Nina DeJonghe, MPP Nina is the Director of Government Relations for the Council of Academic Family Medicine (CAFM). Her work supports academic family medicine issues, including graduate medical education, primary care research funding, the healthcare workforce and increasing access to primary care physicians to improve health outcomes.
In October of 2023, I visited STFM member Jehni Robinson, MD, FAAFP, Chair of the Department of Family Medicine at the Keck School of Medicine at the University of Southern California (USC). Upon becoming chair, Dr Robinson secured funding to create a street medicine team at USC. After which, she partnered with a local county hospital to provide services to more than 60,000 unhoused people.
The USC street medicine team focuses on treating unhoused patients whose needs are often overlooked, if not ignored entirely. I was invited to make rounds to witness firsthand the incredible work the family medicine department does within the community.
Over five hours, we visited several areas throughout South LA. I watched as the team conducted evaluations on new and existing patients, provided wound care, reinstated Medi-Cal insurance, administered medications, and handed out necessities. The providers were compassionate, patient, and kind. The patients were treated with humility, dignity, and the utmost respect. During rounds, we learned a long-term patient was moving into a shelter later that week, which was great news. I held an internal moment of celebration for them, as waitlists for shelters can be extensive. It’s important to note that shelters, while not a long-term solution, provide an important step forward for those experiencing homelessness.
Through Dr Robinson’s leadership with California’s Department of Health and Human Services, and work of the USC street medicine team, physicians in the state are now able to seek Medicare reimbursement of medically necessary professional services to unsheltered homeless individuals, if this care is provided in a “non-permanent” location or found environment.
Since visiting USC, I have spent significant time reflecting on this transformative experience. The street medicine team embodies the spirit of Family Medicine through their dedication, compassion, and unwavering patient support. The contributions of Dr. Robinson and USC’s team are admirable; I am grateful to have had the opportunity to spend time observing their commendable work.
A room will be available at the conference hotel for attendees to assemble care packages during refreshment breaks. Representatives from Water Drop LA will also be on-site to share more about the organization.
Sunday, May 5 from 9:50 to 10:50 am Monday, May 6 from 10:15 to 11:15 am and 12:45 to 1:45 pm Tuesday, May 7 from 9:50 to 10:50 am and 2:45 to 3:15 pm
Water Drop LA is a 100% volunteer-run community organization whose mission is to provide clean water and other necessities to communities facing water inaccessibility. By distributing 2,000+ gallons of water to Skid Row each week and by providing water to our partner organizations across Southern California, Water Drop aims to support existing organizers and to meet the immediate needs of the community
As the 2022-2023 term comes to a close, we sat down with incoming STFM President Renee Crichlow, MD, FAAFP to learn about her journey to family medicine education, her plans for the presidency, the importance of good conference snacks, and her love of Audible.
“We are a community of learners and teachers from and for each other. STFM never stops working for Family Medicine or our learners, teachers, and patients. From clinical teaching through the ranks of academia, the bureaucracy of medical schools, and amid policymakers, STFM is working for you and with you. We are you; together, we are thoughtful, strong, and persistent.”
Renee Crichlow, MD, FAAFP
When you were a child, what did you want to be when you grew up?
As a child, the first job I wanted growing up was to be a rodeo rider. I don’t know why, but I remember writing about it in my journal when I was six. Then I wanted to be an oceanographer because Jacques Cousteau was one of my heroes in the 70s, then I fell in love with rocks. As a kid, I could probably name every rock or crystal you could find. My favorite was feldspar. Then came the point in my life when someone I respected a great deal asked me what I wanted to be when I grew up. I was 12. I was pretty good at science, and people liked to talk to me, so I said I would like to be a doctor. Mrs. Rutherford said I would be an excellent doctor. She was a nurse and someone I admired, so I figured if she said I could be a doctor, I could probably be a doctor. My first job in healthcare was as a phlebotomist in Boston. It was there I worked side-by-side with doctors. I appreciated that they supported and encouraged me to attend medical school. So, I left Boston and went to UC Santa Cruz as an undergraduate. After that, I went to UC Davis, which had a strong family medicine focus.
What drew you to medicine and family medicine education in particular as you grew?
