Mary Isabel Casey | Maspeth, NY – Medicine, Health, and Society, 2018
Mary Isabel Casey is a sophomore from Maspeth, New York. She is majoring in Medicine, Health, and Society and double minoring in Spanish and Women’s and Gender Studies. Mary will be working for a non-profit, public health organization in Newham, a borough of London, as well as interacting with local and governmental officials to gain further insight on health issues facing the community. Mary is excited to learn about London’s healthcare system and hopes to use the knowledge she gains to solidify her future career endeavors in healthcare.
Two and a half days in. Wow. What a tumultuous time to be in London a week since the EU referendum and Brexit, and the value of the pound is decreasing. Some of my first impressions of East London and British culture include:
Commuters - The primary method of transportation in London is Transport for London (TfL), the public transportation system. TfL includes the Tube, the famous red doubledecker buses, the DLR, and more. As a New Yorker, I appreciate the accessibility of London because it is easy to travel from place to place by foot or using TfL. I am still learning the different lines and how to get to different places but I’m thrilled how similar TfL and the New York City subways and buses. The Oyster card (the equivalent of a NYC Metrocard) grants me unlimited travel in certain zones for the duration of my trip.
Diverse - East London is a melting pot of individuals from different backgrounds who are able to coexist beautifully in their communities. There are positive views toward immigration as East Londoners believe the culture is enriched with the influx of other ethnic groups. As I am walking down Mile End Avenue, I can see a Halal chicken restaurant, an Italian restaurant, an Asian restaurant, and a gastropub located right next to each other. I have never experienced such integration of cultures and food as I have in East London. New York City is very diverse as well; however, different cultures have their own communities and spaces within the city. In comparison, diversity seems segregated in New York City.
Soft-spoken - British people are very quiet in public spaces and cognizant of their surroundings. Almost every trip we have taken on the Tube or the bus, we have been the only ones talking. It is obvious that we are Americans but it becomes even more evident when our voices fill public spaces.
We had the opportunity to meet with Damian Atkinson who is the Head of Commissioning for the London Borough of Newham, and other members of the Newham Council. The council is responsible for planning and facilitating community engagement projects with funding from the central government. They manage social care services, housing placements, arts programming, children’s commissioning, etc. Damian shared some interesting statistics with the cohort:
– 42% of Newham residents have no formal qualifications.
– Almost half of local residents are overweight or obese.
Access to education opportunities can be attributed to several factors including intergenerational poverty and immigration status. There are over 100 languages spoken in Newham schools!
In regards to obesity, the council is concerned with preventive public health and encourages proactive behavior in daily life. Chicken shops are prominent in the community and easily accessible, which contributes to the public health issue. One way the Newham Council tries to intervene is regulating licenses distributed to businesses. If there are too many chicken shops within a certain distance, they can prevent more shops from opening. There is also discussion of a sugar tax on products which may dissuade individuals from consuming too much sugar which leads to obesity. Diabetes is also prevalent in East London as it is related to dietary habits, genetics, and geographic location.
The Newham Council is comprised of aspirational individuals who are motivated to deliver better services for better outcomes.
We also had the opportunity to meet with Lisette Johnston from the BBC. The BBC is the world’s largest news-gathering organization and focuses on public service broadcasting, which means broadcasting is for the benefit of the public and not for commercial advertising. One of the challenges the BBC is facing is how to adapt with evolving technology. We live in a society of smartphones and social media, and expect instant gratification. If a news story comes out, we can easily be connected through Facebook or Twitter to find out details of a situation instead of waiting for a news channel to broadcast at a certain hour of the day. Despite challenges, the BBC is dedicated to inform, educate, and entertain the public.
Lisette also spoke about the interaction between the BBC and public health with the 2014 Ebola outbreak and 2016 Zika virus outbreak. Reporters created ‘explainers’, which are short information based videos containing text and graphics to educate the public. The BBC had full news coverage in both Latin America and Africa during both outbreaks. The corporation also used technology to its advantage in the Ebola outbreak and created a WhatsApp public health information system for users in West Africa. The system provided audio and text messages with the latest updates on the outbreak and preventive measures that could be taken.
Although media can be helpful toward public health, who is the target audience of explainers or media coverage on public health outbreaks? People who are affected by the health outbreaks may not have access to television, internet, or smartphones to receive the information. Is it the responsibility of community partners to bridge the gap of educating locals who do not have access to the resources? Initiatives are in place to enhance media services; however, I still find it problematic that people who may need the educational resources the most cannot have access to it due to unaffordability.
