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
Everything Must Go
by Alec Karakatsanis
June 23, 2020
This interview with Alec Karakatsanis, Executive Director of Civil Rights Corps and author of Usual Cruelty, was conducted and condensed by franknews.
frank | Can you introduce us to the work that the Civil Rights Corps does?
Alec Karakatsanis | Civil Rights Corps is a small nonprofit organization based in Washington, DC. We seek to use litigation to change the brutality that is inflicted on people, predominantly people of color, by the criminal punishment bureaucracy. We have led a lot of the fights around the country challenging the cash bail system. We have also done work around prosecutorial misconduct, on the militarization of police and some work around the indigent defense system.
More broadly, we are an abolitionist organization that is trying to get our society to think critically about the purpose of the criminal punishment bureaucracy. We push people to think about what kinds of divestment we can make from the current system, and what kind of investment can be made in other areas to help communities flourish.
Has your work changed since the protests began after Geroge Floyd’s murder?
I think it's important to take a step back and think about what our jail and prison system looked like a few months ago in order to understand this moment.
This is the staggering number of people the police are ripping away from their communities and putting into a bureaucracy of cages, courts, lawyers and police officers. Almost all of these jails are places of unspeakable horror. Virtually every one that I have visited over the country is covered in mucus, feces, blood, mold and urine. They are incredibly overcrowded and cramped. There is a total lack of hygiene or adequate medical care.
When COVID hit, our work gained a new urgency. Suddenly a viral pandemic was threatening to sweep through all of these horrific facilities. We reoriented ourselves. We brought a number of big class action lawsuits in major cities on behalf of human beings confined in jails. We challenged the jail's utter failure to protect the people inside. These are extraordinary stakes for our clients and their families. To give one example, after we filed our lawsuit in Chicago, seven people died of COVID in the Cook County Jail.
In the last few months, a lot of our work has shifted towards trying to tell the story of what's happening inside these facilities. Most people have no window into them. They don't know the extent of the brutality inflicted upon people every single day.
What was the original ask from your organization? Mass clemency? Medical release?
There's really two different asks. One is basic improvement of conditions - soap and hand sanitizer, basic ventilation, and basic protocols for responding to medical emergencies more quickly.
Adjustments within the prison, within the facilities.
Yeah. We also want as many people released as possible, so that medically vulnerable people aren't confined in a place that could kill them.
People can't socially distance in jails and prisons, so the infection is spreading like wildfire. That is horrible, not only for those who are incarcerated and their families, but also for the broader public. If you have a contagion in the jail, with the churn of people going in and out of jails, chances are that it's going to be transferred back out into the community. That is a critical realization - that there are public health consequences from throwing human beings away into cages.
Part of our legal strategy is to really force people to think: Do we have a really good reason to take this woman away from her child and put her in a cage during a viral pandemic? If we don't, did we have a really good reason before the viral pandemic? Those are the kinds of questions that we've been trying to ask with our litigation and push into the broader cultural conversation. Especially in this moment, as people realize that these jails are disproportionately full of Black people, people of color, poor people and people with mental illness.
I wanted to talk more about the criminalization of poverty. How do you explain how our current criminal justice system functions to generate revenue from the poorest people in the country?
Various interests profit off of people at every stage of the process. There are all kinds of financial incentives to punish people.
The police are basically paid to make arrests.
There is also this thing called civil forfeiture, which basically allows the police to seize, keep, and sell private property. When they arrest you, without you being convicted of a crime, they can take the cash out of your wallet or confiscate your car.
Early in my career as a public defender, I was involved in a case where the police were stopping people on the streets and taking their money, or claiming the car someone was driving wasn't theirs and taking the car. They would then send these people a letter and say you're welcome to challenge the seizure, but you have to pay us 10% of the value of the property that we took. That is just for the privilege of challenging it. If you're too poor to afford your car payment, you can’t afford to pay 10% its value to get it back. We succeeded in getting that system struck down as unconstitutional, but it is still going on all over the country.
So the police have all these ways of making money, but then it gets even bigger.
How so?
Prosecutors have these things called diversion programs, which means they say if you pay them x amount, they won’t charge you, they will dismiss your case. Rich people can pay, and the system makes money off of them. Poor people can't pay, and they get prosecuted.
Of course, there is the multibillion dollar cash bail industry.
And in many places, if you can't afford to pay the fines and fees that you owe after your traffic conviction or your criminal conviction, you're put on probation. You owe a monthly fee for probation every month, around $30 or $40. When you are on probation, they can drug test you any time they want - every drug test costs you $20.
People get trapped in a cycle of debt. The scheme looks liek this - you get a $200 speeding ticket. If you can't afford to pay it, you are put on on probation. Now you owe a private probation company $40 a month - plus your original ticket. Let's say you can only pay $20 toward that. You would never be able to fully pay that off. We saw this in Ferguson. When I went to Ferguson after the death of Michael Brown, the city of Ferguson averaged 3.6 arrests per household. Almost all of those arrest warrants for unpaid debt to the city for this kind of like scheme that I've just described.
Can you sort of simplify the cash bail system?
Historically, bail was an unsecured money bail - meaning that you only owed money if you didn’t show up. Around 1900, we saw the rise of the for-profit commercial money bail industry in the U.S., and with it, the rise of secured money bail. A secured money bail means that you have to pay money before you are even let out of jail.
