

rates of African American students; however, from 2016 

to 2017, matriculation was slightly higher or equivalent 

to the national average. While this upswing positively 

correlates with the involvement of minority student 

organizations in the admission and recruitment process, 

Hispanic student matriculation decreased from 2016 

to 2017. In contrast, the matriculation of Caucasian 

students surpassed national rates while that of Asian 

students fluctuated but lied within 2-3% of the national 

average for the same, four-year academic period. 

In Figure 2, analysis of the percent of applicants who 

declined admission offers to PSUCOM from 2014 to 

2017 was also revealing. Across all these academic 

years, it is evident that fewer Caucasian and Asian 

applicants declined offers of admission compared to the 

higher proportion of Hispanic and 

African American students who 

declined offers for each given 

year. Upon closer examination, 

the decline rates for both African 

American and Hispanic students 

were reduced in 2016 and 2017 

from prior years. However, 54% 

of African American students 

declined offers in 2017, 

surpassing the decline rates in 

2014 prior to the implementation 

of student-led strategies. 

Discussion 

While minority, medical student 

organizations play an essential 

role in the recruitment of UiM 

students, more strategies and 

resources are necessary to 

sustain steady UiM recruitment 

rates. Between 2016 and 2017,

Douglas et al. 51 

FIGURE 1 

Matriculants to Medical School by Race (2014-2017) 

there was a drop in African American recruitment; but 

the rates were still higher than that of 2014 and 2015. 

However, recruitment of Hispanic students declined 

below the national average during this same time period. 

Furthermore, American Indian/Alaska Native and Native 

Hawaiian/Pacific Islander students were not recruited 

at all. 

The student-led organizations’ collective efforts 

first began in Fall 2015 with UiM students actively 

participating in interviewee luncheons during Diversity 

Day. Diversity Day is an established day at PSUCOM 

where UiM interviewees are invited to the school 

to attend diversity-based programming during their 

interview visit. Our SNMA chapter members identified 

that, although they all attended this day during their 

interview visits, the Dean of Admissions was the only 

UiM individual that they saw for the entire day. This may 

have created feelings of isolation and unrelatability. One 

solution was the involvement of PSUCOM UiM students 

at these interview luncheons to create a welcoming and 

comfortable environment for UiM applicants to ask any 

questions about the life of a PSUCOM UiM student. 

The night before interviews, given the request of a UiM 

applicant, a PSUCOM UiM student hosted them to 

further provide a comfortable environment to discuss 

what it is like to be a UiM student at PSUCOM. 

With the admission class of 2016, there was an increase 

of African American students from 5% to 9.8%, slightly 

exceeding the national average, while the rate of 

Hispanics decreased from 10% to 7.2%. However, 

in 2016, there was also a decrease in the number of 

declined admission offers among African Americans and 

Hispanics. 

In Spring of 2016, student-led organizations 

created a Diversity Segment for Second Look 

Day which specifically highlighted the different 

activities minority-led organizations held on 

campus, life as a PSUCOM UiM student, and 

a forum for potential UiM matriculants to ask 

questions. Additionally, the PSUCOM SNMA 

chapter implemented the Pre-Med Mentorship 

Program with Lincoln University, a historically 

black university, located approximately 50 miles 

from PSUCOM. The program’s goal was to target 

pre-med UiM students who are used to living in 

rural areas and to foster mentoring relationships 

such that these students may become competitive 

applicants ranking PSUCOM as their top choice. 

In Fall 2016, the program was restructured 

to include only juniors and seniors and was 

extended to pre-medical UiM students of Penn 

State Harrisburg and Franklin & Marshall College. 

The undergraduate mentees were paired with 

PSUCOM student mentors to attend a day-long, 

annual event which discussed the medical school 

application process. Also, there were medical 

student and physician forums. One out of the two 

seniors in the PSUCOM Pre-Med Mentorship Program 

was accepted and matriculated into PSUCOM, while the 

other student decided to take a gap year before applying 

to medical school. 

Primary Care Day is a PSUCOM annual event that 

invites approximately 200 undergraduate students, 

select high school students, and medical students to an 

all-day event to learn more about primary care, medical 

school, and the application process. In Fall 2016, the 

PSUCOM SNMA chapter created a Diversity Segment 

FIGURE 2 

Declined admission offer to PSUCOM 2014-2017 



that was integrated into this event to talk about 

the importance of diversity in medicine. A lunch 

program was also included where members of 

diverse, student-led organizations spoke to UiM 

applicants about applying to PSUCOM. 

Yet in 2017, African American matriculants 

dropped from 9.8% to 6.8%, thus matching closely 

to the national average. Hispanic matriculants 

continued to drop from 7.2% to 5.2%, which 

was below the national average. Decline rates 

increased to 54% for African American students 

but decreased to 20% for Hispanic students in 

2017. 

Institutions interested in improving the diversity 

of their entering classes should implement 

a structured, recruitment program led by the 

institution in collaboration with their minority 

student organizations. Relying solely on studentled 

organizations creates a vulnerable system 

where the number, motivation, and involvement 

of minority students at the institution in a given 

year correlates with the capacity of work the 

organization can take on. Additionally, these 

programs only last for the duration that students 

are in their leadership roles. Implementation 

of an official pipeline program would also 

enable the institution to reach prospective UiM 

students prior to the application season. This 

would provide prospective UiM students the 

opportunity to form a relationship with the school 

and witness the benefits of attending PSUCOM. 

Support based on financial merit could also 

help make PSUCOM a more attractive program 

to UiM students. Furthermore, tracking those 

who attended such programs targeting minority 

applicants is imperative for understanding the 

success level of each recruitment program. 6 

The institution should also send surveys for 

interviewee follow up to ask what influenced 

their decision to decline or accept their offer from 

PSUCOM. 

Informal conversations with PSUCOM interviewees 

showed that most UiM interviewees felt uncomfortable 

moving to a rural region because they feared 

mistreatment from non-UiM faculty, classmates, and 

patients. They were also hesitant about living in a rural 

setting where there is a lack of social support and 

access to ethnic goods as well as sociocultural outlets. 

Therefore, a limitation to the success of our institution’s 

minority recruitment is that PSUCOM is located in 

Hershey, Pennsylvania which is a rural community. This 

is why UiM faculty support is essential. Interviewees 

also expressed wanting a supportive environment at 

the institution. UiM faculty members should be present 

at recruitment programs as well as play more prominent 

roles as mentors once students matriculate. 7 Additionally, 

implementing courses within the medical curriculum 

which focus on the history of racism in medicine, racial 

disparities, and micro-aggressions in healthcare, as 

well as strategies to dismantle structural racism in the 

medical field, would show prospective UiM students 

the school’s commitment to diversity. This would also 

create a more welcoming environment to incoming UiM 

students. 8 

A limitation in assessing our study includes lack of 

longitudinal data which would have allowed us to further 

analyze PSUCOM’s matriculation rates as well as 

applicant demographics. When the data was requested, 

it was unavailable for inclusion in this study due to 

peak interview season and preparations for the Liaison 

Committee on Medical Education. Future research 

should include applicant and interviewee breakdown 

by race/ethnicity over a longer time range, as well as 

a comparison of this data to peer institutions located in 

rural areas. 

Despite efforts made by the student-led minority 

organizations at PSUCOM, only minimal progress 

was made in increasing the overall matriculation of 

UiM students. Nonetheless, these efforts have created 

sustainable impacts at the institution. Our SNMA chapter 


Douglas et al. 

53 

helped formulate a new pipeline program, the Pre-Med 

Mentorship Program which was recently funded and 

expanded by the university. This program will now be 

faculty-assisted, and will support mentees with MCAT 

preparation, thereby creating more opportunities for 

UiM students to immerse themselves at PSUCOM. 

This program will also allow participating mentees to 

be considered by the Office of Admissions should they 

apply to our medical school. In 2016, Diversity Day 

receptions were added to the programming for the 

evening before Diversity Day interviews for prospective 

students and their families to learn more about the 

school. This program was supported by diverse, medical 

student organizations and diverse employee groups 

working at the university. 

Upon the conclusion of Fall 2015, the Dean of Diversity 

& Inclusion announced that the office was also adopting 

the White Coats 4 Black Lives’ initiative to increase 

UiM student matriculation into our medical school. With 

this initiative, our institution now has a goal for 31% 

representation of UiM students in the incoming medical 

class. 

Although there is currently no formal recruitment plan, 

PSUCOM has taken the first steps to form a cohesive 

recruitment strategy after self-evaluating its diversity 

recruitment efforts. Based on best practices from other 

organizations, the PSUCOM Office of Diversity & 

Inclusion has since hired a program coordinator, a data 

analyst, and a Director of Outreach to further construct 

such recruitment strategies. 

