2024 Edition
“When we speak we are afraid our words will not be heard or welcomed. But when we are silent, we are still afraid. So it is better to speak”
Audre Lorde
The Editor’s Take: Disparities and avoiding Despair
Hello AMWA UTD! I am excited for you all to read what your writers have been working on! This month, we bring you articles on service dogs, the privatization of healthcare, Henrietta Lacks, and confronting violence in healthcare. Also tune in for the return of our paired article sections - The Sex Talk You Never Had and What’s Poppin’.
This month’s newsletter handles sensitive and heavy themes, including the pervasiveness of violence, both physical and structural, in society and in medicine.While the word violence often evokes imagery of blood, crime, war, and other physical displays of aggression, violence does not have to be physical. Structural violence describes social structures - economic, political, legal, religious, and cultural - that cause harm or injury to people. Structural violence takes several forms including apartheid, racism, poverty, and lack of access to health care. The challenges of physical and structural violence are daunting, but it is important not to become paralyzed by fear. While it may be slow, progress is possible. The fight against tuberculosis (TB) is a testament to this fact.
Fast facts about TB
TB has killed more humans in history than any other disease at more than 1 billion deaths, and it continues to be the top infectious disease killer globally.
Annually, 10.6 million become sick with TB and 1.3 million people die
On average, 1 person dies of TB every second
Over 80% of TB cases and deaths occur in low and middle income countries
TB is the leading cause of death of people with HIV/AIDS. Nutrition is also a major risk factor for active infection with TB.
Incredibly, cures for TB have existed for 80 years and have successfully been used in TB campaigns in wealthy nations, yet there is a different standard of care for lower income nations. TB kills not because we lack the technology to treat it, but because we have failed to make diagnosis and treatment accessible for the most vulnerable populations. However, there has been incredible progress made this past month. The WHO has officially recommended 4 improved and shortened therapeutic regimens for TB and through the advocacy work of organizations like Partners In Health Engage (including UTD students!), the End TB Now Act of 2024 passed in the U.S. Senate. There is still more work to be done, including passing the End TB Now Act in the U.S. House of Representatives, but these incredible victories are worth celebrating and are a testament to the power of advocacy. If you are interested in adding your voice, please check out this tool to send your representative an email.
It is our hope that this edition of the newsletter will serve as a beacon that not only shines a light on the injustices women and other marginalized groups continue to face, but also highlights the power of our voices in the face of despair. As always, if you would like to submit your own piece of writing, have ideas, or questions, email me at Zoe.Du@utdallas.edu
Zoe
Breaking the Silence: Confronting Violence in Healthcare
By: Gauri Guruprasad
**TW/CW: This article discusses themes of sexual violence and violence in general.
Reader discretion is advised.**
On August 9th, 2024, a young resident doctor at RG Kar Medical College and Hospital in Kolkata, India, had been enduring a grueling 36-hour shift. Exhausted and drained, she retreated to a seminar room for some much-needed rest. But when she was found the next morning, she was no longer alive. She had been raped, beaten, and strangled to death—her partially clothed body bearing the marks of unthinkable brutality. The details are too horrific to recount, and the incident left the entire medical community reeling. The perpetrator was identified as Sanjay Roy, a hospital volunteer—someone who should have been a helper, not a predator. This tragedy is not just another news headline. It’s a glaring reminder of the violence and hostility that women in healthcare face every day, both in India and around the world.
Today, public outcry continues to grow as the case has sparked political protests and demonstrations. Female residents and medical students, standing united, are demanding justice for their fallen sister, whom they affectionately call “Didi”—a term that means sister in Hindi and many other Indian languages. But their fight goes beyond seeking justice for one victim. It’s a fight for safety, for respect, and for the right to work in a profession without fear of violence. Their voices reverberate across continents, resonating with countless women in healthcare who know all too well the dangers of simply doing their jobs.
