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Identity, Access and Health: From Nepal to Chicago | Andrew Trotter | TEDxUofIChicago


okay last one but not least so what I

okay last one but not least so what I want to talk about today is diversity so

want to talk about today is diversity so

want to talk about today is diversity so what is the significance of the labels

what is the significance of the labels

what is the significance of the labels that we put on ourselves what is the

that we put on ourselves what is the

that we put on ourselves what is the significance of the labels that are put

significance of the labels that are put

significance of the labels that are put on us from society do they have a

on us from society do they have a

on us from society do they have a relationship to us in that society and

relationship to us in that society and

relationship to us in that society and also from my perspective does it have a

also from my perspective does it have a

also from my perspective does it have a relationship to us in health and

relationship to us in health and

relationship to us in health and wellness or illness so things like

wellness or illness so things like

wellness or illness so things like gender male female transgender are we

gender male female transgender are we

gender male female transgender are we African American Latino Asian Caucasian

African American Latino Asian Caucasian

African American Latino Asian Caucasian are we single not man single are we

are we single not man single are we

are we single not man single are we married or with a partner a read avoid

married or with a partner a read avoid

married or with a partner a read avoid or widowed are we straight or

or widowed are we straight or

or widowed are we straight or heterosexual are we gay or lesbian or

heterosexual are we gay or lesbian or

heterosexual are we gay or lesbian or bisexual or any of the other sexual

bisexual or any of the other sexual

bisexual or any of the other sexual minorities are we Muslim are we Jews are

minorities are we Muslim are we Jews are

minorities are we Muslim are we Jews are we Christians or Hindus re Buddhists I

we Christians or Hindus re Buddhists I

we Christians or Hindus re Buddhists I speak English

speak English

speak English yo hablo espanol llamo v Papas ku mana

yo hablo espanol llamo v Papas ku mana

yo hablo espanol llamo v Papas ku mana poly vulture or have we been

poly vulture or have we been

poly vulture or have we been incarcerated or are we current currently

incarcerated or are we current currently

incarcerated or are we current currently in prison

in prison

in prison are we foreign-born are we american-born

are we foreign-born are we american-born

are we foreign-born are we american-born these are just a few of the many labels

these are just a few of the many labels

these are just a few of the many labels that are put on us by society but then

that are put on us by society but then

that are put on us by society but then we also label ourselves some of them are

we also label ourselves some of them are

we also label ourselves some of them are very easy and well-defined you’re either

very easy and well-defined you’re either

very easy and well-defined you’re either married partnered or you’re not or you

married partnered or you’re not or you

married partnered or you’re not or you were born in the u.s. you or not but

were born in the u.s. you or not but

were born in the u.s. you or not but things like race and even spiritual

things like race and even spiritual

things like race and even spiritual connection and religion there’s some you

connection and religion there’s some you

connection and religion there’s some you know there’s some kind of subjectivity

know there’s some kind of subjectivity

know there’s some kind of subjectivity to that and these issues really became

to that and these issues really became

to that and these issues really became an interest of mine so I’m an infectious

an interest of mine so I’m an infectious

an interest of mine so I’m an infectious disease specialist I take care of people

disease specialist I take care of people

disease specialist I take care of people living with HIV as a focus and I got

living with HIV as a focus and I got

living with HIV as a focus and I got interested in working with marginalized

interested in working with marginalized

interested in working with marginalized and underserved populations of people so

and underserved populations of people so

and underserved populations of people so you may say well what’s that really mean

you may say well what’s that really mean

you may say well what’s that really mean so these are populations of people that

so these are populations of people that

so these are populations of people that have problems accessing medical care in

have problems accessing medical care in

have problems accessing medical care in our society either because of the

our society either because of the

our society either because of the medical system or because or they are

medical system or because or they are

medical system or because or they are able to engage with healthcare but they

able to engage with healthcare but they

able to engage with healthcare but they can’t follow because of lots of problems

can’t follow because of lots of problems

can’t follow because of lots of problems so they come to the doctor once and then

so they come to the doctor once and then

so they come to the doctor once and then they disappear we can’t figure out where

