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Harvard’s Magazine  on  the  Premedical  Experience     Editor  in  Chief    |  Ellen  Zhang  ‘19            Arts  Director  |  Jang  Lee  ‘19  

       

Staff Writers   Gulenay  Saydahmat   Lance  Johnson   Nick  DiGiovanni   Kushi  Mallikarjun   Rachel  Oshiro   Victor  Agbafe     Staff  Artists     Chinaza  Ochi     Serena  Hoost       With  Special  Thanks  to:   The  Harvard  Premedical  Society      


Prescriptions |  FALL  2016      

Note  from  the  Editor     Sharing  experiences,  ideas,  and  perspectives  is  what  drives  us  to  create,   reflect,  and  act.  In  this  issue,  your  peers  have  offered  a  part  of  themselves  for   you  to  consider.  We  are  more  than  just  students  interested  in  medicine;   rather,  we  have  formed  a  community.  Whether  that  community  was  formed   through  checking  problem  sets  in  Chem17,  participating  in  Health  Leads,  or   taking  part  in  the  Harvard  Premedical  Society,  it  is  this  community  where   we  learn,  ponder,  and  grow.  Within  these  communities,  we  are  serving  as   leaders,  collaborators,  and  actors.  So,  enjoy  this  magazine  to  take  a  look  at   what  your  peers  are  doing  and  perhaps  reflect  on  your  own  path.                                                                                                                                                                          Sincerely,                                                                                                                                                                      Ellen  Zhang  ‘19,  Editor-­‐‑in-­‐‑Chief

Prescriptions is a semesterly publication that serves as an intersection between the arts and medicine. The publication showcases student reflection on health, medicine, and insight into life as an aspiring doctor. Here, students design, write, and create distinctive pieces while sharing their own thoughts, ideas, and experiences – some relatable, each unique, and all reflective. Ultimately. Prescriptions not only aims to inspire and excite, but also strives to facilitate dialogue to create and nurture a wonderful community. Contact ezhang@college.harvard.edu for information on how to get involved! Copyright © 2016 by Prescriptions. All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher.

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Prescriptions |  FALL  2016      

TABLE OF CONTENTS | Volume 1, Issue 1 6.  Happy,  Healthy,  Harvard     Rachel  Oshiro  ‘19     9.  Put  Me  in,  Doc!     Nick  DiGiovanni  ‘19     13.  The  Impacts  of  the  Social   Determinants  of  Health     Kushi  Mallikariun    ‘19     16.  Life  Runs  Out       Serena  Hoost  ’20       17.  Health  Care  for  All:  With  a  Tiered   Caveat?   Victor  Agbafe  ’19      

22. On  Greed,  Lack  of   Professionalism,  and  Sanitation  in     Xinjiang’s  Healthcare   Gulenay  Saydahmat  ’20     23.  Into  the  Woods     Chinaza  Ochi  ’19       24.  Untitled     Chinaza  Ochi  ‘19     24.  Hieratic  Dermis     Ellen  Zhang  ‘19     26.  Listening  for  Your  Heartbeat     Lance  Johnson  ‘18    

               

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Happy Healthy  Harvard    

In front  of  the  Science  Center,  greeting  the   hordes  of  freshmen,  the  year  at  Harvard   begins  with  “Happy,  Healthy,  Harvard.”     Recently,  there  seems  to  be  a  large  increase   on  the  emphasis  to  be  mentally,   emotionally,  and  physically  healthy.     However,  what  does  it  mean  to  be  healthy?       There  are  many  types  of  healthiness,  and  no   one  seems  to  be  able  to  describe  it  in   concrete  terms.    In  the  past,  the  idea  of   health  has  varied.    Just  as  the  concept  of  the   body  was  a  changeable  idea,  the  idea  of  a   good  body  has  changed  too.    The  ancient   Greeks  saw  tension  as  the  basis  of  health,   that  one  was  only  strong  when  energetic   and  strained.    This  is  where  many  of  the   modern  notions  of  health  arise  from.     Health  is  not  something  one  has,  instead   one  must  work  for  health,  laboring  in  an   uphill  battle,  putting  in  effort  to  eat  right   and  exercise.    Health  is  not  the  normal,   equilibrium  state,  instead  it  is  the  peak  that   must  be  strived  forward.     In  Chinese  medicine,  there  was  the  concept   that  one  was  only  healthy  when  once  full  of   jingqi,  and  the  healthy  person  was  one   preserved  the  energy  such  that  noxious   winds  could  fill  the  empty  space.    This   could  be  done  through  mindfulness  and   preserving  the  spirit  within.    The  Chinese   emphasized  that  time  and  relaxation   following  the  natural  rhythms  to  maintain   health.    While  different  from  the  modern   view  of  health,  this  does  not  make  it    

