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 Dalila Rodriguez of Children's Institute, Inc.
by Dalila Rodriguez
June 25, 2018
This interview with Dalila Rodriguez, the educational manager at CII, was conducted and condensed by frank news.
Would you start by introducing yourself?
I'm the education manager at CII. Once upon a time, I was a home visitor and then moved my way into a site supervisor position and was there for a couple of years. Now I'm the education manager. I have moved away from being the administrator over programs and getting that one-on-one face-to-face with families like I did back then. My role is to support staff development and to improve the quality of the services that we provide in all aspects, so curriculum and teaching instruction.
What are the services you provide and who are you serving?
We provide early childhood services educational programs for children and families, birth to five. We have a multitude of programs. One of them, for example, is our home-based program. Our home visitors go into the homes for families, we call that Early Head Start. We start with mothers that are pregnant and then up until three years old. So about 2.6, they transition into a center-based program.
Then we have our center-based programs, which we have from birth to five years of age. Those are called Early Head Start and Head Start center-based programs. We have also programs that are solely funded by the state of California. Those are pre-K programs. We serve about 2,000 children in the community approximately.
Within our Head Start framework, it's a comprehensive program. It's not just educational-based services, but rather it looks at the entire family unit. We know that at that early age, in early intervention programs we want to make sure that we're addressing the entire family. There's someone whose sole role is to work with the families to find out what their goals are as a family.
Then it's the family community partnership team's role and responsibility to build partnerships in the community where we can get resources that are going to support that family. We actually have parents that have finished school, finished their degrees, and work for our agency now, which is amazing to know that, wow, this parent started coming in and asking for help for their child but ended up getting support for themselves, too. We also have a health department. We have a registered nurse on staff as well as a consultant.
We also have our mental health managers. We have a mental health component and we have specialists that go out to the sites. The teacher identifies that there may be a concern with the child experiencing some type of stress or trauma, atypical behavior. They'll write out a referral, they'll send it out to the team. The team goes out and observes the child and then identifies if they qualify for early intervention or if it is a disability ... usually it's both. We all work together: education, disabilities, and mental health. We call it the dream team. All of them have a role in observing on different days and times to see the child's behavior and to make sure that from the education lens, the teacher doing everything they're supposed to be doing to make sure that this child has the environment and the experiences that they need to be successful in the classroom.
Wow. That's a lot. Let's take a step back, can you specific "community" and who you serve?
The Los Angeles population. We concentrate our services to the highest need communities, so for example, our highest concentration of Head Start programs from three to five are in the South Los Angeles area. Our main office is right on Figueroa and Florence. All of the schools, we have about 20+ schools that are within a five mile radius of that center. We have schools in our housing developments over at Nickerson Gardens, Imperial, Avalon.
Are you in Jordan Downs as well?
We're in Jordan Downs, Imperial Courts, Nickerson, Avalon. Yes, we're in all of them. We're also in the South Vermont Green Meadows area, so on the other side of the 110 Freeway. We go as far as Western. That's about as far as we go. The best way I could gauge it is about a five mile radius. We have services out in Compton as well.
What percentage of the kids you're working with are dealing with a parent who's incarcerated?
Percentage-wise, I wouldn't be able to tell you. I could ask our family community partnership specialist because during enrollment, those are some of the things that they may or may not disclose.
It's not something we really quantify where we're like, "Oh, this many children have this many parents incarcerated." It's not something we track to a certain extent.
How do you engage with children who are dealing with trauma?
It's very case-by-case. Basically the way it goes is if the teacher identifies or the home visitor identifies there's something happening here that's not typical, they'll reach out to their mental health specialist. The mental health specialist observes and then from there, we have to have consent. A lot of the barriers we find is obtaining consent.
That's one of the areas we're working on currently. Our mental health manager and FCP manager just got a grant to do some work with families around that. We just started that journey recently. Let's say they do sign the consent and we do get that acknowledgement from the parents, the mental health specialist and the education team that is working with that child go in to provide some early intervention support for the teacher in the classroom first. Step one will be to set up some classroom strategies that are going to help support that child. Right now what we're working on is in implementing a new social emotional curriculum. It's called Conscious Discipline, which is an adult first approach. Something we've noticed too is that teachers are not equipped.
When I went to school, no one told me this is something that you could potentially experience and here are the strategies for you to use in the situation. It's very much the education component and not as much like these are children that ... these are some of the common things you'll see when you see a child that is experiencing stress or trauma. You really learn as you go.
Part of the adult first model is really helping them cope first. Practicing relaxation exercises, how to breathe, how to channel some of your positive energy into that child, and then be able to understand also what is happening in that child's physiological state.
We've been learning a lot about brain development and what trauma causes to the brain. We call it QTIP, Quit Taking it Personal. It's not about you, it's about what's happening to this child. We're supporting teachers and learning how to first cope with that. Then what you transpire or what you're feeling, you're going to emanate. You're going to transfer that to the child. Our goal is to calm them, so how do we calm ourselves first and then approach?