Conclusion 

In summary, student-led minority organizations have 

historically had a limited role in increasing matriculation 

rates of UiM students into medical universities similar 

to PSUCOM. Although student representation is 

a significant part of a student’s choice in medical 

education, other factors that are influential include 

school location, financial incentive, and faculty 

involvement. 9 Thus, to effectively increase the rates 

of matriculating UiM students into medical schools, 

diversity recruitment programs should be led by 

administration with supplemental support from studentled, 

minority organizations. 

Acknowledgements 

We thank Dean of Diversity, Lynette Chappell-Williams, 

the Office of Diversity & Inclusion, and the Office of 

Admissions for their support as well as assistance of 

data collection. ■ 

REFERENCES 

1. Komaromy, M., Grumbach, K., Drake, M., et al. The Role of Black and Hispanic Physicians in Providing Health Care for Underserved 

Populations. New Engl J Med. 1996; 344:1305-1310. http://www.nejm.org/doi/full/10.1056/NEJM199605163342006#t=article. 

Accessed 11/2017. 

2. Agrawal, J.R., Vlaicu, S., Carrasquillo, O. Progress and Pitfalls in Underrepresented Minority Recruitment: Perspectives from the 

Medical Schools. J of NMA. 2005;97(9):1226-1231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594778/pdf/jnma00298- 

0016.pdf Accessed 11/2017. 

3. Cultivating a Healthcare Workforce that Increases Access to and Quality of Care. Association of American Medical Colleges; 2014. 

http://aamcdiversityfactsandfigures.org/section-i-cultivating-health-care-workforce-that-increases-access-to-and-quality-ofcare/. 


4. Current Trends in Medical Education. Association of American Medical Colleges; 2016. http://aamcdiversityfactsandfigures2016. 

org/report-section/section-3/. Accessed 11/2017. 

5. Applicants to U.S. Medical Schools by Selected Combinations of Race/Ethnicity and Sex, 2014-2015 through 2017-2018. 

Association of American Medical Colleges; 2017. https://www.aamc.org/data/facts/applicantmatriculant/. Accessed 12/2017. 

6. Haskins, A.R., Kirk-Sanchez, N. Recruitment and Retention of Students from Minority Groups. Physical Therapy. 2006;86(1):19- 

29. https://academic.oup.com/ptj/article/86/1/19/2805051. Accessed 11/2017. 

7. Thurmond, V. B., Cregler, L.L. Why students drop out of the pipeline to health professions careers: a follow-up of gifted 

minority high school students. Academic Medicine Journal of the AAMC. 1999. http://journals.lww.com/academicmedicine/ 

Abstract/1999/04000/Why_students_drop_out_of_the_pipeline_to_health.44.aspx. Accessed 11/2017. 

8. Vela, M.B., Kim, K.E., Tang, H. et al. Improving Underrepresented Minority Medical Student Recruitment with Health Disparities 

Curriculum. J Gen Internal Medicine. 2010; 25(Supp 2): 82-85. https://link.springer.com/article/10.1007/s11606-010-1270-8. 


9. Rumala, B, Cason Jr, F. Recruitment of Underrepresented Minority Students to Medical School: Minority Medical Student 

Organizations, an Untapped Resource. J of NMA. 2007;99(9):1000-1009. https://www.ncbi.nlm.nih.gov/pmc/articles/ 

PMC2575864/pdf/jnma00208-0032.pdf. Accessed 11/2017. 


Annual Medical 

Education 

Conference 

2018 RECAP 

SAN FRANCISCO, CA MARCH 28-APRIL 1

56 Inside SNMA 

Awardees 

Congratulations!! The SNMA is honored to recognize you for your diligence and 

commitment to our mission. These awards represent the appreciation that we 

have for outstanding members like you. Let this achievement serve as an ongoing 

reminder to continue to excel in all you do. 

2018 WILBERT C. 

JORDAN FORUM 

NATIONAL 

AWARDS 

Basic Science 

Emeka Okafor | University of Chicago 

Pritzker School of Medicine (Region 

II); c/o 2019 

Translational Science 

Appledene Osbourne | Case Western 

Reserve University School of Medicine 

(Region V); c/o 2019 

Clinical Science 

Raveena Gandhi | University of 

New England College of Osteopathic 

Medicine (Region VII); c/o 2020 

Eduardo Bent-Robinson | UC Davis 

School of Medicine (Region I); c/o 

2018 

Social & Behavioral Sciences & 

Public Health 

Adrianna Jackson & Keona 

Thompson | Michigan State University 

College of Human Medicine (Region 

V); c/o 2020 

Naeemah Munir | University of 

California, San Diego (Region I); c/o 

2019 

Basic Science Scholarship 

Claudia Avalos 

Clinical Science Scholarship 

Kelly Butler 

SNMA Member of the Year 

Alana Nichols 

SNMA Chapter of the Year 

Howard University School of 

Medicine 

P.R.I.D.E. Chapter Winner 

University of Alabama- 

Birmingham 

Basic/Translational Sciences 

(Premed) 

Miracle Rogers | Syracuse University 

(Region IX) 

Public Health/ Behavioral & 

Clinical Sciences (Premed) 

Nabila Mohamed | University of 

Minnesota (Region II) 

Community Service Chapter 

Grant (Fall) 

University of Alabama- 

Birmingham 

Vanderbilt University 

Community Service Chapter 

Grant (Spring) 

Herbert Wertheim College of 

Medicine Florida International 

University 

Indiana University Bloomington 

MAPS 

Regional Director of The Year 

Brittany Flemming 

Board Member of The Year 

Charles Grant III 

Adib Rushdan 


AMEC '18 Recap 

57 

REGIONAL 

AWARDS 

V 

SNMA Chapter of the 

Year 

Indiana University School of 

Medicine 

SNMA Chapter Presidents of 

the Year 

Jasmine Holmes | Wright State 

University Boonshoft School of 

Medicine 

Kabwe Chilupe | Ohio University 

Heritage School of Medicine 

Halley Stapes & Cindy Abram | 

Indiana University School of Medicine 

MAPS Chapter of the Year 

Indiana University MAPS 

Regional Research Support 

Award 

Fola Alade | Indiana University MAPS 

“Inspiring Future Leaders” 

Hinds Endowment Winner 

Byrana Marie Robinson | University 

of Cincinnati 

Chapter Awards 

Indiana University MAPS 

Ohio University MAPS 

University of Cincinnati MAPS 

VI 


Year 

Howard University College of 

Medicine 

Member of the Year 

Shihyun Kim | Howard University 

College of Medicine 

Pre-Medical Member of the 

Year 

Anna Torres | University of Virginia 

VII 

SNMA Chapter & 


University of Connecticut 

X 


Year 

Vanderbilt University School of 

Medicine 

PREMEDICAL 

AWARDS 

MAPS Member of the Year 

Sotonye Douglas 


Geisinger Commonwealth 

School of Medicine 

Regional MAPS Liaison of the 

Year 

Osaro Obanor 

Premedical Representative of 

the Year 

Nabila Mohamed 

MAPS Committee Officer of the 

Year 

Akua Frimpong | Ingrid Okonta 

Premedical Scholarship 

Daron Ingram 

MEDHacks 2018 

Brittaney Pratt 

Maryam Farrakhan 

Derek Jones, Jr. 



NEW SNMA 

CHAPTERS 

Region I 

• A.T. Still University College of 

Osteopathic Medicine, Mesa, 

Arizona 

• California Northstate University 

College of Medicine 

• University of Nevada, Las Vegas 

School of Medicine 

Region II 

• University of Illinois College of 

Medicine, Rockford 

• Kansas City University of 

Medicine and Biosciences 

Region III 

• Burrell College of Osteopathic 

Medicine, Las Cruces, New 

Mexico 

• Texas Tech University Health 

Science Center, El Paso 

• The University of Texas Rio 

Grande Valley School of 

Medicine, Edinburg 

Region IV 

• Edward Via College of 

Osteopathic Medicine – Auburn 

Campus 

• University of Southern Florida 

Morsani College of Medicine – 

Tampa 

• Escuela Latinoamericana de 

Medicina, La Habana, Cuba 

Region VI 

• Uniformed Services University of 

Health Sciences, Bethesda, MD 

NEW MAPS 

CHAPTERS 

Region I 

• University of California, Los 

Angeles/Charles Drew 

• Oregon State University 

• Stanford University 

Region II 

• University of Illinois/Champaign 

• University of Missouri-Kansas 

City 

• University of Wisconsin- 

Milwaukee 

• Northern Illinois University- 

Dekalb 

• Iowa State University-Ames 

• Washington University of St. 

