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 INESI
by INESI
February 22, 2019
This interview with Dr. Marla Perez-Lugo and Dr. Cecilio Ortiz Garcia, was conducted and condensed by frank news. Both are faculty at INESI. INESI is the National Institute of Energy and Island Sustainability. It is a multidisciplinary and multi-campus institute of the University of Puerto Rico (INESI) that seeks to insert the university community more effectively into the public energy policy of the country and in the resolution of energy and sustainability problems using as a basis for empirical research and academic knowledge.
Let’s talk about the work you’re doing at INESI.
Dr. Pérez: INESI is the National Institute for Energy and Island Sustainability. It was created in 2014 when we realized that the university was being excluded from the process of developing a new energy policy for Puerto Rico. It was very interesting to us because we have one of the biggest programs in electrical engineering in the nation, and we have expertise in many areas that could contribute to the understanding of what energy issues in Puerto Rico are all about.
We understand them as social technical issues, in the sense that yes, they have a technical component that involves technological development and the physical infrastructure, but also energy issues have a cultural component, and a political component.
We started INESI in trying to insert the University of Puerto Rico into that conversation. We have about 90 affiliates across the 11 campuses of the UPR system. Those affiliates represent more than 23 academic disciplines including psychology, law, electrical engineering, sociology, philosophy, art, natural sciences, and economists. One of our concerns was that most of the resources being included in the conversation were all concentrated in the metropolitan area of San Juan. For us, that was a metaphor for the concentration and the density of decision making in energy policy in general.
What we tried to do was de-concentrate the knowledge being used in decision making by including resources from the other campuses of the UPR system. Since then, we have a standard set approach, to not only the UPR, but also members and sectors of society that are being excluded from those processes. Community based organizations, grass roots movements.
We created the energy stakeholder forum. That includes about 30 organizations across the islands, that at the beginning of this maybe didn't perceive themselves as energy stakeholders. But Maria had a very important function in showing how energy is embedded in all aspects of life.
Dr. Garcia: I want to emphasize that number one, INESI as an institute, is a platform that seeks to interconnect all of the resources Dr. Pérez was mentioning across the 11 campuses of the UPR. It is also a knowledge organization. Before the institute, the way the university was organized, actually created an unequal space for the utilization of resources or knowledge in academia, to impact energy issues in Puerto Rico. By highlighting only the work associated with the technological aspects of energy, like electrical engineering, physics, and maybe economics or law, those become the only areas that can contribute to the transformation of energy issues in Puerto Rico. INESI makes a contribution in terms of energy democracy in Puerto Rico by reframing energy issues in terms of them being not only technical, but like the professor said, socio-technical. We are re-organizing knowledge.
We foster knowledge from outside academia to be mixed with scientific knowledge in order to gain an interdisciplinary view of energy.
Part of the reason this group exists is because you felt left out of the conversation by the government. Has there been a response from the government to your work?
Dr. Pérez: [laughter].
Has that relationship changed?
Dr. Garcia: That's an excellent question.
Dr. Pérez: After Maria, it has gotten worse. When Maria struck, and the electric system collapsed, it would make sense that we were the ones who had a lot to contribute to the rebuilding process, because we knew the system very well.
Dr. Garcia: That was a faulty logic.
Dr. Pérez: Yes, faulty logic. We approached our president, we approached our governor, we approached FEMA, we approached everybody. Systematically the resources in the UPR has been left out from the rebuilding process. What we’ve come to find out is that actors from the outside have been hired. They have been contributing more to the rebuilding process than the people who know the system best, and the people who are going to live with the consequences of that process. We have met universities from the States that have been contracted by our governor's office to do work for hundreds of thousands of dollars that have already been done by UPR resources.
As my colleague here says, it's a manufactured ignorance phenomenon, in which for many reasons, the local government is manufacturing ignorance in terms of the resources and knowledge Puerto Rico has, when talking to outside actors.
Why do you think that is?
Dr. Garcia: It's not that linear. It requires switching frameworks when you talk about governmental resources, or even institutional resources to extreme operating environments after Hurricane Maria in Puerto Rico. It's rather difficult to draw a direct line between the intentional misrepresentation of resources that one has, or does not have, for a particular resource. You are talking about different levels of decision making converging in a particular way, that make it expedient, for certain actors on the ground like the government of Puerto Rico, to behave in a certain way. One of the behaviors we are alleging is happening, is a behavior of not being transparent, with the type of resources you might have available for you to get out of this hole.
When I say, "this hole," you have to look at Maria in the context of Puerto Rico when Maria hit. Puerto Rico was already under certain legislation, and under the fiscal control board series of attacks on our society, and on behalf of US bond holders that are looking to get repaid for their investment. You have a multiplicity of actors, that virtually established a regime where it becomes logical for the Puerto Rican government to act how it acts.