We work on setting a plan with the family. The teacher, the family, the administration, the specialist all get together and have a multidisciplinary team meeting. We acknowledge the parent for whatever things that are happening in the home. Sometimes the home and the school can be very different. It could be that they're great at school and then at home, the parent is really not able to know how to work with the child, or vice versa.
There are times when we refer to our overall CII mental health program, which are more intensive therapies like Parent Child Interactive Therapy. PCIT. The Parent Child Interactive Therapy program is one of the ones that we refer to the most. Again, it's parent-centered, so it's focusing on the parent's role and how they interact with the child.
How does CII decide where there needs to be a physical presence?
The CII's overall mission has always been to work with children and families that have been impacted by some sort of trauma, violence, things that are happening in the community. We acquired the grants over in the Watts/South Los Angeles area about four years ago.
Head Start has very rigorous requirements that we have to follow. Sometimes agencies do not keep up to par with what the Office of Head Start requires.
What is the Office of Head Start?
The Office of Head Start is the grant that we acquire from the federal government. This is how we get the money to offer the services that we provide.
Is everything is government funded here?
Not everything, but mostly. Most of it comes from the Office of Head Start, which is a federally funded government program. That's a nationwide program. We also have state funding, which is the California Department of Ed. For example, this school is a state funded school. They're solely state funded.
Are the national and state guidelines different or at all contradictory?
They're not necessarily contradictory. They're different in the sense that they don't have the comprehensive component. Early Head Start and Head Start that come from the federal government require the comprehensive model.
And the state does not require that.
The state funded programs are more modeled towards families who are experiencing poverty, but are working and/or are going to school, so they qualify for these services. They're still families experiencing poverty. With Head Start, what we find, is that it's more intergenerational poverty where they are not coming out of that cycle. With State funded, we see that they're more young parents that are wanting to go to school but cannot afford childcare. There are immigrant families that have come here and are having trouble finding work, or they may work but they're not making very much. They're making minimum wage.
Are there guidelines where you are dealing with immigrant families?
No. At this point, we don't ask for immigration status. In terms of second language learners, for example, this population here Mid-Wilshire and Otis Booth, this location is highly Korean. They are also coming in with ESL, second language needs. They're also experiencing the same types of immigration issues and poverty issues that all of our Hispanic families are. It's just that we have to modify in terms of language and making sure that we have translation and things like that available for them.
One of the things that I know our family community partnership team has been working on is doing workshops and informationals at parent meetings regarding immigration.
We know our families are experiencing things that are beyond even our comprehension. When you hear the things that happen, it's just like, "Okay. Wow. Where do we start?" I know that's going to be one of the things we're going to see. I know from experience with knowing families that your automatic instinct is don't call the police. Don't go to certain events. Don't go to these things because then you just don't know. Now, with the whole separation of families, who knows what ... That's just an added layer of fear. Fortunately, I feel like we've built a good rapport with the community that we've been working with to support them in still coming to us. It seems like they're still bringing their children to school.
Part of the work that we're doing is trying to really let families know how much more we have to offer because of the type of funding that we have. That we're not just focused on the child's education, we're focused on the whole family's success as a family unit and getting them out of poverty and trying to support the steps that they need to do that. If they've experienced trauma, then getting them the tools and the resources that they need to be able to not only help their child but to help themselves to overcome.
What do you feel is CII's most urgent work?
One of the overall common trends amongst families is wanting the best for their child and wanting to learn how to support their child through the educational system or understanding development and milestones. For us, we have this window of opportunity to get the families in and build trust with them so that they know that we have their child's best interest in mind. While we will get to the educational pieces, we know coming in as an agency that understands trauma, that we're not going to get to the educational pieces now.
Part of the early childhood services side is really helping parents understand development and understand how the environment in the family impacts their child. We can't get them to write their name until we can help them self-regulate and sit in a chair. If your child is still running rampant in the classroom, they're not really ready to learn how to do one plus one, or know their shapes, or know their colors because there's something happening.
Educating the family is our highest priority in terms of really supporting them as educators and advocating for them to say, "Okay, I understand what is good for my child. I understand that learning in terms of academia will come when I have the foundational pieces in place."
Do you feel like CII is on the right path in the way you're working with these families?
Taking a look at our data is very important to us and really analyzing it and understanding what it's telling us so that we know whether or not we're on the right track and what different things we can do to approach it. We can make assumptions all we want, but at the end of the day, what type of data do we have to support that? As of now, it seems like we're on the right track.
Some work we're doing this year is really getting teachers more trauma informed-style trainings that are going to help them understand the process of trauma. What to look for and how to understand it and then build some empathy around it so that they can cope. Then they can do their best to support that child and their family. It's all around understanding the brain. They call it the survival state, the emotional state, and the executive state. They're all pieces of the brain and how they work and how they work when under stress, when under trauma. Then how do we get to the executive functioning? It's really interesting work. I love the adult first approach to it.