Louis 

Region III 

• Louisiana State University- 

Shreveport 

• Tulane University, New Orleans 

Region IV 

• Spelman College 

• Bennett College 

• Furman University 

• Georgia Institute of Technology 

• St. Augustine’s University 

• University of South Alabama 

• University of Alabama at 

Birmingham 

Region V 

• John Carroll University, Ohio 

• Kent State University, Ohio 

• Cleveland State University, Ohio 

• Bowling Green State University 

• Wright State University, Fairborn 

Region VI 

• University of Maryland, College 

Park 

Region VII 

• University of Massachusetts/ 

Boston 

• University of Rhode Island, 

Kingston 

• Harvard College, Cambridge 

• Curry College, Milton, Mass 

Region VIII 

• Allegheny College, Meadville, PA 

• Franklin & Marshall College, 

Lancaster, PA 

• Villanova University, PA 


Poem 

59 

Hippocratic Coates 

KRYSTAL SAVICE, MS 

TOURO COLLEGE OF OSTEOPATHIC MEDICINE 

Like a bird, let us be free 

Fly like an eagle no bullae so super 

Opaque realities disguised in a hazy stuper 

Like a bird that resembles the crow like Jim 

Elusive pursuit of a prestigious acronym 

Without balance there’s no axis 

No access to IV RX RN MD 

Seated fulfillment affirmed to be actionary 

Freedmen arose and still stands 

Knee deep in the trenches of fed up confetti 

Albeit Progress still in progress since Getty 

The immortal strides need recognition for 

which it Lacks but recall, the chancre 

Durham. Williams. Anderson. Mahoney. Crumpler. 

Like a bird that cried in the song of Sir violet rain 

Triangular prisms won’t reign 

On innate nuclear halos 

Like a bird, bronze emanates like a Phoenix 

Luxury blanco draping eulogizes martyrdom 

Tantamount existence intertwined in staff is 

Like a bird, the thing with feathers ■ 

As a second-year medical student at Touro COM, 

Ms. Savice has demonstrated her passion to 

adapt to trends of the growing patient population 

and shifts in cultural heterogeneity. In 2011, she 

graduated from New York University College of 

Dentistry and worked as a Dental Hygienist for six 

years. Ms. Savice made a career transition from 

dentistry to medicine after realizing her desire for 

evidence-based care beyond the scope of the oral 

cavity in a holistic manner. She has conducted 

research assessing the correlation of diabetes and 

periodontal disease, health disparities of New York 

City taxi drivers, and cadaveric case reports of the 

clinical implications of hiatal hernias. As President 

of the Student National Medical Association 

chapter at Touro COM, she creates innovative 

ways of disseminating patient education resources 

concerning mental health, nutrition, and mentoring 

underrepresented minority students. As Creative 

Director of the Diversity Taskforce at Touro COM, she 

has created programming about the pervasiveness 

of implicit bias and its relation to poor patient 

outcomes. As a physician, Krystal plans to provide 

care in underserved communities, especially being 

an advocate for detection of autoimmune disease 

and organ donors. 


60 Opinion 

M a k i n g 

#Underserv e dPat i e n t sMat t e r in 

H e a lt h c a r e: A Proposed Public 

R e l at i o n s Initiat i v e 

By: Jacob Uskavitch 

MD Candidate – Meharry Medical College 

How can we build trust in 

healthcare when there are 

communities that have been 

outright neglected by our system? 

The diversity of biomedical research 

populations is not reflective of the 

U.S. population. If people are 

being systematically excluded 

from biomedical research, and the 

subsequent scientific discourse, 

their collective mistrust in 

healthcare is justified. At the same 

time, it is often being neglected 

that diversity is a missed scientific 

opportunity in fully understanding 

disease and health factors on the 

part of the researchers. 1 The viral 

nature of a hashtag may be the 

tool to bridge this information gap 

because it could give researchers 

the platform to engage, inform, and 

mobilize underserved populations 

more rapidly and efficiently than 

other means. 

A hashtag can spur its target 

audience into action or dialogue 

thus being more likely to become 

viral. 2 Countless, large-scale 

movements have started with a 

viral hashtag that spread an idea 

rapidly from like-minded individuals 

to other users across social media 

platforms. The creation of a 

hashtag to engage social media 

users from neglected communities 

in the investment of biomedical 

research, either as participants or 

researchers themselves, is an excellent 

blueprint for rectifying the mistrust 

between underserved populations 

and our healthcare system. Thus, I 

propose the creation of a researcherinitiated, 

social media campaign: 

#UnderservedPatientsMatter. 

Underserved populations have a long 

history of justified mistrust in traditional 

research efforts. Such populations 

have historically experienced unethical 

studies, such as the Tuskegee syphilis 

study. Unfortunately, there still remains a 

fear that permeates the Black community 

concerning misinformation in the fields 

of science and medicine. The doubts 

regarding these fields also stem from the 

perception that medical research does 

not benefit underserved communities. 3 

For example, a study published in 

March of 2018 showed that minority 

children have a reduced response to 

albuterol. However, albuterol is the 

most commonly prescribed asthma 

medication, and often the only choice 

available to children in low-income 

settings. 4 The American healthcare 

system is thus operating by prescribing 

medication that has a reduced 

effect in minority patients 

based on their biological 

makeup. These patients 

cannot experience maximal 

therapeutic relief simply due 

to their low socioeconomic 

status and inability to afford 

healthcare tailored to their specific 

needs. A concerted investment on 

behalf of medical science providing 

equitably favorable outcomes to all 

patients is necessary for trust to be 

instilled in our nation’s healthcare 

system. That investment begins with 

an emphasis in the recruitment and 

ethical treatment of underserved 

patients in clinical trials. 

Almost everyone can identify at 

least one person they know who is 

considered medically underserved: 

(1) the economically disadvantaged, 

(2) some racial and ethnic minorities, 

(3) uninsured and low-income 

children, (4) some elderly, (5) the 


homeless, (6) some with human 

immunodeficiency virus (HIV), (7) 

some with chronic health conditions 

including mental illness, and (8) rural 

residents and others who encounter 

barriers to accessing healthcare 

services. 5 The phrase used in the 

hashtag “Underserved Patients 

Matter” is a call to action for research 

investments that will not only recruit, 

but also benefit the underserved. 

While community involvement has 

been integral to solving public health 

problems, racial/ethnic disparities 

still exist in the recruitment of 

participants for clinical trials. 

Digital solutions could potentially 

increase healthcare access and 

quality for the underserved, but 

they often neglect those that need 

them the most. High-cost and highneed 

patients tend to be older, more 

racially diverse, and less educated. 6 

Digital solutions have been highly 

touted as “the way” to provide the 

best quality of healthcare. However, 

somewhere along the way, we have 

neglected the human nature of 

patient care by developing digital 

solutions focused on solving medical 

illnesses, improving record-keeping, 

or spreading health awareness. 

The creation of electronic health 

records has enabled better tracking 

of patient medical records and 

better documentation of treatment 

plans. The internet has become an 

overflowing source of information for 

patients to learn about their health. 

Mobile apps are available to track 

dietary habits and remind patients to 

keep up with their medication, thereby 

increasing treatment compliance. 

Despite the introduction of all these 

digital solutions, preventable health 

disparities still exist. Should we not 

invest instead in a social media 

campaign with the goal of improving 

everyone’s health? Regardless of 

their race or demographics—White 

or Black, urban or rural, insured or 

uninsured, rich or poor. 

The systemic neglect of recruiting 

research participants from underserved 

A concerted investment on behalf of medical science 

providing equitably favorable outcomes to all patients is 

necessary for trust to be instilled in our nation’s healthcare system. 

populations often translates into the 

clinical setting as clinician bias. While 

there are disparities in the research 

of medical illnesses, there should not 

be disparities in the management of 

disease. 

That is not the case with our current 

healthcare system. Research 

shows that disparities in pain 

management may be attributable 

in part to bias. False beliefs about 

biological differences between 

Blacks and Whites predict racial bias 

in pain perception and treatment 

recommendation accuracy. 7 Clinical 

care must be freed from these false 

beliefs. Therefore, physicians must 

also educate themselves to become 

socially conscious. Physicians must 

prevent this kind of bias from entering 

their clinical decision-making in 

disease diagnosis and treatment plans 

for patients. Cultural competency must 

not only be included in the training of 

all healthcare workers, but it must 

also be continually emphasized in 

the workplace itself. Future medical 

research must involve participants 

diverse enough to overcome 

the historical neglect and deceit 

experienced by research participants 

from underserved populations. 

Physicians must advocate for the 

medical needs of the underserved. 

If underserved patients matter in the 

recruitment of research participants 

to clinically understand diseases, the 

social consciousness of physicians 

and clinical researchers alike must 

first be increased. 

Researchers must demonstrate their 

willingness to recruit and create better 

outcomes for medically underserved 

communities. A public relations initiative 

using #UnderservedPatientsMatter 

would demonstrate the willingness 

of researchers to do so. It would 

also increase awareness that clinical 

61 

trials are open to the underserved. 

