2023 Edition
"Everything is within your power, and your power is within you."
Janice Trachtman
The Editor's Take
Congratulations AMWA on finishing the Fall 2023 semester! Congratulations to all those graduating, and we wish you the best in your future endeavors!
In this edition, your writers have paired on Ask AMWA, where they delve into the demographics of AMWA UTD, and Global News - Attack on Hospitals: A Modern Humanitarian Crisis. We also bring you articles on Indigenous Health, Epigenetics and Generational Trauma and an account of how a paralyzed man was able to walk again with a brain/spine implant. Lastly, here is our Spotify Playlist for December!
I hope you enjoy this edition, and as always, if you have any questions or ideas, feel free to email me at Tanya.Baiju@utdallas.edu.
- Tanya
Ask AMWA: Demographics of AMWA UTD
By: Hafsa Mohammed and Gauri Guruprasad
In this installment of Ask AMWA, we sought to learn more about our community members - your identities, the sources of your passions, and the challenges you've encountered as pre-health students. To delve deeper into your personal stories, we conducted interviews with a few of you. Your valuable insights have provided a richer understanding of our community. We want to thank the 27 AMWA members who graciously contributed to this article by filling out the Google form, helping us gain a comprehensive view of our diverse population.
There is no question that Healthcare and Social Assistance is the largest sector in the United States, with over 20 million employees (source: Census), most of them being jobs in clinical care. This is also reflected in AMWA's student body. Most students are either Pre-Med (74.1%) or Pre-PA (18.5%) or seeking a career focused on clinical care. An often overlooked field in healthcare that has a significant impact on how people receive care is Public Health.
Cindy N, a Public Health senior and two-year AMWA member, sheds light on her experience as a minority pre-health student.
"Just being in that space, where there are so many people who want to provide clinical care and help people. The environment is fantastic." She reiterates the downside: "There weren't opportunities such as research. AMWA's focus is clinical work, but I think it's worth expanding into other directions as well." Despite not pursuing clinical care, she values the supportive community within AMWA. Cindy emphasizes expanding AMWA's focus beyond clinical work to encompass diverse healthcare directions. She says, "Fostering a community is important, especially in healthcare, in which we are always learning and asking for help."
Regarding the question, "Who inspired you to get into medicine?" the responses were diverse. A significant portion, 41%, credited themselves as their source of inspiration, closely followed by 37% attributing it to their family. Meanwhile, 18% chose "other," and one person credited their mentor. In the subsequent query, "Do you have a relative/close family friend/mentor who is in medicine?" 56% responded affirmatively, while 44% answered negatively. Notably, 67% of those with medical connections had immediate family members in the field, and 33% had family friends pursuing medical careers. These findings were surprising, considering the common narrative that familial or close connections influence most individuals in medicine.
Sreya, a freshman pre-med student, exemplifies this by having multiple family members who are doctors. Despite their candid depiction of the challenges in medicine, they didn't discourage Sreya from pursuing her passion. Her family friends, who are currently in medical school or going through the application process, serve as valuable sources of advice.
Anjali, a freshman pre-med student without direct familial connections to medicine, relies on AMWA for guidance. Being a part of this community allows her to seek advice and assistance from peers with similar aspirations. These personal stories provide valuable insights into aspiring medical professionals' varied paths. Thanks to those who shared their experiences, offering a glimpse into their lives and journeys. Best of luck to each of you in your pursuits.
Inquiring about those without personal mentors in medicine, we requested a difficulty ranking on a scale of 1-10, where 1 represents "the easiest thing you have ever done," and 10 signifies "the most difficult thing you have ever done." Notably, a significant majority (46%) selected 10, while others clustered around this high difficulty level or leaned towards lower numbers.
Kree, a sophomore pre-med student, shares a similar experience to Anjali by not having familial ties to medicine. Her journey has been challenging, seeking guidance primarily from the Internet and upperclassmen peers.
As a sophomore neuroscience major on the pre-med track without medical connections, I, Gauri, have found navigating this journey taxing. Despite the struggle, actively seeking opportunities and maintaining fervor for my path makes it worthwhile. This community of like-minded, passionate individuals is essential for those genuinely committed to changing lives.
