2021 Edition
“Don’t let anyone speak for you, and don’t rely on others to fight for you.”
-Michelle Obama
ABOUT US Here at AMWA UTD, we want to do our very best to inform you of all of the issues relevant to women and healthcare, together and separately. We hope that our monthly newsletter becomes an enlightening source to you all as we learn about the multitudes of important topics and issues that we all need to be aware of.
The Editor’s Take: The November Newsletter + The Ask AMWA Poll
By: Shraddha Trehan
Another month, another newsletter provided by your AMWA newsletter committee! This month we’re coming back with full force, bringing y’all four hard-hitting solo articles along with two of our classic paired articles: The Sex Talk You Never Had and What’s Poppin’! I’m excited to share that your writers have worked hard to create thoughtful opinions on topics such as World Prematurity Day, Antibiotic Resistance, the intersections between climate change and health, and Healthcare Deserts. Moreover, we’ll be touching on heartbreaking and thought-proving news that is happening right now: the Texas Heartbeat Act and the Astroworld Tragedy. Just give us 10 minutes of your time and, hopefully, we can all learn a little bit more about what’s happening in the healthcare world today.
But first, please take a moment to fill out our anonymous ASK AMWA Poll: https://docs.google.com/forms/d/e/1FAIpQLSfkZyOXesEUdoaSYOel_l-OHRAkhFarue-b2cL4o29Onv7taQ/viewform. Your responses will be featured in an article next month, so it’s really important we get an idea of everyone’s opinions!
As always, feel free to email me at shraddha.trehan@utdallas.edu about any topic you feel really needs to be included in future newsletters. Hoping all our readers enjoy this newsletter as much as I did.
Until the next one, Shraddha :)
What’s Poppin’: The Astroworld Tragedy
By: Anjali Binoy and Hibah Rasool
Going to a concert with friends is always an exciting time. The anticipation finally reaches its peak when your favorite artist starts performing on stage and the joy you feel at that moment feels like it can never be matched. On Friday, November 5th, the first night of the Astroworld concert took place in Houston, TX. This concert, which was supposed to be just as thrilling as any other, quickly became an absolute tragedy for the victims, their families, and all the people involved in the incident. Considering how close to home this festival was, many of those who attend UT Dallas may be reeling from the events that occurred. We’d like to take a moment here to touch on survivor's guilt: the symptoms, the signs, the solutions so that you can keep a lookout in the next couple of weeks for yourself and your peers.
According to Dr. Debra Lee Kaysen, a professor of Psychiatry and Behavioral Sciences at Stanford University, individuals that were at the concert and witnessed the chaos may be having reactions such as “asking themselves a lot of questions about how the event could or should have been prevented or blaming themselves or other people around the event." It is believed that concert-goers are at a higher risk for developing trauma and some may already have started experiencing survivor's guilt, anxiety, or PTSD.
Survivors' guilt is defined as “a type of guilt that may develop in people who have survived a life-threatening situation,” by Dr. Diana Raab from Psychology Today. Some survivors may have feelings of regret and feel that they could have done more to help others, and some may feel guilty for surviving while others didn't. Individuals who attended may experience triggered flashbacks, nightmares, and recurring memories of the event. They may also experience trouble sleeping and concentrating, avoidance of negative feelings, difficulty controlling worries, and being on edge. Although some survivors may be avoidant towards discussing feelings regarding the incident, it is important to seek professional help after something this traumatizing.
Trying to move forward with everyday events can be difficult after going through a traumatic experience and it is vital to treat yourself with care as you move along the grieving and healing process. Frequently checking in with yourself mentally is incredibly important and can be just as simple as taking a couple of moments to look back and reflect on your emotions. How have you been feeling? Have you experienced frequent mood swings? Do you experience very intense emotions and very shallow emotions? Not only should you do these check-ins, you can also take care of yourself mentally by taking a break when you feel stressed, being patient with yourself, and not being afraid to let yourself feel sorrow.
Neglecting yourself as you experience survivor's guilt occurs often, but try and remind yourself that you are worthy of life and what occurred is not through any fault of your own.
Taking care of yourself physically is also just as important. Try to create a schedule for and journal about your day. Exercising and participating in activities that bring joy to you are simple ways to feel peaceful and hopeful - or even on the toughest days, can help at least distract your mind from ruminating on any sorrowful memories. Eat nutritious food and really take care of your body. Remember, your body and mind are so important and they quite literally help you sustain life so take care of yourself.
During this difficult time, if you went to the Astroworld festival or know someone that did, remember to remind yourself and them that all of us are worthy of love and care. Surround yourself with people you can rely on, and always know that there are so many resources you can reach out to if you ever need professional support.
