Unmasking inequality: the power of community organization during COVID-19 [PODCAST]

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“Touted by some as a ‘great equalizer,’ the COVID-19 pandemic has brought to the forefront long-standing disparities in access to health for Black, Latinx, immigrant, and low-income communities. While we are all in this fight together, some are bearing the burden more than others. Studies have shown that Blacks in the United States are especially affected, with them being represented twice as often among COVID-19 deaths as they are in the population (13 percent of the population vs. 27 percent of COVID-19 deaths). In New York City (NYC), primarily Black and Latinx neighborhoods are being ravaged, while whiter and wealthier areas are seeing fewer cases and deaths. Furthermore, there has been a mass exodus from whiter and wealthier neighborhoods, while New York’s Blacks, Latinxs, immigrants, and those from socioeconomically disadvantaged backgrounds have been unable to escape financial, mental, and literal suffocation by the virus.”

Aishwarya Raja is a medical student. Inginia Genao is an internal medicine physician.

They share their stories and discuss their KevinMD article, “Unmasking inequality: the power of community organization during COVID-19.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Aishwarya Raja and Inginia Genao. Aishwarya is a medical student, and Inginia is an internal medicine physician, and together they co-wrote the article “Unmasking inequality: the power of community organization during COVID-19.” Welcome to the show, both of you.

Aishwarya Raja: Thank you for having us.

Inginia Genao: Thank you for having us.

Kevin Pho: Aishwarya, I’m going to start with you. Can you share your story and your journey to where you are today? And we’ll get into your article in a little bit.

Aishwarya Raja: Of course. Hi, everyone. My name is Aishwarya. I am a fourth-year medical student at Mount Sinai. Growing up in northern New Jersey, I really was actively involved in community service, and from a young age I developed a love for advocating for and working with underserved communities. My parents instilled in me the value of education, but they also reminded me of my power and privilege as an individual and the importance of giving back to those who are the most in need.

And so now, as a medical student at Mount Sinai, I’ve really kind of continued this work and advocacy, working with the underserved and also conducting research on the disparities in health outcomes among these populations. This has manifested in my leadership at Mount Sinai’s student-run free clinic, my grassroots organization, Mask Transit, which I talk about in this article in particular, and most recently, my research, where I worked for a year at Beth Israel Deaconess Medical Center. I really hope to have a career that blends this research, advocacy, and clinical work, and particularly touches the lives of underserved populations.

Kevin Pho: Wonderful, and best wishes on your residency interviews coming up. And Inginia, can you share your story and your journey to where you are today?

Inginia Genao: Sure. I am originally from the Dominican Republic. I came to New York City when I was 15, and then I went to college close to New York City, Maryland College, and I did my internal medicine residency at the University of Rochester. There, that’s when I think, for me, my work with the underserved community started. I did a summer internship at one of the community health centers in Rochester.

After I finished residency, I went to work at Emory University in Atlanta, and I was based at Grady Memorial Hospital. So working with the inner-city hospital, attending to the community, gave me a lot of joy, and I have been doing that ever since. At Emory, I created a department that we called the Department of Cultural Affairs. We also have an International Medical Center addressing the needs of the community. And when I came to Yale, it was very similar, working in the underserved New Haven community, and I led the clinic for the residency.

Now what I’m doing is leading the efforts on diversity, equity, and inclusion for both the Department of Medicine and also graduate medical education. So we’re doing a lot of work on diversifying the physician workforce, because we see the benefits of having a diverse workforce of physicians that address and basically correlate with the patients that we serve.

Kevin Pho: Excellent. So let’s get into the KevinMD article that both of you wrote, “Unmasking inequality: the power of community organization during COVID-19.” Aishwarya, for those who haven’t read the article, can you just walk my audience through it and share the story of why you decided to co-write it?