We must ask the difficult questions to learn from each other, challenging or reaffirming our own beliefs in open dialogue.
I will be making weekly blog posts, which are intended to reflect on my service project and other activities during my program. Please join me as I expand my knowledge of public health, explore the U.K., and continue to “live the questions”. Happy reading!
Here are some pictures recapping my first few days:
Blog Post Two:
Week Two: Whirlwind
I have been in London for 10 days now and so much has happened in this time span – I am still trying to wrap my head around all of it.
On Saturday, July 2nd there was a Brexit protest in Parliament Square Garden, which is located across the street from the Houses of Parliament. Some members of my cohort and I were able to witness the protest from a safe distance and the street was filled with EU flags and a variety of protest signs with powerful statements on them. One sign in particular that caught my eye was a red stop sign that said “Stop Racism” and on the back of it, the protestor painted a green go sign that said “Go Immigration”. The implications and long-term effects of the referendum are still unclear; however, I do not expect the emotional reaction and response from the public to dissipate.
My first day of service with Social Action for Health (SAfH) was Monday, July 4th. The organization has four core values that drive their programmes and learning initiatives:
- We start with the people
- People have the right to take control of their own lives
- People’s health can be improved by tackling isolation, poverty, racism and unemployment
- Healthy communities are good for the whole society
In service work, I believe it is extremely important to dedicate your time to organizations whose values are similar to your own. SAfH takes a hands-on approach in interacting with the marginalized communities it serves in both Tower Hamlets and Hackney. The programmes primarily focus on education in preventative public health, tackling diseases such as diabetes and obesity, and empowering individuals to use their voices to speak out against injustices in the health care system.
I am serving specifically with the Patient Leaders Programme in Tower Hamlets. Individuals who are interested in health care and want to take a leadership role in health care policy can apply to the programme and a group of about 10 are accepted to become Patient Leaders (PLs). The programme is one year of training modules for personal and professional development that occur on a weekly basis. PLs also have meetings with the Tower Hamlets Clinical Commissioning Group and Healthwatch Tower Hamlets to discuss issues regarding the National Health Service (NHS). I will speak more about these two groups in next week’s blog post. PLs are required to design a project related to an aspect of health care of interest to them to be implemented in the community. My current project with Patient Leaders is evaluating the individual impact and overall outcomes of the programme to see how the organization can improve its efforts in the future.
On Thursday, July 7th, as part of our enrichment activities, my cohort and I had the opportunity to meet Stephen Timms who is a member of parliament (MP) for Newham. MPs are very accessible and host surgeries (local meetings) for constituents to voice their concerns. I could not believe how close we were able to sit in proximity to MP Timms – we would not be able to do the same in the United States. We discussed a variety of topics from education, to health care, to the implications of Brexit, to poverty and unemployment. As an MP for over 20 years, he has seen Newham’s local economy rise over time with increased railway access, train stations, and the 2012 Olympic Games. There is a large-scale building project currently taking place to establish foreign businesses in Newham, which will create about 30,000 jobs in the area.
After our meeting with MP Timms, we toured the Houses of Parliament and sat in on a debate in the House of Commons regarding the regulation of social media to prevent cyber bullying. I found it ironic how the majority of the very few MPs who showed up to the debate were on their cellphones and iPads as others voiced their opinion on the matter. It was a once in a lifetime opportunity, nonetheless!
On Friday, July 8th, we visited the Newham Collegiate School (NCS), which is a two year, government-funded school for students ages 16 to 18 to prepare for university entry. The highest achieving students from Newham are accepted to NCS and are challenged with rigorous coursework and profound academic enrichment. NCS operates on A Level curriculum in which students select four subject areas to focus on and take achievement exams at the completion of each year. Students who want to pursue medicine must select Chemistry and Biology as two of their four courses. In comparison to students in the United States, students in the U.K. must decide at younger ages what career path to follow so they can plan out their courses accordingly. At the end of our day at NCS, we had a debate with first-year students comparing the United States and United Kingdom health care systems.