they disappear we can’t figure out where

they disappear we can’t figure out where they are and so they don’t benefit from

they are and so they don’t benefit from

they are and so they don’t benefit from the health care service and and for

the health care service and and for

the health care service and and for their health and a lot of times the

their health and a lot of times the

their health and a lot of times the challenges are bilateral the patient’s

challenges are bilateral the patient’s

challenges are bilateral the patient’s face many barriers there are lots of

face many barriers there are lots of

face many barriers there are lots of issues there’s other things going on in

issues there’s other things going on in

issues there’s other things going on in their lives it’s difficult for them but

their lives it’s difficult for them but

their lives it’s difficult for them but a lot of the times the deficiency is in

a lot of the times the deficiency is in

a lot of the times the deficiency is in us the deficiency is in the healthcare

us the deficiency is in the healthcare

us the deficiency is in the healthcare system and many times the healthcare

system and many times the healthcare

system and many times the healthcare system actually places active barriers

system actually places active barriers

system actually places active barriers to prevent certain populations of people

to prevent certain populations of people

to prevent certain populations of people from accessing medical care these types

from accessing medical care these types

from accessing medical care these types of issues really became central to us

of issues really became central to us

of issues really became central to us some of my interests you may ask well

some of my interests you may ask well

some of my interests you may ask well what are different examples of these

what are different examples of these

what are different examples of these populations so I’ve worked in different

populations so I’ve worked in different

populations so I’ve worked in different countries and I work I work in urban

countries and I work I work in urban

countries and I work I work in urban settings here in Chicago so it’s a bit

settings here in Chicago so it’s a bit

settings here in Chicago so it’s a bit different but they may be racial ethnic

different but they may be racial ethnic

different but they may be racial ethnic caste minorities they mean maybe non

caste minorities they mean maybe non

caste minorities they mean maybe non English or non majority speaking

English or non majority speaking

English or non majority speaking populations they may be win women

populations they may be win women

populations they may be win women because of gender inequality they may be

because of gender inequality they may be

because of gender inequality they may be people who struggle with substance use

people who struggle with substance use

people who struggle with substance use mental health issues people that are

mental health issues people that are

mental health issues people that are homeless people that are from LGBT

homeless people that are from LGBT

homeless people that are from LGBT populations so there’s many different

populations so there’s many different

populations so there’s many different ways that you can look at these issues

ways that you can look at these issues

ways that you can look at these issues but the reality is that these identities

but the reality is that these identities

but the reality is that these identities do have links to your health and illness

do have links to your health and illness

do have links to your health and illness that are very real so let me take you

that are very real so let me take you

that are very real so let me take you back in time to the 1990s or so around

back in time to the 1990s or so around

back in time to the 1990s or so around 1995 1996 in a small suburb of a small

1995 1996 in a small suburb of a small

1995 1996 in a small suburb of a small city in Pennsylvania it’s a very

city in Pennsylvania it’s a very

city in Pennsylvania it’s a very homogeneous place so it’s all white it’s

homogeneous place so it’s all white it’s

homogeneous place so it’s all white it’s all middle-class it’s all Christian

all middle-class it’s all Christian

all middle-class it’s all Christian maybe there is one person of color and

maybe there is one person of color and

maybe there is one person of color and every year or every other year in the

every year or every other year in the

every year or every other year in the local high school there’s very few

local high school there’s very few

local high school there’s very few non-christians and there’s really no

non-christians and there’s really no

non-christians and there’s really no openly LGBT people although there’s a

openly LGBT people although there’s a

openly LGBT people although there’s a lot of gossiping going on in the school

lot of gossiping going on in the school

lot of gossiping going on in the school about different teachers and people but

about different teachers and people but

about different teachers and people but there’s nobody who’s really out there

there’s nobody who’s really out there

there’s nobody who’s really out there that’s open about it this is the place

that’s open about it this is the place

that’s open about it this is the place where I grew up so one of the things I

where I grew up so one of the things I

where I grew up so one of the things I remember the most about my child what

remember the most about my child what

remember the most about my child what kind of my high school and middle school

kind of my high school and middle school

kind of my high school and middle school was I played sports and so we would take

was I played sports and so we would take

was I played sports and so we would take trips to these games for an hour to sit

trips to these games for an hour to sit

trips to these games for an hour to sit on a bus you know talk about whatever

on a bus you know talk about whatever

on a bus you know talk about whatever you know sixteen-year-olds talked about

you know sixteen-year-olds talked about

you know sixteen-year-olds talked about and a lot of times we face teams that

and a lot of times we face teams that

and a lot of times we face teams that were from different backgrounds some

were from different backgrounds some

were from different backgrounds some that were in from urban settings in in

that were in from urban settings in in

that were in from urban settings in in the area that we were in and so they

the area that we were in and so they

the area that we were in and so they were different than us and I remember

were different than us and I remember

were different than us and I remember distinctly words that came up words that

distinctly words that came up words that

distinctly words that came up words that were used basically derogatory worms

were used basically derogatory worms

were used basically derogatory worms racist terms things I’m not going to

racist terms things I’m not going to

racist terms things I’m not going to repeat but you can probably imagine what

repeat but you can probably imagine what

repeat but you can probably imagine what they are and you know for some people

they are and you know for some people

they are and you know for some people those words came very easily but for

those words came very easily but for

those words came very easily but for other people they just allowed them to

other people they just allowed them to

other people they just allowed them to be spoken and I think that in the

be spoken and I think that in the

be spoken and I think that in the context of my community is very easy for

context of my community is very easy for

context of my community is very easy for us to not say anything and to label that