Aishwarya Raja: Yes, of course. The article really came about as a natural progression of the work that we had already been doing for months, around the time that COVID-19 had really hit New York City the hardest, which was in April of 2020. And so it’s a summary of the efforts of this grassroots organization that I founded, Mask Transit, as well as the lessons and things that we learned along the way, in terms of the importance of community organization and the importance of mobilizing groups from different walks of life to address a major public health crisis.

And so, Mask Transit itself: I decided to found this organization in April of 2020 after seeing kind of the disproportionate impact that COVID-19 was having on communities of color, those who are low-wage frontline workers, and those who are undomiciled. And I really wanted to make a difference in a way that was important for these individuals. And so I mobilized a group of medical students at Mount Sinai to develop a concerted effort to provide masks and educational materials to these communities.

Starting in New York City, addressing the needs of the East Harlem community members, and then quickly expanding to include efforts in New Haven, Connecticut, with Dr. Genao, as well as in Boston and other major cities, we really were able to create this national coalition of individuals who were addressing this particular gap that existed in our society. And so that’s how Dr. Genao and I connected, and we knew that this was a story that really needed to be broadcasted to a wider audience.

Kevin Pho: And Aishwarya, give some specific examples of the impact Mask Transit had. Can you give some stories of specific families and patients that your program has impacted?

Aishwarya Raja: Of course. So, Mask Transit: Initially, we wanted to target the patients and families that were seen at Mount Sinai’s student-run free clinic. And so there are about 300 patients that are served at that clinic, and if you multiply that by three or four, the average number of individuals within their household, we were able to provide over a thousand masks and educational pamphlets to these individuals alone.

And just one example of a person or an individual who really touched me personally was a patient that I worked with at the clinic who was a low-wage frontline worker. She had a very difficult job working at a deli, and she expressed to me the difficulty of attaining masks at a price that was affordable to her, and there were also shortages at that time. And so working with her and realizing that these masks could really impact the lives of patients like my patient really was the catalyst for the eventual founding of this organization.

Kevin Pho: Wonderful. And Inginia, in your practice at Yale, whether inpatient or outpatient, can you share some stories and examples of the disparity that COVID-19 really is exacerbating?

Inginia Genao: Sure. During the pandemic, I was doing a lot of telehealth, addressing the needs of the patients that way. And what I heard from my patients was the fear of seeking care because of contracting COVID in the hospital. So many of them were not leaving their homes, much less seeking care when they were sick. So what we saw was a worsening of chronic conditions because of fear of seeking care. The other disparities that we observed, and obviously this is not just in New Haven but throughout the country, were in terms of people of color being disproportionately impacted by COVID.

The other thing: This is where I think that need for addressing the community with masks was the driver for me, because the patients had issues with social distancing. Many of them live in a very crowded home environment. So immediately, we couldn’t say, “OK, here’s a home for you.” But what could we have done? And so the easiest thing was to educate and provide masks. So we had basically a mask drive, going out into the community to educate them along with providing them a mask. So that’s what we initially did.

Kevin Pho: And Inginia, we are speaking in the last week of December. In fact, we’re speaking on New Year’s Eve. And now we have two vaccines that have been approved and possibly a third one that’s going to be approved within the next month or so. Can you share some of the obstacles people of color have when it comes to perhaps accessing the vaccine going forward?

Inginia Genao: Well, one thing is that it’s not yet available. I have been vaccinated, but it’s not yet available to the community. I think the main obstacle is trust, the trust in the medical community, because there is a strong history of us physicians, we, the health care workforce, basically abusing the underserved communities. And so we have to regain that trust. And that is one of the things with those of us in health care getting vaccinated: It’s a way of saying, “This is safe. I did it myself, and you can do it too.” So I think the top barrier that I see is trust when that vaccine becomes available.

Kevin Pho: So I’m an internal medicine physician as well, and I agree that there’s a lot of skepticism right now about the vaccine. On my Facebook feed, for instance, I see a lot of patients having a lot of questions about the speed at which the vaccine was produced. So Inginia, if there’s a patient in the exam room and they have questions about the vaccines, what are some things that I can say to them to help them with that trust?