necessarily wrong.    The  modern  equivalent   of  the  Chinese  view  of  health  seems  to  be   more  of  the  mental  health  model  of   mindfulness  where  one  stops  to  relax  and   take  note  of  their  surroundings  and  their   own  body.    The  recent  medical/physical   view  seems  to  still  have  clear  roots  in  that   of  the  ancient  Greeks.    This  derivation  of   where  the  ideas  of  modern  health  comes   from,  while  helpful,  still  does  not  entirely   elucidate  the  meaning  of  healthiness.    The   definition  of  health  seems  to  come  from  a   personal  viewpoint  based  on  values  and   goals.             In  modern  times  when  speaking  about   health,  people  will  espouse  the  importance   of  balance:  “balanced  diet,”  “a  balanced   schedule,”  “healthy  work-­‐‑leisure  balance.”     This  seems  counter-­‐‑intuitive  to  the  idea  of   tension  and  work  discussed  above.    Balance   is  a  natural  state,  the  definition  of   equilibrium,  and  the  negative  consequences   occur  when  there  is  an  imbalance  such  as   too  much  dessert,  too  little  exercise,  too   much  stress.    Tension,  however,  is  an   uncomfortable  state  where  one  is  fighting   and  going  against  that  which  is  natural.     Which  one  then  is  healthy:  strain  or  stasis?     Those  studying  medicine  often  forget  the   importance  of  staying  healthy  and  taking   time  for  oneself—to  work  towards  their   ideal  state  of  well-­‐‑being.    In  the  whirlwind   of  organic  chemistry,  physics,  research,   extracurriculars,  shadowing,  and   6  


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volunteering, when  does  one  have  the  time   to  think  about  self-­‐‑care?    When  is  there  time   to  go  to  the  gym?    Sleep,  what  is  this  sleep   you  speak  of?    Grabbing  a  cookie  is  much   easier  than  sitting  down  and  eating  a   sandwich.    There  simply  are  not  enough   hours  in  the  day  to  be  healthy  and  to  get   into  medical  school.         For  me,  there  is  a  point  every  semester   where  I  just  feel  overwhelmed,  like   everything  is  just  coming  at  me  all  at  once.     This  is  when  I  want  to  just  go  into  the   dining  hall  and  stuff  my  face  with  a  dozen   cookies  and  down  it  all  with  five  scoops  of   ice  cream.    Yes,  I  am  an  emotional  eater,   and  often  I  feel  like  the  sugar  in  dessert  is   the  only  thing  giving  me  energy.    After  that   splurge,  I  feel  even  more  guilty  and   stressed,  for  now  I  have  to  worry  about   either  going  to  the  gym  to  burn  off  all  the   horrible  stuff  I  just  put  in  my  body,  or  the   five  extra  inches  to  my  waistline.    This   clearly  is  an  unhealthy,  self-­‐‑inflicted  cycle   that  will  never  end  well.    For  many  pre-­‐‑ meds  though,  I  feel  that  this  is  normal  and   almost  desired.    It  seems  that  one  is  not  a   real  pre-­‐‑med  if  they  have  time  to  be   emotionally  and  physically  happy.     This  is  almost  hypocritical  considering  this   is  preparation  for  a  career  in  health  care.     Recent  studies  about  doctors  show  that   doctors  are  not  as  healthy  as  one  would   think.    The  Mayo  Clinic  in  2015  published,   “Chronic  Disease  Prevalence  and  Healthy   Lifestyle  Behaviors  Among  US  Health  Care   Professionals”  which  detailed  that  doctors    

are not  the  pinnacle  of  health  that  they   espouse.    The  study  shows  that  while   doctors  do  seem  slightly  less  at  risk  for   disease  than  the  rest  of  the  population,  they   still  have  many  of  the  diseases,  and  more   and  more  are  developing  the  diseases.     Doctors  make  unhealthy  decisions  despite   being  educated  on  the  negative   consequences.    As  the  future  doctors,  it  is   important  to  be  aware  of  this.    First,  doctors   are  not  perfect;  doctors  will  make  mistakes,   eat  pizza,  forget  to  work  out,  and  will  do   unhealthy  actions.    Second,  there  needs  to   be  an  effort  to  change  this.    Patients  cannot   take  their  own  health  seriously  if  doctors  do   not  either.    Both  of  these  must  be   considered  when  contemplating  the  path  to   becoming  a  health  practitioner.         Pre-­‐‑meds  develop  habits  that  will  carry   over  into  their  life  as  both  medical  students   and  as  doctors.    This  is  simply  a  reminder   that  health  is  an  important  aspect  of  life  and   that  the  definition  of  healthy  is  not  the  same   for  everyone.    Stay  healthy.        

Rachel Oshiro  ’19,  Staff  Writer    

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Jang Lee  ’19,  Art  Director    

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Prescriptions |  FALL  2016      

according to  team  physicians,  wouldn’t  be   able  to  play  at  “maximum  capacity”  unless   he  received  an  injection.  The  doctor  had   two  options:  1.  Obey  the  wishes  of  this   influential  coach  and  fly  to  the  team’s   headquarters  to  give  a  quick  injection  that   would  temporarily  remedy  the  ankle  until   after  the  game  (and  presumably  earn  a   handsome  sum  of  money),  or  2.  Say  no,   probably  ending  his  relationship  entirely   with  the  team  and  leaving  them  to  figure   something  out  with  another  doctor  (or   bench  the  star  athlete).    

Put me  in,  Doc!  

