Author: Jess Guh

  
As a queer woman, when it comes to film, I fulfill pretty much all of the stereotypes. I don’t really like action films. I am underwhelmed by special effects and action sequences. As my wife once complained, “All the movies you like… nothing happens in them.” My undergraduate thesis was on documentary film theory. I am, absolutely, one of those insufferable film snobs.

I love Black Panther.

Even as I state that, I feel confused. It’s just an action flick, which superficially doesn’t really have much to write home about. The acting was fine. Nothing particularly stand-out, but no cringe-worthy moments either. The action sequences were similar. Fun special effects, but really nothing revolutionary.

But of course, we all know that given the world we live in, Black Panther is so much more. The entire film is like a live-action Kehinde Wiley exhibit and it was just as emotionally powerful.

As you’re introduced to the nation of Wakanda, it’s the first time you’ve ever seen elements of African culture embedded in an empowered society. As if that were how it always was. For once, you’re not given a choice between poverty and beautiful, colorful textiles and armbands. It’s a breath of fresh air when you didn’t even know you were suffocating.

Literally, simply the setting of the film choked up my chest and brought tears to my eyes. My right foot, left arm, and whole face started tingling. Wondering if I was losing circulation, I uncrossed my legs and tried to spread out my arms. Nope. Still tingling. Those images are just that powerful. Cathartic in so many ways, I was saddened when it all came to an end. Never in my lifetime did I think that I would get to witness a white man being called “colonizer” as a joke in a mainstream, Hollywood film. There’s even a token white character who has the refreshing role of taking orders and being willing to sacrifice his life in pursuit of the greater good!

As I sat there, reveling in the images, I couldn’t help but yearn for my own version. I thought, it would be so incredible to see an Asian movie like this!

Like any good action film, it plays with larger philosophical issues in between stunts and guns. The eternal debate between liberation by “any means necessary” and non-violence is the crux of the conflict in the film. I appreciated the poignancy of N’Jadaka’s character, played by Michael B. Jordan, illustrating intergenerational trauma. It reminds us that even if we were able to miraculously stop the pervasive mass incarceration and over-policing of Black communities tomorrow, the psychological impacts would exist for generations to come.

But a third of the way through the film, I still couldn’t help but wonder to myself: “Don’t men know how to do anything besides fight and wage civil wars?” The entire conflict, climax, and resolution of the movie revolve around a battle for the throne from two men in the royal bloodline. The king is dead and the privileged but kind-hearted and wise son, T’Challa, played by Chadwick Boseman, takes his place. Just as this happens an unknown son of the bloodline, N’Jadaka (aka Erik “Killmonger” Stevens), resurfaces after being abandoned in the slums of Oakland, CA.  

In the most recent issue of Neurology, Dr. Altaf Saadi and colleagues reveal the disheartening news that African Americans and Hispanic Americans receive lower quality neurologic care than their white counterparts.

Analyzing data from the Medical Expenditure Panel Survey from 2006-2013, they found that Black patients were 30% less likely to see an outpatient neurologist even after adjusting for social factors such as insurance coverage. Hispanic patients were 40% less likely.

They looked at neurologic diseases such as stroke, headache, multiple sclerosis, Parkinson’s disease, and epilepsy. According to the CDC, strokes kill over 130,000 Americans each year, about 5% of deaths. Strokes are also the leading cause of long-term disability. Furthermore, the risk of stroke is nearly twice as high for Black Americans as opposed to whites. Yet, despite higher rates of stroke, Black Americans are seeing neurologists, the experts on strokes, less.

The authors postulate that there are likely simultaneous factors. The first factor they cite is low health literacy. Not only are patients unaware of all the possible follow up care that can prevent another stroke or minimize the impact of a recent one, folks might not even recognize the symptoms of stroke, multiple sclerosis, or Parkinson’s disease to begin with.

Folks of color are more likely to have their care across more than one healthcare system making it difficult for the primary care doctor, the emergency room doctor, the neurologist, and the hospital doctor to coordinate their care. If you live in the Southeastern United States, the number of neurologic specialists is far lower than anywhere else in the country.