us to not say anything and to label that

us to not say anything and to label that other people as others

other people as others

other people as others so anybody different than us because

so anybody different than us because

so anybody different than us because really we had no relationship with

really we had no relationship with

really we had no relationship with people that were different from us we

people that were different from us we

people that were different from us we didn’t understand what’s going on and

didn’t understand what’s going on and

didn’t understand what’s going on and they weren’t like kind of real to us we

they weren’t like kind of real to us we

they weren’t like kind of real to us we didn’t really have any way to really

didn’t really have any way to really

didn’t really have any way to really relate to them and so it’s easy for us

relate to them and so it’s easy for us

relate to them and so it’s easy for us to do that so after I went to school I

to do that so after I went to school I

to do that so after I went to school I went to college where one distribution

went to college where one distribution

went to college where one distribution class so like a kind of we call like

class so like a kind of we call like

class so like a kind of we call like it’s kind of like a required

it’s kind of like a required

it’s kind of like a required distribution class which ended up being

distribution class which ended up being

distribution class which ended up being in Hinduism became an entire major in

in Hinduism became an entire major in

in Hinduism became an entire major in the religions of the Indian subcontinent

the religions of the Indian subcontinent

the religions of the Indian subcontinent and by the way biology because I did end

and by the way biology because I did end

and by the way biology because I did end up going to medical school eventually

up going to medical school eventually

up going to medical school eventually and so this was something I really knew

and so this was something I really knew

and so this was something I really knew nothing about except for maybe this guy

nothing about except for maybe this guy

nothing about except for maybe this guy do you guys remember him so Simpsons

do you guys remember him so Simpsons

do you guys remember him so Simpsons were very popular to me when I was

were very popular to me when I was

were very popular to me when I was growing up and this is basically what I

growing up and this is basically what I

growing up and this is basically what I knew about India in that part of the

knew about India in that part of the

knew about India in that part of the world if you don’t remember him he’s a

world if you don’t remember him he’s a

world if you don’t remember him he’s a poo he’s the kind of stereotypical

poo he’s the kind of stereotypical

poo he’s the kind of stereotypical Indian immigrant who owns the

Indian immigrant who owns the

Indian immigrant who owns the kwik-e-mart in Springfield in the

kwik-e-mart in Springfield in the

kwik-e-mart in Springfield in the Simpsons so that’s a whole discussion

Simpsons so that’s a whole discussion

Simpsons so that’s a whole discussion about what that means is that good that

about what that means is that good that

about what that means is that good that I knew something or is it not great that

I knew something or is it not great that

I knew something or is it not great that that’s what I thought it was but to to

that’s what I thought it was but to to

that’s what I thought it was but to to kind of summarize it I didn’t know very

kind of summarize it I didn’t know very

kind of summarize it I didn’t know very much so I learned a lot not just because

much so I learned a lot not just because

much so I learned a lot not just because it was religion it was kind of a very

it was religion it was kind of a very

it was religion it was kind of a very different thing than the sciences but

different thing than the sciences but

different thing than the sciences but also I learned a lot about culture and

also I learned a lot about culture and

also I learned a lot about culture and history of a place I really didn’t know

history of a place I really didn’t know

history of a place I really didn’t know anything about so I went to college then

anything about so I went to college then

anything about so I went to college then I went to medical school here in Chicago

I went to medical school here in Chicago

I went to medical school here in Chicago so I went to a

so I went to a

so I went to a came to a very diverse city was exposed

came to a very diverse city was exposed

came to a very diverse city was exposed to more diversity then went to India for

to more diversity then went to India for

to more diversity then went to India for the first time out of the first trip out

the first time out of the first trip out

the first time out of the first trip out of country then to Bolivia then to India

