Through the Disparities in Women’s Health elective at my medical school, I spent four weeks at different clinical sites across New York City - from Rikers Island, the largest jail in NYC, to various family health centers in low-income areas of Brooklyn. When I first decided to take this elective, I thought I was comfortable in my knowledge of health disparities - five years of serving as co-founder of Project Stree and working with underserved women and girls in Gujarat, India provided me a solid understanding of the barriers that patients face when accessing care.
However, within the first week, I realized I had more to learn. My biggest takeaway this past month was recognizing the biases I didn’t even know I had. This became especially clear in my experience working at Rikers. Before this elective, I honestly had not thought much about the incarcerated population, especially since Rikers is commonly known to be “out of sight, out of mind” for many New Yorkers. One of the most memorable experiences was with an inmate who was pregnant when she arrived at Rikers. She gave birth just a few weeks after arriving at the jail and her baby stayed in the nursery with her at Rikers. I had the opportunity to visit her in the nursery with the medical director. I sat with her and watched her take care of her baby. The medical director told me that regardless of what she was in there for, she was an excellent mother. Just in the few minutes I spent with her, I could see how attentive and caring she was with her child. She shared that her baby would turn one year old in just a few weeks. For any other mother, it would be a time to celebrate. However, she was dreading that milestone. When the baby turned one, it would be taken away from her mother and would go live with her family, while the mother would be transferred to a prison upstate to serve her sentence.
Before this interaction, I would have mentally labeled someone like her simply as an inmate, but I came to see her—and others at Rikers—as individuals with complex lives beyond their incarceration. We judge others so easily and I realized the importance of being aware of these biases. This experience reminded me to approach each future patient I interact with with empathy and a commitment to understanding their unique circumstances.
On Wednesdays, I saw OB/GYN patients, including prenatal visits, at a community health center in Red Hook in Brooklyn. A majority of our patients were underserved, and many faced significant challenges attending routine prenatal visits. They juggled childcare responsibilities, dealt with inflexible work schedules, and managed multiple comorbidities like gestational diabetes and hypertension. While this Red Hook clinic has historically served low-income patients, it has become gentrified over the last few years. In 2017, the median household income in the Red Hook Houses project was $17,000, which was about three and a half times less than the citywide median. Today, the annual household income in Red Hook is $144,733.
Given the unique history of the area, we saw a mix of patients from various socioeconomic backgrounds, including a few affluent patients. Their visits revolved around questions like when they could go on their babymoon, if their multi-step skin care regimen was pregnancy-safe, and the costs of a private hospital room. I noticed that, while many of our other pregnant patients were just trying to manage day-to-day prenatal challenges, these other patients could focus on other aspects of pregnancy, thanks to their access to resources and a strong support system.
In medicine, we often label patients as “noncompliant” or “nonadherent” and once that is added to their medical chart, it leads us to immediately place judgment on that person. These judgments affect the quality of care and attention these patients deserve. We must step back and try to recognize what might be causing patients to miss their appointments or forget to update their daily glucose monitoring sheet - whether it be a lack of access to transportation, finding childcare, or difficulty accessing healthy food. We need to dig deeper to provide more compassionate and effective care. Access to healthcare is about meeting patients halfway and working with them rather than against them.
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