interviews
Call It What It Is
by LaShyra Nolen
July 1, 2020
This interview with LaShyra Nolen, Harvard medical student, and the first Black woman to become class president, was conducted and condensed by franknews.
frank | You've written and spoken about your experience within a dual reality – of being both a medical student at Harvard, and a person committed to your own identity and equity.
LN | The dual reality is you're training at the best medical school in the world, but there is so much suffering going on in your community. And whatever knowledge you gain still isn't going to necessarily translate to the improvement of the condition of Black people. For example, I could go on to become the best surgeon in the world. I could save the life of a Black patient. But they can go outside, drive home, get stopped by a police officer, move too fast, and get killed.
That is the dual reality. You're learning, but you're not necessarily getting to the root cause of the suffering of your people.
You always have to think about it from both of those perspectives, that of a student and that of a Black person in America.
In addition, you go into class and you are expected to maintain professionalism. You are expected to just talk about the science and to talk about the assignment at hand – when that same morning you watched yet another police lynching of a Black man. You're trying to deal with those emotions, and you have no idea how it's going to be taken if you say, "Hey guys, I'm really not doing that well. Another Black man was killed. Racism is pervasive in our country and we're all complicit in it." It is a challenge that all Black professionals have. You have to walk in and put on this face, even though internally you are dealing with the turmoil and hurt of your community.
What does this moment feel like at Harvard, as a student?
As a medical student, I feel like I can speak out more than my mentors or faculty members who are more ingrained into the system of medicine. Academic medicine is very hierarchical. The higher up you go, the more you have your hands tied, and you can't speak as much truth because you're trying to move up to an associate professor position so that you can finally start to use your voice. I know that there's a risk that comes with speaking up, but I, personally, can no longer just pretend like everything's okay, and allow people to continue to suffer in silence. Even the most brilliant people have been complicit in racism, and some of them genuinely have never even thought about it.
They've grown up in a bubble, their entire lives, and all this is happening and they're just like,
"Oh my gosh, I'm a good person. I'm not racist." And you kind of have to be like, "No, but you really are though."
These brilliant people who are excellent in their field, are just now realizing they're complicit in this system.
Again, I am happy that's occurring, but I'm always just like, look how much it took for us to get here. NASCAR is just now removing the Confederate flag. Suddenly now I have Juneteenth popping up on my Google calendar. I'm like, what?
My classmates and professors have really been amazing actually. We are all from different backgrounds. Some are fourth-generation physicians, and some grew up on reservations and are bringing medicine to indigenous folks. All of them realize that the system needs to change, and they have been so supportive. Beyond just talking the talk and posting the black box on Instagram, they've been reaching out to me saying, “Here are the notes from class today. I got this recording for you because I know you've been putting in work on the advocacy front.” That's true allyship to me. I've really been pleasantly surprised and happy to see the support that I've gotten from my classmates.
There has been a widespread acknowledgment that COVID is affecting communities and people of color at much higher rates. I am curious if you think there has been an appropriate conversation around why that’s the case?
I think that in order to understand that we have to look at our history, and at policy. The original ill was, of course, chattel slavery. This country has not valued Black lives. The policy reflects that, and policy ties into our healthcare. That history of systemic discrimination is important to look at to examine the current landscape of COVID-19.
Redlining decided where people live in this country, and which communities our government and our local city councils were going to invest in. Black communities were not invested in. As a result, Black communities have not had access to the basic resources that they need to survive and thrive. They don't have access to healthy food. They don't have access to safe places to exercise. They are exposed to environmental pollution. They have less access to education. I mean, then you look at who is more likely to be an essential worker - Black people are overrepresented.
It doesn't end there. Once people get into the clinic, they have to deal with the biases and systemic racism in the hospital system. There are studies that have shown there are medical students and residents who still think that Black people have a higher pain tolerance.
We can take maternal mortality as an example of treatment differences. Black women, at all income levels, are dying disproportionately compared to white women. When they get to the hospital, doctors don’t believe their pain. I mean, it happened to Serena Williams. It is safer for Black women to not engage with the healthcare system because of the violence and harm it causes.
How do you think mistrust of the medical system compounded the COVID crisis?
I think it all comes back to this conversation of access, right? When COVID-19 first hit, the testing centers were predominantly located in affluent communities, and a lot of Black communities were left without access to testing. The lack of Black physicians and Black health care professionals means that when Black patients come in and say they have COVID-19 symptoms, they are less likely to get treatment compared to white people.
If you know there are no testing centers in your neighborhood, you know there is no representation in the hospital, and you know that you are going to be discriminated against once you walk in that door, you know your life is being devalued. That knowledge prevents Black people from seeking care from our healthcare system. With anecdotes of horror coming from your community, of course you are going to be nervous to trust the healthcare system.
What does a better understanding of investment into public health look like to you?
I think we need to turn all of the conversations that we've been having into public health initiatives. Racism was declared a public health emergency in Boston. That is the direction I think we should be moving in.
