Finding Agency Through Advocacy
Author: Browning Haynes
Keywords: advocacy, service, social determinants of health
The guilt and shame I felt watching the family’s case spiral out of control has persisted to this day. The patient was an 8-year-old boy with a neurologic disorder and complex behavioral problems whose family had recently moved to Portland. Initially, my role was to help him, and his family navigate the healthcare system as they began to establish medical care in Portland. However, it soon became clear that this family needed more than just navigation assistance, especially given the challenges brought on by the COVID-19 pandemic.
He and his family—which included his twin brother, parents, and extended relatives— lived in a two-bedroom apartment. Their housing was meant to be temporary while they searched for a more suitable place to live. I spent time with the family providing housing resources in addition to coordinating their medical care. But with the pandemic, his mother was laid off from work, and they could no longer afford a new home. A couple months later, I learned the entire family had developed chronic lung issues related to black mold in their apartment, which the landlord had previously been notified of, but refused to remediate. I felt frustrated by the challenges the family faced and the apparent injustices to which they were subjected. Rather than improving their health, I watched, powerlessly, as it declined. This sense of ineptitude in the face of real social and economic hardships has been all too common in my early experiences in medicine.
As a medical student, I am preparing to take on the responsibilities of managing and improving the wellbeing of patients. Although healthcare institutions are created to improve health, it seems counterintuitive that these institutions fail to address the health-harming, oppressive forces in our society. This paradox has caused me notable moral distress during my clinical rotations as I continue to witness, first-hand, the stark health inequities experienced by many patients and communities. Rather than waiting for healthcare to establish a “standard of care” for treating social determinants of health, I have discovered, during my training, the humble power of advocacy.
Over the last year, I have had the privilege of working with an interdisciplinary team of medical providers, medical trainees, and legal professionals who, together, provide families of neonatal intensive care unit (NICU) patients free legal services. Medical-Legal Partnerships (MLPs) are collaborations between health systems and legal organizations that aim to address the health-harming legal needs of patients. Some of these needs include unlawful evictions, employer discrimination, and habitation concerns such as black mold removal. MLPs practice preventive law to achieve health and legal justice for each patient and family. The type of impact achieved by MLPs is not only appreciable on the patient level, but also on a population level given its upstream approach to health and potential for legislative solutions.
I have been galvanized by the potential of policy to address individual challenges through sustainable, population-level solutions. My interest in legislation led me to other opportunities, such as taking part in the Oregon ACP Advocacy Day Policy, Research, and Education Subcommittee. We focused on creating up-to-date educational handouts and presentations on current legislative topics such as universal healthcare and climate change. This information was presented to attendees of the Oregon ACP Advocacy Day event and helped bolster their testimonies to the state legislature. This was a wonderful opportunity for early advocates, like myself, to begin working at the policy level.
The challenges we face as a society can be overwhelming and can produce significant moral distress, especially when one feels they lack the tools necessary for change. Moral distress is dangerous, particularly for the paralysis and resignation it can engender. However, as in my case, it can also be a necessary catalyst for action. Advocacy—whether fighting for health justice on an individual level or testifying for policy before the state legislature—is not only a productive way to find agency amid moral distress, but a truly meaningful step towards a healthier and more just society.
About the author: Browning Haynes is a third-year MD/MPH student at Oregon Health & Science University planning on pursuing a career in pediatrics. Her other interests include health policy, physician advocacy, and community engagement. She is a proud member of the Doernbecher Medical-Legal Partnership team as well as the Oregon Chapter of the American College of Physician’s Advocacy Day Policy, Research, and Education sub-committee. Outside of medicine, Browning volunteers at the Oregon Humane Society and serves as a wish granter at Make-A-Wish Oregon. In her free time, she enjoys running, bouldering, skiing, and practicing yoga.