by Keisha Ray, Ph.D.
This week Doctors for Camp Closures posted a video of protesters, including physicians, being arrested by police and military personnel after physicians went to the U.S. Customs and Border Protection (CBP) headquarters in San Diego to offer flu vaccinations to detained migrants. Despite their well intentions the authorities turned them away. In the video protesters can be seen laying on the ground in front of the facility’s driveway and being picked up off the ground by police officers and men in military uniforms and placed in restraints. Doctors for Camp Closures are against the detainment of migrants and refugees but wanted to offer flu vaccinations to the migrants because they believe that health care is a human right. Citing the number of refugees who have died of the flu while in a U.S. detainment center, Dr. Julie Sierra said “People die of the flu, but the people who have died of the flu in CPB (Customs and Border Protection) custody, it was completely preventable.”
This protest seems to be at least in part a response to a 2018 video recently released of 16 year old Guatemalan boy, Carlos Vasquez who died of the flu while in a detainment center. Vasquez can be seen in the video collapsing on the floor where he is believed to have laid for several hours despite authorities aware of his symptoms. Other than Vasquez at least three other minors have died of the flu while in a U.S detainment center in recent years. The protestors from Doctors for Camp Closures were arrested despite the CDC recommendation that all detainees be vaccinated against the flu. CBP, however, has said that they have no intention of providing the flu vaccination to detainees.
The Doctors for Camp Closures and White Coats for Black Lives are examples of social and political engagement and activism conducted by physicians. Groups like these initiate and organize protests, work to change legislation, fund social justice initiatives, and help bring media attention to public health issues such as the detainment of refugees or racism against black people as a public health issue. With the attention that physician advocacy and activism has been receiving lately in non-academic arenas and in academic journals like the recent issue of the journal Bioethics I have begun to have these conversations with my medical students. I’ve been interested in where this sense of activism comes from in physicians and is it something that can be taught, is it something that is a natural part of the profession or is the desire to engage in activism dependent upon the person, and therefore, a desire that students either develop or do not develop before entering medical school.
In my courses advocacy mostly comes up in my science fiction and bioethics course in which 4th year medical students and myself discuss common topics in bioethics such as resource allocation, euthanasia, public health, and death through the lens of science fiction films, tv shows, and literature. Science fiction is a great medium to discuss advocacy because a common theme in science fiction is an idealization of social justice, or how society ought to function. Because science fiction typically includes different races of people it is also a great backdrop to discuss how people ought to be treated.
In the course when I ask students if they feel that they have a responsibility to participate in activism, including campaigning for political candidates that support their views of health care, advocating for legislation that protects patients’ interests, and donating time and/or money to causes and organizations that help vulnerable patients almost every student gives a confident yes. Typically, the reason they cite for their convictions is that activism is a continuation of the oaths that they take before practicing medicine. They see advocacy as an extension of their duties to provide proper care for their patients. Frequently, they don’t see how they can fulfill their obligations to their patients if they don’t also advocate for them outside of the hospital setting given that many of the policies and laws that affect patient care are determined outside of the hospital.
Although these student responses are a small sample size and in no way count as formal research it does offer insight into the reasons why medical students and physicians, and other health care providers take on the role of activist. Perhaps they perceive that their duty to medicine and their duty to their patients calls for them to ensure patient safety, protection, and health at all social and political levels. Perhaps their training encourages them to see disregard for people’s health as an injustice wherever that injustice may occur, whether it’s in hospitals, jail cells, or detainment centers. Although, I’m sure not all physicians feel compelled to participate in sit-ins, or protests, or testify at congressional hearings about the state of health care, I do not think that choosing to not engage in these activities makes a physician a bad health care provider. Patient advocacy can occur in many forms. Helping a patient get a much needed intervention covered by their insurance or not taking kickbacks from pharmaceutical companies, and many other actions that physicians perform every day are also acts of patient advocacy and activism.
I’m not sure that we can teach medical students the value of activism, but we can teach them that injustice is wrong, how to spot it, and what they can do to combat it. We can teach students that as future physicians they have a level of visibility and power that other people do not have, and thus have the potential to spur awareness and change. As an educator of medical students I do not think that it is my job to turn them into activists. It is my job to make them aware of the injustices in health care and in public health. But if students should show that they have the activist spirit, educators should be prepared to nurture it and offer guidance when necessary.