As a senior graduating this semester, I, Hafsa, have spent time reflecting on the past few years. AMWA has been a golden resource for me in gaining resources and connecting with people. The feeling I once had as a freshman of swimming alone in the dark sea has slowly transformed with every person I've met along the way. My friends, such as Cindy mentioned previously in this article, have brought a fresh perspective to my eyes and to my other friends who have struggled with me every step of the way.
If you want to take a look at the rest of the responses, please click on this link.
Indigenous Health
By: Zoe Du
Turkey, mashed potatoes, mac and cheese, pie, and more, Thanksgiving has become a time of year to spend time with family and enjoy good food. It is touted as a celebration of the pilgrims’ survival of their first winter and first successful harvest due to the help of Squanto and the Wampanoag tribe. However, this tale of the first Thanksgiving glorifies the violent history between white settlers and indigenous peoples in America, who to this day still experience structural violence and harrowing health disparities.
Health Disparities
By nearly every health metric, Native Americans experience poorer health outcomes than other Americans. Their life expectancy is the lowest among races and ethnicities in the United States. While rates of diabetes were historically low, Native Americans are now 3x more likely to be diagnosed with diabetes, 2.3x more likely to die of diabetes, and 2x more likely to develop renal failure due to diabetes. These increased rates can be tied to systemic issues like the inaccessibility and low affordability of healthy foods. The US Department of Health and Human Services (HHS) also identifies a high prevalence and risk factors for mental health, suicide, substance abuse, teen pregnancy, and more.
Structural Violence
The health disparities that Indigenous communities face in the United States represent a form of structural violence that follows a history of colonialism and, subsequently, genocide, disenfranchisement, displacement, discrimination, and trauma. The history between white Americans and Native Americans is long, complex, and violent. When we hear the term violence, it conjures up images of gore and physical violence, but just as nefarious and harmful is the perpetration of structural violence, a form of violence in which social structures harm individuals, groups, and societies by preventing them from meeting basic needs and reaching their full potential.
One example of structural violence perpetrated against Native communities in the US was forced assimilation via boarding schools. Estimates indicate that by 1926, over 80% of school-aged Native children were attending boarding schools where they faced shaming, abuse, and the prohibition of their culture and traditions. The removal of Indigenous children from their families was not prohibited until 1978. In addition to separating Indigenous peoples from their cultural identities, the federal government also sought to separate them from their land with the Termination Act of 1953, which aimed to disband tribes and relocate them. These types of policies have had enduring consequences, and one way we see them is in health disparities.
The United States has a legal obligation to provide health care to more than 560 recognized tribes through the Indian Health Service (IHS). Still, Congress has chronically underfunded the agency, forcing it to limit services. An analysis performed by the National Congress of American Indians found that funding would have to double to match the level of care provided to federal prisoners, let alone the benefits guaranteed to Medicare or Medicaid recipients.
While much of the change needed has to be systemic, there are still actions that we can take. We can amplify Indigenous voices, practice cultural competence and humility, and advocate for policies that can help provide the necessary funding and services.
Epigenetics and Generational Trauma
By: Sahaana Anand
The word "trauma" is commonly used in modern-day culture and conversation, so it is not a new concept that has a lot of stigma. What does, however, have much conspiracy and confusion around it is the aftermath of said trauma and how it impacts an individual or group's daily life and the people around them. A closely related topic that many do not know about is the world of epigenetics. Epigenetics is the study and research behind how one's behaviors and environment can cause changes that molecularly affect the functioning of one's genes. More specifically, the changes caused by epigenetics are reversible and have to do with how your body reads a DNA sequence but not the DNA sequence itself.