And finally, the impact of implicit bias and stereotyping cannot be underestimated. Though most doctors are well intentioned and would like to be “color-blind” study after study has shown that we have also absorbed the subtle messages that society sends us that folks of color are inferior or less deserving of care. As this study points out, even at high volume specialty sites, Black and Hispanic patients get delayed care compared to whites.

But perhaps the most distressing part of this article is that time and resources were put towards it at all. We already know that Black Americans, Hispanic Americans, Asian Americans, get lower quality care and that they die younger because of it. David Hatcher, former Surgeon General reports that from 1991-2000, 880,000 excess deaths could have been averted had the health of Black Americans matched that of whites.

 While it has been mildly entertaining to watch Trump’s healthcare plan slammed by liberals and conservatives, that’s only a thin silver lining to the unconscionable piece of garbage that has been named the American Health Care Act. While conservatives have been concerned that the tax credits for insurance premiums are simply one more entitlement programs for the poor (which in it of itself is confusing as tax-funded vouchers for private schools have been a longstanding strategy for the Republicans), the reality is that the bill is actually an entitlement program for the already rich and powerful.

Healthcare analysts estimate that 10-20 million Americans will lose their health insurance under this plan. The populations that stand to lose the most? Low-income Americans, our elders, and women. What’s going unsaid is that rich men stand to gain the most.

  The American Health Care Act touts the same fiscal bullshit that has never helped the average American: deregulation and tax cuts. The fact is that tax cuts to the wealthy never “trickle down.” It’s so crazy that we even tout “trickle down” as a reasonable option. Why would we think that under-resourced Americans with the cards stacked against them should get a trickle?!

The same criticism applies to Medicaid block funding, another part of the Republican plan. Not only does Trump want to repeal the Medicaid expansion that was part of the Affordable Care Act; he wants to move to block funding of that program too. That means that states will get a hunk of money without any guidance or regulation on how it must be spent. Legislators will have free reign to redefine who qualifies for Medicaid without any accountability to make sure that our most disenfranchised communities get the coverage. People of Color, Women, those who suffer from mental illness, are wll groups that have never gotten what they deserve when getting it depends upon the goodwill of those in power.

The bottom-line is that deregulation always benefits those in power. For those white, middle-class Americans who voted for Trump because they wanted to “drain the swamp?” This is the opposite and it’s just proving what the rest of us knew all along: Donald Trump is a rich, white man and the definition of the swamp. In fact, that swamp used to be a beautiful pond until people like Trump polluted it in order to amass their fortunes.

Healthcare costs continue to be a major cause of bankruptcy. Under the Affordable Care Act, the credit amount that citizens got towards buying insurance was based on the actual cost of insurance in their local market. Under Trump’s new plan, everybody gets a flat rate voucher that is a pittance compared to actual premium costs. The result? Americans can’t afford health insurance and that only exacerbates the bankruptcy problem.

It’s the weekend after Thanksgiving and, for once, I’m not scheduled to work at the hospital. Yet, on Friday evening I found myself fastening my badge to my clothes and walking into the Intensive Care Unit.

One of my most beloved patients, Ms. Chhem is passing away. I’ve come to say goodbye. It’s not a complete surprise as she’s had serious chronic medical issues for years, but after being part of her care team for a countless number of prior hospitalizations, it’s hard to believe that this will be her last.

When I first met her five years ago, I was shocked at the number of hospitalizations she had survived. Her chart identified her as a refugee from Cambodia with significant psychological trauma, two kinds of hepatitis from poor healthcare, and end-stage kidney disease requiring dialysis three times a week. She had low health literacy, few resources and didn’t speak English. I was terrified to be the young doctor in charge of coordinating her care and keeping track of all the pieces that inevitably get lost in our complex medical system.

Of course, in real life, she was nothing like the chronically ill patient her chart suggested. Despite the physical and emotional trauma her life had brought, she was always upbeat, laughing, and ready to experience life’s next moment. Or perhaps it was because of that trauma that she learned that this was the only way to cope.

During our visits her delightful pragmatism grounded me in what otherwise seemed like an impossibly chaotic healthcare plan. Our last visit had only been only 72 hours ago. As I walked into the exam room she had erupted into laughter, jumped up, and grabbed my hands with both of hers in greeting. It was a relaxed visit. Ironically, for once I was feeling good about her medical care. All of the loose ends I had been trying to resolve had recently been tied up.

