Guns and public health advocacy [PODCAST]

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“Nineteen children were killed in a mass shooting in Texas. I have barely escaped the pandemonium of the pediatric emergency department to scarf down a bowl of pasta when I hear the announcement on the breakroom TV. My stomach drops. Again? How is it possible?

I step back into the ED and immediately am called over by an agitated mother whose infant came in with respiratory distress 30 minutes earlier. Any moment they would be transferred to the intensive care unit – I hurry over, worried a crisis with her infant awaits me.

She wants to talk about the shooting. In despair, she asks how she can send her other child to kindergarten the next day.”

Marina Mai is a medical student.

She shares her story and discusses her KevinMD article, “Senators are killing children by failing to enact gun control laws.”

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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. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/follow. Today on the show we have Marina Mai. She is a medical student. Her KevinMD article is titled “Senators are killing children by failing to enact gun control laws.” Marina, welcome to the show.

Marina Mai: Thank you so much.

Kevin Pho: So we’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Marina Mai: Sure. I’m a fourth-year medical student at the University of Miami. I’m getting my dual degree, so along with my MD, I’m also studying for my master’s in public health. I’ve always been very interested in public health. It’s kind of what keeps me grounded and what inspired me to go into medicine in the first place. So it’s been really rewarding to see kind of the broad reach and impact it’s had on people’s lives.

I’d definitely say my upbringing shaped that appreciation for public health. I grew up in California, in the San Francisco Bay Area, so I’ve kind of seen the role that public health can have as a catalyst for change. California’s really been at the forefront of public health initiatives, whether that’s tobacco control, food safety, or climate change. So I’ve been very fortunate to have that shape my viewpoints. On the other hand, I went to undergrad in Missouri, at Washington University. I studied anthropology, ballet, and French there, and it was just a whole different world, public health-wise. So I’ve had the privilege of seeing kind of the perspectives of two political extremes and how that shaped the support and funding for public health.

Kevin Pho: So tell me about that contrast that you mentioned. You did undergraduate in Missouri, and you grew up in the San Francisco Bay Area. Draw a little bit of that contrast when it comes to the public health role.

Marina Mai: Definitely. In California, it just feels like it’s saturated in the culture here, so people have a similar mindset. The funding is there. The support is there. So I think there isn’t so much resistance as in Missouri. The public health initiatives that I worked on there just had kind of a lot more obstacles to struggle against, so it made it more difficult. But I think it was really, really interesting to see how passionate that made people about public health. And for the people that worked in it, that interface for change was really exciting, because you could definitely see the difference, and there was a real need for public health in Missouri.

Kevin Pho: So what’s an example of one of those obstacles that you talked about when it comes to initiating public health initiatives in Missouri?

Marina Mai: For example, I worked with this group called Club CHIPS. It was a youth performing arts group, and we would go to different schools and perform kind of public health skits that they’d made up. So it might be a rap or a small drama skit or a song, and it would be within the community and get that public health message peer-to-peer, from these high school kids performing to their own peers. Just some really, really cool projects. But every year, their funding went down, and it just made it harder and harder, and the fundraising took up a bigger part of the time that these kids were supposed to be creating that public health material. So it just kind of drew focus away from it. But they were still able to get their message across. It just was a little harder.

Kevin Pho: All right, so let’s talk about your KevinMD article that you wrote back in May, titled “Senators are killing children by failing to enact gun control laws.” Now, for those of you who get a chance to read your article, just briefly walk my audience through it and share the story of why you decided to write it.

Marina Mai: Yeah, of course. Given my background, and that I’m studying for a dual degree, I’ve kind of gone through medical school trying to be aware of the public health issues around me and how they might manifest in the clinical setting. And I think gun control is a great example of a public health crisis that shows up repeatedly in the medical setting.

So back at the end of May, I was doing a rotation in the pediatric emergency department. I was taking my dinner in the break room, and the news came on about the mass shooting in Uvalde, Texas, and I was horrified. I stepped back out into the ED kind of with this pit in my stomach, hoping I wouldn’t be too distracted to finish the end of my shift, and I was immediately called over by this mother whose infant had come in earlier in the evening with respiratory distress. I’d been following her, so I rushed over, hoping nothing was wrong with her infant, but she in fact wanted to talk about the shooting. You could just see how much fear and despair she was feeling. She was worried about sending her five-year-old child to kindergarten the next day, and it was a really, really powerful moment for me. There have been so many shootings in this country, but to see this mother get hit with worrying about the safety of her kid at school, when she was already dealing with a child in respiratory distress in the emergency department, it was just so dissonant.

