The idea for the inaugural Rodham Institute Teach-in, held March 24 and co-sponsored by the GW School of Medicine and Health Sciences (SMHS) Office of Graduate Medical Education, came from founding director Jehan “Gigi” El-Bayoumi’s childhood.
“Those of you of a certain age may recall teach-ins were the way people got educated about South Africa’s apartheid system, and certainly that’s how I grew up,” recalled El-Bayoumi, M.D., RESD ’88, professor of medicine at SMHS. “The concept of a teach-in is that all learners here … bring different lenses, different experiences, different expertise.”
With an informal, conversational structure, the teach-in focused on the concept of neighborhood and the “built environment,” or how housing affects health, with a mixture of media: videos, panels, and question-and-answer sessions. The thread weaving it all together, however, was storytelling.
“I actually think that these more individual conversations and stories and anecdotes build and bring to life the issues that we’re talking about, and that’s the point of this teach-in,” El-Bayoumi said.
The stories — and the potential solutions offered by the storytellers — highlighted key issues facing people without easy access to care or affordable, quality housing. Baltimore City Health Commissioner and former SMHS faculty member Leanna Wen, M.D., for example, related her efforts following the Freddie Gray protests in April 2015.
“After the unrest in Baltimore City … what people may have seen were these videos of cars and stores being burned, but what they may not have seen were all the individuals in our city who did not have access to medications and to food, because their pharmacies and stores were burned down,” she said. She and her staff set up a prescription and food resource hotline and went door-to-door in the affected neighborhoods. Her team received two recurrent questions when residents opened their doors: What candidate is this for, and what survey is this?
“Our residents weren’t trying to be sarcastic or ungrateful, but they were telling us in no uncertain words that they always saw us there for our needs, not theirs,” Wen said. “The work that’s cut out for us in academia, in communities, in policy, is we have to go to where they are. We have to address the needs they’re identifying as the most important. We cannot simply be lip service.”
Susie Bathgate, M.D., associate professor of obstetrics and gynecology at SMHS, echoed Wen’s statement. “[We need] more outreach, being able to go where patients are,” she said.
Some of Bathgate’s patients, whom she described in what El-Bayoumi termed “vignettes,” are homeless pregnant women struggling to balance both their health and a sense of stability. In one case, Bathgate, who focuses on high-risk pregnancies, was helping a pregnant 19-year-old patient who came from an abusive household.
“She was staying with friends a few weeks at a time. No prenatal care. [She] ended up in our care at about 33 weeks gestation. Unfortunately, pretty shortly thereafter, she delivered [twins] early,” Bathgate recalled. “I remember my conversations with her, being 19 years old, not having a home to go to, having two babies in the NICU. What I had in my power to do was to [connect her with] a social worker.”
Bathgate described two other patients, both of whom were pregnant and in adverse situations — one was employed but living outside, the other lived in a shelter and had a 9-month-old child — and needed assistance. The former was able to find housing through Catholic Charities, the latter came into Bathgate’s care after trying to commit suicide.
It’s these types of situations that the Rodham Institute and the panelists are trying to solve. Having advocates – like Bathgate and Wen – is critical to ensuring that patients are healthy. As panel member Jessica Kleinman, staff attorney with Children’s Law Center, noted, “one in six people need legal help to be healthy.” In her experience, health is a direct result of appropriate housing.
In one of her cases, a family, using a locally based voucher, rented a home that had mold, lead-based paint, and mice infestations. “The child has asthma and has had repeated ER visits,” she added. Per protocol, Kleinman did an initial inspection of the home, and with evidence to establish housing code violations, wrote a strongly worded letter to the landlord.
“In this particular case, the landlord right now is being responsive,” she said. “I’m hopeful that we can get things done without having to go to court.”
In other cases, however, Kleinman’s seen a “terrible cycle” of discrimination and retaliation from landlords against tenants. It’s precisely why she thinks it’s crucial that Washington, D.C., create more affordable housing and more programs to support families. “I do personally hope for a day when we don’t need lawyers in every case, because we should be able to navigate the system without having to file lawsuits against people,” she said.
Another teach-in panelist, Kristal Wortham, executive director of eNotion Foundation, whose son has paranoid schizophrenia, raised another serious issue related to housing: life events, she said, can lead to homelessness, and 50 percent of those who are homeless have a serious mental illness.
“What’s important to understand about mental illness is you’re living in mental illness because, for whatever reason, you’re not getting treated. That is the difference between mental health and mental illness,” she said. “When you don’t get treatment, your brain doesn’t get the appropriate care it needs to repair itself.”
The solution, she said, is to be vigilant about mental health and to be conscientious around others; knowing what might trigger someone could be unpredictable. “Your mental health should always be a priority,” she said. “You are working with fragile populations, but more importantly, you have the ability to save a life. If you’re not able to think and function properly, how will you be able to save someone else?”
El-Bayoumi posed a similar question to teach-in participants at the conclusion of the event: “How can we not only take the information that we’ve learned — we’ve heard so much from the heart, the stories that people have shared — but now [take] the next step. How do we go to action, but not action for action’s sake? Action that allows for things that can be built, maintained, and sustained and financially can go on?”
With the idea of teamwork and collaboration in mind, El-Bayoumi noted, “We’re in a fix right now, so we have to come together.”