We need to move beyond equality to think about equity. We need to recognize that not everyone is on the same playing field. We need to truly make sure everyone's specific situation is taken into consideration. We do that by investing in those communities, and by looking at how we make sure they have access to good education, access to health care, access to housing, access to good food. Improving the conditions where people live, work, pray, play will improve their healthcare outcomes and our healthcare system.
Of course, we need things like the physical exam, but often patients go into that physical exam with preexisting chronic diseases caused by disparate suffering. Going as upstream as possible will lead to better healthcare outcomes and in the long run, improve healthcare costs. Even if investing in public health didn't improve healthcare costs, I still think that it's the moral thing to do. I think we're too driven by what's going to save money in our country. We need to do what's right.
Everyone deserves to have the basic resources they need, to live out a viable, joyous life. Right now we are doing nothing to guarantee that.
Someone said to me once, we’re too focused on raising the ceiling and not at all focused on raising the floor in the American healthcare system. Do you feel like this starts as a medical student?
I can definitely speak to that culture. As a medical student, I'm really passionate about community activism. I am passionate about making sure that everyone has access to healthcare, and ensuring that we're teaching medical students anti-racism so that they don't go out and further harm communities. I can spend two years doing that – serving on committees, writing up reports, and changing curriculum at my institution. But my peers who are spending the same time publishing papers on very specific proteins and disease processes might have a better chance at residency.
In medicine, you're not incentivized to do work that you don't get credit for. You always want to be able to publish, and activism isn't always publishable.
It has been the responsibility of Black students, students of color, and indigenous folks to improve their institution. They do the work so that they can thrive and survive, and so the next generation can do the same. But at the same time, they still have to do everything they have to do as a medical student to get to the next level. I'm literally trying to improve the very environment that I'm suffocating in, while also trying to handle everything else that medical students are expected to.
There was a letter early on from public health officials advocating for protest as it’s needed to fight racism within the healthcare system. Does that feel new or was it already a part of the conversation?
I think it's always been a part of the conversation for those who have been oppressed.
But that is what is special about this moment. We literally had a global pandemic that exposed the disparate suffering of Black people across the country, across the globe. And then on top of that, you have back to back to back killings of Black people. It's heartbreaking that it took this much for us to start having these conversations, but we are having them, and people can’t run away from them.
There are no distractions. We're not going to get anywhere if people don't name systemic racism for what it is.
We need to say Ahmaud Arbery. We need to say Breonna Taylor. We need to say their names, and we need to name the issue at large.
Big-name organizations are just finally starting to realize that this is something that they need to get on board with. It’s hard to know if it's really genuine or not. I think that people don't want to be on the wrong side of history. Regardless, learning is still happening. I'm very happy that anti-racism is becoming the status quo and that we are having these conversations. We need to continue to push the envelope to get people things they need to live a good life.
interviews
In Conversation with Hannah Teicher
by Hannah Teicher
May 31, 2018
How did the path you're on now begin?
By 2014, things had transitioned in the sustainability field towards an emphasis on climate change. I did a project looking at how the real estate industry in Boston was adapting, or if they were, because it seemed like city governments weren't doing enough. And it seemed like real estate companies should have major vested interest in doing something.
They seemed to be doing something, but still just the bare minimum, the low hanging fruit, and mostly disaster response or disaster preparedness.
I was lucky to see an ad for the Dutch Dialogues in Norfolk, Virginia.
Why is it called the Dutch Dialogues?
bringing Dutch experts to U.S. cities. It was started in New Orleans after Hurricane Katrina by a big architecture and urban planning firm down there, Waggonner and Ball, that has led flood infrastructure projects since then. They had been looking at the Dutch example, and began this workshop process to bring Dutch and local experts together. To think about how you could address flooding in a more innovative and integrated way— and a way that wasn't necessarily typical of American design.
They replicated the process in Norfolk, because Norfolk is also one of the cities on the East Coast that is very vulnerable to sea-level rise. I went and it was a really interesting process. I was somewhat critical of the design approach, it was a little bit facile and convenient at times.
Right.
It's not that easy to turn a street into a canal.
So that's what really got me interested in the intersection of the defense presence and climate change. That's how I came to the topic I'm looking at in my dissertation.
Which is?
Urban defense collaborations for adaptation to climate change.
So, the Department of Defense and climate change.
Yeah. It's a tricky topic because I'm always concerned that people will see me as somehow being pro-military by looking at this but that's -
The idea that studying the military is in any way advocating for the military is ridiculous.
Ok, they are a hugely powerful institution in American society and they have a huge amount of money at their disposal. I wondered to what extent that could be a resource, and whether communities could leverage a military presence for adaptation.
And what's the conclusion been?
So far, I think there's a qualifying yes. It's one avenue that cities can take. New York City has Wall Street, other cities have other resources. This is one way some smaller cities, secondary and tertiary cities, might be able to get access to more dollars and federal resources. In Norfolk right now, there are several joint planning processes going on between multiple bases and municipalities that seem promising. They're actually sponsored by the Office of Economic Adjustment, which now appears to be on the chopping block. One of these vestiges of the welfare state, and Republicans have gotten hip to that. They're like, oh we can ax that too.
Does the DOD have a line item in the budget for environmental research?