In  the  chaos  following  Jimmy  Garoppolo’s   recent  shoulder  injury,  Patriots’  coach  Bill   Belichick  was  grilled  by  the  media  about   whether  or  not  Garoppolo  would  be   returning  for  game  three  against  the   Houston  Texans.  After  one  reporter   wouldn’t  let  up,  persistently  asking  how   the  quarterback  situation  would  be   handled,  Belichick  said  “It’s  dependent  on   what’s  best  for  the  football  team.  The   player’s  personal  health  always  comes  first.   That’s  not  a  football  decision,  that’s  a   medical  decision…I’m  a  football  coach,  I’m   not  a  doctor.  I  coach  the  team;  the  medical   people  handle  the  injuries.  They  don’t  call   plays;  I  don’t  do  surgery.  We  have  a  great   deal  there…it  works  out  good.”  Since  the   birth  of  professional  sports,  coaches  have   been  known  to  stick  their  players  back  in   the  game  against  medical  advice,  so   hopefully  Belichick’s  noble  statement   wasn’t  just  something  his  PR  rep  told  him   to  say.  For  far  too  long  in  sports  history,   stories  have  emerged  about  professional   athletes  being  temporarily  “fixed”  by  their   team  doctors.    

The informant  weighed  his  options  for   several  hours,  considering  every  possible   factor  and  outcome.  What  bothered  him   most  was  that  this  procedure  would  never   be  his  go-­‐‑to  decision  were  this  a  normal   scenario.  The  injection  was  a  transitory  fix   that  would  undoubtedly  circle  back  to  the   original  issue  and,  in  some  cases,  even   leave  lasting  nerve  damage.  And  the   informant’s  motto  has  always  been  the   same:  “If  you’re  going  to  do  something,  do   it  right.”  So  without  anymore  thought,  he   called  back  and  said  no.   In  the  United  States,  health  care   professionals—including  the  team   physician,  the  physical  therapist,  and  the   athletic  trainer—are  faced  with  the   challenge  of  returning  athletes  to   competition  as  quickly  and  safely  as   possible.  In  countless  famous  situations   across  history—take  Ronnie  Lott  or  Curt   Schilling,  for  example—doctors  have   chosen  the  first  option  presented  above  and   seen  very  bad  outcomes.    

I was  recently  lucky  enough  to  interview  an   orthopedic  surgeon  who  presented  me  with   a  medical  dilemma.  For  the  purpose  of   identity  protection,  I’ll  keep  the  following   story  as  general  as  possible:  During  a  recent   Baseball  World  Series,  the  informant  was   asked  to  give  an  injection  to  a  superstar   player  who’d  sustained  a  bad  ankle  injury.   Said  player’s  ankle  was  in  severe  pain,  and,    

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Personally, I  would  have  chosen  the  same   option  given  the  information  I’ve  received   from  the  informant.  Why  put  another   individuals  life  or  well-­‐‑being  at  risk  for  a   sports  game?  Certainly,  some  people  may   have  a  different  approach  to  this  issue,  but   that’s  the  fascinating  part  about  medical   ethics;  the  possibilities  are  endless.    

   

Nick DiGiovanni  ‘19,  Staff  Writer    

Jang Lee  ’19,  Art  Director      

 

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Prescriptions |  FALL  2016        

Jang Lee  ’19,  Art  Director    

     

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Prescriptions |  FALL  2016      

Impact of  the  Social   Determinants  of  Health     Rosie  walked  up  to  the  Health  Leads  desk   one  cold  winter  morning  to  tell  us  that  her   house’s  heat  had  been  turned  off  the   previous  day  because  she  had  been  unable   to  pay  her  utility  bills.  Her  arthritis  was   worsening  and  her  anxiety  seemed  to   increase  without  bounds.  Rosie  sought  help   from  Health  Leads  because  it  is  a  nonprofit   organization  that  utilizes  college  volunteers   to  connect  patients  to  resources  in  their   community.  Volunteers  work  as  patient   advocates  to  help  fulfill  their  “social   determinants  of  health,”  meaning  food,   Jang  Lee  ’19,  Art  Director     transportation,  utilities,  prescription  access,   and  more.  In  Rosie’s  case,  her  immediate   The  first  time  I  heard  about  the  so-­‐‑called   need  was  her  heating  bills.  For  her,  we  were   “social  determinants  of  health,”  I  doubted   able  to  get  her  doctor  to  fax  a  letter  to  her   how  much  they   heating  company  to   “I believe that physicians and pertained  to  medicine,   turn  her  heating   back  on.  However,   hospitals should view it as their as  I  assumed  the  power   to  make  people  healthy   the  long-­‐‑term   duty to incorporate these social came  in  the  form  of  IV   problem  still  existed:   fluid,  surgery,  and  the   she  had  few   determinants of health into the prescription  of   resources  to  pay  her   utility  bills.   regular doctor’s appointment to medications.  However,   after  being  a  patient   Consequently,   ensure that all these factors are a advocate  for  more  than   Health  Leads   connected  Rosie  to   consistent part of managed care.” a  year,  I  know  now  that   the  ability  to  make   several  services  that   patients  healthy,  as  a   offered  utility  bill   future  physician,  lies  in  one’s  power  to   discounts,  helped  her  apply  for  these   know  their  complete  situation.  Knowing  a   resources,  and  sent  Rosie  home  with  new   patient’s  condition,  including  the  myriad   hope  and  the  ability  to  feel  secure  and  to   factors  that  influence  health  to  a  great   keep  her  body  healthy.    