What happened to Didi is not an isolated incident. Gender-based violence against healthcare professionals is a global epidemic that often goes unnoticed and unaddressed. A 2021 report from the World Health Organization revealed that up to 38% of healthcare workers experience physical violence at some point in their careers, with women facing a disproportionate share of these assaults. In the United States, a 2021 study by the National Institute for Occupational Safety and Health found that female healthcare workers were nearly four times more likely to experience violence than their male colleagues. Similar trends have been observed worldwide, where nurses, doctors, and other healthcare providers regularly report verbal harassment, sexual assault, and physical attacks from patients, their families, and even colleagues. As future healthcare professionals, we cannot turn a blind eye to these harsh realities. It is our responsibility to advocate for systemic change, push for better reporting mechanisms, and foster a culture of zero tolerance for violence in any form.
Didi’s story is a sobering reminder that even within the walls of hospitals, safety is not guaranteed. But it should also serve as a call to action. We must hold our institutions accountable and ensure that every healthcare professional, regardless of gender, can work in an environment free from fear. This fight is not just for justice—it’s for creating a future for ourselves and later generations where stories like Didi’s are no longer a tragic reality but a thing of the past.
Henrietta Lacks and HeLa cells
By: Sahaana Anand
When you look at the extent to which scientific research has advanced compared to less than a 100 years ago to now, you will be shocked to realize that most of it is all due to the cells of one particular woman. Henrietta Lacks was an African American woman born in 1920in Virginia, whose cells are the reason for so much advancement in scientific research, including biomedical sciences, cancer research, stem cells, and more. She had faced many difficulties throughout her life, such as health problems, poverty, and ones that come from her identity. After being diagnosed with cervical cancer in 1951, she had gone to Johns Hopkins Hospital in Baltimore, Maryland. However, she was done wrong in this setting when without her knowledge or consent, doctors removed a sample of her tumor cells while she was receiving treatment. These cells would eventually be dubbed HeLa cells, and they would rank among the most crucial instruments in medical study.
Given that these HeLa cells were the first human cells to be successfully produced in a lab, HeLa cells are special. HeLa cells are able to proliferate indefinitely, in contrast to most cells that perish after a few divisions, as always understood by the science behind cell division. They were invaluable for study because of this extraordinary phenomenon that they displayed. HeLa cells were crucial in the development of vaccines, including as the polio vaccine, and in the knowledge of human biology, genetics, and cancer. In that sense,Millions of lives have been saved and numerous scientific advances have been made possible by the success of HeLa cells.
Nevertheless, the tale of Henrietta Lacks and her cells also poses significant moral and ethical dilemmas. Henrietta never consented to the use of her cells for research purposes, and it took a long time for her family to learn the importance of her contributions. This circumstance emphasizes the necessity of informed consent in medical research, which guarantees that participants are aware of and approve of the intended use of their biological samples. How justifiable is it truly, to know that she was used for a good cause, but never was given the proper recognition or fruit for her contribution to medicine? It was not until decades later when the outcome of studying and applying her cells became known by the general public. The tale of Henrietta shows us how crucial it is to treat every person with decency and respect in the name of science.
The memory of Henrietta Lacks serves as a potent reminder of how ethics and science overlap. Her HeLa cells have advanced our understanding of numerous diseases and made major contributions to medical science. However, her tale also highlights the significance of informed permission and the moral treatment of subjects in study. As we reap the benefits of the technological advances made possible by HeLa cells, we owe it to Henrietta to make sure that we never lose sight of ethical issues at the forefront of scientific inquiry.
The Privatization of Healthcare: Financial Gains vs. Patient Care
By: Riya Ramani
In recent years, the trend toward privatizing public hospitals has sparked considerable debate regarding its impact on patient care and access. While privatization is often justified on the grounds of improving financial efficiency, emerging research highlights significant concerns about its effects on the quality of care and accessibility, particularly for vulnerable populations such as Medicaid patients. Recent studies reveal a nuanced picture, showing that while privatization may boost financial performance, it often does so at the expense of patient care.