Dr. Pérez:
Our constitution recognizes higher education as a societal investment. That has been an ideological fight between the constitution and the more conservative, or pro-statehood administrations. When the fiscal control board came to power, the first thing they did was to claim power over the UPR, and claim that there was too much money going into the UPR system. So the budget for the UPR has been severely cut. In fact we have experienced a budget cut of more than 50%, and some of the campuses are singled out for closing in the incoming years.
The budget cuts are increasing, and increasing, and increasing, and the tuition cost for the students are increasing as well, but not enough to cover all the UPR expenses. When you have 95% of the research being conducted in Puerto Rico, conducted in the UPR system, you are killing research, and you are killing the resources that have the knowledge to actually contribute to the betterment of Puerto Rican society.
Dr. Garcia: That's an excellent point. Hurricane Maria brought the administration to a fork in the road. "How am I going to use my research? Well I have to manufacture reality, for outsiders in order for me to be aligned with what I've been using as my policy towards the university." It’s a policy of killing. It's a policy of closing. It's a policy of minimizing.
Dr. Pérez: Exactly.
Dr. Garcia: I cannot be highlighting those same resources out in the open, because I left myself open for questions about, "Well wait a second, aren't you killing the University of Puerto Rico?" It gets really complicated. It's in a complex policy environment. And all Maria did was serve as a catalyst for all of these different pathways, the visions of Puerto Rico's reality, to come up to the surface.
What is your mission moving forward?
Dr. Pérez: We connected with municipal governments. Instead of going to the state government, we connected with municipal governments, mostly in the mountain regions that were communities that were basically identified as low reconnection priority. After the collapse of the electrical system, it was said by authorities that communities in the mountains were less likely to be reconnected because it was not cost effective. So we drew our attention to that region. While working with mountain communities, we started assembling an electric oasis, a solar oasis. So people in the town square could recharge small electronics, and store medication in small fridges.
We realized there were more than 20 universities from the States coming to Puerto Rico to do several things. To do humanitarian work. Using the disaster as the classroom in a study abroad course, or doing quick response research, rapid grants, from foundations and other funding sources. We realized that those initiatives, although very well intentioned, were disorganized. They lacked coordination. And because there was nobody looking at the big picture, most of the universities were concentrating their efforts in less than 10 municipalities. We have 78 of them. That is a problem for several reasons. From the humanitarian standpoint, if you saturate some areas with aid, but then neglect other areas, that means not everybody is able to receive the aid you’re bringing from the outside. From the scientific perspective, if you base your science in very few, and selected case studies, your science will be faulty.
We started contacting all these universities, and realized that there were teams from the same universities on the ground that didn't know about each other. We started connecting them. We started organizing virtual workshops to give them the context, and to give them the most updated information about the state of the electrical system, because we mainly focused on electricity and sustainability. After that we focused on allowing them to talk to each other, so they could start collaborating instead of competing for spaces, money, etc. Then we invited them all to Puerto Rico for a three day workshop last June to reflect on their experiences, and identify what was wrong and what was right. What can we learn and extrapolate for future occurrences? In the climate change era, these things are going to occur more often now, and in more severe ways.
What do you think the future looks like?
Dr. Garcia: Unfortunately there's many steps, and they are all going to have to be taken at the same time. There is no recipe book for doing this. But the main thing that stands out, with regards to Puerto Rico being an example for both disaster environments and interventions by federal agencies, by universities, by multiple units of government, is that we have a long way to go in learning how to organize ourselves to do better.
We have to build relations in places we know are prone to these events, so that we do not fall prey to the manufactured ignorance we've been talking to you about.
More directly for universities, even though were are not set up to be first responders, our experience with Maria has shown us that we are. We end up being first responders. We have a responsibility to look at ourselves, to get together and at least discuss what our role is as universities, in post disaster situations. This goes from how we organize our resources, to how we organize our scientific and non-scientific knowledge, and how we provide spaces of collaboration between different discipline.
Is the goal of your stakeholders forum to raise awareness but also to raise a sense of responsibility in this mission?
Dr. Garcia: Absolutely. If I was going to rank them, the stakeholder forum has been our most effective tool in fighting manufactured ignorance. Not only has it served as a sounding board, and a bulletin board for many, many, many groups who have not historically haven't been included in energy decision making, it has also allowed for an honest dialogue and an open dialogue to exist between university resources and civil society. That is very, very powerful. Especially as we aspire to higher levels of energy democracy in Puerto Rico.
We hope the stakeholder forum internally in Puerto Rico keeps on making big strides towards energy democracy in the islands. And we want to experience that with the RISE platform that can bring a better understanding of what energy democracy involves, not only inside the island, but with other localities around the globe.
To reinforce the point – global warming and climate change are global phenomenons. The relationship between human beings and those phenomenons are local. And as local phenomena, we cannot change that, or expect that one recipe is going to fix every local experience. So it's up to us, universities around the world, to embrace this fact, and to develop new relationships between ourselves and our own communities, and share those experiences between other universities and other communities. That exchange, not only of data, and of science, but also of human relationships, and communication, is the only way that we can develop true local resolutions to what are becoming very, very, wicked problems around us. And if INESI can help in attaining that, then we have been successful.