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extent, is  usually  not  touched  upon  in  the   regular  doctor’s  visit,  as  in  Rosie’s  case.   Factors  such  as  access  to  doctors’   prescriptions,  adequate  home  heating  to   prevent  infection,  transportation  to  medical   appointments,  and  access  to  healthy  foods   often  impact  a  patient’s  health  as  much  as,   if  not  more  than,  a  physician’s  diagnoses   and  instructions.  I  believe  that  physicians   and  hospitals  should  view  it  as  their  duty  to   incorporate  these  social  determinants  of   health  into  the  regular  doctor’s   appointment  to  ensure  that  all  these  factors   are  a  consistent  part  of  managed  care.  

Carter is  able  to  call  in  to  his  work  sick,  is   able  to  take  the  week  off,  and  uses  some   resources  from  his  employer  to  get   massages  and  therapy.  He  is  referred  to  an   orthopedic  surgeon,  who  prescribes  the   medication  and  eventually  provides   surgical  treatment,  and  after  a  few  years,   his  life  is  largely  the  same  and  his  injury   has  mostly  healed.  By  contrast,  Kevin  can’t   take  time  off  of  his  job  without   relinquishing  his  wage,  doesn’t  have  any  of   the  same  workplace  resources,  has   marginal  insurance,  and  as  a  result,  does   not  heal  for  a  very  long  time.  In  a  few  years,   his  injury  has  not  gone  away,  and  he  is  in  a   much  worse  place  than  his  neighbor  across   the  street,  despite  the  exact  same  initial   condition  as  Carter.  

To see  how  much  social  determinants   matter,  imagine  two  hypothetical  men  in   their  40s,  Carter  and  Kevin,  who  live   directly  across  the  street  from  one  another.   They  are  both  in  relatively  good  health  and   I  had  always  thought  that  science  and   have  no  history  of  major  illness.  Carter   especially  medical  science  was  the   works  for  an  insurance   paramount  answer   company,  and  his   to  all  of  our   “However, I have learned that family  is  living  a  life   questions  concerning   there is much more to health where  they  can  afford   health.  After  all,   all  reasonable   logically,  a  disease  is   than what most physicians are necessities  and  desires.   a  problem  with  our   taught in college and medical Meanwhile,  Kevin  is  a   physiology,  and   foreign  refugee  who   thus,  medications   school.” works  as  a  laborer  in  a   that  shift  our   factory,  and  he  rents  a  few  rooms  in  a  home   physiology  in  the  correct  direction  should   across  from  Carter’s  house.  Kevin  and  his   leave  us  with  greater  health.  However,  I   family  make  enough  to  live  but  are  just   have  learned  that  there  is  much  more  to   staying  afloat.  If  these  two  men  undergo   health  than  what  most  physicians  are   the  same  exact  injury,  a  back  injury,  per   taught  in  college  and  medical  school.  Yes,   say,  they  will  have  radically  different  paths   patients  must  take  certain  medications  to   through  the  medical  field,  due  to  the  result   keep  them  healthy,  but  what  if  they  don’t   of  differing  social  factors  that  affect  their   have  transportation  to  get  to  the  pharmacy   health.   to  access  their  medications?  Yes,  patients    

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Prescriptions |  FALL  2016      

need antibiotics,  but  what  if  they  can’t   afford  their  utility  bill,  and  their  heat  gets   shut  off,  so  their  infection  only  gets  worse?   Yes,  doctors  need  to  tell  people  to  “eat   healthy,”  but  what  if  they  can’t  afford   healthy  foods?  The  social  determinants  that   impact  a  person’s  health  are  often  just  as   influential  in  their  prognoses  as  a  doctor’s   prescription.  As  in  the  case  of  Rosie,  her   health  would  have  been  much  more   compromised  if  her  social  determinants  of   health  were  not  taken  into  account.  For  this   reason,  physicians  of  the  future  must   endeavor  to  treat  not  only  a  person’s   disease,  but  their  entire  condition  and  social   situation  in  society  to  the  best  of  their   ability.  

         

Kushi Mallikarjun  19,  Staff  Writer                              

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Prescriptions |  FALL  2016      

                           

Essentially, this  is  an  X-­‐‑ray  image  of  a  hand  making  a  gesture.  This  gesture  is  the  symbol  of  love,  but  at   first  glance  it  also  looks  like  the  hand  is  pointing  at  something.  The  life-­‐‑supplying  arteries  of  the  hand   extend  out  into  flowers  all  around  the  hand.  These  flowers  are  backlit,  as  if  they,  too,  are  subjects  of  the  X-­‐‑ ray.  The  overall  message  is  that  while  doctors  and  researchers  focus  on  the  biology  or  pathology  of  a   patient,  we  have  to  remember  that  patients  are  grandmothers,  brothers  and  best  friends.  It  reminds  me  to   never  forget  the  personal  significance  of  preserving  a  life.                                                                            

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   Serena  Hoost  ‘20,  Staff  Artist  


Prescriptions |  FALL  2016      

or exchange  patients  due  to  the  “low  rates   [of  reimbursement]  and  administrative   burdens.”    

Healthcare For  All:  With  A   Tiered  Caveat?
  