Financial Efficiency vs. Quality of Care
A comprehensive review published by the University of Oxford in The Lancet Public Health examined 13 longitudinal studies across high-income countries, assessing the quality of care in hospitals before and after privatization (Goodair et al., 2024). The findings indicate a consistent trend: hospitals that transition from public to private ownership generally exhibit a decline in care quality. Key metrics, including staffing levels, patient mix, and the availability of services, typically worsen post-privatization. This deterioration is often attributed to cost-cutting measures, such as reducing staff numbers and focusing on more profitable patient groups.
Privatized hospitals frequently reduce the proportion of patients with limited health insurance, such as those covered by Medicaid, to enhance their financial performance. This shift often leads to fewer services and higher infection rates, as evidenced by increased reports of patient infections and avoidable deaths in some studies (Goodair et al., 2024).
Impact on Patient Access
The effects of privatization on patient access are particularly concerning. Research by Dr. Atul Gupta Ph.D from the Wharton School (2023) revealed that privatizing hospitals results in a significant decrease in patient volume, with a notable 8.4% reduction observed across various privatized facilities. This decline is most pronounced among Medicaid patients, who experience reduced access to care as privatized hospitals prioritize more profitable patients.
This shift in patient demographics can have severe implications for vulnerable populations. Medicaid patients, who already face significant barriers to healthcare access, may encounter longer wait times or increased travel distances to receive care. The study highlights that privatized hospitals often limit Medicaid admissions to avoid the financial strain associated with low reimbursement rates, thus exacerbating access issues for these patients (Wilson, 2023).
Policy Implications
The findings from these studies underscore the need for a nuanced approach to hospital privatization. Policymakers should consider several key recommendations:
Strengthen Protections for Vulnerable Populations: To mitigate the negative impacts of privatization, there should be stronger protections to ensure that privatized hospitals continue to serve Medicaid patients and other vulnerable groups. Ensuring that these populations are not disproportionately affected by privatization is crucial to maintaining equitable access to healthcare (Wilson, 2023).
Scrutinize Privatization in Low-Income Areas: In areas with fewer hospitals and lower income levels, the adverse effects of privatization can be more pronounced. Policymakers need to carefully evaluate the potential drawbacks of privatizing public hospitals in these settings and consider alternative models that better balance financial efficiency with care quality (Wilson, 2023).
Support Public Hospitals: To address the negative effects of privatization, state and federal governments should explore ways to support public hospitals. This support could include increasing Medicaid reimbursement rates or providing financial assistance to help public hospitals remain operational without compromising care quality (Wilson, 2023).
The evidence from recent research suggests that while hospital privatization may improve financial performance, it often does so at the cost of patient care and access. The reduction in care quality and increased barriers to access for Medicaid patients highlight the need for a balanced approach to healthcare policy. Policymakers should weigh the financial benefits of privatization against its potential drawbacks and consider measures to protect vulnerable populations and ensure high standards of care. Future research should continue to explore the complex impacts of privatization on various aspects of healthcare to inform more effective and equitable policy decisions.
Honoring Service Dog Awareness Month: The Transformative Power of Canine Companions
By: Shannon-Renee Odoi
Service dogs are more than loyal pets; they are highly trained professionals who assist with a range of tasks to improve their handlers’ quality of life. Their contributions are significant, particularly in therapy and daily support.
Service dogs provide crucial mobility assistance by retrieving items, opening doors, and offering stability while walking. This support enhances independence and reduces physical strain. In addition, these dogs offer emotional support, providing comfort and companionship to those dealing with mental health conditions such as anxiety and PTSD. Their calming presence helps reduce feelings of isolation and stress. Beyond these roles, service dogs are trained to assist with specific tasks tailored to their handlers' needs. This can include reminders for medication or alerts to medical conditions, which helps in managing health effectively.