Furthermore, the National Institutes 

of Health (NIH) and research 

universities should use their various 

social media platforms to support 

the #UnderservedPatientsMatter 

campaign. NIH-funded research 

should be diverse enough to 

advance scientific knowledge as far 

as possible. Their advertisements 

for clinical trials should highlight 

the #UnderservedPatientsMatter 

movement. Visible signs should be 

placed in hospitals and research 

facilities dedicated to the mission of 

creating better health solutions for the 

underserved. 

When underserved patients truly 

matter to our healthcare system, then 

their trust in our healthcare system 

will be established thereby resulting 

in better health outcomes for their 

communities. ■ 

REFERENCES 

1. Oh SS, Galanter J, Thakur N, 

et al. Diversity in Clinical and 

Biomedical Research: A Promise 

Yet to Be Fulfilled. PLoS Med, 

2015; 12(12) 

2. Saxton GD, Niyirora JN, Guo C, 

et al. #AdvocatingForChange: 

The Strategic Use of Hashtags in 

Social Media Advocacy. Advances 

in Social Work, 2015; 16(1): 154- 

169 

3. Scharff DP, Mathews KJ, Jackson 

P, et al. More Than Tuskegee: 

Understanding Mistrust about 

Research Participation. J Health 

Care Poor Underserved, 2010; 

21(3): 879-897 

4. Weiler N. Genomic Analysis 

Reveals Why Asthma Inhalers Fail 

Minority Children. University of 

California San Francisco, 2018 

5. Vulnerable Populations: Who are 

They? American J of Managed 

Care, 2006; 12(13): S348-S352 

6. Van Winkle B, Carpenter N, 

Moscucci M. Why aren’t our 

Digital Solutions Working for 

Everyone? AMA J of Ethics, 2017; 

19(11) 1116-1124 

7. Hoffman KM, Trawalter S, Axt 

JR, Oliver MN. Racial Bias in Pain 

Assessment. PNAS, 2016; 113 

(16): 4296-4301 


62 Opinion 

Osteopathic 

Medicine as 

an Avenue to 

Address the 

Medical Needs 

of Underserved 

Populations 

Sarah K. Grewal, OMS-II 

A.T. Still University School of 

Osteopathic Medicine in Arizona 

Attending to the healthcare 

needs of underserved patients 

is, perhaps, the most important 

role of physicians in society today. 

Physicians can be found serving 

these vulnerable populations across 

virtually every specialty and in 

various geographical locations. But, 

as an osteopathic medical student, I 

have come to learn that osteopathic 

physicians are uniquely suited to help 

address healthcare disparities across 

America. 

Over the years, osteopaths (D.O. 

physicians) have always gone 

hand-in-hand with allopaths (M.D. 

physicians) with what seems to be 

an increased emphasis in family 

medicine or general practice. As I 

navigated through my first year of 

medical school, I learned why that is 

the case—the core philosophy and 

historical background of osteopathy 

focuses on primary and preventive 

care. 1 In fact, rural and urban 

underserved areas are one of the 

biggest targets of today’s osteopathic 

physicians. The data shows that more 

than 30% of osteopathic graduates 

have plans to practice in underserved 

areas, and it is this type of commitment 

and training that allows them to thrive 

in that environment. 2 I, myself, am 

one of those students. I grew up in 

a number of both rural and urban 

underserved areas. Being able to 

witness the need firsthand gave me 

a concrete understanding and was 

ultimately the deciding factor for me 

to become a D.O. 

One of the ways I was first introduced to 

the osteopathic commitment to service 

was during my first year of medical 

school. In my medical skills class, I 

learned to incorporate topics such 

as cultural barriers, socioeconomic 

status, and family considerations 

into our discussions with patients. 

Afterwards, I noticed I received much 

better patient feedback and felt more 

personal satisfaction from my patient 

encounters. When reflecting back to 

my own experience of being seen as 


63 

a patient, I realized that these topics 

were not commonly brought up in the 

doctor’s office. Interestingly enough, 

this disconnect was quite resolvable, 

and that is what osteopaths have 

always been taught to address. I 

decided that I would have to teach 

myself to bridge those gaps in 

my own practice. However, to my 

relief, the integration of my clinical 

and osteopathic training proved to 

accomplish the job for me. 

Treating the patient as a whole, 

however, is just one of the things 

that makes osteopathy a good 

choice for addressing the needs of 

underserved populations. Another 

major point is the makeup of 

osteopathic physicians themselves. 

Time and time again, we hear or 

read about the quality of patient care 

and medical outcomes increasing in 

situations where patients look like 

and are from the same community 

as their physicians. 3 This then 

means that, in order to increase the 

number of osteopathic physicians 

that go to these underserved areas, 

we must recruit students directly 

from these areas who have strong 

ties encouraging them to go back 

and serve their communities. 

In addition to locational recruiting, 

there has been an upward trend in 

the number of underrepresented 

minorities (URMs) applying to D.O. 

schools. 4 In fact, many schools 

across the country have started 

programs as early as elementary 

school to encourage and prepare 

URM students to follow a path into 

osteopathic medicine. 5 

With osteopathic schools establishing 

partnerships and pipeline programs, 

as well as placing students directly 

in community health centers in 

underserved areas, the number 

of physicians working in these 

areas is increasing significantly, 

thereby creating access to highquality 

primary and specialty care. 

This result has been affirmed by 

more than a 50% increase in D.O. 

physicians since 2010 in areas of the 

U.S. predominantly considered to be 

underserved. 2 With an increase in 

the number of osteopathic schools 

opening every year in underserved 

areas and their respective community 

programming efforts, it is an expected 

conclusion that individuals from the 

local population will be accepted into 

these medical school classes. This 

will directly contribute to creating an 

environment of inclusiveness and 

cultural competency, something that 

is critical to equitable patient care. 

By providing this type of learning 

environment conducive to 

increasing medical practice in 

underserved areas, osteopathic 

schools are encouraging meaningful 

conversations and training on how 

to better treat patients with diverse, 

cultural needs, rather than deferring 

to a generalized healthcare plan 

for entire subsets of populations. 

Looking forward to the future of 

healthcare, I hope that health 

disparities will be alleviated one day, 

"Looking forward… 

in healthcare…I hope 

that health disparities 

will be alleviated…and 

I am convinced that 

osteopathic physicians 

will serve a key role…" 

and I am confident that osteopathic 

physicians will serve a key role in 

the solution. ■ 

REFERENCES 

1. American Association of Colleges of Osteopathic Medicine. “What Is Osteopathic Medicine?” AACOM, American Association of 

Colleges of Osteopathic Medicine, 2018, www.aacom.org/become-a-doctor/about-om. 

2. American Osteopathic Association. “Growth of Osteopathic Medical Profession Addresses Physician Shortage in Rural and 

Underserved Areas.” AOA, American Osteopathic Association, 3 Feb. 2016, www.osteopathic.org/inside-aoa/news-andpublications/media-center/2016-news-releases/Pages/2-3-growth-of-osteopathic-medical-profession-addresses-physicianshortage-in-rural-and-underserved-areas.aspx. 

3. Traylor, Ana H. et al. “Adherence to Cardiovascular Disease Medications: Does Patient-Provider Race/Ethnicity and Language 

Concordance Matter?” Journal of General Internal Medicine 25.11 (2010): 1172–1177. PMC. Web. 12 June 2018. 

4. Petersen, Vicki Martinka. “Building Dreams: New COM Reflects Diversity of Surrounding Community.” The DO, American 

Osteopathic Association, 25 Aug. 2016, thedo.osteopathic.org/2016/08/building-dreams-new-com-reflects-diversity-ofsurrounding-community/. 

5. Foston, Nikitta. “Is There a Doctor in the House? Increased Diversity Measures Are Promoting More Opportunities for Minorities.” 

The DO, American Osteopathic Association, 8 Mar. 2018, thedo.osteopathic.org/2018/03/doctor-house-increased-diversitymeasures-promoting-opportunities-minorities/ 


64 Commentary 

Chile: A Model for 

U.S. Recruitment and 

Retention of a Rural 

Physician Workforce 

KIA BYRD 

MD-MPH CANDIDATE AT HARVARD MEDICAL SCHOOL 

Despite progressive strides to eliminate healthcare 

disparities in the U.S., such disparities continue 

to exist among those in urban and rural areas of 

the country. The Affordable Care Act sought to expand 

insurance coverage to millions of the nation’s uninsured 

as a means to improve overall health outcomes and 

reduce health disparities. In many states that chose not 

to expand Medicaid coverage, individuals from rural 

areas are more likely to fall in the “insurance gap.” 1 

Even among states that chose to expand Medicaid 

coverage, rural residents may have more difficulty 

accessing provider services due to geographical 

isolation or limited awareness of resource availability. 