of country then to Bolivia then to India

of country then to Bolivia then to India again then to Namibia and southern

again then to Namibia and southern

again then to Namibia and southern Africa and then after I finished my

Africa and then after I finished my

Africa and then after I finished my infectious disease training I went to

infectious disease training I went to

infectious disease training I went to Nepal where I lived for three years and

Nepal where I lived for three years and

Nepal where I lived for three years and my focus there was taking care of people

my focus there was taking care of people

my focus there was taking care of people living with HIV in Nepal I experienced

living with HIV in Nepal I experienced

living with HIV in Nepal I experienced in my face very clearly what social

in my face very clearly what social

in my face very clearly what social marginalization was in a way that I had

marginalization was in a way that I had

marginalization was in a way that I had no concept of because of where I came

no concept of because of where I came

no concept of because of where I came from and who I was I saw people living

from and who I was I saw people living

from and who I was I saw people living with HIV be completely socially isolated

with HIV be completely socially isolated

with HIV be completely socially isolated subject his discriminate Okin

subject his discriminate Okin

subject his discriminate Okin discrimination in every aspect of their

discrimination in every aspect of their

discrimination in every aspect of their life kicked out of their village kicked

life kicked out of their village kicked

life kicked out of their village kicked out of their house lost their job

out of their house lost their job

out of their house lost their job doctors won’t touch them take care of

doctors won’t touch them take care of

doctors won’t touch them take care of them

them

them violence against them and then just very

violence against them and then just very

violence against them and then just very poor access to medical care and the

poor access to medical care and the

poor access to medical care and the thing that one of the things that was so

thing that one of the things that was so

thing that one of the things that was so offensive to me was that health care

offensive to me was that health care

offensive to me was that health care workers who were supposedly the most

workers who were supposedly the most

workers who were supposedly the most educated people in society sometimes or

educated people in society sometimes or

educated people in society sometimes or at least heavily educated in terms of

at least heavily educated in terms of

at least heavily educated in terms of schooling maybe were no different

schooling maybe were no different

schooling maybe were no different physicians would send them away

physicians would send them away

physicians would send them away we don’t take patients like you go to

we don’t take patients like you go to

we don’t take patients like you go to this hospital nurses wouldn’t take blood

this hospital nurses wouldn’t take blood

this hospital nurses wouldn’t take blood from them they wouldn’t touch them and

from them they wouldn’t touch them and

from them they wouldn’t touch them and it was very unfortunate because because

it was very unfortunate because because

it was very unfortunate because because of the chronic neglect both from the

of the chronic neglect both from the

of the chronic neglect both from the social and cultural aspect but also from

social and cultural aspect but also from

social and cultural aspect but also from the medical system many of the patients

the medical system many of the patients

the medical system many of the patients became what came to us were so advanced

became what came to us were so advanced

became what came to us were so advanced in their disease when really what we

in their disease when really what we

in their disease when really what we could do for them was treat them like a

could do for them was treat them like a

could do for them was treat them like a human being

human being

human being and nobody did and this kind of

and nobody did and this kind of

and nobody did and this kind of environment really showed me what this

environment really showed me what this

environment really showed me what this kind of marginalization could really be

kind of marginalization could really be

kind of marginalization could really be and it was very hard for me because I

and it was very hard for me because I

and it was very hard for me because I was never confronted with that and I

was never confronted with that and I

was never confronted with that and I felt alone because everyone else kind of

felt alone because everyone else kind of

felt alone because everyone else kind of did it there weren’t very many people

did it there weren’t very many people

did it there weren’t very many people where that were champions for this

where that were champions for this

where that were champions for this population of patients and it was very

population of patients and it was very

population of patients and it was very frustrating and and discouraging and

frustrating and and discouraging and

frustrating and and discouraging and some of the young people here may say

some of the young people here may say

some of the young people here may say well how is this possible like we’re

well how is this possible like we’re

well how is this possible like we’re it’s 2017 how can people be acting like

it’s 2017 how can people be acting like

it’s 2017 how can people be acting like this in this day and age HIV is not that

this in this day and age HIV is not that

this in this day and age HIV is not that big of a deal but those of you that are

big of a deal but those of you that are

big of a deal but those of you that are older

older

older you that that exact same thing happened

you that that exact same thing happened

you that that exact same thing happened here in the 1990s and only after law and

here in the 1990s and only after law and

here in the 1990s and only after law and a lot of activism and other things in

a lot of activism and other things in

a lot of activism and other things in our society here have things changed

our society here have things changed

our society here have things changed kind of because what I’ll tell you is

kind of because what I’ll tell you is

kind of because what I’ll tell you is that it still exists here I still take

that it still exists here I still take

that it still exists here I still take care of patients who face this issue

care of patients who face this issue

care of patients who face this issue it’s not in your face because it’s

it’s not in your face because it’s

it’s not in your face because it’s illegal but physicians will refer them

illegal but physicians will refer them

illegal but physicians will refer them to other people

to other people

to other people for services which they could provide

for services which they could provide

for services which they could provide but they don’t under the guise of kind

but they don’t under the guise of kind

but they don’t under the guise of kind of a referral to another professional so

of a referral to another professional so

of a referral to another professional so those types of issues happen and in fact

those types of issues happen and in fact

those types of issues happen and in fact in 2013 there were two cases seen by the

