Anti-racism in Family Medicine: Then, Now, and Going Forward
By Amber Hollingsworth, OHSU School of Medicine – Communications Program Supervisor
When George Floyd was killed by Minneapolis police in May, it was one more brutal act of violence in the 400+ years of violence against Black people in America. But for the nation as a collective, it has proven to be a turning point. People filled the streets in protest, and everyone – in every sector of society – was called upon to reflect on their roles in perpetuating systemic racism. OHSU’s Family Medicine faculty, residents, students, staff, and the department as a whole are responding to that call.
Family Medicine began as a social justice movement in the 1960s, so it’s no surprise our team members have long been at work combatting injustices and improving care for the underserved. But the events of the past year have shown us how much more work is left to do, not only to advance equity out in our communities, but to create a more anti-racist and welcoming culture for all staff and learners within the walls of health care.
For many of our Black, Indigenous, and people of color (BIPOC) colleagues in health care, this sharpened focus on systemic racism has been complicated. They’ve been asked to process their feelings alongside their white colleagues, help their white colleagues process theirs, and review and propose solutions. Sometimes this happens in a supportive group, sometimes under a spotlight.
“I’m African American. I’ve been living with this my whole life,” says Kimilia Kent, PharmD at Family Medicine’s Richmond Clinic. Dr. Kent and Kael Tarog, medical assistant and Filipino American, led an anti-racism conversation at the clinic in early June.
“I’m happy people are showing up and listening,” Dr. Kent says, “but these can be difficult conversations for us to have.” She describes the challenge of having to transition back to work after vulnerable and sometimes confrontational conversations. “I remember trying to work afterwards thinking, ‘now I’m upset again.’”
Kael agrees these conversations aren’t easy: “Unlearning things takes a long time – it can be really uncomfortable and messy, but that’s how we grow, change, and evolve. This is going to be generations of work.” He stresses the importance of listening to BIPOC voices.
The department is trying to create space for those voices while not unduly burdening our BIPOC colleagues. For example, the Health Equity and Social Justice (HESJ) group has been in place for four years, but this summer it changed how it holds its discussion events.
Health Equity and Social Justice Group
HESJ creates a regular space for reflecting, discussing, and learning about issues of equity and structural forms of oppression, in service of healing, building a more welcoming departmental community, and creating leaders, team members, clinicians, researchers, and community members who are committed to eliminating social injustices. Amanda Aninwene, MD, who recently completed her Family Medicine residency, is one of the group’s founding members.
“I was the only Black resident here for three years,” Dr. Aninwene says. “My first year, there were all these murders of unarmed Black men. I felt alone in my struggle – watching this happen then coming into work and no one was talking about it.”
That’s when Brian Park, MD, MPH, a second-year resident at the time, invited colleagues to his house to discuss how these events were impacting them and the communities they served. The group wanted to continue coming together to heal, reflect, and build community with one another, and the Health Equity and Social Justice group was formed. The residents partnered with faculty members like Rebecca Cantone, MD, Rebekah Schiefer, MSW, LCSW, and Christina Milano, MD, to elevate HESJ’s profile within the department. Participation in events has grown, with an increase in support and commitment from department leaders over the last several years.
HESJ has helped foster a shared language and understanding of structural racism, and is now using racial caucusing for its gatherings: The caucus of white attendees focuses on learning about whiteness and privilege, while the POC caucus focuses on self-care practices and building communities of care. The goal of this approach is to foster healing and braver spaces for all to engage in honest, vulnerable dialogue and co-learning, without causing harm to POC colleagues.
This kind of evolution is key to anti-racism work.
Examples of longstanding anti-oppression work by OHSU Family Medicine faculty, trainees, and staff:
- Erik Brodt, MD, leads The Northwest Native American Center of Excellence (NNACoE), which works to comprehensively and sustainably address the health care needs of all people by amplifying Native American voices in the U.S. health professions workforce.
- Christina Milano, MD, co-founded OHSU’s Transgender Health Program. Our clinics provide safe, comprehensive, affirming health care for the transgender and gender-nonconforming communities.
- Cliff Coleman, MD, MPH, is an award-winning expert in health literacy, developing and delivering a curriculum to make clear communication the norm in health care.
- Sonia Sosa, MD, is an expert in integrative medicine, including nutrition, western herbs, mind-body medicine, and manipulative medicine.