At the end of this week, the deaths of Alton Sterling, Philando Castile, and the Dallas police officers have left a heavy weight on my heart. I see friends and communities hurting back home and feel helpless because of my distance. Since I cannot access U.S. based news reports, I have had to rely on international news networks to deliver accurate, impartial accounts, which is difficult. On Tuesday, before any of the events had taken place, I went to the British Museum and saw a sculpture titled “Tree of Life”. Four artists created the piece using weapons that had been used during the Mozambique civil war. I reflected on the image in light of the recent events and I have tried to make sense of its title. How can we equate something full of life such as a tree with something that destroys lives like guns? Even though we cannot see the roots of the tree, we know they exist. Violence is deeply rooted in our society. Violence breeds violence. It’s time to make a change and take a stand so we can protect more innocent lives from being taken.
I leave you with this quote:
“And we never know at the beginning where we’ll end up. And it doesn’t matter…All she did was take that first step, and then the next, and then the next. This is how the world changes. And this is why we need to step forward for what we care about. Little by little, step-by-step we can resolve the frightening issues of this time and restore hope to the future.” – Margaret Wheatley (2008)
To my family, friends, mentors, and others back home who are hurting: you are loved. You are valued and important. I am thinking of you.
Blog Post Three:
Week Three: Perspectives
“Pick my brain. Ask me about my views on something. Dig deeper than the obvious. Let’s make each other think. Show me a different perspective.” – Unknown
This week has been filled with different perspectives – opening my eyes to see things in a new way, stretching my brain to analyze new thoughts, challenging my own beliefs and defending my point of view to others. Our perspectives are formed on our lived experiences. We do not know the successes and failures, the trials and tribulations, the good fortune or hardship of a stranger; therefore, it is important to remember that individuals are entitled to their opinion and we must respect them for it. However, we can respectfully disagree and share our beliefs for fruitful dialogue. And this is how we learn…sharing ideas, challenging thoughts, and expanding horizons.
The Patient Leaders met with the Tower Hamlets Clinical Commissioning Group and Healthwatch Tower Hamlets to discuss issues regarding the National Health Service (NHS). Each borough has a Clinical Commissioning Group (CCG), which is responsible for “planning, buying, and monitoring a range of local services including most hospital, community–based and mental health services”.
Tower Hamlets CCG provides funding to community organizations like Social Action for Health in programs like Patient Leaders to make a difference in health care. Healthwatch Tower Hamlets is a local sector of Healthwatch England and strives to improve health and social services using first-hand accounts from the local community. “We can act as the eyes and ears of the people of Tower Hamlets, working closely with existing voluntary and community groups and our partners so together, we will see and investigate the important local issues and trends.”
With their slogan, “Your Voice Matters”, I am amazed at the efforts of Healthwatch Tower Hamlets to make underrepresented voices heard at larger platforms to make changes in the health care system. I think we would benefit greatly in the United States if we had more feedback mechanisms in place with our health care system to provide spaces where individuals could approach health care stakeholders and share experiences to improve delivery of services.
On Tuesday, July 12th, my supervisor and I attended a Health Inequalities Summit sponsored by Tower Hamlets Council for Voluntary Service (THCVS). The summit had three facilitators who provided statistics on health inequality in Tower Hamlets as well as ways in which individuals can drive change in their community.
The focus of discussion was the idea of community self-organization, NOT projects. There are many organizations that create projects based on what the organization leaders think or see are the needs of a community. The projects are funded and implemented in communities and although some change is made, the project is not sustainable and will eventually fail. Why? The answer is very simple. Communities are not given a chance to define their needs or given the power to voice their concerns. Individuals are not involved in planning initiatives. The community knows what the community needs. This shows the importance of listening and how organizations can use their reach to provide platforms for community members to have voices, to share their needs, and to create change.
One of the facilitators, Cormac Russell, was very inspirational and well spoken. I would like to share some quotes with you from his presentation:
Make small the new big.
If you cannot say NO, your YES is meaningless.
3 powers we can give communities:
- power to define the problem
- power to define the solution
- power to define the action
Any health professional working in the field must be willing to dissent.
And my favorite:
Health is about having someone to love, somewhere to live, and something meaningful to do.
As a future health care professional, I cannot stress enough the importance of looking at people as citizens and not patients. Health is more than just a disease or an illness; health is education, employment, income, neighborhood planning, environmental conditions, race and ethnicity, and citizenship status. We have to stop treating people as patients and address community issues that are perceived as medical issues.