No, not at all.
If anything, what they do is mainstream environmental and climate efforts into their larger codes and plans. That seems to be a way to make it more neutral, non-political, and less vulnerable to being axed.
The perspective I tend to hear is they're concerned about any and every threat. Clearly, climate change is a threat, sea-level rise, drought, whatever climate impacts. They're all a threat. They're going to be aware of those and plan for those.
What defines the community, and what is the difference between, let's say, the physical community adjacent to Norfolk, and someone's individual mission to be a leader in climate change adaptation?
When I say community I'm using it very loosely, and not how it's always used in planning.
I'm talking about what city elites are doing. And they seem to be the ones championing this. For obvious reasons, they have the power and the resources and the networks to do things.
But those efforts won't get where they want to go without larger, systemic support?
Without federal support. Right now, especially with us withdrawing from Paris, there's this huge move to want to say that cities are the answer, and cities can do it on their own. But cities don't have the resources for this scale of infrastructure. Whether it's gray infrastructure or green infrastructure, it requires a huge amount of money, and cities don't have that. That's why they need federal resources.
I do look to the Dutch model and other European models in terms of more comprehensive spatial planning, where it's not this fragmented effort.
We need comprehensive spatial planning, though I can't foresee that happening here.
The spatial planning toolkit seems to have been born out of the Army Corps and looking at nature as a threat. Is pushing adaptation out of the DOD furthering one idea that might actually be maladaptive?
That's always a big risk. Highly likely. The culture within the Army Corps is changing. Of course, the Army Corps is fairly de-centralized too. They are a bunch of different districts. I spoke to people in the Army Corps in the Norfolk district and there's definitely an interest there in starting to integrate these nature-based solutions. But their procedures are slow to catch up, so they have these ossified cost-benefit ratios that they use, and those don't really allow for adequate evaluation of what green infrastructure can do. But there is an awareness of that, and an effort to change that.
How does the conversation between the Army Corps and the Department of Defense happen?
That’s an interesting inflection point. I see the Army Corps as potentially being this boundary organization that does work across military and civil agendas— though they try very hard to keep them separate. There have been some efforts to bridge that, because it's clear, in the case of a large Naval base, that you can't just put a wall around the Naval base, or off the coast of the naval base, and then leave the rest vulnerable. It's been a really strong theme with almost everyone that I talked to. They realize there is inter-dependence between the bases and the communities, largely because of transportation.
It's really obvious. Roads get flooded and people can't get to the base. Most people who work on the base live off the base. There have been some lobbying efforts now to try to be able to bridge that fence-line. One of them is through Army Corps means. There's also a new initiative I found out about recently called the Sea-Wall Coalition. They're trying to expand defense access roads policy to infrastructure. It already allows military spending off-base to improve roads. All of these are very long term efforts, none of the change is going to happen quickly.
In resilience planning, you hear the rhetoric of ‘protect critical infrastructure first.’ Which can be used to justify protecting only the naval base.
All of this has a big risk. I don't think it's a necessarily good solution to open up defense spending to be able to be spent off-base, because clearly it's still going to protect certain interests, and it's not going to protect a lot more vulnerable people in the community.
Can you talk about the idea of threat and threat-multiplying, and how climate plays into the view of threat both at home and abroad?
2003 was the first defense report that was doing future scenario planning about climate change. It was Sherri Goodman who had been at the DOD and is now a defense analyst at the Wilson Center. She coined the term threat multiplier for climate change with the specific intent of getting political momentum behind that, and it seemed to really work. Convincing people that climate change itself wasn't going to cause conflict, but it would enhance all of the other drivers of conflict that might be out there. That's the basic thesis.
If you already had things that might be causing migration or resource wars, then climate will just enhance that, and it is much more of a international or geo-political view rather than a domestic view. That's one thing I'm trying to bring to this. Look more at the urban, and more at the domestic interface of military, climate change, and communities.
Some cities that are more advanced have formal relationships and procedures where they meet on a regular basis. The city and the base both let each other know about their plans.
How do you plan on getting this message out there?
What I'm most interested in coming out of this is how can communities partner with unlikely allies? I see the military as being one. But there are other ones. It really gets at best practices for collaboration and working together, and what can support that, and even what kind of political messages might help to do that. Climate security framing is really interesting from that perspective because it does seem to help bridge a partisan divide on climate change. It helps to reach a more conservative audience. There is also some potential for backlash against that, but from what I've been hearing on the ground, it sounds like it has been somewhat effective.
We’re not gonna talk about who's causing this...
Yes.
We'll skip that conversation, and that's a good way of getting past it.
Avoiding causes is kind of across the board, especially for more conservative audiences. But then the climate security angle, specifically saying that this is a threat to national security. When you have top military brass on the stage saying that, more people are going to listen than otherwise would.
Really my message coming out of this isn't that the military is some kind of cure-all. It's just one avenue to pursue. Another avenue that could be really interesting is the large hospital systems. They're also invested in having to weather disaster, and having to be there for the long-term. There's the whole public health argument for climate change.
I view that as potentially being very parallel.