The people I admired were the family docs that worked and taught at UC Davis. The specialists at UC Davis were very kind, compassionate people, but the folks that were doing the kind of work that I thought the doctor was supposed to do (take care of people from the time they were born till the time they die and everything in between) were the family docs. The department Chair at the time, Dr Klea Bertakis invited me to interview after she heard my Grand Rounds in my chief resident year. She asked me to consider becoming an attending at the UC Davis Dept of Family and Community Medicine. I’ve always enjoyed teaching, tutoring, and mentoring. I come from an academic family, so the thought of teaching at the graduate level sounded like an excellent way to continue learning and growing as a physician and a person, so I jumped in and never looked back.
When you’re not revolutionizing family medicine education, how do you like to spend your time?
I like to spend my time traveling with my family and reading books or having books read to me. My wife and I have three teenagers, and they are each fantastic in their own way; traveling the country with them has been filled with surprising and wonderful adventures. Also, I am quite likely emotionally dependent on Audible.com in ways that others might consider unhealthy; what do you mean you can’t listen to books in the shower? Why else would one have waterproof earbuds?
What do you wish all members and non-members knew about STFM?
The Society of Teachers of Family Medicine is shaped by and shapes the specialty of Family Medicine. We are a community of learners and teachers from and for each other. STFM never stops working for Family Medicine or our learners, teachers, and patients. From clinical teaching through the ranks of academia, the bureaucracy of medical schools, and amid policymakers, STFM is working for you and with you. We are you; together, we are thoughtful, strong, and persistent. That’s what I’d want them to know. Also, they should know that when I’m typing, my autocorrect flags “STFM,” which always suggests “storm” instead.
If you could impart your past self with any wisdom from the future, what would it be and why?
I would tell past Renee that loving who you are now is a path to becoming who you can be. It may not be the only or easiest path, but it will sustain you. I would tell her that building joy is courageous and starts with me. I would look her straight in the eye and say, “Stillness is the ground, fear is the noise, and Love is both the signal and receiver.” Past Renee would then look at me, think I was a little eccentric, and then she would go out and make the same mistakes I made in the past that I have now learned from, allowing me to become who I am today. That is the other path; experience plus reflection equals wisdom.
What accomplishment are you most proud of in life, and why?
My children are kind and courageous. My learners are innovative and bold. I can, have, and will be a catalyst for systems change, and I have learned to lead from love and help unleash people to claim their own power.
What drives you to show up every day?
Black Jeep with seat warmers and remote starter…just kidding. I show up. I understand that change is the only constant, and we must help shape that change. But that was a journey; first, I showed up because I wanted to survive, and if I didn’t, only bad things would happen. Then, I started realizing I needed more than survival. I wanted to live, which meant showing up for myself too. Then, I understood that I needed more than just survival and more than just to live. I want to thrive, which means showing up for myself and showing up for and with others. I show up to shape change.
What is your most used STFM resource?
My colleagues, this community of learners is my most useful STFM resource. Other than the members, I would say STFM Connect, which helps me stay connected with those colleagues.
What would you tell medical students and residents about their journey ahead?
Family Medicine is THE FUTURE of Healthcare. Machines or Artificial Intelligence can never replace us. We are a critical component in a compassionate and functional healthcare system. We need to build that compassionate and functional healthcare, and together we can.
Has a lesson you’ve learned stuck with you your whole life?
Be kind. Be kind to me and others.
What do you most look forward to most in your term as STFM president?
I look forward to shaking the US medical and educational system to its core, reshaping it into a model for the world, and choosing snacks at conferences.
Note from the Editor: The December blog contains two important submissions on global family medicine and the factors that contribute to inequities in the field including but not limited to funding, climate change, geopolitical events, and more. Thank you to Barry Bacon, MD, Martha Sommers, MD, Bhargavi Chkuri, MD, and Meredith Milligan, MD
Dream School: How One Patient Encounter Can Change the Direction of Your Life
One patient encounter can change the direction of your life.
Our team, Gambella Medical Team Connections in Western Ethiopia and Anchor Health for South Sudan in South Sudan, dreams of creating a medical school to change health outcomes for the region. This long-term strategy will build up the region’s workforce with physicians and other local-to-the-area healthcare workers familiar with the area’s needs.
The challenges we face include:
Lack of livable wages. Doctors in South Sudan are employed by the government and receive $12 per month.
Lack of funding and support. Donor countries who had been sponsoring healthcare support in South Sudan have retracted their financial support.
Lack of access to quality medical care. There are five hospitals in the Gambella region serving a million people. These hospitals have one functioning x-ray machine and one functioning operating room.