This is  very  troubling  for  proponents,   including  myself,  who  see  the  Affordable   Care  Act  as  an  integral  piece  of  legislation   to  the  U.S.  get  on  track  to  guarantee  that  all   people  have  access  to  quality  health   insurance  while  maintaining  a  private   market  system  for  health  insurance.  The   mechanisms  of  insurance  related  to   providing  people  with  health  insurance  are   specifically  expansions  in  the  size  of   medicare  on  a  state  by  state  basis  by  raising   the  eligibility  threshold.  Hence,  this  allows   people  to  obtain  private  insurance  through   exchanges  that  can  be  subsidized.  The  issue   comes  into  place  if  certain  doctors  choose   not  to  accept  these  insurance  plans,  or  only   accept  them  for  certain  procedures  then   patients  may  have  health  insurance  but  it   will  not  provide  with  the  adequate  health   care  these  patients  need.  This  would  create   tiers  of  healthcare  in  which  those  who  have   private  insurance  would  have  access  to  a   much  larger  array  of  services  than  those   who  have  health  insurance  partially  or  fully   subsidized  by  the  government.    

When the  Affordable  Care  Act  passed  in   March  of  2010,  one  of  the  main  purposes  of   the  legislation  was  to  make  sure  that   everyone  had  access  to  affordable   healthcare.  One  of  the  main  metrics  to  use   to  measure  this  objective  is  the  uninsured   rate.  Before  the  Affordable  Care  Act  passed   in  2010,  15.7%  of  people  had  been   uninsured.  However,  in  2016  for  the  first   time  since  the  National  Health  Interview   Survey  began  keeping  track  the  uninsured   rate  fell  below  9%.  However,  although  less   people  are  uninsured  on  paper,  that  doesn’t   necessarily  mean  they  have  the  same  access   to  care.     In  recent  times,  Medicare  has  reimbursed   physicians  about  40%  of  the  full  posted   price  of  a  procedure  while  medicaid  has   reimbursed  patients  34%  less  than  medicaid   rates.  In  addition  to  this,  the  private  plans   that  individuals  obtain  from  the  Affordable   Care  Act  exchanges  according  to  early   evidence  seem  to  also  bill  substantially  less   than  the  full  posted  price.  As  a  result,  many   doctors  are  deciding  not  to  cover  patients   who  are  insured  through  these  government   programs  or  subsidized  insurance.  In  fact,   only  about  50%  of  doctors  accept  new   Medicaid  patients,  and  in  places  like  Texas   only  about  60%  of  doctors  accept  new   Medicare  patients.  In  addition  to  this,  Dr.   Bob  Russo,  the  President  of  the  Connecticut   State  Medical  Society  worries  that  many   doctors  will  decide  not  cover  new  medicaid    

As the  system  stands  now,  the  National   Health  Services  Corps  recruits  primary   physicians  who  have  just  finished  medical   school  to  provide  services  in  communities   without  significant  access  to  healthcare  in   exchange  for  student  loan  forgiveness.  This   could  possibly  serve  as  a  vector  through   which  to  treat  patients  who  would  not  fall   in  this  “first”  tier  of  healthcare.  The  main   16  


Prescriptions |  FALL  2016      

concerns with  this  type  of  system  would  be   how  to  get  the  massive  amount  of  young   doctors  needed  provide  for  patients  who   don’t  fall  in  the  top  tier,  especially  with  the   amount  of  baby  boomers  about  to  retire,   and  also  how  to  maintain  the  same  quality   of  care  for  these  patients  as  many  of  these   doctors  in  the  National  Health  Services   Corp  will  be  inexperienced.  If  the  correct   investments  and  allocation  of  resources  are   not  made  into  the  National  Health  Services   Corps  then  in  order  to  provide  people  with   adequate  health  care  there  will  need  to  be   deeper  structural  changes  to  the  employer   based  health  care  system  or  even  a  total   revamping  of  the  system  in  order  to   reorient  the  incentive  structure  for   physicians.    

a lower  standard  of  care  for  the  most   vulnerable.  So,  as  debates  over  how  to  solve   the  healthcare  issue  in  America  continue   the  focus  shouldn’t  just  be  on  the  insurance   side  but  also  on  how  to  legislate  effectively   in  order  to  help  maximize  the  optimal   allocation  of  care.    

Victor Agbafe  ’19,  Staff  Writer                  

Overall, it  is  evident  that  while  the   Affordable  Care  Act  may  be  a  very   consequential  legislative  action  that  aims  to   minimize  the  amount  of  people  without   health  care,  one  must  think  beyond  the   drop  in  the  uninsured  rate  in  order  to   gauge  how  effective  the  law  has  been  in   expanding  care.  It  would  be  effectively   meaningless  for  low  income  individuals  to   get  health  insurance  and  yet  lack  options   for  care.  To  come  up  with  a  solution  for  this   issue  would  require  a  deliberation  that   would  hopefully  include  physicians   themselves  on  what  a  fair  compensation   package  entails.  Without  such  a  push,   efforts  to  make  healthcare  accessible  will   have  left  out  the  most  important  unit  of  all   when  it  comes  to  expanding  care:  the   doctors.  This  would  end  up  turning  good   intentions  to  expand  healthcare  for  all  into    

