FALLING THROUGH THE CRACKS

In the midst of a global pandemic, Tufts University has decided to limit students’ access to medical notes while simultaneously mandating them. According to a new policy introduced on October 1, 2021, “neither Health Services nor Counseling and Mental Health Services will provide notes to excuse ill students from midterms or final exams.” Unless Tufts removes its requirement for medical notes, this new policy will only serve to harm chronically ill and low-income students.

The administration has encouraged students to abide by class and department policies regarding missed classes and exams. In addition, they advise sick students to complete the Student Illness Notification form located on SIS. However, the October 1 email notes in bold that “the illness form does not excuse students’ absence, missed coursework, deadlines or exams.” In a period of time where we have seen firsthand how illnesses affect others, Tufts has chosen to take away the guarantee that illness will not impact students’ class performance. Faculty are encouraged—but not required—to request doctor’s notes or medical documentation. The administration seems to rely solely on the good graces of professors and students’ self-advocacy instead of providing tangible ways to ensure that students can get excused from class without academic repercussions.

Michelle Bowdler, executive director of Health and Wellness Services, said in an email that “the [new] policy does not change any practices related to Health Service’s current treatment models, with [the Dean of Student Affairs], the advising deans and others to help students with chronic or extended illness, disability, bereavement, or ongoing mental health concerns.” Instead, the policy allegedly serves to alleviate the stress on Health Services to deal with heightened numbers of students in waiting rooms

and requesting appointments to meet with a clinician. Bowdler stresses that “the needs of ill students are extreme right now and volume and acuity are high.” This is a pressing issue. Given the current climate, Tufts should put money into expanding Health Services, instead of downgrading the services it provides to students. The new policy emphasizes a “trust-based process,” according to Bowdler, and puts the decision-making between the professor and student, supposedly making room for them to devise a solution together. This solution should work for most students with kind and lenient professors. However, not every professor will abide by this new vague set of guidelines. This becomes especially worrisome when considering that certain professors could become wary of students abusing a “trust-based process.” In the end, some students will fall through the cracks—namely chronically ill and low-income students.

As a chronically ill and immunocompromised student with ulcerative colitis, an autoimmune disorder that impacts my large intestine, this new policy is especially distressing. In order to keep my faulty immune system at bay, I take medicine that suppresses my immune response. In layman’s terms, I get sick—a lot. Along with fellow students struggling with similar diseases, I require more sick days than the average student. But most professors’ absence policies do not provide enough sick days for immunocompromised students. While the Student Accessibility and Academic Resources (StAAR) Center does provide some academic accommodations for students with disabilities, medical notes have always served as a concrete exemption from class. They are a trump card: they take away the worry and pressure of missed coursework and exams while chronically ill students deal with serious medical issues.

While I appreciate that the administration has taken steps to advocate for a “trust-based system,” this sounds like instead of focusing on my health and well-being, I will end up overwhelmed thinking about missed classes and make-up exams. Undergraduate Studies Dean Carmen Lowe explained in an email to the Tufts Observer that “even with the support of an advising dean, the student needs to be involved and take an active role when it comes to planning a strategy for keeping up with academic work.” This puts all the pressure on me to communicate with advising deans and professors about my illness, resulting in increased stress and anxiety that my concerns may still get dismissed. For many chronically ill students, stress both provokes and exacerbates symptoms. In response to students who may be too ill to deal with coordinating with their professors, Dean Lowe suggested discussing other options, such as a medical leave. But for chronically ill students, taking a medical leave every time our symptoms flare is not feasible. The administration has made it clear that it falls upon students to stand up for themselves, and the last thing any chronically ill person needs is to focus on grappling for extensions while we deal with, frankly, more life-threatening matters.

Low-income students encounter different, but equally important, concerns with this new policy. Many of these students rely on Student Health Services as their primary care option. Limiting these services only further marginalizes a student population that Tufts historically has not assisted. A low-income student who prefers to stay anonymous stated “the logic of refusing to provide [medical] notes in the midst of a pandemic is unclear, especially when in-person activities are back.” They highlight an important point—Tufts should not look to limit Health Services as they strive to reopen campus. The administration cannot create a safe campus environment without also providing safety nets for students that will inevitably fall ill, whether it be from COVID-19 or another issue.

The student continued by saying, “as a first-generation student, I am still trying to navigate how to use healthcare on campus… With this policy, if I were to need a [medical] note, I would have to go to an off-campus medical office, which is frankly confusing and inconvenient, especially when one considers the transportation logistics and costs.” The administration might assume that professors will stop requiring medical notes but most students encounter at least one or two incredibly strict professors over the course of their education. It should not fall onto lowincome students to have to explain to a professor that going out of their way to get a medical note in order to prove their illness is unreasonable. At the end of the day, any policy that makes something more difficult for some students over others has no place at Tufts. For an institution that prides itself on being progressive, this policy seems antithetical to Tufts’ goals.

Chronically ill and low-income students should hold prominent positions in discussions regarding Student Health Services— not get left behind to fall through the cracks. With that being said, Health Service workers should not have to overextend themselves in order to treat the entire student population. Instead of cutting back, Tufts administration should look into expanding Health Services. Either the administration could hire more staff members or look at how other schools are managing the increase in student medical needs. Many colleges have taken advantage of the turn to telehealth in the pandemic and established partnerships with online mental and physical health platforms. This outsourcing allows schools to continue to provide quality care to students without sacrificing important responsibilities, like providing medical notes. More nurses and providers would allow for more students to both get treated and receive medical notes. If Tufts cares about student health as much as their unending stream of emails suggests, maybe they should try investing in it.