Lack of physicians. There are 120 physicians in South Sudan serving a population of 12 million, a ratio of 1:100,000. In 2013, there were nine midwives and eight OB/GYNs identified in all of South Sudan. As a result, one in seven women die from childbirth complications. We witnessed a child dying in his parents’ arms while waiting to be seen by a physician at the central hospital.
Lack of access to medicines, equipment, and tools required to provide quality care.
Lack of tools. Nursing schools in Gambella don’t even have a blood pressure cuff and must teach their students without one.
Outsourcing. Medical care is outsourced at a cost of $200 million per year to other countries.
Conflict. There are 400,000 refugees in the Gambella region. Facility transfers must transport patients during times of conflict.
Many members of our team fled South Sudan and Gambella due to the conflict and violence. After arriving in the United States, they received an education and they returned to the region, bringing colleagues and US recruits with them with the goal of transforming healthcare in South Sudan and the Gambella region of Ethiopia. Thanks to presentations at the 2019 and 2021 AAFP Global Health Summit, we were able to grow our team and support network. The connections built by our team, along with their local knowledge led to Marshall University’s Family Medicine Global Health Division joining the effort; and the sharing of widespread contacts that contribute to our progress.
We’ve been offered a hospital in Juba to create a multi-specialty healthcare center and a base for medical education. Our vision is to invite US-based instructors and specialty teams to provide care for patients while teaching medical students and South Sudanese physicians. Additionally, we must address the policy fiascos that prevent healthcare professionals from receiving sustainable, livable income. For over five years, we’ve worked on our dream of developing an international medical school with campuses, and teaching sites in remote hospital and clinical settings in South Sudan and Western Ethiopia. We have the support of both leaders in South Sudan, the Gamebella regional government, and are audacious enough to believe we will accomplish our dream.
Globally, the world is asking more of family medicine. As teachers of family medicine, we are learning how to meet the needs in South Sudan and Gambella, and focusing on increasing opportunities to involve medical students, residents, and colleagues as we move forward.
Join us.
Barry Bacon, MD 250 S Main St Colville, WA 99114 Anchor Health for South Sudan Gambella Medical Team Connections baconbarry@juno.com
Martha Sommers, MD Assistant Professor Department of Family and Community Medicine Marshall University
Modernizing Global Women’s Health Curricula: Inclusivity, Intersectionality, and Climate Change
by Bhargavi Chekuri, MD, University of Colorado School of Medicine, Aurora, CO, and Meredith Milligan, MD, Dartmouth-Hitchcock Medical Center, Lebanon, NH
Gender inequality remains one of the most important drivers of disparities in health and well-being worldwide. To address these disparities, global women’s health research and curricula have been developed to better meet the unique health needs of women worldwide. While training programs often provide much needed focus on reproductive and obstetric care, infectious diseases, and cancer screening, significant blind spots remain.
First, gender continues to be categorized as binary in most of the research focused on global women’s health. As a result, teaching in this field fails to incorporate intersectionality, overlooking the physical and mental health needs of other sexual and gender minorities (SGMs). Additionally, teachers of global women’s health, and indeed medical educators more broadly, do not adequately integrate planetary health into their curricula. This is problematic because climate change is already worsening current global health disparities with well-documented gender-specific impacts, making it one of the most important, cross-cutting determinants of health in the 21st century. Research and teaching at the nexus of all three of these issues (global women’s health, health needs of other SGMs, and climate change) is even rarer, despite the fact that SGMs are particularly vulnerable due to compounding issues such as discrimination.
Gender-specific Impacts of Climate Change
Climate change harms human health by altering the quality and quantity of our air, water, food and weather. Increased temperatures and drought, poor air quality, more intense extreme weather events, and changing disease patterns all affect mortality and morbidity, resulting in injury, poor cardiovascular and respiratory outcomes, and worsening mental health worldwide. Globally, women and other SGMs face increased exposure to the consequences of climate change due to existing health disparities as well as differences in gender roles and responsibilities. When faced with these exposures, unequal resource distribution further limits the adaptive capacity and resilience of women and other SGMs. Women in low-income countries (LIC), for example, have disproportionate exposure to food insecurity because they are more likely to live in poverty and rely on subsistence farming to feed themselves and their families. When faced with lower crop yields, women are at higher risk for nutritional deficiencies, both because of increased reproductive demands (like menstruation and pregnancy), and because of underlying cultural norms that may prioritize feeding others. Similarly, gender-based social and cultural norms place responsibility for managing household water supply on women in LICs. As climate change strains freshwater resources globally, women spend more time and travel farther to locate, transport, and secure household water. Along the way, they can have increased exposure to heat, musculoskeletal injury, and face the threat of violence or abuse. Climate-related disasters like wildfires, storms, and flooding also have gendered health impacts. Women in low and middle-income countries are more likely to die from extreme weather or flooding events than their male counterparts because they are also more likely to be homebound, serving as caregivers, and unable to immediately escape climate-related disasters. Simultaneously, women have unequal access to disaster response services in the aftermath of such events, often losing access to essential sexual health and reproductive health services (SHRH) right when they need them the most.
