10/29/2018 0 Comments Day 3: Navigating the System Today started with another early wake up as we went to meet with two community partners who both do work concerning the issue of disparities in cancer care. After yesterday’s activities provided a more contextual look at the issues that cancer patients face, today’s information sessions had more to do with our specific issue of inequality. We made our way to the Columbia University Irving Cancer Research Center for an information session led by Karen Schmidt, who works in their Cancer Services department. Her job is to make the cancer care at the hospital as accessible to the underserved and underrepresented populations of Manhattan as possible. We learned about the different “social determinants” of health, such as different qualities of housing, food, and transportation. For example, we were asked to consider how people living in polluted areas or areas where healthy food is not accessible would be more susceptible to asthma, diabetes, and obesity, all conditions that can contribute to cancer. In order to help remedy this, Karen’s program offers free screenings, regardless of socioeconomic or immigration status. If patients are found to be in need of care and they are documented, they are offered a fast track to Medicaid coverage and begin treatment. If they are undocumented, there are partners in public hospitals that can offer treatment at no cost. However, there can still be problems even for those who are legal residents and have insurance. For example, we were reminded that in our current political climate, it is unclear if pre-existing conditions will be legally required to be covered in the near future. It was really fascinating to hear about all the diverse sets of issues that different segments of the population might face. It showed that this isn’t an easy or simple process for most people, and that there are real obstacles beyond the primary concern of beating the disease through treatment. We also heard from a representative of We Act, an environmental justice group based in Northern Manhattan. Milagros de Hoz, a health programs manager for the organization, discussed how knowledge of science and research skills can be applied to advocating and educating for safer public policies. These include a regulation We Act supported that prevents school buses from idling along curbs, so that the pollution from the exhaust is not directed towards children for long periods of time. We also spoke about how high schools need to do a better job of teaching about environmental justice issues, and there was plenty of criticism of the American high school education system to go around. Hearing about these issues way really eye opening. There are so many aspects of cancer prevention and care that it is so easy not to think about, and so many different issues that can combine to contribute to whether people get cancer and how they experience it. Continuing with the theme of different levels of access, we then took a long subway ride to Queens to the New York Presbyterian Cancer Services program. We met with Jacqueline Xouris, the head of the department, and her entire staff. Similar to the one in Manhattan, this service works with different communities in the Queens area to address specific issues such as language barriers, lack of access to healthcare information, and cultural factors that can serve as obstacles to getting screened or treated. It was emphasized to us that immigrants from places such as China, Korea, or the Dominican Republic may not speak English, and may be relying on their English speaking children to connect them to healthcare options like Cancer Services. Additionally, immigrants are more reluctant to come in for appointments due to fear of ICE raids in the area, another social factor that affects how people get healthcare. Again, it was really revealing to see just how many different issues can coalesce to influence how cancer healthcare works in these communities. It is impossible to separate problems of language, culture, income inequality, and public policy from the more scientific/medical questions of treatment. There is clearly always a need to be sensitive to the complications that each individual may face as they try to navigate this system, even if patients can be “trouble” sometimes. After a stressful sprint/walk back to the subway, we returned to the church for some very authentic homemade tacos courtesy of Shayla and Agatha, followed by an outing to Times Square. It was a great way to end the day as we split up to shop, get bubble tea, and go ice skating without telling anyone. Overall, the day was a really good mix of different informative talks, looking like idiots playing Contact on a crowded subway, and fending off an overly-friendly Spider Man. Quotes of the Day“Cancer Care inequalities start way back in inequalities in health care" - Karen Schmidt "Our first conversation with patients is always barrier assessment" - Jacqueline Xouris "Imagine being good at sports, like as a concept”- Agatha “Green veggie straws are soaked in spinach” - Shayla “I have yet to see an attractive person in New York” - Shayla “I’ve never had a city hype me up before” - Agatha “Last year for Halloween I dressed up as a sugar daddy” - Leyla
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