So I think it all comes down to the lack of gun control legislation that we’ve had in this country, up until actually this most recent bipartisan bill passed by the Senate at the end of June. The American Public Health Association has long established that gun violence is a public health epidemic, a crisis. And just to give a few statistics, it’s the leading cause of premature death in the U.S. Guns kill more than 38,000 people and cause 85,000 injuries each year. And then, of course, there are mass shootings, defined as four or more victims that are shot or killed, and each year that tally has been growing. These past two years have been record highs, with 2021 recording 693 mass shootings, according to the Gun Violence Archive. In 2022, there have already been, to date, 300 mass shootings, and at least 27 of those were a school shooting. So we’re sadly on track to break even last year’s record.

So I think, given all of that information, gun control should not be a political issue. It should be a public health one. In my article, I talk about this filibuster power of the Senate and how that has historically blocked national policy, because it’s based on the votes of individual states rather than the majority vote. So that means even though there’s a majority consensus in favor of measures like background checks and assault weapons bans, the bill proposed, for example, back after Sandy Hook was negated. A lot of that has to do with our strong Second Amendment, backed by the NRA and gun lobbyists, and senators wanting to get reelected. But I think the big message is that this is a public health crisis, and it shouldn’t be getting caught up in the politics that’s going on.

Kevin Pho: So it goes without saying that guns are one of the most divisive and heavily politicized issues that we have in this country. Now, as a future physician and health care advocate, public policy advocate, how do you talk to someone who doesn’t necessarily agree with what you’re saying? How do you persuade and convince someone when your message doesn’t necessarily resonate with them?

Marina Mai: I think that’s a really difficult conversation to have with somebody. Personally, I want to go into pediatrics, so that is a conversation that needs to happen with a lot of parents, because guns in the home are responsible for a lot of unintentional shootings and injuries for children. So I think the number one thing is to try to remain non-judgmental; otherwise, there’s going to be no perspective sharing or common ground. And then just to provide facts in the setting of child safety, because I think people are really on board when kids are in the mix. Kids are some of the most vulnerable in our society, and I think that’s part of what got this bipartisan bill passed in the Senate: People really just are horrified when they hear about children getting caught up in this unintentional violence.

And so I think it’s just reminding parents that it’s not about encroaching on your rights. It’s just about creating public health safety, the most safe environment. So it doesn’t mean you have to get rid of the gun in your home. It just means let’s store it locked up. Let’s store it away from ammunition.

Kevin Pho: When physicians in the past spoke up regarding culturally divisive issues, they’ve been told, for instance, to stay in their lane. What do you envision as the role of physicians when it comes to speaking out against these culturally divisive issues?

Marina Mai: I think it’s incredibly important, and absolutely the role of physicians, to speak out on these issues that affect our population. So for pediatricians, anything that’s going to affect the health and safety of children needs to be addressed. So 4.6 million children live in a household where a gun is kept unlocked and loaded. Given that gun shootings and unintentional violence are the second leading cause of death among children and adolescents, this is a pediatrician’s lane. This is a pediatrician’s issue, and it is absolutely their right and their duty to make sure that policies are enacted, that parents are informed and aware of how to best keep children safe.

Kevin Pho: Now, what are some ways where pediatricians, and other physicians for that matter, can advocate on behalf of their patients and speak out when it comes to political issues?

Marina Mai: I think you can go all the way from the patient level up to the policy level. So just in those health checkups, asking, “Do you have a gun kept in the house?” I know in Florida that was kind of very controversial: Can physicians even ask that question? Is that stepping on people’s toes? And I think that’s the first step. You need to ask: Is there public health safety in the home? And then all the way going up to being involved in local politics, whatever that means. I know close by to where I am from, San Jose just in January passed the first-of-its-kind gun insurance law, and that’s something that physicians can support, that kind of new, creative way of tackling public health issues. And the physician voice does hold weight in the community, and it’s important to show up and use that voice.

Kevin Pho: We’re talking to Marina Mai. She’s a medical student. Her KevinMD article is titled “Senators are killing children by failing to enact gun control laws.” Marina, what are some of your take-home messages that you want to leave with the KevinMD audience?

Marina Mai: First and foremost, I know I already said it, but gun control, gun legislation, is not political. It’s a public health issue. It’s a medical issue. You have to look at who these policies are affecting, and they’re affecting kids, and they’re the most vulnerable in our population, and they deserve our support and protection. And also, just get your voice out there. I’d never written an opinion piece before, but I had a lot of fun writing it. It felt very satisfying to be able to share my perspective. So you don’t have to be a political activist. No matter what field you’re in or stage of your career, there’s always a way to share your perspective and find a way to speak out about what’s important to you.

Kevin Pho: Marina, thank you so much for sharing your time and insight. Thanks again for being on the show.

Marina Mai: Thank you.

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