A multilevel approach to addressing disparities 

includes not only expanding insurance coverage, 

but also increasing providers in underserved 

communities. As the number of uninsured 

continues to decline, policymakers should begin 

to place more emphasis on addressing the 

shortage of medical healthcare providers in rural 

areas of the U.S. The U.S. is one of several 

developed countries working to find solutions to 

the healthcare provider shortage in rural areas. 

The Chilean government, with its successful 

attempt at healthcare reform, should serve 

as a model for such countries in search of 

solutions to achieve effective healthcare 

coverage. 

Rural Health Workforce in the U.S. 

Recent reports from the Association of American 

Medical Colleges (AAMC) document an 

estimated shortage between 14,900 and 35,600 

primary care physicians by 2025 in the U.S. 2 

This shortage stands to disproportionately impact 

rural areas of the U.S. According to census data, 

minority populations including African Americans, 

Hispanics, American Indians, and Asians are 

increasing in rural communities. Populations 

having minority backgrounds are increasing at 

a higher rate in rural areas compared to urban 

areas. Thus, strategies for recruiting and retaining 

physicians in rural areas will plausibly impact 

racial health outcomes and healthcare disparities. 

Presently, only 8.9% of physicians practice in rural 

areas, despite 19.3% of the total U.S. population living 

in such areas. 3 

At the federal and state levels, the U.S. has created 

a number of programs to increase the rural physician 

workforce. These programs focus primarily on offers 

with institutional and individual incentives. One such 

program is the National Health Service Corps, a 

scholarship and loan repayment program that places 

providers in rural shortage areas. The Indian Health 

Service (IHS) is another federal agency responsible 

for providing health services to American Indians and 

Alaskan Natives. The IHS offers a number of loan 

repayment programs for physicians committed to 

serving at Indian health centers with staff shortages. 

The Patient Protection and Affordable Care Act also 

includes sections addressing workforce shortages in 

rural areas. For instance, Section 5301—Training in 

Family Medicine, General Internal Medicine, General 

Pediatrics, and Physician Assistantship—authorizes 

the Secretary of Health Resources and Services 

Administration to make five-year “capacitybuilding” 

grants for medical schools and programs 

that (1) have a record of training individuals 

from underrepresented minority groups, rural 

areas, or disadvantaged backgrounds and (2) 


65 

establish formal relationships with 

federally qualified health centers, 

rural health clinics, clinics located 

in underserved areas, or clinics 

that serve such underserved 

populations. 4 

Despite efforts to retain rural 

physicians through loan repayment 

programs and innovative federal 

policies, programs such as the 

National Health Service Corps have 

historically experienced difficulties 

in maintaining long-term retention. 5 

A 2017 AAMC review article outlines 

a theoretical model delineating 

characteristics that contribute to 

rural physician identity and retention 

in the U.S. For example, the authors 

emphasize cultivating community 

engagement and leadership 

and family medicine physicians—a 

shortage that will have greater 

implications for rural areas. 10 To 

combat the dwindling numbers 

of primary care physicians, many 

Chilean cities recruit physicians 

from other countries such as 

Ecuador, Bolivia, and Cuba to 

tackle the challenges of caring for 

the country’s rural population. 

The Rural Practitioner Programme 

in Chile was created in 1955 with 

the primary objective of attracting 

medical professionals to work in 

rural primary care hospitals for 

a three-year minimum or a sixyear 

maximum. When applying 

to residency programs for most 

specialties, graduates from 

Chilean medical schools have the 

community outreach, developing 

community and health projects, 

and participating in management 

functions. 11 Additionally, the 

Programme retained all participants 

from the most recent cohort 

(2017) for at least the three-year 

minimum. 12 

Implications for U.S. Policy 

In continuing to build upon the 

progress of the U.S., there are 

several aspects from Chile’s 

implementation of the Rural 

Practitioner Programme to consider 

when thinking about a novel 

American strategy for recruitment 

and retention of a rural physician 

workforce. A similar approach to 

training rural physicians may be 

beneficial to the U.S. 

Recent reports from the Association of American Medical Colleges (AAMC) document an 

estimated shortage between 14,900 and 35,600 primary care physicians by 2025… 

development opportunities in rural 

areas during residency as important 

for developing a rural physician 

identity. Physician integration into 

the community and developing 

a sense of belonging were also 

critical for physician retention in 

rural areas. 6 

Rural Health Workforce in Chile 

There are approximately 25,000 

to 30,000 practicing physicians 

in Chile, which has a population 

of about 17.9 million according 

to the World Bank. 7 Metropolitan 

Santiago, the capital city of Chile, 

has a physician-to-inhabitant ratio 

that is 53% higher than the national 

average. 8 Similar to the U.S., the 

most rural areas of the country have 

the lowest physician-to-inhabitant 

ratios, particularly among general 

practitioners. 9 Chilean physicians, 

like those in other developed 

countries, prefer working in urban 

centers due to better training 

opportunities at more reputable 

academic centers and higherpaying 

medical specialties. 

As a result, there is a growing 

shortage of general practitioners 

option to either enter the residency 

application cycle through the Rural 

Practitioner Programme or apply 

directly to residency programs. 

Those applying through the 

Programme do not self-finance their 

applications and receive residency 

benefits, including salaries 

proportional to their degree of 

geographic isolation and workload 

during the service period. Data 

reporting Programme outcomes 

from 2001 to 2008 illustrate that the 

majority of participants engaged in 

the following activities during their 

service period: continuous medical 

training, health education, training 

and teaching clinical staff, authoring 

research publications, coordinating 

First, policymakers and leaders in 

graduate medical education may 

consider integrating programs 

that place medical graduates in 

areas with provider shortages into 

the National Resident Matching 

Process. Applicants applying to 

this placement program would 

agree to (1) serve in a rural setting 

for a required number of years in 

exchange for free applications to 

residencies in the specialties of their 

choice and (2) receive residency 

incentives, including a salary and 

benefits, proportional to the degree 

of geographic isolation and the 

work demand. Programs such as 

the National Health Service Corps 

recruit medical graduates primarily 

interested in primary care fields 

such as Internal Medicine, Family 

Practice, Pediatrics, and OB/GYN. 

An alternative placement program 

incorporated into the residency 

application cycle would result in the 

recruitment of medical graduates 

applying for a variety of specialties 

including those outside of primary 

care. Bringing a variety of medical 

specialties to rural areas may result 

in more scholarly work and creativity 


66 Commentary 

towards devising innovative ways to implement specialty 

care in the rural U.S. 

In addition, administrators of loan repayment and 

scholarship programs can create more opportunities 

for participants to engage in scholarly activities such as 

research, community engagement, and management 

opportunities to facilitate the development of potential 

rural physician identities. Management opportunities, for 

example, may include working as a Director or Associate 

Director for a service/unit, or as a Program Manager for 

a public health initiative. Engagement with these types of 

activities in rural settings may increase the likelihood of 

program participants staying and practicing in those areas 

following the conclusion of their service period with the 

recruitment program. ■ 

Kia Byrd is a native of Jackson, Mississippi and 4th year MD/ 

MPH candidate with a concentration in health policy at Harvard 

Medical School and the Harvard T.H. Chan School of Public Health 

in Boston, MA. As a member of SNMA, she has served locally as 

the HMS-SNMA Vice President and nationally as a member of 

the Health Policy and Legislative Affairs Committee. She also 

served as the Co-Chair for the Women of Color in Medicine and 

Dentistry organization. During medical school, she engaged in 

research with the Massachusetts General Hospital Division of 

Global Psychiatry and served as a health policy intern for MA 

Congressional candidate, Ayanna Pressley. She is a current Anne 

Murray Bell Scholar and recipient of the Harvard Chan School 

of Public Health James H. Ware Award. She hopes to integrate 

her training in health policy and medicine into a career as both 

a clinician and advocate, working to expand medical, legal, 

and social services for vulnerable, disenfranchised populations, 

particularly in the southern United States. She is applying 

into Internal Medicine residency. Prior to medical school, 

Kia attended Howard University in Washington, DC where 

she completed her bachelor of science degree in biology 

with a minor in chemistry in 2014. She is the recipient of the 

Howard University Biology Department 150th Anniversary 

Outstanding Alumnus Award. 

Continued from page 17 

and "was greeted with the steady metronome of the 

pacemaker beat"—a metaphor between the pacemaker 

and the metronome, an important tool for musicians. 

She does not stop there. When contemplating the actions 

of those who wreaked havoc on the once pristine bodies 

of so many of her patients, she says: "To live in this world, 

to accept that such cruelty was a reality, I had to know 

that beauty was an equal reality. Even if some humans 

seemed to exist solely to offer pain and destruction, 

there were others who existed only to create beauty. The 

chance to feel the hem of that beauty graze the cheek, was 

sometimes the only thing that kept the last straw at bay." 