Antibiotic Resistance: A Microbial War
U.S. Antibiotic Awareness Week: November 18-24
By: Zoe Du
Kills 99.9% of all germs! Hand sanitizers and soaps, especially antibiotic soaps, have long claimed to virtually eradicate bacteria and fungi from surfaces, but what about that 0.1%? As many of us are aware, 99.9% is a marketing tactic, but it points to an important fact: sanitizers and soaps are not 100% effective and the microbes that survive contribute to the widespread development of antibiotic resistance.
Antibiotics have been used for millennia, but Alexander Fleming’s discovery of penicillin and its subsequent mass production revolutionized modern medicine. Infectious diseases that had plagued humans, ranging from syphilis to staph infections, were suddenly treatable; penicillin appeared to be a miracle drug. Unfortunately, bacteria failed to receive the memo. Penicillin was first released in 1941; penicillin-resistant Staphylococcus aureus was already identified by 1942.
Antibiotic resistance is a classical example of natural selection. When exposed to antibiotics, susceptible bacteria will die, while bacteria that survive replicate, passing on their resistance. Additionally, many antibiotic resistance genes are encoded in plasmids, which enables horizontal gene transfer mediated resistance. In other words, bacteria can acquire resistance. Antibiotic resistance was inevitable, but the misuse and overuse of antibiotics have rapidly accelerated the process.
Misuse of antibiotics includes premature termination of treatment. It can be tempting to stop taking medicine as soon as we feel better, but if antibiotic treatment is not followed as prescribed, then the risk of recurring infection by resistant bacteria increases. Overuse of antibiotics involves the use of antibiotics when they are not needed. This includes treating viral infections, like the common cold or COVID-19, with antibiotics or using antibiotic soaps that “kill 99.9% of germs.”
So, why does it matter? Antibiotic resistance is compromising our ability to treat deadly infectious diseases. For example, Staphylococcus aureus is resistant not only to penicillin and newer drugs but is also becoming increasingly resistant to vancomycin, the last remaining effective treatment. The impact is far from trivial. According to the CDC’s 2019 Antibiotic Resistance Threats Report, more than 35,000 Americans die due to antibiotic-resistant infections annually.
The problem is not limited to any national borders. Antibiotic resistance is a global issue threatening public health everywhere. In the 1990s, Peru was hailed for its tuberculosis control program as one of the best in the developing world. Yet, when Partners In Health arrived, they found an epidemic of multidrug-resistant TB (MDR TB). Recurring cases had been repeatedly treated with the same regimen, producing strains of TB resistant to four, five drugs. Not only is MDR TB difficult to treat with an ever-shrinking arsenal of effective drugs, but it is also expensive. For many, effective treatment is simply inaccessible.
In 2021, another global health threat is commanding the world’s focus, as COVID-19 continues to devastate communities, but antibiotic resistance is no less relevant. In fact, the COVID-19 pandemic poses a unique challenge. Studies estimate that over 70% of COVID patients are placed on antibiotic treatments as preventative measures against secondary respiratory infections, like pneumonia. With COVID patients arriving in troves, standard antibiotic usage has skyrocketed. Increased antibiotic usage is also fueled by misinformation and misuse. Antibiotics are ineffective against viruses, but that is not necessarily common knowledge. Products claiming to be antibacterial become very tempting in a time defined by infectious diseases, but their use is completely unnecessary and even harmful.
As we observe Antibiotic Resistance Awareness week, what can we do in the race against antibiotic resistance? An easy way is to be more conscious of your use of antibiotics. When you go shopping for soaps or detergent, avoid antibiotic versions. Take preventative measures against bacterial infections by staying up to date on vaccinations and practicing good hygiene. Wash your hands regularly with soap and water, rather than relying on hand sanitizers. The threat of antibiotic resistance has no easy solution, but we can all take small measures to combat it and protect our loved ones.
World Prematurity Day - November 18th
By: Anjali Binoy
If you look around, you probably know plenty of pre-me babies. In fact, 1 in 10 infants around the world is born prematurely. Prematurity is such an expansive topic, but I’ll try to cover some of the basics for now.
Pregnancy on average lasts between 38 to 42 weeks. Thus, the following list contains the classifications of prematurity as defined by the World Health Organization and other websites that track fetal development:
Late preterm -- 34 to 37 weeks: Between these four weeks, the organs (except for parts of the lungs and brain) are now fully formed, the fetus is practicing breathing in the amniotic sac, and is now almost filling out the amniotic sac.
Moderately premature -- 32 to 34 weeks: During this time period, the internal organs of the fetus are near full development. Their skin becomes more opaque from the even distribution of fat, and the immune system is also developing.
