“Freedom is not a state, it is an act.”
— Rep. John Lewis
On the morning of January 6, I awoke ecstatic to the news of Reverend Raphael Warnock and Jon Ossoff’s predicted wins in the Georgia run-off elections. Along with Vice President Kamala Harris’s tie-breaking vote, these results shifted the Senate majority to Democratic control. I smiled from afar in Chicago as I thought of my parents, two of Georgia’s newest voters, who had recently relocated for work to the state’s northern rural mountains and had diligently researched their polling places’ social distancing guidelines and early voting dates.
To be frank, I have become hesitant to hope while inured by the near-daily attacks on civil rights by the Trump administration via executive orders and federal policies. Over the past four years, I witnessed with pride — but also fear — as community activists tirelessly organized to combat racist policies which threatened the lives and livelihoods of my patients, my family, and the communities I serve through promotion of systematic voter disenfranchisement, codified discrimination by religion or gender identity, and relentless marginalization of communities I serve.
Since the beginning of the COVID-19 pandemic, I spend most days buried in the electronic medical record of my telehealth primary care clinic as a family medicine and preventive medicine physician-in-training. At our urban safety-net hospital, we primarily serve Black, indigenous, Latinx, and other communities of color. I scowl at the vast monetary sums that pour into politics, yet somehow never reach the front lines of public health. The $830 million spent on this historic Georgia Senate race could have easily covered the budget woes of our health system and prevented the recent closure of two of our residency clinics on the South Side of Chicago.
Intellectually, I understand the importance of those funds for purchasing air-time and direct mailings to promote voter turnout in a crucial election. Emotionally, I still feel that if those resources were invested in the community, our Mandarin- and Cantonese-speaking patients wouldn’t have to travel an hour by bus to see a physician who spoke their language. With those resources, our Black patients wouldn’t again be deprived of compassionate doctors who looked like them, which has been shown to reduce mortality as early as the newborn period. Our patients could be cared for without question, rather than be viewed with suspicion like the tragic death of Dr. Susan Moore in our neighboring state of Indiana. Despite having the credentials of a physician, even she was unable to code-switch enough for her pain to be taken seriously by the physician, ultimately leading to a possibly preventable death by COVID-19 and medical racism.
I function daily in a public county health system, whose people and mission I deeply love, but that is hampered by limitations of systemic racism in health care. For example, despite chronic budget shortfalls, I do my best to adjust insulin doses and diagnose rashes verbally over the telephone because my patients are on the forgotten end of our modern-day digital redlining amidst a global pandemic. Our lack of video calls are not because my health system won’t provide the technology, but because our patients often do not have the means to access it.
On the other hand, the private hospitals in my city have resources to send home blood pressure kits and oxygen monitors along with the video visits to high-risk patients. I regularly counsel COVID-positive patients over a scratchy phone connection, attempting to discern whether they are well enough to isolate at home. I advise others to go to the emergency room based on their symptoms alone and whether I can hear a cough or stridor in their voice, imagining their anxious family members on the other side of the line.
At the end of my afternoon clinic session, my attending asked solemnly, “Did you see the news?” I confessed that I hadn’t, my mind still lingering if I had remembered to specify “Spanish instructions” in the special notes section to the pharmacy on the last few prescriptions I sent electronically.
“You should turn it on, just to know what’s happening,” she said. “Feel free to text or call if you need anything.”
I thought, like any reasonable attending, she was prompting me to forward my questions regarding patient care. I scrolled through the front pages of the major news sites, horrified.
Mass gatherings of unmasked rioters storming the U.S. Capitol barricades. The confederate flag, fully unfurled within the halls of our temple of democracy. Lawmakers cowered under desks as quick-thinking aides ushered the nation’s uncertified electoral ballots to safety. The ramifications of death, destruction and delusions of a stolen election were now our collective reality.
Those who follow the insidious foundations of white supremacy are not surprised because these acts of violence have been seen before. Most of my patients in Chicago, like my family, are new to this country in the last generation. Some by choice; many by force. The wrath of authoritarian strong men like Trump, and their ability to incite violence while refusing to cede power, are no strangers to many from Central America, Eastern Europe, and others from the Middle East or Asian diaspora. I grew up with my parents’ stories of Ferdinand Marcos’ decades of martial law in the Philippines. Stories of disappeared journalists or activist college classmates, once distant memories, but today their echoes resonate in multiplying social media threats promoting insurrection and worse, even bolstered by then-presidential tweets.
John Lewis, the late Georgia U.S. Representative and civil rights legend, remarks in his memoir on movement building, “Freedom is not a state; it is an act. It is not some enchanted garden perched high on a distant plateau where we can finally sit down and rest. Freedom is the continuous action we all must take, and each generation must do its part to create an even more fair, more just society.”
As physicians who witness and care for patients directly affected by our continued medical apartheid, our act of freedom is to provide health care with dignity for all of our patients, regardless of ability to pay. If you are a fourth-year medical student interviewing for residencies, have you researched if your prospective institutions exclude Medicaid patients from their academic hospitals?
Our act of freedom is to pressure our medical institutions to continually question why “charity care” isn’t actually the core of their purpose as a health care system. If you are a medical resident, will you fight for your fellow trainees to rotate in federally qualified health centers or the Indian Health Service that serve one in five of the uninsured population?
Our act of freedom is to advocate through our personal networks, professional societies and elected representatives to demand equitable health care and to eliminate health disparities. Although the Biden-Harris administration has introduced a national strategy to combat COVID-19, ensuring justice within our separate and unequal health system pandemic response will not happen without a community committed to the struggle.
To all physician-advocates getting into “good trouble” — in the spirit of Congressman Lewis’s famous invocation to the movement — keep safe, keep well and keep going. We have yet to manifest freedom, but the hope for our democracy lies in the collective actions of each and every one of us.
Image credit: US Capitol by Mike Maguire licensed under CC BY 2.0.
Resident Physician Contributing Writer
Melissa Palma is an Iowa-raised daughter of Filipino immigrants and aesculapian advocate. She trained in family medicine at safety-net community health centers and is a board-certified Preventive Medicine and Public Health physician in Chicago, IL. Her writing reflects on the privileges and responsibilities we have as physicians to advance health equity for our patients and our communities. When not in clinic, you can find her reading non-fiction while nursing a taro boba tea.