That's what you sort of see play out on TV. You're arrested, you're brought in and you're told you're free to go back to your family if you hand us some money. Of course, most people who are arrested in this country are very poor and have no hope of paying that money. That is where for-profit bail business comes in. If you pay them 10% of the bail, they will pay the rest. It's kind of like an insurance policy. The companies get paid back in full when you show up to court, but you never see that 10% again.
There are really two problems with the cash bail system. Number one, most people are too poor to pay even 10% of the bail set. If you are charged with a $10,000 money bond, you would have to have a thousand dollars in cash laying around. So, you are just stuck in jail just because you are too poor. Number two, if you can pay, you are paying into a for-profit money bail industry. Take the city of Los Angeles.
And that's just one police department in one American city. The cash bail system monetizes your personal liberty.
Who profits?
That money goes into the hands of the for-profit American money bail industry, which is really controlled by a small group of insurance companies. Prosecutors and the courts, as I mentioned, also benefit every time someone pleads guilty, because they usually pay a fine or a fee that goes back into the court system. They want to coerce as many guilty pleas as possible.
And if you can't afford to pay bail, are you allowed to be held indefinitely?
Well, when we say “allowed,” our team is working to show that it is unconstitutional to keep a human being in a cage just because they can't make a payment. We struck down this system in California two years ago. But you are right, that's exactly what's been happening. If you can't make a payment, you're kept in jail, even though you're presumed innocent until your case ends. And if you want to take your case to trial, it can take a long time.
It’s been central to trying to release people from prison during COVID. One of the profoundly disappointing things is that there's been virtually no change in state prison populations or the federal prison population as a result of COVID. But there has been a significant decrease in local jail populations, largely because places have paused their cash bail schedule. Meaning that for most nonviolent offenses you would be released without having to pay money. In California, it is estimated that that measure reduced the jail population by 20,000 people – in California alone. As of tonight (6/10) around 7:00 PM, it looks like the courts are going to reinstate the cash bail system, which is horrific and inexplicable.
So, in normal circumstances, you just wait until trial comes and hope?
Well many people can't wait. They can’t be away from their children. They can’t be away from their family and their life. And they're told, ‘if you plead guilty today, we'll let you out or we'll give you a much shorter sentence.’
What kind of choice is that? Either you can sit in jail for another seven, eight months until the courts are ready for your trial, and risk a really long sentence, or you can take the deal and plead guilty today. That's why many people, including innocent people, plead guilty every single day in this country.
Can you talk about the relationship between police and prisons?
The police are not raiding Yale and Harvard University for drug use, they're rating poor neighborhoods a few miles down the road. They're not raiding the homes of wealthy Americans for tax evasion, they're raiding the homes of poor people.
95% of all police arrests in this country are for things that the FBI says are not serious violent crimes. We know that there are hundreds of thousands of violations of the clean air and clean water regulations by large corporations every year. We don't devote any police resources to investigate that. Instead we post police officers up in poor neighborhoods and ask them to arrest people who are in possession of a plant that they're not supposed to possess. These are the kind of choices we've been making for a long time with our policing system.
The number one arrest in most jurisdictions is marijuana possession, and it is disproportionately arrests of Black and poor people. In many jurisdictions, the number one arrest driving on a suspended license. There are 13 million licenses that are suspended in this country, not for violations, but for owing the courts debts like those I was speaking about earlier.
Our legal system and the police are choosing certain offenses to prioritize, while allowing others to get away with criminal activity. These are just distributive choices that have disparate impacts across race and class.
Police are choosing who goes to prison, with explicit knowledge about how they’ll be treated.
No question.
I don't think most people appreciate what the consequences can be. Minor arrests can result in people not being able to get a job for the rest of their life. Even if you're fortunate enough to be avoid the problems rampant in jails - sexual assault, infectious diseas, physical beatings, reentry can be very difficult because of all the consequences that our society puts on people with a criminal record.
Professionally, personally, economically.
At the beginning of this, you said your organization is an abolitionist, non profit organization. How do you see the defunding of these institutions working together? Do you feel like it's something that needs to be approached simultaneously or separately?
I think it's simultaneous. I think we need to be talking about removing resources from this entire bloated system. The criminal punishment bureaucracy is five times bigger than it ever was in this country's history until 1980. It's five to ten times bigger than it is in other comparable countries. There's no need for this bureaucracy. There's no evidence that it does anyone any good. There would be outrage if we were to scrutinize the punishment system and its return on investment by the same standards that we scrutinized schools, or medical clinics, or healthcare.
What are we getting from this? Think of the trillions of dollars we spent on the drug war. We’ve caged tens of millions of people in this country. We've separated tens and millions of children from their families. We've surveilled everyone's cell phone. We've sprayed pesticides all over Latin America. Yet drug usage rates are the same or higher in many places in this country.
The people who run the system aren't stupid. It's not like they don't know all of these things. So the only reasonable conclusion is that the purpose of these systems wasn't to reduce drug use, it was something very different.
We must significantly divest from them and then invest in the things that communities need - theater, music, art, poetry, athletics programs for children, in addiction treatment, and in safe places to live. I think it's obvious to anyone who thinks about it honestly, for just a few minutes, that we need to divest from this entire bureaucracy.