Inginia Genao: So I would say, I mean, putting myself first, as I mentioned, I got the vaccine. I put myself in their shoes, and I can tell them my experience with the vaccine. I had a sore arm, a little bit more sore than the flu shot, but otherwise I had no symptoms myself. And then if we take it to the population, based on the studies done on the vaccine, the side effects are so minimal compared to the actual infection of COVID.

So I think we have to put it in perspective: the vaccine side effects versus getting the infection of COVID, which has so many other complications that we still don’t know. So, you know, we may not know all the side effects of the vaccine, let’s say, three years from now, but we also don’t know all the potential complications of COVID three years from now. So I think it’s basically a way to measure the side effects versus the actual infection.

Kevin Pho: Aishwarya, you co-wrote that article back on October 2, and again, we’re speaking in the last week of December. Now, what do you anticipate are some of the ways that medical students can be involved in, hopefully, the last few months of the pandemic, and what do you anticipate some of the challenges to be going forward?

Aishwarya Raja: Yeah, definitely. And kind of speaking a little bit about this, the vaccination misinformation and how we can help as medical students and also help through Mask Transit and these grassroots organizations, looking forward in the next couple of months, we are now trying to partner with faith-based organizations and community-based organizations within East Harlem and other communities as well to form these partnerships, with the aim of really bridging the gaps and kind of dispelling some of the myths and misinformation that really exist surrounding the vaccine. And so working alongside physicians of color, working alongside faith leaders, bridging these gaps, and perhaps even forming new connections that had previously not been formed are ways that medical students can help.

And so we will be planning some live virtual community Q&As with physicians as well as faith leaders. We’re creating prerecorded digital content with physicians of color speaking about the vaccine and answering some of the most common questions that the community members have, and finally, disseminating it widely. And so this includes email listservs with these faith organizations, perhaps kind of forming a digital way of broadcasting this information through electronic health records or other means. So we’re always kind of thinking ahead about how we can get medical students involved in addressing these issues in a way that is smart and really tailored to the communities that we’re working with.

Kevin Pho: And if I’m a medical student and I do want to get involved, whether it’s with your organization or other organizations who do similar things, what are some resources that you can suggest?

Aishwarya Raja: Yeah, so I would say definitely, if a medical school or medical students are involved, you can definitely reach out to our organization in particular. We have a lot of community ties, so we can either kind of connect them to community organizations within their cities that are already doing something similar, or they can partner with us. And so you can email us at [email protected] or go to our website, masstransit.org, and all the information is there about how to get in touch with us. And we are more than happy to include more medical schools and cities to really bring this out nationally.

Kevin Pho: Great. And we are talking to Aishwarya Raja and Inginia Genao. They both co-wrote the KevinMD article “Unmasking inequality: the power of community organization during COVID-19.” So I’m going to end by asking both of you the same question. Aishwarya, I’m going to start with you. What is your take-home message that you want to send to the KevinMD audience?

Aishwarya Raja: So I would say the take-home message is, for situations that require swift and judicious action, it’s really important that formalized institutions, like hospitals, government, distributors, and manufacturers, really leverage the power of community organization and pre-existing infrastructure to deliver effective and sustainable solutions. It’s not enough to work in isolation. It’s important that all of these parties get their message heard and that we work together to formalize a response.

Kevin Pho: And Inginia, what is your take-home message that you want to leave with the KevinMD audience?

Inginia Genao: Sure. I think what I would like to say is that when we are facing a major issue like the COVID-19 pandemic, sometimes it is paralyzing when we think of ourselves as individuals. But just one person sharing an idea with another person can actually be a catalyst to something major, basically to come together and unite forces to do the best we can for the community. Because as individuals, there is so little we can do at times, but when we come together, we can actually do a lot better and have a stronger impact on the community that we’re serving.

Kevin Pho: Wonderful. Well, thank you to both of you for sharing your insight and time, and thanks again for being on the show.

Inginia Genao: Thank you for having us.

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