Cormac left me with “food for thought”. I hope as I continue my path in health care, I am enriched by the ideas and opinions of others to represent and serve my community as best as I can.
At the end of this week, I moved in with a host family and my supervisor invited me to her house for dinner. I am so grateful for their kindness in welcoming me into their homes and families with open arms. I look forward to the time we will continue to spend together over the next few weeks.
Blog Post Four:
Week Four: Resilience
I cannot believe we are halfway through the program and have two weeks left in London. Summer finally arrived with much warmer temperatures and a heatwave, making some days a bit unbearable. There are very few air conditioned facilities, which surprised me. I’m hoping for cooler temperatures during the remainder of our stay.
This week, I was grateful to have my mom, sister, grandmother, aunt, best friend and her mom in town for a few days. My family is extremely supportive of my endeavors and I know I would not be where I am today without their love and encouragement. I enjoyed my time with them greatly.
I decided to title my blog post ‘Resilience’ because I have observed events and listened to testimonies on several occasions in which individuals or communities have shown determination and willingness to overcome obstacles. I will share some of these stories with you.
The first is about my grandmother. My grandmother, or Abua as I refer to her, is turning 90 years old this November and she was able to board a plane and travel to visit me which I find truly amazing. I hope when I am 90 years old, I am in as great of shape and have good health like Abua. Although she had a cane for support, she was able to walk all around London, visit tourist attractions, and keep a positive attitude. She was unstoppable. Abua had dreamt of traveling to London for many years and seeing the constant joy on her face is something I will never forget. On her last night in town before we said goodbye, she said to me, “Mary, you have a long life ahead of you so go live it.” I took her words to heart and thought about the many opportunities I have had at Vanderbilt and the prospect of future ones that would not be possible without my mom’s and Abua’s sacrifices that have had a chain reaction in our family. Thank you, Abua, for being the remarkable woman you are; you are an inspiration to many.
The second account of resilience involves one of the Patient Leaders. As I mentioned in previous blog posts, my service project is to capture the impact of the Patient Leadership Programme on individuals and the greater Tower Hamlets community through evaluation reports. On Monday, I had the pleasure of interviewing one of the Patient Leaders to assist him with writing his evaluation report. We spoke for two hours about his project regarding mental health awareness, his impression of the programme, and his impact in the community. He shared with me that he did not receive a formal education and therefore struggles with gathering his thoughts on paper. He also faces a language barrier and at times cannot remember the English words for the message he is trying to convey. Nevertheless, the Patient Leader was able to make quite the impact on his community. He chairs many events and meetings about mental health. He is in charge of a task force about reforming mental health services. He has gotten many reports written up by organizations, which are also accessible to the public. His iPhone 4 is his computer and he manages to get all his work done on it. This goes to show that despite not having all the resources at times, you can still make strides and be successful. I am impressed by the work of this Patient Leader in his community and know he will continue to make a difference with his wisdom, perseverance, and charisma.
The last story is about the Borough of Newham. This week, we had the opportunity to meet Sir Robin Wales, the mayor of Newham, and attend a Newham Cabinet Meeting. Sir Robin Wales told us, “It’s always sunny in Newham.” I learned several things at both meetings:
- Newham is gentrifying. Young professionals are moving to the outskirts of the borough where public transportation is extremely accessible. Therefore, residents of Newham are having to move to the poorer neighborhoods within the borough where housing is more affordable and health care is inadequate. Hospitals in these neighborhoods are “more challenging” according to health professionals, and doctors do not want to work in these communities. Despite the displacement of many individuals, statistics about poverty and income are improving. Are the statistics really changing or are the type of people living in the borough changing? I think it’s the latter.
- Health = Wealth. In the United States, the amount of money a person makes determines the quality of their health. Income is related to education received, housing you can afford, the type of job you have, access to health insurance, and the neighborhood you live in, which are all factors in one’s health and wellbeing. I’ve learned that a similar phenomenon happens in London even though there is universal health care. Researcher Dr. James Cheshire from University College London created a map called Lives on the Line, which is a visual representation of life expectancy along the tube line. Oxford Circus, a wealthier area of London, has the highest life expectancy at 96 years old, whereas Prince Regent, a stop in east London (the poorer area of London), has a life expectancy of 76 years old. A 20 year disparity between two communities that are 10 miles apart. Wealthier individuals can demand better health services. Additionally as I mentioned above, hospitals and doctors are more accessible and of higher quality in wealthier neighborhoods.