The overarching basics of epigenetics can be looked at in three categories: DNA methylation, histone modification, and the synthesis of non-coding RNA. According to the CDC, methylation, where a chemical group is added to the DNA in specific places to read the gene, can be turned "off" or "on," leading to demethylation. The same goes for reading histone proteins that are found around DNA. Similarly, non-coding RNA usually controls gene expression and, in this case, can modify those histones to turn the genes "off" or "on." Various factors, such as development, aging, and environment, can play a role in these epigenetic changes. A recent discovery that flags concerns over epigenetics is the impact trauma has on one's epigenetics. Before delving into that, gaining a clear understanding of trauma is essential.
According to the American Psychological Association, Trauma is defined as an emotional response to a terrible event such as (TW): an accident, rape, combat, or natural disaster. Trauma has both short and long-term impacts on a person and their emotional behavior, and some take longer to move on with their lives than others. A 2018 research article published in 'World Psychiatry’ reviews the evidence behind how intergenerational transmission of trauma can affect epigenetic mechanisms. Focusing on factors such as sex-specific epigenetic effects, parental developmental stage such as sex-specific epigenetic effects, parental developmental stage at the time of exposure, and maternal stress during pregnancy all play a role in epigenetics.
However, while complex, there is a side to this that can be seen as positive. Evidence suggests that epigenetic mechanisms may pass trauma's effects to at least two future generations. An example that displays this is one from the Radiolab podcast called "Inheritance." In this, the hosts and guests explain that if someone had a grandfather who grew up during his childhood having little to no access to food and starved, then you, being the representative of someone two generations away, would be much less likely to get heart disease. The grandchild would have one-fourth less risk for heart disease or diabetes.
Though this is only one example, the realm of epigenetics is highly complex and has many scientific and ethical aspects that continue to be explored and debated. Moreover, the implications of these findings intersect with mental health and intervention, which requires deep exploration before making any general conclusions. For more literature on this, check out NIH and the NPR podcast!
Attacks on Hospitals - A Modern Humanitarian Crisis
By: Zoe Du and Sahaana Anand
While Israel’s actions against Palestinians have polarized public opinion, it should not be political or controversial to condemn bombing and deliberately attacking hospitals, which are protected under international law. The U.N. Security Council has identified and condemned attacks on schools and hospitals as one of six grave violations, and the Geneva Conventions have asserted that civilian hospitals are under no circumstances to be the object of attack and are instead to be protected as early as in the first iteration in 1864.
The protection provided to hospitals under the Geneva Conventions can only end if they are “used to commit, outside their humanitarian duties, acts harmful to the enemy … [and] after due warning has been given.” While Israel has argued that hospitals such as al-Shifa house Hamas operations and tunnels, little to no evidence has been provided, nor is there justification for the sheer brutality that has been used against nearly all of Gaza’s hospitals. According to a recent Al Jazeera report, at least 26 of 35 hospitals in the Gaza Strip are no longer functioning after attacks by the Israeli army and lack of fuel, increasing the burden on the remaining hospitals already working over capacity. Hospitals should be a place of healing and security; while under siege and attack, they can be neither.
To shine attention on the dire happenings in Gaza, the tragedy that took down the Al-Shifa Hospital should be looked at. Al-Shifa, or “healing” in Arabic, used to have around 800 patient beds in a densely populated area in Gaza City. While standing as Gaza’s largest standing hospital and a center for refugees to seek shelter, the Al-Shifa Hospital used to be a haven for around 700 patients, 400 healthcare providers, and 3,000 displaced persons, according to statistics from the U.N. Though both Israel and the United States have asserted to believe that Hamas are running their leadership underground these hospitals, workers and first aid responders all have denied this to be the truth. The hospital and others in Gaza are standing at little to no function due to damage from the attacks. Limited supplies, healthcare workers, and non-sterile environments are all contributing to an even more tragic situation for the people of Palestine.
Unfortunately, what we are seeing unfold in Palestine is not unique. While attacking civilian hospitals has long been recognized as a war crime, it has also become a strategy of modern warfare. As of 2022, there were 601 documented attacks on medical facilities in Syria and more than 600 attacks in Russia’s invasion of Ukraine. From 2016 to 2020, the nonprofit Insecurity Insight reported more than 4,000 attacks on medical facilities worldwide.