in 2013 there were two cases seen by the

in 2013 there were two cases seen by the Department of Justice about patients in

Department of Justice about patients in

Department of Justice about patients in the United States who were refused

the United States who were refused

the United States who were refused healthcare one doctor actually the

healthcare one doctor actually the

healthcare one doctor actually the patient said the doctor actually said to

patient said the doctor actually said to

patient said the doctor actually said to them I don’t take care of patients like

them I don’t take care of patients like

them I don’t take care of patients like you so this still exists and so you

you so this still exists and so you

you so this still exists and so you don’t have to go to some other place but

don’t have to go to some other place but

don’t have to go to some other place but it’s actually something that we see and

it’s actually something that we see and

it’s actually something that we see and to me HIV was kind of a form an

to me HIV was kind of a form an

to me HIV was kind of a form an expression of a type of identity that

expression of a type of identity that

expression of a type of identity that the patient had sure there’s medical

the patient had sure there’s medical

the patient had sure there’s medical issues they have a positive antibody

issues they have a positive antibody

issues they have a positive antibody test of a la blah blah blah blah but

test of a la blah blah blah blah but

test of a la blah blah blah blah but within the context of society there were

within the context of society there were

within the context of society there were implications of being HIV positive that

implications of being HIV positive that

implications of being HIV positive that affected them just like there was

affected them just like there was

affected them just like there was aspects of them being Dalit or an

aspects of them being Dalit or an

aspects of them being Dalit or an untouchable or being in a non Nepali

untouchable or being in a non Nepali

untouchable or being in a non Nepali speaking language person or a woman or a

speaking language person or a woman or a

speaking language person or a woman or a transgender so to me I saw kind of in

transgender so to me I saw kind of in

transgender so to me I saw kind of in that way and I wanted to just take a

that way and I wanted to just take a

that way and I wanted to just take a second to explain it in this way so this

second to explain it in this way so this

second to explain it in this way so this is an example of how HIV stigma affects

is an example of how HIV stigma affects

is an example of how HIV stigma affects people living with HIV anywhere and I

people living with HIV anywhere and I

people living with HIV anywhere and I wanted to explain it because I think

wanted to explain it because I think

wanted to explain it because I think this is an example that really relates

this is an example that really relates

this is an example that really relates to all these types of identity because

to all these types of identity because

to all these types of identity because it’s complicated it’s not just about

it’s complicated it’s not just about

it’s complicated it’s not just about medicine it’s about the social and

medicine it’s about the social and

medicine it’s about the social and cultural aspects so people with HIV or

cultural aspects so people with HIV or

cultural aspects so people with HIV or people that are part of different risk

people that are part of different risk

people that are part of different risk groups like sex worker or sexual

groups like sex worker or sexual

groups like sex worker or sexual minorities people that have substance

minorities people that have substance

minorities people that have substance use issues or even just women because

use issues or even just women because

use issues or even just women because there’s such huge gender inequality

there’s such huge gender inequality

there’s such huge gender inequality issues in many parts of the world they

issues in many parts of the world they

issues in many parts of the world they all are subject to stigma and for some

all are subject to stigma and for some

all are subject to stigma and for some of these risk groups like for women for

of these risk groups like for women for

of these risk groups like for women for instance it’s like what people would say

instance it’s like what people would say

instance it’s like what people would say it’s like it’s double stigma dr. Andrew

it’s like it’s double stigma dr. Andrew

it’s like it’s double stigma dr. Andrew it’s not just that I have HIV but I’m a

it’s not just that I have HIV but I’m a

it’s not just that I have HIV but I’m a woman how am I supposed to deal with

woman how am I supposed to deal with

woman how am I supposed to deal with this with both of those things and so

this with both of those things and so

this with both of those things and so people would say it’s like

people would say it’s like

people would say it’s like double and triple discrimination because

double and triple discrimination because

double and triple discrimination because of these issues so they’re subjected to

of these issues so they’re subjected to

of these issues so they’re subjected to stigma within society

stigma within society

stigma within society this creates vulnerability to violence

this creates vulnerability to violence

this creates vulnerability to violence to isolation to stink to stigmatization

to isolation to stink to stigmatization

to isolation to stink to stigmatization discrimination and everything i heard

discrimination and everything i heard

discrimination and everything i heard all every kind of discrimination can

all every kind of discrimination can

all every kind of discrimination can think of was possible and also poor