Protestors in Washington the first time the ACA was challenged

So despite being familiar with intubated patients, it was jarring to see Ms. Chhem, the same woman who just a few days ago was relating to me the hilarity of coping with recently misplaced dentures, as a patient, intubated, sedated, and surrounded by machines and IV drips. Death doesn’t impact me the way it used to when I first became a doctor, but I still choked up as I held her hand and said goodbye.

As I walked home, I reflected on how, despite all the obstacles, she had received top quality medical care in her lifetime. For Ms. Chhem, medicine did exactly what it was supposed to do: prolong and improve health to allow patients to lead more fulfilling lives.

And then my thoughts darkened. What would happen to my patients if the Affordable Care Act is repealed?

I fear its repeal. As a queer person, I fear its repeal even more than a repeal of same-sex marriage.

 
Media coverage of the Standing Rock protests against the Dakota Access Pipeline has been hopelessly myopic. Certainly environmental justice, police brutality and the violation of sacred burial grounds are important topics, but no one has addressed the larger systemic issues at play: Native American treaty rights and how their handling portends dismally for the everyone else. Even the most self-centered and politically apathetic must realize Pastor Martin Niemöller’s warning that it’s only a matter of time before even the most mainstream of society are persecuted.

To truly appreciate the full significance of the face-off at Standng Rock, one has to understand the historical context of this struggle, which has seen supporters from 300 Indian tribes lining up to back the Sioux People.

Every person in the United States has the right to clean water, but for Native Americans, that right is two-fold. The treaties that set up Indian reservations were not simply land ownership agreements. The terms actually dictated a broader set of terms. This includes not just land, but also the obligation to protect tribal property and assets; in other words, natural resources such as clean water.
  
Protectors at Standing Rock

Furthermore, the Snyder Act of 1921 delineated that the federal government is also obligated to provide health care to federally recognized tribes. While this typically takes the form of providing clinics and health insurance through Indian Health Services, ensuring clean water is obviously a basic tenant to providing basic public health care.

So when the Sioux who live on the Standing Rock Indian Reservation demand that their source of clean water is protected, it’s not simply a matter of basic human rights, but also a contractual financial obligation.

But the bigger concept at play here is that the 56.2 million acres of land that are identified as reservation land (totaling about 2% of the United States), are actually held “in trust.”

Most of us don’t know what that means. In life experience of the average American, you either own something or you don’t, but a “trust” is something in between. Some rich children have an idea. It’s similar to the “trust funds” that wealthy people set up for their children. The money is named to them and for their use, but with active management and significant restrictions on its use. Only at least with rich kids, at a certain age, the trust money usually is given to them outright and they can spend it however they see fit. That will never happen for the lands held in trust for Native Americans.

What that means on a practical level is that even if a specific tribe has rights to the land of reservation, it’s only in the setting of the high regulation from the Bureau of Indian Affairs.

Women of color have long had a love-hate relationship with white feminists. While the two groups clearly have the united goal of dismantling the patriarchy, all too often the efforts are co-opted by white women. “Wins” are typically not “wins for women” but in fact, “wins for white women.” The pro-choice movement has been no different.

However, in that dark landscape of frustration is Jan Bianchi. And though she has recently passed away, like every other unsung hero, her legacy will live on. Unlike many white feminists, her work has greatly benefited women of color.
  
Jan Bianchi, 1944-2016
 

With an increasing number of TRAP laws and the recent battle against most liberal abortion legislation in the country. Washington is also the only state that legalized abortion through popular vote rather than through legislators.

Seattle, WA — Ever since moving to Seattle it’s become clear to me that though most of its inhabitants identify as liberals, the dominant white culture enables a culture of armchair liberals. When it comes to LGBT rights, Seattle will stand up, but when it comes to addressing issues that actually threaten the comfortable, largely white and privileged population of the Seattle, it’s another story.

In 2015, the Washington State Supreme Court started fining the state government $100,000 a day for continuing to underfund K-12 public education. In 2011, after a 9-month investigation, the Civil Rights Division of the United States Department of Justice sued the Seattle Police Department for a “pattern of excessive force” that violates the US Constitution and federal law.

This year, Washington has a second chance to address police brutality and in compliance with international human rights laws.