Despite all arguments, bombing and seeking to destroy hospitals in all places is a crime against humanity in all forms. This humanitarian crisis that we are lucky enough to only hear about, and some for whom it may be close to home, is a part of our reality in every way. These attacks are war crimes, but to date, responsible parties have not been held accountable internationally, and we are seeing history repeat itself. Regardless of our stances on political conflicts, we should not abandon our ethics or compassion for other human beings, and while it may feel as though we are powerless, we can still use our voices. Keep educating yourself and encourage others to do what you can!
Paralyzed Man Walks Again with Brain/Spine Implant
By: Gauri Guruprasad
Twelve years ago, a Dutch man named Gert-Jan Oskam had a terrible motorcycle crash while in China. As a result of the accident, he severely injured his spinal cord and became paralyzed from the waist down. Now, after a brain-spine interface (BSI) implant, he can walk again.
In 2017, Gert-Jan Oskam received an experimental spinal cord implant. This device, triggered by lifting his heel, generated an electrical current stimulating nerves in his spinal cord, enabling him to take steps. Despite this progress, navigating and walking remained challenging, and after two years, his recovery plateaued. In 2021, Oskam joined a proof-of-concept study, undergoing the insertion of two cortical implants over his sensorimotor cortex to record cortical activity (electrical patterns of neuronal firing) (Lorach). An additional implantable pulse generator was introduced, establishing a wireless digital bridge between the brain and spinal cord (BSI). This intricate system converts Oskam's cortical activity (his thoughts) into epidural electrical stimulation, activating the muscles of his lower limbs and allowing him to stand and walk comfortably. Artificial intelligence is crucial in decoding brain waves and transmitting signals to the spine. The ability to connect one's thoughts, or neural impulses, to a device that can stimulate targeted areas represents a mind-boggling advancement in research.
In just a few short years, Gert-Jan Oskam's remarkable journey from awkward steps in 2019 to navigating challenging terrains in 2023 epitomizes the dynamic landscape of neuroscientific research. As Oskam himself puts it, 'The stimulation before was controlling me, and now I'm controlling the stimulation' (Bendix). This shift towards agency in the face of paralysis is not only inspiring but also marks a transformative phase in medical technology. Onward, the pioneering company behind Oskam's brain-spine interface (BSI) system is now venturing into studies to assist individuals with paralyzed upper limbs and stroke victims. Witnessing these advancements unfold in real time fills me with hope and excitement. Moreover, incorporating artificial intelligence into these systems is a poignant reminder of our rapidly evolving world, where unforeseen discoveries are becoming commonplace. This study is a beacon of progress, pointing towards a future where once-impossible realities become tangible possibilities.
Sources
https://minorityhealth.hhs.gov/american-indianalaska-native-health
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1621099/
https://minorityhealth.hhs.gov/diabetes-and-american-indiansalaska-natives
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127768/
https://www.apa.org/topics/trauma
https://radiolab.org/podcast/251876-inheritance/transcript
Bendix, Aria. “Brain and Spine Implants Enabled a Paralyzed Man to Climb Stairs and Walk on Rough Terrain, Study Shows.” NBC News, 24 May 2023, https://www.nbcnews.com/health/health-news/brain-spine-implants-restored-movement-paralyzed-man-rcna85586.
Nature Magazine and Lewis, Dyani. "Brain-Spine Interface Allows Paralyzed Man to Walk Using His Thoughts." Scientific American, 25 May 2023, https://www.scientificamerican.com/article/brain-spine-interface-allows-paralysed-man-to-walk-using-his-thoughts/.
Lorach, Henri et al. “Walking naturally after spinal cord injury using a brain-spine interface.” Nature vol. 618,7963 (2023): 126-133. doi:10.1038/s41586-023-06094-5
https://magazine.jhsph.edu/2022/ending-violence-against-health-care-conflict
https://childrenandarmedconflict.un.org/six-grave-violations/attacks-against-schools/
https://www.washingtonpost.com/world/2023/11/15/israel-gaza-al-shifa-hospital-hamas-map/
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