What does it mean to be a socially conscious physician? 

Dr. Ofri teaches us that it starts with listening to 

our patients, their struggles, and their triumphs. ■ 

REFERENCES 

1. Newkirk VR II, Damico A. The Affordable Care Act and Insurance Coverage in Rural Areas. https://kaiserfamilyfoundation.files. 

wordpress.com/2014/05/8597-the-affordablecare-act-and-insurance-coverage-in-ruralareas1.pdf. Published May 2014. 

2. Association of American Medical Colleges (AAMC). The complexities of physician supply and demand projections from 2014 

to 2025: Final Report. 2016. https://www.aamc.org/download/458082/data/2016_complexities_of_supply_and_demand_ 

projections.pdf 

3. United States Census Bureau. 2010 Census Urban and Rural Classification and Urban Area Criteria. https://www.census.gov/geo/ 

reference/ua/urban-rural-2010.html. Accessed Nov 28, 2017. 

4. AAMC. Summary of PPACA Provisions Related to HRSA’s Health Professions Programs and Other PHSA Workforce Programs. 

2010, https://www.aamc.org/download/131010/data/hrsa.pdf.pdf. Accessed Nov 28, 2017 

5. Pathman DE, Konrad TR, Ricketts TC 3rd. The comparative retention of National Health Service Corps and other rural physicians. 

Results of a 9-year follow-up study. JAMA. 1992 Sep 23-30;268(12):1552-8. PubMed PMID: 1518110. 

6. Parlier AB, Galvin SL, Thach S, Kruidenier D, Fagan EB. The Road to Rural Primary Care: A Narrative Review of Factors That Help 

Develop, Recruit, and Retain Rural Primary Care Physicians. Acad Med. 2017 Aug 1. doi:10.1097/ACM.0000000000001839. [Epub 

ahead of print] PubMed PMID: 28767498. 

7. Román O, Acuña M, Señoret M. Availability of doctors in Chile in 2004. Rev Med Chile 2006; 134 (8): 1057-64. 

8. Torres C, Solimano G. Training of medical specialists in the context of the Health Reform. School of Public Health; 2005. 

9. Roman O. [Evolution of the availability of physicians in Chile]. Rev Med Chile 2010; 138: 22-8. 

10. Bossert, TJ, Leisewitz, T., Innovation and change in the Chilean Health System. N Engl J Med 2016; 374:1-5. 

11. Peña S, Ramirez J, Becerra C, Carabantes J, Arteaga O. The Chilean Rural Practitioner Programme: a multidimensional strategy to 

attract and retain doctors in rural areas. Bull World Health Organ. 2010 May;88(5):371-8. doi: 10.2471/BLT.09.072769. PubMed 

PMID: 20461139; PubMed Central PMCID: PMC2865660. 

12. Listado de cupos provisorio-primer llamado a viva voz 1 de Septiembre de 2017. Chile Ministry of Health. http://web.minsal.cl/ 

wp-content/uploads/2017/06/FINAL-BECAS-EDF-2018.pdf 



coverage or insurance. The times 

when we did have it, we still had 

costly co-pays, so we avoided 

going to the doctor unless it was 

dire. Additionally, my mother 

had always tried traditional 

Nigerian remedies before relying 

on Western medicine. I then 

explained to him that this is a 

common experience in minority 

communities, and that as future 

physicians, we should try to 

understand our patients rather 

than judge them. 

This is just 

one example 

of how I have 

educated 

my peers 

on cultural 

sensitivity 

and empathy. 

Although I 

have no issue with doing so, I 

believe that the onus should be 

on medical schools to make sure 

that their students are aware of 

cultural differences and social 

determinants of health. This is 

especially important if schools 

are encouraging students to 

volunteer in SRFCs early on in 

their medical education. It would 

have been very unfortunate if my 

peer had taken his ignorance into 

a clinical setting and had made an 

insensitive comment to a patient. 

In addition to cultural sensitivity 

and cultural competency, 

physicians should strive for 

cultural humility. For physicians, 

this means embracing “lifelong 

learning and self-reflection, 

[include] examining one’s own 

cultural identity, unconscious and 

conscious biases, and patterns of 

thought and behavior that improve 

or detract from effective patient 

care”. 5 Listening to patients and 

understanding their perspectives 

is important for everyone, but it is 

even more crucial when working 

with patients from historically 

underserved groups. 4 A lack of 

empathy for different races and 

ethnicities strains the physicianpatient 

relationship and makes it 

less likely for such patients to go to a 

clinic in the future. Medical schools 

need to provide more robust training 

in cultural competency and humility 

to ensure that their students are 

prepared to foster healthy physicianpatient 

relationships in all clinical 

settings, particularly SRFCs. 

In my experience, I have also found 

SRFCs to be inefficient. This is not 

due to negligence, but instead to the 

fact that many first-year students 

are not yet skilled at collecting the 

pertinent information from patients in 

a timely fashion. One study assessed 

patient satisfaction with SRFCs, and 

the lowest satisfaction rates were 

“associated with length of visit and 

wait time”. 2 In a clinic designed to 

acclimate inexperienced students to 

the world of clinical practice, longer 

patient encounters and waiting 

periods are to be expected. However, 

the shortage of attending physicians 

at many SRFCs further exacerbates 

the issue as many students and their 

patients must also wait in line to be 

seen by an attending. Total patient 

time at the clinic can reach an hour 

Continued from... 

67 

and a half to two hours. 3 Oftentimes, 

patients are sent home without even 

seeing a provider or getting refills on 

their medications. I cannot imagine 

how frustrating it must be for patients 

who are already denied access to 

healthcare by traditional means to 

then be denied access at SRFCs due 

to crowded clinics and exorbitant wait 

times. 

However, patient satisfaction in terms 

of the care they received at SRFCs 

was high overall. Patients appreciate 

being able to receive free medical care 

while aiding in the teaching process for 

medical 

students. 2 

I believe 

t h a t 

SRFCs 

are a great 

resource 

for both 

students 

and patients alike, but we cannot 

remain complacent just because things 

are functional. As scholars and future 

clinicians, we should always strive to 

improve ourselves and to do better 

by our patients. That includes making 

sure medical schools are promoting 

a curriculum that embraces empathy, 

humility, cultural competency, and 

compassion. It also means making 

sure that students absorb and carry 

those characteristics into the clinic so 

that they can provide optimal care to 

each patient they serve. ■ 

"If medical schools are sending students and physicians into 

underserved areas without first educating them on this history, 

they are running the risk of increasing the distrust between the 

African American community and healthcare providers." 

REFERENCES 

1. Smith, S., Thomas, R., Cruz, M., Griggs, R., Moscato, B., & Ferrara, A. (2014). 

Presence and Characteristics of Student-Run Free Clinics in Medical Schools. 

Jama,312(22), 2407. doi:10.1001/jama.2014.16066 

2. Lu, K. B., Thiel, B., Atkins, C. A., Desai, A., Botwin, A., Povlow, M. R., . . . Pasarica, 

M. (2018). Satisfaction with Healthcare Received at an Interprofessional 

Student-run Free Clinic: Invested in Training the Next Generation of Healthcare 

Professionals. Cureus. doi:10.7759/cureus.2282 

3. Hu, T., & Leung, F. (2016). An evaluation of wait-times at an interprofessional 

student-run free clinic. Journal of Interprofessional Care,30(4), 532-535. doi:1 

0.1080/13561820.2016.1181614 

4. Tucker, C. M., Herman, K. C., Pedersen, T. R., Higley, B., Montrichard, M., & Ivery, 

P. (2003). Cultural Sensitivity in Physician-Patient Relationships Perspectives of 

an Ethnically Diverse Sample of Low-income Primary Care Patients. Medical 

Care,41(7), 859-870. doi:10.1097/00005650-200307000-00010 

5. White, A. A., & Stubblefield-Tave, B. (2016). Some Advice for Physicians and 

Other Clinicians Treating Minorities, Women, and Other Patients at Risk 

of Receiving Health Care Disparities. Journal of Racial and Ethnic Health 

Disparities,4(3), 472-479. doi:10.1007/s40615-016-0248-6 


68 Continued from... 


with hypersplenism warrant the need 

for chronic blood transfusions and 

suffer from mechanical obstruction 

due to the enlarged size of the 

spleen. In this case, the CT scan 

demonstrated an enlarged spleen 

abutting the stomach. The patient 

also had decreased appetite and 

early satiety which may have been 

secondary to the splenomegaly 

causing extrinsic compression of the 

stomach. 