- Richmond Clinic’s Health Equity and Leadership (HEAL) Team implements relational community organizing to instill anti-oppressive team practices, organize listening sessions, and create community-powered structural change.
- A number of our team members are engaged in culturally specific community leadership.
Integrating anti-oppression into learning
Another recent Family Medicine residency grad, Brit Nilsen, MD, saw a need to bring anti-oppression topics into regular learning. “All residents meet for weekly lectures, but sometimes a lot of time would pass between sessions on anti-oppression topics in this setting,” Dr. Nilsen says. So she, fellow resident Maria Palazeti, MD, and Rebekah Schiefer organized spring and fall sessions on microaggressions and discrimination for all residents.
“We modeled how it could be done twice a year, and the department has already allocated time to these topics in next year’s residency schedule to really build it into the curriculum.” She suggests incorporating discussions of inequalities into all lectures. “For example, if we’re talking about kidney disease, let’s reframe the presumed ‘biological differences’ as results of a racist system and history.”
On this same track, third-year resident Justin Lee, MD, has been working on bringing Structural Competency into Family Medicine resident training. He’s co-led the OHSU School of Medicine’s Structural Competency course for medical students for the past seven years – it explores the ways that social, economic, legal, and cultural structures impact health, through issues such as immigration, gender, trauma, substance abuse, and racism.
“It’s a curriculum that’s both taught and experiential,” Dr. Lee says. “We’re working to make Structural Competency a model for how we systematically learn, integrate, and put practices into place around anti-racism and anti-sexism.”
Financial support
At the end of July, Department of Family Medicine leadership endowed a portion of departmental reserves – and established a spending fund – to support Diversity, Equity, and Inclusion and Social Determinants of Health initiatives. Alongside it, DFM launched a giving campaign in which donations will be matched up to $25,000.
“We are launching this campaign as a way to put our values into action — to support our BIPOC members more meaningfully, and also to enhance the incredible work individuals and teams throughout the department are doing to dismantle racism and improve health equity,” Department Chair Jen DeVoe, MD, DPhil, says.
As of Sept. 10, $23,000 has been raised for the fund.
Looking forward
What’s been great – Drs. Aninwene, Nilsen, and Lee agree – is that their ideas have been well-received in the department. They see people doing the work across all levels: learners, teachers, researchers, leaders, and staff. For Kael, it was apparent from the day he interviewed at Richmond.
“Because of the diversity here [in patients and staff], Richmond Clinic is the first place in my medical career where I felt like I belonged,” Kael says. He’s on the Health Literacy Committee, joined HESJ when it launched, and has been involved with the Transgender Health Program Committee and the Trauma-informed Care Committee. “I feel the need to help all people who are oppressed. It’s in my blood,” he says.
Kael has found a home in Family Medicine because so many around him feel the same way. But what the recent murders of George Floyd, Breonna Taylor, and Jacob Blake have so painfully reminded us all is that addressing racism and oppression is not the work of a few passionate people like those profiled in this piece — it is all of our work. It is all of our work to not only learn about and act to eliminate the internalized and interpersonal forms of racism we personally perpetuate, but just as critically, the institutional and systemic forms of racism we each perpetuate every day. The energy created by the recent murders of Black individuals must move beyond words, emotions, and committees, and translate into department- and university-wide policy change and action, particularly change “that shifts power and holds people accountable,” Dr. Lee says.
Dr. Nilsen reminds us that “the evaluation of our success isn’t that our providers are culturally competent. It’s that these known values of inequality – these known health outcomes don’t exist anymore. If our patients are still suffering, it’s not the end of the work.”
“The results that people want require discomfort and sacrifice,” Dr. Aninwene says. “If we want to decrease the mortality rate of Black mothers by half, we have to do this work, not just talk about the ideas. It’s frustrating when you know how much faster we could get there if the whole institution was behind it.”
Many in Family Medicine have committed their careers to making health care equitable. But as the recent disproportionate rates of COVID-19 across racial/ethnic identities demonstrates: health care remains a largely inequitable system. Re-building toward a truly anti-racist health care system will require unlearning the systemic practices that have been socialized within us that (unknowingly) perpetuate health inequities, and re-building a system that amplifies the voices of BIPOC and other communities most impacted by systems of oppression. This process, while urgent, must be done intentionally, thoughtfully, and with humility.
For Dr. Aninwene, it’s essential that we earn the trust of the Black community now. “I want our department, our hospital to be a safe place for Black people to go in a world that does not protect them.
“This is a call to action.”