          Sources:     http://www.forbes.com/sites/jeffreydorfman/2013/12/12/obamacare-­‐‑will-­‐‑usher-­‐‑ in-­‐‑a-­‐‑two-­‐‑tiered-­‐‑he  alth-­‐‑care-­‐‑system/#1b43d42e1b3e     http://www.npr.org/sections/health-­‐‑shots/2014/08/03/337071268/two-­‐‑doctors-­‐‑ weigh-­‐‑whether-­‐‑to-­‐‑  accept-­‐‑obamacare-­‐‑plans     http://health.usnews.com/health-­‐‑news/hospital-­‐‑of-­‐‑ tomorrow/articles/2013/10/30/top-­‐‑hospitals-­‐‑opt  -­‐‑out-­‐‑of-­‐‑obamacare     http://healthblog.ncpa.org/coming-­‐‑a-­‐‑two-­‐‑tiered-­‐‑health-­‐‑care-­‐‑ system/\  http://khn.org/news/a-­‐‑doctors-­‐‑perspective-­‐‑on-­‐‑obamacare/   http://www.gallup.com/poll/180425/uninsured-­‐‑rate-­‐‑sinks.aspx   http://www.politico.com/tipsheets/politico-­‐‑pulse/2016/09/uninsured-­‐‑rate-­‐‑falls-­‐‑ below-­‐‑9-­‐‑percent-­‐‑for  -­‐‑first-­‐‑time-­‐‑216190  http://obamacarefacts.com/uninsured-­‐‑ rates/  

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Prescriptions |  FALL  2016      

access to  healthcare.  During  the  course  of   my  time  there,  I  had  the  opportunity  to   speak  with  a  few  of  the  patients  who  came   into  our  unit.  A  significant  portion  of  the   Uyghurs  traveling  from  rural  areas  of  the   region  had  never  been  formally  schooled   and  could  therefore  never  be  expected  to   understand  what  the  surgeons  were  saying   when  they  yelled  at  them  in  Chinese  to  go   home  because  there  was  nothing  they  could   do  to  help  them.  Then,  other  Uyghurs   translated  the  message  for  them  and   explained  the  situation  at  the  hospital  to   them.  The  look  on  their  faces  when  they   realized  they  were  being  denied  care  was   heart  wrenching.      

On Greed,  Lack  of   Professionalism,  and   Sanitation  in  Xinjiang’s   Healthcare     Bright-­‐‑eyed  and  full-­‐‑hearted,  I  boarded  my   flight  for  Urumqi  one  morning  in  late  June.   Still  riding  on  the  uncontainable  joy  of   being  done  with  high  school,  I  took  the  24-­‐‑ hour  transit  head-­‐‑on  and  was  determined   to  make  the  most  of  the  unique  opportunity   I  had  before  me.  I  was  set  to  spend  the  next   month  and  a  half  shadowing  the  abdominal   surgery  department  of  the  Xinjiang  Uyghur   People'ʹs  Hospital  in  Urumqi,  the  center  of   ethnic  conflict  between  the  communist   Chinese  government  and  the  Uyghur   people  who  have  been  persecuted  and   oppressed  for  six  decades.  Despite  the   genocide  and  tense  political  situation  in  the   area,  I  decided  that  the  experience  and   being  reunited  with  my  extended  family,  all   of  whom  live  in  Xinjiang,  was  worth  the   risk.  

About a  week  after  my  arrival,  it  was   determined  that  I  was  ready  to  observe   surgery.  I  was  given  the  schedule  of   surgeries  for  the  week:  every  day,  there   were  at  least  three  surgeries  per  surgeon,  of   which  there  were  four  on  our  team  working   on  any  given  day.  At  first,  I  was  astonished   by  the  volume  of  surgeries  but  I  came  to  see   that  it  was  as  such  because  of  two  factors,   the  first  being  that  the  more  patients  you   see,  the  greater  the  number  of  surgeries  that   need  to  be  performed,  and  the  second  being   that  since  the  surgeons  were  also  the   doctors  that  saw  patients,  they  often   pushed  surgery  on  patients  by  presenting  it   as  their  only  treatment  option.  The  idea  that   surgery  should  only  be  used  as  a  last  resort   was  completely  abandoned,  though  not  for   the  lack  of  knowledge  of  other  alternatives.   In  fact,  some  of  the  professionals  I  worked   with  had  studied  in  the  United  States  and   had  gotten  their  PhDs  before  returning  to  

Two days  after  I  arrived  in  Urumqi,  my   time  at  the  hospital  began.  What  proceeded   from  that  day  forward  until  the  day  that  I   returned  to  Virginia  was  the  most  life-­‐‑ altering  period  I’ve  experienced  to  date.  I   walked  into  the  hospital  and  was  taken   aback  by  the  amount  of  people  in  there.  I   knew  that  China’s  population,  the  largest  in   the  world,  was  vastly  greater  than  the   population  of  the  United  States  but  I  had   underestimated  its  effect  on  the  quality  and    