Splenic sequestration crises occur 

when RBCs sequester in the spleen, 

thus leading to a massive decrease in 

the hemoglobin levels to as low as 2-3 

g/dl. Major drops in hemoglobin levels 

can lead to severe neurological deficits 

as a consequence of the hypovolemia 

and hypoxic encephalopathy that 

results. Chronic blood transfusions 

can be used to alleviate these 

consequences. However, chronic 

transfusions are associated with many 

risk factors including allosensitization, 

hepatitis, and other bloodborne 

infections. Thus, splenectomy in 

these patients is the most optimal 

form of therapy. 6 Splenic abscess 

is an uncommon phenomenon in 

SCD due to early autosplenectomy, 

however, persistent splenomegaly 

predisposes patients to multiple 

splenic infarcts which may lead to 

a splenic abscess. The proposed 

standard of care for a splenic abscess 

includes therapeutic splenectomy, 

CT-guided percutaneous catheter 

drainage, and the use of antibiotics. 12 

Conclusion 

This case is presented due to the 

rarity of splenomegaly in adult 

patients with SCD as a cause of 

chronic pain. Overall, there are limited 

reports of splenomegaly in the SCD 

patient population. Splenomegaly in 

SCD is associated with many lifethreatening 

complications that must 

be managed appropriately, thus 

prompting the need for splenectomy 

either laparoscopically or via an open 

approach. There is still an immense 

need for research in order to generate 

more data that will demonstrate the 

effectiveness of splenectomy in such 

patients. 

Limitations 

The limitations of the study are 

centered around the study type. As 

a case study with only one patient, 

there is a lack of comparison for 

the presentation of this patient’s 

symptoms with others’. Therefore, 

generalization is not possible as 

the subject was not chosen from a 

simple random sample that would 

be considered representative of the 

relevant population. Thus, information 

on rates, prevalence, and incidence 

could not be generated. 

Acknowledgements 

Sarah Ayad BSc and Ezinwanneamaka 

Morayo Ejiofor BSc are medical 

students from St. George’s University, 

Grenada, currently completing their 

4th year clinical clerkships in New 

York. The 2nd author was one of the 

first members of the Student National 

Medical Association Chapter at St. 

George’s University, Grenada. Kirolos 

Gergis MD is a recent graduate of 

St. George’s University. Alice Higdon 

DO was the Chief Resident on the 

case. Sergio Baerga MD was the 

surgeon and Barry Levinson was the 

hematologist/oncologist. We wish 

to thank Trinitas Regional Medical 

Center, Elizabeth, New Jersey 

and the Journal of the Student 

National Medical Association for this 

opportunity. ■ 


how you have hurt me?” Black and 

African American culture need not 

be stripped further of its autonomy 

and ability to contribute to our own 

narrative. The stories of Tuskegee 

that have largely circulated have not 

included the voices of those who 

have suffered. Their perspectives 

are long gone. We, as a society, have 

largely allowed erasure to become 

normalized in this narrative and many 

other stories untold—eradicating 

people and rewriting the story as 

simply “mismanagement.” Our society 

does this instead of calling it by its 

appropriate name and the means of 

its operation: racism. ■ 

Kristina Redd is a nontraditional premedical 

student. She graduated from 

the University of North Carolina at 

Chapel Hill in 2015, earning a Bachelor 

of Arts degree in Global Studies with a 

concentration in Global Health and the 

Environment and a minor in Journalism/ 

Public Relations. She completed a Pre- 

Medical Post-Baccalaureate Program 

at the University of North Carolina at 

Greensboro in December 2016. She 

previously served as a 2016-2017 Future 

Leadership Project (FLP) Fellow for the 

SNMA. She currently serves and directs 

the nationwide pipeline programming 

activities in SNMA as the Pipeline 

Mentoring Institute (PMI) Fellow. 


In addition to establishing rapport with 

patients, she also has a passion for 

engaging in thoughtful discussions and 

learning about other cultures. 

Mekbib Gemeda currently serves as the 

Eastern Virginia Medical School (EVMS) 

Vice President of Diversity and Inclusion 

and Assistant Professor of Health 

Professions. He leads efforts to integrate 

diversity and inclusion as a strategic 

priority across the mission areas of 

education, patient care, and research at 

EVMS. Before joining EVMS in 2013, he 

was also the Assistant Dean for Diversity 

Affairs and Community Health and the 

founding Director of the Center for the 

Health of the African Diaspora at New 

York University School of Medicine. He 

has more than ten years of experience 

in national and local efforts to reduce 

health disparities and increase diversity 

in the biomedical workforce. 

Stephanie Peglow, DO, MPH is a 

psychiatrist, Assistant Professor, and 

faculty member at Eastern Virginia 

Medical School (EVMS). She received her 

Doctor of Osteopathic Medicine degree 

at West Virginia School of Osteopathic 

Medicine. She completed her psychiatry 

residency training at EVMS, where she 

was chief resident and attended Yale 

for an Addiction Psychiatry Fellowship, 

a Mental Illness Research Education 

Clinical Center (MIRECC) research 

fellowship, and a Master’s degree in 

Public Health. She enjoys teaching 

students and her research interest is in 

health policy and addictions. 


C O N T A C T 

P U B L I C A T I O N S @ S N M A . O R G 

P R I N T | D I G I T A L | W E B | S O C I A L M E D I A

70 Continued from 

B l a c k H i s t o r y 

M o n t h 

Chapter Activities and Highlights 

REGION I 

Western University of Health Sciences College of Osteopathic Medicine of the 

Pacific, Northwest (WesternU COMP) 

REGION II 

This year we had Dr. Herman Bell, the first African 

American to graduate from WesternU COMP back 

in 1983, return to our campus to be interviewed on 

WesternU's Alumni Round Table show. The interview 

was broadcasted live on YouTube while the in-house 

audience enjoyed pizza and salad. Dr. Bell entertained 

us all with the memories he shared from his time as a 

student at WesternU. 

University of Illinois College of Medicine, Chicago (UIC) 

To end Black History Month with a bang, a Black Panther-inspired campaign called #showthemwhoyouarechallenge 

was launched. People of color are constantly being told who we are, or who we cannot be. Our SNMA Chapter 

challenged professional students and professionals of color to use our voice and tell the world who YOU say you 

are! The purpose of the campaign is to reclaim the narrative for people of color and show society who we are as 

defined by us ̶ not stereotypes, negativity, and limitations. Share your narrative and inspire the next generation 

to be what they see. Join the challenge! 

University of Illinois College of Medicine, Rockford 


BHM Highlights 

71 

The SNMA Chapter of the UICOM-Rockford Campus was reactivated this year and did not waste any time! We 

hosted many activities and events, especially in February to celebrate Black History Month. This included an outing 

to see the much anticipated movie, Black Panther and a Black History Month Bingo event organized by secondyear, 

medical student Janelle Mathus. The food for the bingo event was provided by first-year, medical student 

Irisha Clark, her family, and Bebe's Soul Food in Rockford. In honor of this month, Janelle also decorated the 

College of Medicine-Urban Health Program’s bulletin board. At the end of the month, we co-sponsored a Salsa 

Night fundraiser along with the Latino Medical Student Association Chapter. 

REGION III 

University of Texas McGovern Medical School at Houston 

Our Chapter celebrated Black History Month with our annual program. This year’s theme was The Evolution 

and Advancement of African Americans in Medicine, featuring keynote speaker Dr. Valerae Lewis, Chair of the 

Department of Orthopaedic Oncology at MD Anderson Cancer Center. Food was provided for the participants as 

Dr. Lewis led a discussion about African Americans and medical advancement. 

Louisiana State University Health Science Center - Shreveport (LSUHSC-S) 

LSUHSC-Shreveport’s SNMA Chapter used social media platforms to highlight the contributions of African 

Americans to the field of medicine. We also hosted a Black History Month Seminar. The keynote speaker for the 

event was LSUHSC-S alumnus, Dr. Marius McFarland, who currently owns a private family medicine practice in 

the area. Dr. McFarland captivated the audience with his speech entitled, American Heroes: A Legacy of Black 

Excellence and Compassion, where he spoke on the adversity that Black physicians face and overcome on thier 

journeys within the field of medicine. All in attendance, both students and faculty alike, left the seminar feeling 

empowered. 

University of Texas Medical Branch at Galveston (UTMB) 

UTMB’s SNMA Chapter had a Mardi Gras-themed event. It included Cajun/Creole food and a jazz saxophonist 

for entertainment. The main program of the event was a Black history-themed Family Feud game! We asked 



questions about prominent Black people and their achievements throughout history. The winning team was gifted 

a special prize. We had a great turnout, and the event was very well-received. 