think of was possible and also poor

think of was possible and also poor access to health services and not just

access to health services and not just

access to health services and not just poor access but poor health care they

poor access but poor health care they

poor access but poor health care they had poor when they did finally see

had poor when they did finally see

had poor when they did finally see someone that we could see them they

someone that we could see them they

someone that we could see them they weren’t even providing really the

weren’t even providing really the

weren’t even providing really the minimum so the actual quality of their

minimum so the actual quality of their

minimum so the actual quality of their health care is poor this all these

health care is poor this all these

health care is poor this all these societal things can then contribute to

societal things can then contribute to

societal things can then contribute to poor emotional and psychological

poor emotional and psychological

poor emotional and psychological well-being then it can predispose them

well-being then it can predispose them

well-being then it can predispose them to further risky behaviors that then

to further risky behaviors that then

to further risky behaviors that then again predisposes them to other risk

again predisposes them to other risk

again predisposes them to other risk factors they become marginalized

factors they become marginalized

factors they become marginalized socially economically legally and this

socially economically legally and this

socially economically legally and this can all relate to poverty because they

can all relate to poverty because they

can all relate to poverty because they lose their job and other things and then

lose their job and other things and then

lose their job and other things and then ultimately poor health for me this is an

ultimately poor health for me this is an

ultimately poor health for me this is an example with HIV because HIV is close to

example with HIV because HIV is close to

example with HIV because HIV is close to my heart those are the patients I take

my heart those are the patients I take

my heart those are the patients I take care of but all these other kinds of

care of but all these other kinds of

care of but all these other kinds of ideas about identity I think are very

ideas about identity I think are very

ideas about identity I think are very similar the circles may be filled in

similar the circles may be filled in

similar the circles may be filled in with a little bit different words and

with a little bit different words and

with a little bit different words and the pathways may be a little bit

the pathways may be a little bit

the pathways may be a little bit different but it’s complicated it issued

different but it’s complicated it issued

different but it’s complicated it issued it’s with cultural social all these

it’s with cultural social all these

it’s with cultural social all these different issues are there and the thing

different issues are there and the thing

different issues are there and the thing about is is it’s not about just the

about is is it’s not about just the

about is is it’s not about just the identity in Crystal Society today it’s

identity in Crystal Society today it’s

identity in Crystal Society today it’s also about the past and acknowledging

also about the past and acknowledging

also about the past and acknowledging the historical issues that come with

the historical issues that come with

the historical issues that come with these identities so for instance there’s

these identities so for instance there’s

these identities so for instance there’s this so I don’t know if any of you

this so I don’t know if any of you

this so I don’t know if any of you recognize this picture this is a picture

recognize this picture this is a picture

recognize this picture this is a picture of the Tuskegee experiments which were a

of the Tuskegee experiments which were a

of the Tuskegee experiments which were a public health initiative that was

public health initiative that was

public health initiative that was sponsored by the federal government in

sponsored by the federal government in

sponsored by the federal government in the 1930s to 1970s in which

the 1930s to 1970s in which

the 1930s to 1970s in which african-american men in the south who

african-american men in the south who

african-american men in the south who had syphilis which is a chronic disease

had syphilis which is a chronic disease

had syphilis which is a chronic disease that has you know in the long term as

that has you know in the long term as

that has you know in the long term as very debilitating side of side effects

very debilitating side of side effects

very debilitating side of side effects and can be actually lethal of n they

and can be actually lethal of n they

and can be actually lethal of n they were basically followed to see what

were basically followed to see what

were basically followed to see what happens when you’re not treated for

happens when you’re not treated for

happens when you’re not treated for syphilis so even though this the

syphilis so even though this the

syphilis so even though this the penicillin was discovered in the 1940s

penicillin was discovered in the 1940s

penicillin was discovered in the 1940s they weren’t given penicillin

they weren’t given penicillin

they weren’t given penicillin so we could study what

so we could study what

so we could study what since this type of issue is still in the

since this type of issue is still in the

since this type of issue is still in the mind of patients of mine from the

mind of patients of mine from the

mind of patients of mine from the southside of Chicago that I take care of

southside of Chicago that I take care of

southside of Chicago that I take care of a certain generation of why they look at