Very premature -- 28 to 32 weeks: When the pregnancy hits twenty-eight weeks, the fetus is developing various parts of the brain and developing the ability to have a positive outcome if the baby is to be delivered soon. In a hospital with adequate resources, technology, and a well-equipped NICU (neonatal intensive care unit), delivery at this point should be safe and the baby will be able to develop and grow with the facilities available in the hospital.
Extremely premature -- 23 to 28 weeks: The fetus is now looking like a baby as this period starts! They now have the basic organs (but not the ability) to survive outside the womb, the skin is still a translucent color, and they are starting to recognize sounds. If the baby were born around this period, survival is a possibility in well-equipped and established facilities.
It’s necessary to educate ourselves on prematurity because pre-me babies are becoming more common than ever. As I initially stated, 1 in every 10 children is born prematurely. Further, world prematurity day helps bring awareness to the advancements we have made technologically to sustain life for premature babies. Finally, I think it’s really important to acknowledge our privilege to live in an area with hospitals that have the right facilities to provide positive outcomes for premature births. Unfortunately, in some regions, premature births are still dangerous and high-risk procedures. Those of us who make up the future of healthcare can educate ourselves now so that we can help progress medicine and society into a world with equity among communities all around the world.
The Sex Talk You Never Had: The Texas Heartbeat Act
By: Zoe Du and Megan Zachariah
The Texas Heartbeat Act (SB 8) recently took effect in September, once again bringing abortion rights to the center of national debate. The entire bill can be found here, but in essence, the bill places a ban on all abortions after a “fetal heartbeat” is detected. SB 8 is by no means the first heartbeat bill, but it is now the most restrictive policy in the country. The bill offers no exceptions for rape or incest - only for medical emergencies affecting the mother’s health - and in an unprecedented move, SB 8 allows private individuals to sue anyone suspected of “aid[ing] or abet[ting]” illegal abortions for a reward of $10,000 in a successful suit. SB 8 is only one of the slew of abortion restrictions passed in 2021, which has been deemed “the worst legislative year ever for U.S. abortion rights” by the Guttmacher Institute. As abortion continues to galvanize American politics, we think it is important to address some misconceptions and misinformation about sex, pregnancy, and abortion so that we can have more informed debates and make informed decisions.
SB 8 defines a fetal heartbeat* as “cardiac activity or the steady and repetitive rhythmic contraction of the fetal heart within the gestational sac,” which is typically detectable at around 5-6 weeks gestation**. For many women, 5-6 weeks means little more than a late period, a common occurrence due to variables such as stress, birth control, or even exercise. And that’s assuming a regular menstruation cycle. It is estimated that 14-25% of women of childbearing age have menstrual irregularities with causes ranging from polycystic ovary syndrome to hyperthyroidism to eating disorders. In any case, few women are aware of pregnancy before the 6-week cutoff.
SB 8 cites the fetal heartbeat as a key predictor of a pregnancy resulting in a live birth. In Roe v. Wade, the determining factor in the legality of abortion was viability. Viability is reached when the attending physician determines that there is a reasonable chance of the fetus surviving post-birth, and it generally occurs around 20-26 weeks gestation. These two definitions result in two very different timelines, which brings us to an important point about language. Language can be interpreted differently and it can be manipulated to create misconceptions. For example, politicians have speculated about abortions occurring at birth, which simply do not occur. However, the use of phrases like “late-term abortion” and “born alive abortion” can create the misconception that women do in fact receive abortions after reaching term. Again, this does not occur. As such, the medical community is often critical of these rhetorical choices.
Now for a rapid-fire edition of MythBusters:
Myth 1: Abortion occurs during all nine months of pregnancy.
A vast majority (91%) of all abortions occur within the first 13 weeks of pregnancy, and only around 1% occur after 20 weeks. Abortions that occur after 20 weeks are almost always because of either barrier to abortion or medical issues including fetal anomalies or health risks to the pregnant person.
Myth 2: The fetus feels pain when aborted at 20 weeks gestation.
Research shows that fetal pain perception is not likely until 29-30 weeks gestation, and the Royal College of Obstetricians and Gynecologists has asserted that pain perception is not even physically possible until week 24.
Myth 3: Abortions are dangerous.
As with all surgical procedures, abortions do carry a risk. However, the national mortality rate associated with abortions from 2003-2009 was 0.67 deaths per 100,000 abortions. In comparison, the 2019 U.S. maternal mortality rate was 20.1 deaths per 100,000 live births or 30 times higher.
Myth 4: Abortions would not be needed if people used contraceptives.