The positive impact of service dogs extends beyond their immediate tasks. They significantly boost independence by enabling individuals to engage more fully in daily activities and social interactions. Their companionship can greatly enhance emotional well-being, and they often facilitate social interactions, helping to reduce loneliness. Additionally, service dogs offer vital safety benefits, including alerts to medical episodes and navigation assistance.
Supporting service dog teams involves respecting their role while they are working. It’s important to avoid distracting them to ensure their focus remains on their handler’s safety. Promoting awareness of the roles and rights of service dogs can also help ensure they are treated with the respect they deserve. Additionally, supporting organizations that train and provide service dogs through donations and volunteer efforts helps extend these benefits to more people in need.
Service Dog Awareness Month serves as a reminder of the vital contributions of service dogs and their handlers. These extraordinary companions improve daily living, enhance well-being, and foster social connections. By supporting service dog teams and raising awareness, we contribute to a more inclusive and respectful environment.
To all service dogs and their handlers, thank you for your dedication and the remarkable difference you make every day.
What’s Poppin’: Premenstrual Dysphoric Disorder
By: Gauri Guruprasad and Sahaana Anand
As almost every menstruating person does at some point in their life, I also experience PMS (premenstrual syndrome) before the onset of my menstrual cycle. I become so emotional to the point where a video of a cute kitten will make me sob hysterically, I become easily irritable and have to perform deep breathing exercises to calm myself down. I generally feel sore, tender, and bloated in my lower abdomen, and I get hormonal breakouts on my chin that seem to last for weeks (ughhh). These are just a few of the uncomfortable symptoms of PMS. However, if you notice that your symptoms are intensified to an extreme level—if you’re feeling overwhelmed with debilitating anxiety, profound depression, or even experiencing suicidal thoughts—you might not just be dealing with PMS. You may be experiencing PMDD.
The difficult part about diagnosis, as we will all come to learn as aspiring healthcare professionals, is that other conditions such as depression, dysrhythmia, anxiety, and hypothyroidism can cause similar symptoms (Harvard Health). According to the Mayo Clinic, if you have attempted every remedy in the book—lifestyle changes, over-the-counter medications, or even birth control pills—and are still struggling, it’s important to consider a more thorough evaluation with a healthcare provider who specializes in women’s health. Once you start talking to a healthcare provider, they may require several months to track your symptoms alongside other medical tests - such as thyroid function tests or a complete blood count (CBC) - to rule out other causes. Once diagnosed, treatment options may include antidepressants (SSRIs), hormonal therapies like birth control pills, or lifestyle modifications such as dietary changes and exercise. In some cases, cognitive behavioral therapy (CBT) can also help manage the intense mood changes associated with PMDD.
So when almost 10% of those who menstruate experience PMDD, how come there is still so little understanding about where this comes from, and women’s health in general? The long-going bias that lies in the policies, treatments, and research as it pertains to women in clinical trials, particularly women of color and other marginalized communities, experience disease in ways that are less understood. A lot of them, women are told to take the simple way out of the symptoms by getting a generic answer for their symptoms, instead of being given the importance and dignity of finding the root cause of their symptoms. So much of their health should be given so much more value. Though trials are more inclusive compared to even a hundred years ago, there is still far to go.
All of this is to say that if you or one of your loved ones have or are currently experiencing symptoms of PMDD or other menstrual issues, we encourage you to consult with a gynecologist or physician. Neglecting health, especially when it comes to women’s reproductive health, is often seen as the norm, since society has made so many of us to believe that we should just deal with it on our own. As if pain isn’t already inherited in the female experience, there is no reason to let the issues that come with it be. Standing up for ourselves, our autonomy, and well-being is so important for ourselves and our community. As we continue to weave through the complexities and various facets that women go through in life, it is key to face the truth that informed choices, screenings, discussions, and access are all factors that contribute to empower women and their journeys to be led well-equipped and confidently.