a certain generation of why they look at

a certain generation of why they look at me and kind of are like okay and it

me and kind of are like okay and it

me and kind of are like okay and it takes time there’s trust there’s other

takes time there’s trust there’s other

takes time there’s trust there’s other things that are there and it’s because

things that are there and it’s because

things that are there and it’s because we have to understand the roots of these

we have to understand the roots of these

we have to understand the roots of these issues so the identity issues are so

issues so the identity issues are so

issues so the identity issues are so complicated it’s not just about the kind

complicated it’s not just about the kind

complicated it’s not just about the kind of graph those issues going on now

of graph those issues going on now

of graph those issues going on now but it’s also about what’s happened

but it’s also about what’s happened

but it’s also about what’s happened before and where that because that that

before and where that because that that

before and where that because that that that affects people’s collective

that affects people’s collective

that affects people’s collective understanding not just themselves passed

understanding not just themselves passed

understanding not just themselves passed from generation to generation but also

from generation to generation but also

from generation to generation but also the communities the other thing that’s

the communities the other thing that’s

the communities the other thing that’s interesting is that there’s bias that

interesting is that there’s bias that

interesting is that there’s bias that happens bias related to these ideas of

happens bias related to these ideas of

happens bias related to these ideas of identity so there’s things like explicit

identity so there’s things like explicit

identity so there’s things like explicit and implicit bias so explicitly is is

and implicit bias so explicitly is is

and implicit bias so explicitly is is very easy to understand explicit bias is

very easy to understand explicit bias is

very easy to understand explicit bias is a bias that you have or someone has

a bias that you have or someone has

a bias that you have or someone has that’s consciously there you know it you

that’s consciously there you know it you

that’s consciously there you know it you don’t like green things or you like

don’t like green things or you like

don’t like green things or you like yellow or whatever it’s very clear to

yellow or whatever it’s very clear to

yellow or whatever it’s very clear to you it’s conscious so for instance

you it’s conscious so for instance

you it’s conscious so for instance during that same period of time this is

during that same period of time this is

during that same period of time this is a example of explicit bias this was a

a example of explicit bias this was a

a example of explicit bias this was a sign in Detroit Michigan in the 1940s

sign in Detroit Michigan in the 1940s

sign in Detroit Michigan in the 1940s from a white community saying basically

from a white community saying basically

from a white community saying basically we don’t want anybody but white people

we don’t want anybody but white people

we don’t want anybody but white people here this is a white community we don’t

here this is a white community we don’t

here this is a white community we don’t want any of you other people this is a

want any of you other people this is a

want any of you other people this is a clear public display of explicit bias

clear public display of explicit bias

clear public display of explicit bias now you may say again well that’s back

now you may say again well that’s back

now you may say again well that’s back then but I think all of your knows

then but I think all of your knows

then but I think all of your knows that’s not really what’s going on

that’s not really what’s going on

that’s not really what’s going on because you watch the news and listen to

because you watch the news and listen to

because you watch the news and listen to what people are saying and really now

what people are saying and really now

what people are saying and really now it’s just being replaced by a different

it’s just being replaced by a different

it’s just being replaced by a different message to another group of people

message to another group of people

message to another group of people this is a modern example in 2017 of

this is a modern example in 2017 of

this is a modern example in 2017 of explicit bias directed towards a certain

explicit bias directed towards a certain

explicit bias directed towards a certain group of people in our country so these

group of people in our country so these

group of people in our country so these things are not new and I don’t think

things are not new and I don’t think

things are not new and I don’t think that they’re going to go away but I

that they’re going to go away but I

that they’re going to go away but I think it’s important for us to

think it’s important for us to

think it’s important for us to understand these things and what’s

understand these things and what’s

understand these things and what’s interesting is it’s not just about

interesting is it’s not just about

interesting is it’s not just about explicit bias it’s also about implicit

explicit bias it’s also about implicit

explicit bias it’s also about implicit bias implicit biases bias that affects

bias implicit biases bias that affects

bias implicit biases bias that affects our judgment and behavior but we don’t

our judgment and behavior but we don’t

our judgment and behavior but we don’t consciously under theirs very

consciously under theirs very

consciously under theirs very interesting studies in health care about

interesting studies in health care about

interesting studies in health care about this because it’s found been

this because it’s found been

this because it’s found been that implicit bias affects our behavior

that implicit bias affects our behavior

that implicit bias affects our behavior not just the practitioner but also the

not just the practitioner but also the

not just the practitioner but also the patient and when the relationship

patient and when the relationship

patient and when the relationship between the two is so important that is

between the two is so important that is

between the two is so important that is a really big issue so this was a study

a really big issue so this was a study

a really big issue so this was a study that was in 2010 of first-year medical

that was in 2010 of first-year medical

that was in 2010 of first-year medical students and it looked at their implicit

students and it looked at their implicit

students and it looked at their implicit and explicit bias against gay and

and explicit bias against gay and

and explicit bias against gay and lesbian individuals and the interesting

lesbian individuals and the interesting

lesbian individuals and the interesting thing is that no matter what they said

thing is that no matter what they said

thing is that no matter what they said as far as if they have explicit implicit

as far as if they have explicit implicit

as far as if they have explicit implicit bias this barred line is their level of

bias this barred line is their level of

bias this barred line is their level of implicit bias so it was the same

implicit bias so it was the same

implicit bias so it was the same regardless of the viewer conscious of

regardless of the viewer conscious of

regardless of the viewer conscious of that bias or not very similarly they had

that bias or not very similarly they had

that bias or not very similarly they had similar bias and so the idea is that how