While the use of contraceptives is a component of safe sex practices, they are not completely effective. Even when used properly, contraceptives will occasionally fail. Contraceptives also are not always easily accessible. Furthermore, sex education in the United States often emphasizes abstinence rather than safe sex.
Myth 5: Abortion targets female fetuses.
There is no evidence that the decision to receive an abortion is sex-selective. Furthermore, sex reveal via ultrasound generally occurs around weeks 16-20, after most abortions occur. The very earliest sex can be determined is around 11 weeks.
Abortion will inevitably be a controversial and divisive topic. To formulate informed opinions, we all need to think critically and sift through facts and misinformation.
*For clarification, “fetal heartbeat” is somewhat of a misnomer: healthcare providers generally do not use the label “fetus” until week 8 and the heart is not fully formed until around day 50.
**Gestational age is measured from the first day of the woman’s last menstrual cycle.
The Impacts of Climate Change on Health
By: Hibah Rasool
Climate change significantly influences human health in various ways. Changes in physical, biological, and ecological systems result in increased vulnerability for respiratory and cardiovascular diseases along with the spread of illnesses and other infectious diseases. Pre-existing health threats are intensified and unanticipated health threats emerge due to these disruptions.
The impacts of climate change currently include precipitation changes, warming temperatures, increases in frequency and intensity of the weather, and rising sea levels. These changes directly affect the most basic human requirements: clean air and water, food, and shelter. Exposure to severe heat can lead to heat strokes and dehydration which can result in hypovolemic shock. Rising CO2 levels directly impact airborne allergens and food nutrition. High concentrations of CO2 "fertilize" lowers the level of essential minerals in some crops making them less nutritious.
An increase in the intensity and frequency of severe weather can result in the reduction of safe water and food along with damage to roads and housing. Illness due to contaminated water is caused by exposure to waterborne pathogens and chemicals caused by human activities. Hurricane Harvey left streets flooded with sewage water which had high levels of bacteria. This caused an increased number of integumentary, gastrointestinal, auditory, and eye infections. Polluted air along with bacteria and mold growth resulted in worsened respiratory problems. Furthermore, the health effects of climate change vary based on location, and certain populations are more vulnerable than others to these effects.
For many years, human activities have heavily contributed to climate change. Transportation, electricity production, and land use are just some of the factors that have amplified Earth's natural greenhouse effect. It is important to address the causes and understand the threats posed to human health by climate change in order to limit further harm.
Healthcare Deserts: Stratifying Care
By: Megan Zachariah
In a recent episode of Last Week Tonight, John Oliver covered the poignant topic of affordable housing options as it relates to the US housing market. A recurring theme throughout the video was the feasibility of many of the alternative housing options for the homeless, from housing vouchers to state-sanctioned housing complexes. However, many of the housing initiatives stagnated in the legislature due to widespread protests brandishing the phrase “not my backyard”. Despite the funding and resources to provide options for the homeless and underemployed to dwell in privileged areas, it was the staunch opposition of affluent residents who wielded their blatant bigotry as concerns for safety. Not only were these individuals denied housing, but all of the associated benefits, including access to quality education, safety, and most importantly high-quality healthcare.
While the connection between housing and education may be more straightforward, higher property taxes beget higher quality education, the connection to healthcare may be less obvious. Unfortunately, in the United States, both private and public healthcare facilities are subject to the same capitalist pressures as many businesses. Given that most funding to hospitals and healthcare professionals comes through insurances, there is a higher incentive for medical establishments and trained professionals to populate in affluent areas, servicing individuals that are more likely to have a high premium, and thus more kickback from insurance companies for their services. This stratification in care results in the conscious movement of hospitals and quality medical professionals away from impoverished neighborhoods to affluent metropolitan areas. A longitudinal study spanning from 1990-2010 found that 148 hospitals closed in low- and middle-income neighborhoods. The vacuum left behind by absconding healthcare facilities allows the division between those who can afford care and those who desperately need it to fester.
Understanding the multifaceted benefits affordable housing can have for those in need makes the arguments wielded by those who actively deny these fundamental human rights all the more superficial. It becomes particularly scathing upon realizing that the woman in the video is a resident of Plano, Texas, a fact that demonstrates that these issues are not only of national interest but affect us here locally.
As aspiring physicians, we will be faced with the financial pressure to serve in the areas where we will be compensated for our years of debt and time dedicated to practicing medicine. However, it is in our power to narrow this healthcare accessibility gap by making a conscious effort to serve in the communities that have been abandoned by the health insurance market and let down by the phrase “not my backyard” when it is a matter of livelihood.
Comentarios