The Sex Talk You Never Had: Vaginal Health 101
By: Riya Ramani and Shannon-Renee Odoi
“Is that smell me?”
Let’s be honest: we’ve all experienced this moment and immediately start ordering wipes, soaps, solvents, and all the other overzealously marketed products that promise to make us smell the way we think we’re supposed to. But before you hit ‘add to cart,’ take a step back. Your vagina is a finely tuned, self-cleaning organ with its own natural scent. Most of the time, there’s nothing to worry about. In fact, using too many products can do more harm than good. So, how do you know what’s normal and what’s not? Here’s everything you need to know about vaginal health and how to keep things fresh the right way.
1. Your Vagina Is NOT Supposed to Smell Like a Rose Garden
Despite what marketing campaigns might have you believe, a healthy vagina has its own natural scent—and no, it doesn’t smell like flowers. In fact, trying to mask your natural scent with perfumes or scented hygiene products can throw off your vaginal pH, leading to infections like bacterial vaginosis or yeast infections. Your vagina is self-cleaning, and its natural discharge is one of the ways it maintains its health. So, step away from the fragrant sprays and trust your body’s built-in system.
2. Stop Over-Cleaning
One of the biggest mistakes people make is thinking that vaginas need aggressive cleaning. Your vagina does an excellent job of taking care of itself, so there’s no need for douching or fancy scented soaps. In fact, these can disrupt your natural pH balance, leading to irritation, infections, and a whole lot of discomfort. Stick to mild, unscented soap and water for external cleansing. The internal part? Leave that to your body’s own processes.
3. Keep an Eye on Discharge
Healthy discharge can tell you a lot about what’s going on. Clear or whitish discharge is normal and changes throughout your cycle. However, if you notice a change in color (green, gray, or yellow), texture (thick and cottage cheese-like or foamy), or odor, it’s time to check in with your healthcare provider. These could be signs of an infection that may need treatment.
4. What’s Your pH Saying?
Your vagina’s pH level hovers around 3.8 to 4.5, which is slightly acidic. This acidity helps protect against infections. Common causes of pH disruption include menstruation, sex, and certain medications like antibiotics. If you notice irritation, odor, or discharge, your pH might be off-balance. Probiotics, like those found in yogurt, can sometimes help restore balance, but you should consult your doctor for persistent issues.
5. Safe Sex = Healthy Vagina
Practicing safe sex is one of the easiest ways to keep your vagina healthy. Condoms, dental dams, and regular STD testing are essential for preventing sexually transmitted infections (STIs) that can wreak havoc on your reproductive health. Many STIs are asymptomatic, so it’s important to get tested regularly even if everything seems fine.
6. Choose the Right Underwear
Fancy lace underwear can feel luxurious, but the vagina prefers practicality. Cotton underwear is your vagina's best friend because it's breathable and moisture-wicking, helping prevent unwanted bacterial growth. Moisture-trapping fabrics like nylon or polyester may be a breeding ground for bacteria and yeast.
7. Wipe Front to Back
It may sound like simple advice, but many people don’t realize that wiping front to back is a key move in preventing urinary tract infections (UTIs). The last thing you want is to bring bacteria from the rectal area into your urethra or vagina. Also, be mindful of your toilet paper or wipes—unscented and hypoallergenic are your best bet to avoid irritation.
8. See Your Gynecologist Regularly
Regular check-ups with your gynecologist are key to staying on top of your vaginal health. Whether it’s a Pap smear to screen for cervical cancer or a chat about any changes in your body, these appointments are essential. Don’t wait for something to go wrong before seeing a doctor—prevention is always better than treatment.
So, is that smell you? Maybe, but it’s probably not something to stress over. Your body knows how to take care of itself, and often, the best thing you can do is to listen. If something feels off—whether it’s an unfamiliar odor, pain, or abnormal discharge—don’t hesitate to reach out to your healthcare provider.
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