SGMs are particularly socially vulnerable during disasters due to existing inequities as well as discriminatory disaster response policies. In the U.S., for example, LGBTQ+ people are more likely to live in poverty, experience unstable housing, and have chronic physical and mental health conditions, all leading to a higher risk of direct and indirect injury during extreme weather events. Additionally, disaster response policies in the U.S. do not explicitly prohibit discrimination based on sexual orientation or gender identity, or routinely recognize gender-diverse family structures, opening LGBTQ+ people to harm and separation when pursuing relief.
A Path Forward
Unfortunately, these are just a few of the many ways women and SGMs around the world are disproportionately impacted by the changing climate. Practitioners and teachers of global women’s health must be aware that current gaps in global health research limit our ability to fully understand and address gender-based health disparities worldwide. Integrating an intersectional and inclusive lens while defining, understanding, and teaching global women’s health is an important first step in addressing health disparities felt by women and other SGMs. Global women’s health practitioners must also use and teach a planetary health lens so they are better prepared to address contemporary health threats. Those leading community-based collaboration and bidirectional global women’s health partnerships must understand and teach concepts like gender-mainstreaming and climate action when developing projects aimed at improving women’s health. Lastly, global women’s health practitioners must understand and teach the importance of applying reproductive justice and human rights frameworks to climate action plans; this not only improves the adaptive capacity and resilience of women and other SGMs but also subsequently improves gender-based health disparities.
Definitions:
Sex refers to the biological characteristics that define humans such as female or male.
Gender refers to the socially constructed characteristics, norms, roles, and behaviors attributed to women, men, girls, boys, and non-binary people. Because gender is a social construct, ideas about gender vary across societies and time.
Gender equality refers to the equal rights, responsibilities, and opportunities of all genders.
LGBTQ+ is an acronym that collectively refers to individuals who are lesbian, gay, bisexual, transgender, or queer. The “Q” can also stand for questioning, referring to those who are still exploring their own sexuality and/or gender. The “+” represents those who are part of the community, but for whom LGBTQ does not accurately capture or reflect their identity.
Sexual and gender minorities (SGMs) refers more broadly to people whose biological sex, sexuality, gender identity and/or gender expression depart from majority norms. The term ‘sexual and gender minorities’ includes considerable diversity as well as a multiplicity of identities and behaviors, including, but not limited to, individuals who identify as LGBTQ+. The term ‘sexual and gender minorities’ is preferentially used in global health contexts because the term ‘LGBTQ+’ is derived from Western contexts which may not apply to many people in the world.
Intersectionality refers to a theoretical framework born out of the Black feminist movement which maintains that individual identities (such as race, class, gender, sexual orientation, immigration status, etc.) intersect to create experiences of inequality within society. Research using intersectionality methods is ideally built on a foundation of coalition-building with the aim of gaining a deep understanding of the diversity of lived experiences and the ways in which systems of oppression and privilege impact these varied experiences. Such research also maintains that emphasis on one identity over another fails to capture the true causes of disparity in the world.
Gender mainstreaming is defined by the UN as “the process of assessing the implications for women and men of any planned action, including legislation, policies, or programs, in all areas and at all levels. It is a strategy for making women’s as well as men’s concerns and experiences an integral dimension of the design, implementation, monitoring, and evaluation of policies and programs in all political, economic, and societal spheres so that women and men benefit equally, and inequality is not perpetuated. The ultimate goal is to achieve gender equality.”
Bhargavi Chekuri, MD, is Co-Director, Diploma in Climate Medicine, and Assistant Professor, Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
Meredith Milligan, MD, is Family Physician and Leadership Preventive Medicine Resident, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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