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Prescriptions |  FALL  2016      

practice in  the  hospital,  so  not  only  were   States,  this  greed  is  reflected  in  the  fact  that   they  knowledgeable,  but  also  experienced.   there  are  many  who  do  not  see  a  specialist   However,  motivation  for  most  behaviors   because  they  simply  cannot  afford  the   can  be  traced  to  greed.  Surgeons  made  the   astronomical  costs  for  simple  check  ups   greatest  profit  for  their  time  if  they   with  a  healthcare  provider.  Pharmaceutical   performed  surgeries.  Surgeons  received   companies  have  been  known  to  increase  the   cash  bonuses  depending  on  the  number  of   price  of  vital  drugs  ten-­‐‑fold  because  they   surgeries  they  performed.  With  no  system   want  their  margins  to  be  as  large  as   in  place  to  check-­‐‑in  with  the  patients  once   possible.  This  is  all,  unfortunately,   they  received  their  surgery,  there  was  no   common.   way  to  keep  track  of  whether  the  surgery   The  lack  of  professionalism  was   was  beneficial  to  the  patient  or  not-­‐‑  even  if   astonishing.  I  had  never  heard  a  surgeon   the  surgeon  performed  it  incorrectly  or  if   scream  at  a  patient  until  I  followed  these   the  patient’s  incisions  did  not  heal  properly   surgeons.  After  the  morning  meetings,  they   or  were  infected,  it  did  not  matter  because   would  make  their  rounds  and  visit  the   at  the  end  of  the  day,  the  surgeon  had   patients  assigned  to   operated  and   them.   Motivation for most behaviors deserved  to  be   Understandably,   compensated,   can be traced to greed.” patients  were  had   regardless  of  the   questions  about  their   quality  of  their  work.     symptoms  and  the  course  of  action  that   I  began  to  reflect  on  my  experiences  after   could  be  taken  to  treat  their  condition  and   only  a  week  there  because  my  constant   naturally,  when  these  questions  arise,   shock  made  me  notice  preconceptions   patients  feel  inclined  to  ask  their  healthcare   about  the  medicine  and  healthcare  that  I   provider  about  their  opinion  and  plan  for   hadn'ʹt  even  realized  I  carried  with  me.  It   treatment.  On  most  such  instances,  the   was  then  that  I  determined  how  to  describe   surgeons  would  respond  with  some  variety   the  way  the  hospital  operated  in  three   of  “Why  do  you  ask  so  many  questions?   concise  statements:  greed,  lack  of   Can’t  you  see  I’m  busy!”    I  think  that   professionalism,  and  lack  of  hygiene.     sacrificing  quality  of  care  in  order  to  meet   with  as  many  patients  as  possible  is  the   The  greed  of  the  surgeons  was  the  least   source  of  much  of  the  skepticism  of  western   shocking  of  the  three.  Around  the  world,   medicine  amongst  Uyghurs.  This  same   there  are  a  large  number  of  people  who   situation  has  presented  itself  in  the  United   only  do  what  they  do  to  make  money  or   States,  although  not  due  to  the  sheer   maximize  their  profits,  not  because  they   amount  of  people  flowing  into  hospitals  but   enjoy  it,  and  I  cannot  pretend  these   because  of  the  paperwork  that  must  be   pressures  only  exist  in  China.  In  the  United   filled  out  and  filed  with  each  patient  that  is  

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Prescriptions |  FALL  2016      

seen. Physicians  are  spending  less  time   actually  with  their  patients  and  diagnosing   and  more  time  seated  at  desks,  behind  a   computer,  filling  out  endless  series  of   forms.  Although  these  responses  are  meant   to  protect  patients,  it  is  actually  harming   them  by  cutting  the  time  that  physicians  are   able  to  interact  with  them  to  determine  the   true  cause  of  what  is  ailing  them.  This  can   lead  to  misdiagnoses  and  prescriptions  of   "ʺquick  fix"ʺ  drugs  that  do  not  fix  the  root   problem  but  simply  address  superficial   symptoms,  such  as  prescription  of  opiate   painkillers  to  "ʺtreat"ʺ  back  pain.    

the amount  of  patients  receiving  care  in  the   many  different  wings  of  the  hospital  made   it  very  difficult  to  manage  the  waste  being   produced,  most  of  which  were  marked  as   biohazards.  However,  the  piles  of  waste  at   the  end  of  every  hall  that  would  sometimes   sit  for  weeks  seemed  potentially  dangerous,   especially  to  those  patients  who  had   compromised  immune  systems,  the  elderly,   and  the  children  that  were  walking  those   halls  every  day.  This  waste,  from  what  I   saw,  was  composed  primarily  of  used   syringes,  used  bandages  and  patient   dressings.  Even  worse  was  that  healthcare   providers  would  change  dressings  without   washing  their  hands  and  wearing  gloves.    