REGION IV 

University of Alabama College of Medicine 

The SNMA Chapter at UASOM hosted a Lunch & Grow lecture with the 16th United States Surgeon General 

and former Director of the Centers for Disease Control and Prevention, Dr. David Satcher. He reflected on his 

decisions to become a physician and a leader, shared his passion for health equity, and discussed how students 

can effect change early in their careers. He taught the attendees that "leadership is a team sport". We also hosted 

our 4th Annual Integrative Healthcare Summit for underserved high school and college students from across the 

state. More than 200 people, including 150 students and parents, were in attendance. The one-day conference 

consisted of workshops facilitated by admissions program representatives from 15 undergraduate and health 

professions programs across the Southeastern United States. Interactive sessions in suturing, ultrasound, and 

physical exams as well as a dynamic speech by motivational speaker Timothy Alexander all took place. The 

keynote speaker, physician scientist and Susan G. Komen Breast Cancer Foundation grant winner Dr. Erica 

Stringer-Reasor stressed the value of mentorship and flexibility in achieving one's goals. The UASOM Chapter 

also awarded a Kaplan course scholarship to premedical student Nadia Hollings, and received the SNMA National 

Community Service Grant which supported this conference. 

Edward Via College of Osteopathic Medicine - Auburn Campus (VCOM-Auburn) 

We kicked off Black History Month by highlighting our current African American 

medical students on the monitors throughout the school. This was followed by 

a Minority Physician Panel entitled “Untold Stories: Life as an African American 

Physician”. The panel consisted of six physicians from the surrounding area whose 

medical specialties ranged from Pediatrics to Plastic Surgery. Each physician was 

given the opportunity to share their experiences and encounters as a minority 

physician, while also taking on questions from the audience. The Minority Physician 

Panel served as an avenue to both express and address the many concerns of 

African American students as it dealt with race 

in the workforce. Additionally, the Physician 

Panel served as an opportunity for both medical and undergraduate MAPS 

members to speak directly with physicians and inquire about the application 

process for medical school and residency, while also gaining mentorship 

opportunities. We culminated Black History Month with our Diet and Disease 

Series featuring African American Heritage. This exposed students at VCOM- 

Auburn to the dietary customs and cultures of the African American community 

along with addressing health issues and disparities that prevail in the African 

American population. 



73 

REGION V 

University of Cincinnati College of Medicine 

Students at UC CoM performed a Step Show for 

the entire school to demonstrate Black excellence 

and culture. The legacy of step has been an integral 

part of African American culture as it was used as 

a form of expression when our music was taken 

away from us. Additionally, AJ Strayhorn, a secondyear 

medical student and SNMA Chapter member, 

performed an original spoken word at our annual 

Black History Month Celebration. 

Wright State University Boonshoft School of Medicine (WSU BSOM) 

The WSU BSOM’s SNMA Chapter kicked off Black History Month with SNMA Day, which was designed to remember 

and honor different aspects of the African diaspora. We filled our building with visible reminders to highlight the 

great contributions of people of color throughout history. Faculty, staff, and students enjoyed deliciously prepared 

food, great music, trivia, and games. During the Wine Down Event we held at J.W. Wine Cellar, chapter members 

and our peers tasted different wines and purchased items to show their support for this Black-owned business. The 

2nd Annual Mahogany Medical Gala (MMG) was a space to learn about culture and history. Attendees enjoyed live 

musical performances, ample desserts, and savory dishes. MMG ticket proceeds and donations will go towards 

scholarships and BSOM SNMA programming. We ended our month-long celebration with the African Americans 

in Times of War Event. This was an enlightening event as Veterans and current service members discussed their 

experiences as members of the Armed Forces. 

REGION VI 

University of Maryland School of Medicine (UMB SOM) 

Chapters of the Student National Medical Association (SNMA), the Student National Dental Association (SNDA), 

and the Student National Pharmaceutical Association (SNPhA) at UMB SOM highlighted the successes and 

accomplishments of remarkable underrepresented minorities in their respective fields. The speakers shared their 

stories on how they got to where they are now, provided advice for students, and spoke many words of inspiration 

and encouragement. The UMB’s SNMA Chapter also hosted a MAPS Pre-medical Student Visit and had a Care 

Bags for the Homeless Event to support our community with non-perishable foods, water, gloves, bandages, and 

so much more. The care bags included handwritten notes and were delivered throughout the community by the 

students themselves. 



Virginia Commonwealth University School of Medicine (VCU SOM) 

The VCU SOM’s SNMA Chapter and affiliate MAPS 

Chapter had the pleasure of enjoying a tour of the 

Black History Museum and Cultural Center of Virginia. 

The museum provided insight into the lives of the 

brave African Americans who resided in the former 

confederate capital, and boasted about the rich 

heritage and accomplishments of African Americans 

in Virginia. 

Edward Via College of Osteopathic Medicine - Virginia Campus (VCOM-VA) 

Barbara Ross-Lee, DO, addressed first-and secondyear 

students at VCOM-VA as the keynote speaker 

for the William G. Anderson, DO, Black History Month 

Series. Dr. Ross-Lee is the first Black woman to serve 

as dean of a medical school in the United States and is 

the founder of the Health Policy Fellowship program. 

Her presentation was dynamic, thereby challenging 

students to become a part of the solution for health 

care disparities. She not only educated us on the 

importance of why Black history is celebrated, but 

also shared with us some of the educational and life gems that she has learned over the years. 

REGION VIII 

Lewis Katz School of Medicine at Temple University (LKSOM) 

LKSOM’s SNMA Chapter held a lunch talk to discuss the Philadelphia Soda Tax and its implications on our patient 

population. We also hosted a wonderful discussion on the complexities of compliance and how the many social 

determinants of health play a role in adherence to health care plans. This discussion was led by Dr. Nora Jones, 

PhD who is Assistant Professor of Bioethics and Associate Director for the Center for Bioethics, Urban Health, and 

Policy at our school. We later hosted a Health Professionals Roundtable where health professionals from different 

backgrounds discussed how to advocate for patients. Lastly, the LKSOM’s SNMA Chapter and students from the 

other health sciences programs were able to enjoy a private screening of Black Panther with the sponsorship of 

the Student Faculty Center. 

REGION IX 



75 

Cooper Medical School of Rowan University (CMSRU) 

Kim Upshaw, Vice President of Compliance and Privacy Officer for TridentUSA Health Services, was invited to lead 

an insightful and educational discussion on how America's history of health care treatment and experimentation in 

the African American community affects patient privacy, consent, and trust today. The CMSRU’s SNMA Chapter 

also hosted a physician panel full of minority physicians from Cooper Hospital. We discussed the unique challenges 

that minority physicians face today, and the physicians shared their pearls of wisdom with our students for their 

journeys through medicine. We collaborated with the Rowan School of Medicine’s SNMA Chapter for a Black 

Panther Movie Night. We also hosted our Annual Black History Month Potluck fundraiser. Both students and 

faculty were in attendance, and for entertainment, some of our members choreographed a dance! The room was 

decorated with posters of Black history facts and important Black figures in science. To end our month of events, 

some of the medical students participated in a MAPS panel at the Rowan University, Glassboro campus. We shared 

advice for the journey into medical school and gave words of encouragement to get us through this trying journey. 

Stony Brook University School of Medicine (SBU SOM) 

The African Diaspora Celebration is the major cultural event for the SNMA Chapter at SBU SOM. Each year, the 

first-year medical students organize this fun, exciting night to uplift everyone and shine a light on Black culture 

throughout the diaspora. The event also serves as an opportunity to raise funds for several vital causes that 

primarily impact minority and underserved communities. For example, the Stony Brook Home which is a studentrun, 

free clinic for the uninsured and the Hemoglobinopathy Center at Stony Brook Children’s Hospital, which is 

state-recognized for assisting children with disorders such as sickle cell disease and thalassemia. 

State University of New York Upstate Medical University (SUNY) 

The SNMA Chapter at SUNY hosted its annual Black History Gala. Our theme for this year’s Gala was Reaching 

Back to Leap Forward. The night featured artistic displays of Black heritage and pride through spoken word, 

various song selections, and the inspiring words of our keynote speaker Dr. Donna-Annn Thomas. The gala is a 

fundraising event that honors the achievements of organizations within Syracuse, NY that focus on giving back to 

an underserved community. This year’s honoree was Girls Inc Zonta House, a locally based organization whose 

mission is to provide mentorship, tutoring, and science-oriented exposure to young ladies between the ages of 

6 and 16 in Syracuse, NY. Founded by three medical students including one of our executive SNMA members, 

the Girls Inc Zonta House, affectionately known as “Zonta House”, aims to encourage young girls to nurture and 

pursue their passion for a career in the STEM field. With the help of many student volunteers and our generous 

donors, we raised a total of $3000 for Zonta House!

JSNMA FALL 2018 Filling the Gaps with Socially Conscious Physicians Vol. 24 Is. 1 Preview

Create successful ePaper yourself

Delete template?

Save as template?