As it currently stands, Washington has some of the most feudal police use-of force-laws in the country. It is essentially impossible to prosecute a police officer for murder. As it is currently written, Washington law states that if a police officer kills someone, as long as the cop acted “without malice and with a good faith belief that such act is justifiable,” he or she is immune from prosecution. King County Prosecutor Dan Satterberg stated, “This almost perfect defense to a mistaken use of force has kept police officers out of court as defendants.”

In fact, according to an analysis done by the SeattleTimes, from 2005 to 2014, 213 people were killed by police officers in Washington only one of whom has been prosecuted.

Earlier this year, House Bill 2907 was considered which would have struck the “malice” clause from the state law, but it wasn’t even voted on. Frustrated with the lack of action from politicians, an activist group called Washington for Good Policing have proposed Initiative-873, which if passed, will strike the “without malice and with a good faith belief” clause from state law. The initiative will need over 250,000 signatures to get placed on the ballot for general voting.

I could talk about the sanctity of queer nightclubs. Queer nightclubs are to queer civil rights as black southern churches are to black civil rights.

I could point out that Donald Trump’s asinine statements about Muslims and a radicalizing second generation are exactly the kind of ignorant bigotry that spurs these sorts of hate crimes to begin with.

I won’t though, because we all know that this has already been done and will continue to be done until this devastating event’s emotional significance is reduced to meaningless babble on repeat.

However, what has yet to come is the inevitable discussion about the mental state of Omar Mateen and the role that might have played in the shooting. Already, there is foreshadowing of this discussion as journalists report those around him describing him as “bipolar” or “erratic.”

I’m nipping it in the bud. We cannot go down that path. It’s distracting and unproductive because mass shootings are not just about mental health. Of course, mental health plays a role, but guess what plays an even larger role? GUNS.

Liberal and conservative politicians alike focus on mental health as a strategy to avoid discussing the true heart of the gun control debate. 

 
Zika has been described as extraordinary in so many ways. But the only thing that’s really extraordinary about the whole thing is how incredibly dispassionate I am about it.

At this point, even extraterrestrials have probably heard that the World Health Organization declared the recent spread of the Zika virus an international public health emergency. That sounds pretty scary. It’s only the fourth time that the WHO has ever declared a PHEIC (Public Health Emergency of International Concern) so it seems like it ought to be a big deal.

However, it’s important to keep things in perspective. As of May 4, there were 1,278 confirmed cases of microcephaly, the birth defect linked to Zika virus infection that causes an abnormally small head and brain. There are approximately 250 suspected neonatal and fetal deaths. In comparison, the last PHEIC was the Ebola virus outbreak of 2014. The current total number of reported cases of Ebola is 28,616 causing 11,310 deaths. Finally, the WHO estimates that the annual run-of-the-mill flu season – not famous epidemics like the Swine Flu – causes 250,000 to 500,000 deaths every year around the world.
  
Illuminating Graph
I understand how Zika tugs on our heartstrings. Babies are precious, innocent, and full of potential. But I would like to point out that children are also precious and worth protecting and I have yet to see a media blitz or public outcry as passionate for the over 300,000 children who suffer from physical abuse every year in the United States alone.

Women’s health advocates were uniformly jubilant on March 30, 2016 when the FDA updated its labeling for the medication, mifepristone. Mifepristone, sold under the brand name Mifeprex by Danco Laboratories, is commonly referred to as “the abortion pill.” It is used in combination in the United States with misoprostol to provide medical abortions. Medical abortions account for nearly a quarter of all abortions and over a third of all abortions before nine weeks of gestation.

Raegan McDonald-Mosley the chief medical office of Planned Parenthood described the change as “a significant step forward for science, for women, and for health care providers.” Vick Saporta, the president of the National Abortion Federation said that she was “delighted” by the change. Amy Hagstrom Miller, the president of Whole Women’s Health, the plaintiff in the case against Texas HB2, stated “[the] label change…is a significant advancement for women in the United States.”

Their elation is understandable. In an era of illegal and misleading smear campaigns and aggressive TRAP laws (“Targeted Regulation of Abortion Providers“), the FDA announcement is a welcome victory. Since 2010, states have adopted 345 abortion restrictions, an unprecedented number of assaults on women’s health.