Potentially the  most  concerning   characteristic  of  the  hospital  was  their   overall  lack  of  hygiene.  Understandably,  

One of  the  most  upsetting  experiences  I  had   while  I  was  there  occurred  in  the   Jang  Lee  ’19,  Art  Director     operating  room,  where  surgeons   hold  the  futures  of  their  patients     in  their  hands.  While  in  the   operating  room  in  the  United   States,  typically  the  only  contact   that  surgeons  have  are  with  the   other  healthcare  providers  in  the   room  assisting  with  the  surgery.   In  this  hospital,  however,   surgeons  brought  their  phones   in  with  them  and  ensured  that   the  ringers  were  on  full  volume   in  case  they  received  a  message   or  phone  call.  On  more  than  one   occasion,  they  answered  phones   while  performing  surgery,   yelling  at  one  patient  over  the   phone  while  they  held  the  life  of   another  in  their  hands.  One  day,   an  elderly  man  came  in  

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Prescriptions |  FALL  2016      

unresponsive-­‐‑ complications  in  his   gastrointestinal  system  had  left  him  so   weak  that  he  could  no  longer  function   properly.  At  first,  the  surgeons  were  against   performing  the  surgery  because  they   assumed  he  could  not  afford  it.  Once  funds   had  been  secured,  we  went  into  an   emergency  procedure  to  save  this  man’s   life.  After  a  half  hour  into  the  surgery,  the   ringtone  that  had  become  so  familiar  over   the  course  of  my  time  at  the  hospital  began   its  fierce  cry  once  more.  As  expected,  the   surgeon  yelled  for  someone  to  bring  the   phone  to  him.  One  of  the  nurses  held  the   phone  to  his  ear  while  he  performed  this   emergency  procedure.  Never  before  have  I   witnessed  firsthand  such  blatant  disregard   for  the  well-­‐‑being  of  a  patient.  Not  only   were  these  surgeons  charging   astronomically  high  prices  for  the  surgery,   but  they  did  not  have  the  decency  or  the   respect  for  their  patients  as  people  to  pay   attention  and  do  their  very  best  to  ensure   the  success  of  the  surgery  and  protect  the   health  of  the  patient  who  has  sacrificed   everything  they  have  to  undergo  surgery  in   hopes  that  they  will  recover.    

   

Gulenay Saydahmat  ’20,  Staff  Writer      

       

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Prescriptions |  FALL  2016      

Into the Woods Chinaza Ochi  ’19,  Staff  Writer   It  is  a  gruesome  road   It  is  a  narrow,  gruesome  road  with  sharp  rocks,  wolves  and  poison  ivy   It  is  a  walk  in  the  dark  with  no  shoes  on   In  woods  that  are  cliffs   Yet  we  wander  on   Our  feet  are  cut   Arms  scratched   Eyes  burn  from  the  sweat  that  seeps  out   Blood  paints  the  night   And  we  walk  on   The  ivy  decorates  our  flesh   Bumps  and  welts  of  red   The  wolves  hunger  for  our  demise   A  chorus  of  howls,  waiting  for  the  weak  to  fall   Yet  we  wander  on   The  night  is  long   There  is  no  break   No  rest   No  water   We  are  alone   Our  shaky  breath  is  lost  in  the  roar  of  the  wind   There’s  nobody  to  hear  our  cry   The  cry  of  a  warrior   A  cry  that  says  we  won’t  be  defeated   We  will  continue  to  march  on   For  every  snag,  we  will  take  another  step   For  every  sting,  we  will  take  another  step   The  roar  of  the  deafening  wind  licks  our  wounds   The  trees  stand  for  support   The  moon  casts  a  watchful  gaze   When  the  cold  night  threatens  to  freeze  our  progress   The  fire  that  is  ignited  in  us  will  thaw  and  propel  us   Pain  may  shred  through  our  scalp   Perspiration  dot  our  vision   Hands  quake   Lips  quiver   The  journey  of  medicine  may  be  rough   But  it’s  not  impossible   We  will  make  this  journey   We  will  be  okay  

         

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Prescriptions |  FALL  2016      

Chinaza Ochi  ’19,  Staff  Artist      

 

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Prescriptions |  FALL  2016      

Article removed    

 

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Prescriptions |  FALL  2016      

Jang Lee  ’19,  Art  Director    

       

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Prescriptions |  FALL  2016      

Listening for  Your  Heartbeat   She  was  unusually  tall,  but  not  tall  enough  to  tower  over  you.  She  had  a  judging   outlook,  but  not  enough  to  be  abrasive.  She  was  affectionate  with  her  patients,  but   not  enough  to  be  unprofessional.  She  was  impatient  and  got  easily  frustrated,  but   not  enough  to  be  irritable.  She  was  encouraging,  but  not  enough  to  change   someone’s  behavior  with  just  a  few  minutes  of  talk.  She  was  confident,  but  not   enough  to  be  oblivious.  She  spoke  many  languages,  but  not  enough  to  be   understood  by  every  patient  in  the  clinic.  She  had  many  assistants,  but  not  enough   to  make  her  daily  schedule  run  smoothly.  She  asked  a  lot  of  questions,  but  not   enough  to  intimidate  you.  She  was  knowledgeable,  but  not  enough  to  make  a   woman’s  husband  love  her  again.  She  was  focused,  but  not  enough  not  to  be   distracted  by  a  toddler.  And  when  she  listened,  and  listened,  and  listened  for  a  fetal   heartbeat  in  a  radiant  would-­‐‑be  mother,  and  when  it  was  clear  to  everyone  that  the   heartbeat  had  stopped,  she  was  there  in  that  room  with  a  woman  who  was  not   destined  to  raise  a  child  she  had  imagined.  And  in  that  room,  with  that  would-­‐‑be   mother,  she  was  human,  and  that  was  enough.       Lance  Johnson  18’,  Staff  Writer      

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