Jan 25, 2011

Martin Luther King Jr. Day: Socioculturalism in Medicine

When you are born with yellow skin and black hair into a multicolored country, socioculturalism is a daily reality. Although my parents label me as an ABC (American Born Chinese) with amusement, unbeknownst to them, every day is a continuous combination of integration, negotiation, and assessment of how my decisions and actions define who I am. For example, if I choose Peking duck over sirloin steak for dinner, does that make me more Chinese? Where did this preference for a northern Chinese delicacy even stem from? My parents are from Shanghai, so my preferred protein should really be freshwater shrimp. Of the dance styles that I enjoy the most, my decision is straddled between Chinese and hip hop. When I’m seeking symptomatic relief from colds, I instinctually reach for Acetaminophen, Ibuprofen, and Phenylephrine. But, for sore throat relief specifically, my first line treatment of choice is Nin Jiom herbal lozenges and syrup. Asian Americans are predisposed to specific cancers and there is an overwhelming prevalence of Hepatitis B in the Asian American community. Because my diet is probably closer to the average American diet, what disease risk factors and predispositions do I actually have?

As illustrated above, I am socioculturally stochastic. Even the best statisticians would not be able to make any sense of this variability and extract a reliable pattern to predict my future actions. While I have never felt intimately tied to my ancestral culture, my physical appearance is a daily reminder that there is no escaping it. Despite my inability to lean one way or the other, whether I like it or not, I am American, Asian, and Chinese. Although I have traveled extensively around the world and have lived in several microcultures within the US, it wasn’t until I traveled to Ghana that I began to understand the significance and potential consequences of my blended identities within a broader context.

Wherever I walked in Ghana, people around me would whisper, mutter, scream, and shout the word, “Obroni,” which roughly translates to white person. Within days, I responded to “obroni” faster than my actual name. And after walking into an internet cafĂ©, one of the most cosmopolitan buildings in the city, I quickly realized that I was in Ghana not just representing myself, but also my family, my school, my country, my ethnicity, and perhaps even all peoples of the world who have yellow skin and black hair. That’s a lot of responsibility for one person. Did I ask for this leadership role? If given the choice behind the proverbial Rawlsian veil of ignorance, would I choose Asian American physical features if I knew that my actions would forever shape how others perceived all those who merely looked like me?

This new inherent responsibility did not directly dictate my behavior while I was in Ghana. However, I do recall expending more effort describing the Asian countries I had visited, explaining why I primarily use English and not Chinese to communicate with my parents, and searching the entire city for ground pork and Tostito chips so that I could make Chinese dumplings and guacamole to share, respectively. The learning and exploration went both ways. By participating in health fairs at local churches in Ghana, I learned that measuring blood pressure on Ghanaians was slightly different from what I had grown accustomed to doing. Blood pressures tended to run higher in Ghanaians, so I had to make minor modifications in my use of the sphygmomanometer. These behaviors only seemed natural as I tried to absorb as many of the cultural nuances of Ghana. I was sure that this blatant sociocultural exchange would end as soon as I returned to the US because I’d be reunited with “my people,” people who understood me.

However, when I finally did return to the US, I realized that my sociocultural position here at Michigan is not too dissimilar from Ghana. Similarly, in Michigan, I have not only a lot to share, but also a lot to learn. I am one of a few Asian Americans in the school, one of a handful of students who attended college in the Northeast, and just one of a pair of students from Boca Raton, Florida. Just like in Ghana, my opinions and behaviors are important learning experiences from the more grandiose displays such as choreographing and performing a Chinese drum dance at the biannual Biorhythms show to more subtle mediums such as sharing cultural foods and my opinions within our small groups. Because I am unique and represent an eclectic combination of experiences and influences, that intrinsic responsibility I felt in Ghana is always with me. I am inherently a sociocultural leader, and I must confess that I spent much of this first semester struggling with those responsibilities.

It wasn’t until I took some time to reflect upon the significance of Dr. Martin Luther King Jr. Day that I resolved my inner conflict of being appointed a sociocultural leader without ever asking for such responsibilities. In 1963, Dr. Martin Luther King Jr., delivered his watershed, “I Have a Dream” speech. He described a future where the colored people of the nation could walk side by side with the white—a harmonious existence. Today, with an African American Commander in Chief, we can say that we have truly come a long way since 1963. However, I’d argue that we still have a lot more work to do before we achieve the future that Dr. King described. In regards to health equity specifically, the color of your skin is still the strongest predictor of health, not cholesterol levels, blood pressure, or hemoglobin A1c levels as one would suspect. Today, we are walking together, but I cannot say with confidence that we are talking and listening. We are not learning from each other.

Medical school admissions committees work very hard to construct a diverse class. But, we are failing at taking full advantage of this deliberate design. We cannot simple wait for required activities to engage in diversity. And even during such events, it feels like we passively wait for experiences and opinions to crash into each other to hopefully reach a blended resolution. In lectures, diversity is treated like an afterthought. We are constructing more barriers to understanding health equity when we are presented with racial, ethnic, and gender epidemiological data placed only within the biomedical context.

Yes, it is true. I physically appear different from the majority of my classmates and faculty at the medical school and carry the responsibility to speak up to share my point of view. But, I am not alone. I am not the only student with this burden of being a sociocultural leader. This is a leadership burden that is shared among all of us. We all must accept the inherent challenge to listen to others and share our experiences. We should acknowledge differences and carve out the best ways to utilize and understand those differences. That is how we will engage in diversity. That is how we will be able to better understand health equity challenges. And that is how we will together achieve Dr. King’s dream.

If not for our personal benefit, we owe it to our future patients and the greater goal of achieving equitable health care to step up to this leadership challenge instead of asking, “why me?” At the very least, as sociocultural leaders and the future leaders of medicine, we should take some time within our busy days to ask each other questions, respect disagreement, and truly listen and share.