Spring Quarter

I shadowed Dr. Bann twice this quarter. It was truly a transformative experience - I think I found my calling. Ever since I read Mountains Beyond Mountains about Paul Farmer and his work with Partners in Health in high school, I have wanted to work with marginalized communities. That is a huge reason why I raised money for and supported local homeless shelters as a high schooler. Throughout college, especially in this last year since I’ve taken public health courses, I have become more and more uncomfortable with the idea of participating in a healthcare system that treats health as a commodity. I want to serve populations that cannot access the healthcare that our society has made so inaccessible and expensive. When I shadowed Dr. Bann, I was so happy to have found the intersection between my interest in medicine and my desire to help those most in need. Harborview’s target population – people uninsured/underinsured, people living homeless, victims of sexual assault or domestic violence, people with substance abuse, people with STIs and so on – is exactly who I want to work with, and I am glad that there are safety-net hospitals like this one where I can champion health as a human right, not a luxury.
 

Here is the discussion post I made after my first shadowing session:

"The past year in the public health major made me so disillusioned with U.S. healthcare that for a brief moment a few months ago I wondered if I would be happier working abroad in a universal health care system. The out-of-pocket model, in comparison to the more effective mandated insurance or single payer models, and the commodification of healthcare fostered a high level of cognitive dissonance - I felt unethical and uneasy about wanting to join a workforce that does not treat health as a human right. 
 

That’s why after reading Harborview’s mission statement, I felt like this was my calling. By “this”, I meant providing care for people via a safety-net institution like Harborview that treats those who have been consistently ignored, oppressed, and rejected by society. 
 

Two things struck me about this mission statement. First, it was blunt. In societal discourse, things are often sugarcoated. Heck, I just read a scientific paper that said a baby “expired” instead of “died” (seriously, like a carton of milk). People like to ignore the parts of society that are less "pretty" and prove that life isn’t all sunshine and rainbows. This mission statement blatantly listed over eight groups of people with conditions/circumstances that are heavily stigmatized.
 

It’s a powerful thing in this society to simply acknowledge the existence and needs of these individuals with experiences ranging from domestic violence to sexually transmitted diseases, and an even more powerful thing to say that you will prioritize their care over more privileged groups that traditionally dominate society. And like Mara says, it is horrific that Harborview even needs to state that these are the most vulnerable residents of King County because everyone should have equitable access to healthcare no matter who they are. 
 

The second thing that I realized about this mission statement was that it was on display for anyone passing by on the street to see. What a thoughtful idea to place a mission statement across from a window where it can be read by pedestrians. It’s just one example of how Harborview is accessible even outside the confines of its buildings - for example, those who are experiencing homelessness are now more likely to see this mission statement than if it was displayed on the inside. From my time volunteering at Swedish, I do not believe ever seeing a mission statement; though, to be fair, I was never actively looking for it. At Harborview, I can stumble upon it without even entering the building. 
 

Beyond the mission statement, I was impressed with the quality of care provided given the resources that Harborview receives. I was surprised to learn that Harborview does not receive any funding from the government, despite being owned by King County. This definitely seems unique to a US-based environment, since the U.S. is the only high-income country where hospitals are not run, regulated, and/or reimbursed by the government in some form. 
 

A weakness of the safety-net system thereby revealed itself to me - while it’s there to save others, it needs something to save itself. A safety net for the safety-net hospital, essentially. I was under the impression that it was people with external power that provided that foundation, like the government or wealthy donors looking to help a good cause, but after talking with Mara, this does not seem to be the case. It’s Harborview’s own doctors that are holding up the safety-net hospital by doing elective surgeries to generate revenue to make up for the low-cost/free care they provide those who need it. They also accept that their pay is a fraction of what other doctors make at hospitals like Swedish or Virginia Mason, which keeps operating costs lower.
 

This is not to say that the doctors at Harborview do not have power like the government or donors - in fact, I would argue that they are more powerful, because they are successfully providing care to communities in ways that those external institutions are failing to do, and they are doing it without the enormous wealth or influence. It goes to show that safety-net institutions run on altruistic and selfless values, and that’s what makes them sustainable, since they are held up from within themselves.   
 

This made me think more about how almost everyone has power depending on the context. One thing I noticed and appreciated about the care Mara and her senior resident provided was that they gave power to the patients. Actually, it might be better to say that they preserved and respected the existing power of the patients, enabling them to maintain their autonomy. I was touched by the way the senior resident squatted down by the bedside, as to be on the same level as the patient, rather than towering above them. I liked how Mara asked the patients what they wanted to do, what they thought she could do to support them best, and even humbly apologized for gaps in communication. A lot of the doctors I have met were arrogant and dismissive - you would never catch them apologizing. I have not shadowed in a healthcare setting before that was so empowering, collaborative, and empathetic. Even the interactions between Mara and the senior resident revealed the nature of power dynamics at Harborview. At Swedish, I saw a hierarchy where attendings seemingly viewed residents as inferior. Here, I saw none of that. At Harborview, it seems like everyone knows that the priority is the patients - and they do not fuss about who is more qualified or important among the staff. 
 

These were just a few observations I made. I appreciated the debrief that we had at the end of the shadowing session. I ended up asking more about the social dynamics within the hospital (namely, between doctors and nurses), the prevalence of racism and sexism throughout the medical field, and the intersection between public health and medicine, among other things. I have learned that while healthcare in the U.S. is not universal, the notion that it is a commodity is also not universal. Institutions like Harborview give me hope that marginalized communities can access the care they need, and that there is potential for a future U.S. that does not place a price tag on people's lives and their health."