similar bias and so the idea is that how

similar bias and so the idea is that how do we understand these biases and the

do we understand these biases and the

do we understand these biases and the reality is from my perspective I think

reality is from my perspective I think

reality is from my perspective I think of this from a medical standpoint but

of this from a medical standpoint but

of this from a medical standpoint but this is a societal issue this is about

this is a societal issue this is about

this is a societal issue this is about all of us and how we interact with each

all of us and how we interact with each

all of us and how we interact with each other because after all healthcare is

other because after all healthcare is

other because after all healthcare is made done by people people that have

made done by people people that have

made done by people people that have biases we have sin sometimes their

biases we have sin sometimes their

biases we have sin sometimes their systems of injustice but also the

systems of injustice but also the

systems of injustice but also the individuals like physicians are in a

individuals like physicians are in a

individuals like physicians are in a position where they can block and access

position where they can block and access

position where they can block and access and allow different accesses to services

and allow different accesses to services

and allow different accesses to services health care and all sorts of things and

health care and all sorts of things and

health care and all sorts of things and so these types of biases are very

so these types of biases are very

so these types of biases are very important so I feel lucky in a way

important so I feel lucky in a way

important so I feel lucky in a way because I’ve been able to work in a

because I’ve been able to work in a

because I’ve been able to work in a position with communities where I feel

position with communities where I feel

position with communities where I feel like I can try to work with these issues

like I can try to work with these issues

like I can try to work with these issues I can serve communities that deal with

I can serve communities that deal with

I can serve communities that deal with these issues and there’s disparities and

these issues and there’s disparities and

these issues and there’s disparities and I also find I’ve learned the power of

I also find I’ve learned the power of

I also find I’ve learned the power of teaching medical students residents

teaching medical students residents

teaching medical students residents fellows because they will be the future

fellows because they will be the future

fellows because they will be the future of our healthcare system and a lot of

of our healthcare system and a lot of

of our healthcare system and a lot of these issues like bias you have to be

these issues like bias you have to be

these issues like bias you have to be conscious of the first step is being

conscious of the first step is being

conscious of the first step is being conscious of it and then you can

conscious of it and then you can

conscious of it and then you can understand oh you know it’s weird I was

understand oh you know it’s weird I was

understand oh you know it’s weird I was busy and I made I did this thing but

busy and I made I did this thing but

busy and I made I did this thing but maybe that was maybe that was kind of

maybe that was maybe that was kind of

maybe that was maybe that was kind of off why did I do that but I think that

off why did I do that but I think that

off why did I do that but I think that the issues of identity and and diversity

the issues of identity and and diversity

the issues of identity and and diversity that I talked about today have a larger

that I talked about today have a larger

that I talked about today have a larger context because a lot of these issues I

context because a lot of these issues I

context because a lot of these issues I think of from a medical context but are

think of from a medical context but are

think of from a medical context but are really a societal issue and I think that

really a societal issue and I think that

really a societal issue and I think that those issues are very important because

those issues are very important because

those issues are very important because what do we think about diversity I mean

what do we think about diversity I mean

what do we think about diversity I mean let’s turn on the TV and listen to what

let’s turn on the TV and listen to what

let’s turn on the TV and listen to what people have been saying for the last six

people have been saying for the last six

people have been saying for the last six or eight months

or eight months

or eight months whatever do we believe that diversity

whatever do we believe that diversity

whatever do we believe that diversity and identity is a positive thing in our

and identity is a positive thing in our

and identity is a positive thing in our society or do we believe that this is

society or do we believe that this is

society or do we believe that this is something that separates each other and

something that separates each other and

something that separates each other and how are we going to deal with these

how are we going to deal with these

how are we going to deal with these things and I think that the question

things and I think that the question

things and I think that the question really is to you you are part of this

really is to you you are part of this

really is to you you are part of this society in this this country as well

society in this this country as well

society in this this country as well what do you think about diversity and

what do you think about diversity and

what do you think about diversity and identity do you think that diversity and

identity do you think that diversity and

identity do you think that diversity and identity and those types of issues are

identity and those types of issues are

identity and those types of issues are something that we should that strengthen

something that we should that strengthen

something that we should that strengthen us that that really bind us together as

us that that really bind us together as

us that that really bind us together as humans because in the end seeing across

humans because in the end seeing across

humans because in the end seeing across diversity is about seeing our collective

diversity is about seeing our collective

diversity is about seeing our collective humanity or is it just something that

humanity or is it just something that

humanity or is it just something that will accentuate our differences from one

will accentuate our differences from one

will accentuate our differences from one another okay I’m done

another okay I’m done

another okay I’m done [Applause]

”

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