You can view the map using this link: http://life.mappinglondon.co.uk
Sir Robin Wales and the Newham Council are dedicated to improving quality of life in Newham. Both have positive attitudes toward the future despite the challenges in their way.
On Friday, we met with Satbinder Sanghera, Director of Partnerships & Governance for Newham CCG. In last week’s blog post, I talked about Tower Hamlets CCG and defined their work and responsibilities. Newham CCG is the same commissioning service as Tower Hamlets CCG from the National Health Service (NHS), but serving a different borough and different population. Satbinder’s presentation was less optimistic than testimonies we had previously heard about Newham; he shared with us some of the harsh realities facing the borough.
- ¼ of children are obese when they start primary school. I asked if children have annual checkups with a physician, which is recommended (or required) for children in the United States. He told me that children see a health provider for immunizations according to a timeline from birth to about 13 years old. It was unclear how often children are mandated for health checks when their height and weight are taken – I am going to look into this further. I think if children’s development can be monitored a bit more closely by health professionals, parents can be given more advice about nutrition and active lifestyles for their young children to prevent the onset of childhood obesity.
- 80% of resources are spent on 20% of the population. Life expectancy is increasing and with a large, older population it is more expensive to provide health care services.
- Satbinder said, “We must empower people to take control over their lives.” He was referring to the normalization of diabetes in Newham communities – so many people have been diagnosed with diabetes that the fear of developing the condition is decreasing. He also mentioned the misuse of services at General Practitioner (GP – equivalent of a primary care physician) practices and Accident & Emergency (A&E – equivalent of the emergency room). 1 in 3 GP appointments are no show. The wait list to make a GP appointment is quite extensive and individuals who really need to see the GP may have to wait a few days or even weeks, while others do not go to their appointments for reasons I am not aware of at the moment. Those who need to see their GP and cannot get an appointment quickly go to A&E instead where they know they will be seen and given the medication for their cold, or the stitches for their cut finger. This is creating more influx in A&E. To manage this, urgent care centers are emerging to serve as a middle ground between the GP practice and A&E. Satbinder thinks it is the responsibility of the third sector (non-profits and other community organizations) to educate the community since they know the community the best.
If it is the responsibility of the third sector to educate and empower individuals on preventive health, who is going to help fund their efforts to carry out these programs? I have felt that responsibility is being tossed around with different parties pointing to other parties and saying it is their responsibility for performing x, y, and z. I wish one group could “own” the responsibility or figure out a way to incorporate many parties to figure out solutions. It would make things get done a little easier.
“We cannot all succeed when half of us are held back.” – Malala Yousafzai
Blog Post Five:
Week Five: Triple A – Advocacy, Agency, and Agenda
“Advocacy – to change ‘what is’ into ‘what should be.’” – Unknown
Although the themes of advocacy, agency, and agenda have been prevalent throughout the program, I have seen them exemplified in several ways this week.
As I have continued my reporting and evaluation of the Patient Leaders Programme, I had the opportunity to interview another Patient Leader who shared her story with me. Before Patient Leaders, she worked in one of the local hospitals as a receptionist and saw flaws in the system but decided not to speak out against it. Unfortunately, the Patient Leader experienced some health problems and could no longer work. She liked to be active in her community and she was encouraged to attend support groups to help her cope with her condition. She told me how much she enjoyed attending the groups – it was something she looked forward to each week as it got her out of the house and she made friends with the familiar faces she’d see week to week. Through these friendships, she found out about more support groups and events on various topics which she began attending. She found out about Patient Leaders through a friend and is grateful for the programme for boosting her self-esteem and confidence. She is interested in Mental Health Awareness and helps facilitate support groups much like the ones she used to attend. I am really proud of this Patient Leader for becoming an advocate for those suffering from conditions similar to her own and bringing her perspectives as both a patient and health care professional to her work.
For our enrichment activities, we met with representatives from ActiveNewham and One Hackney and City. ActiveNewham is a prediabetes intervention programme with a focus on physical activity. An individual is considered pre-diabetic when their sugar level is higher than normal but not high enough to be classified as Type 2 Diabetes. Without intervention and lifestyle changes, it is likely for pre-diabetic individuals to develop diabetes in a few years. One of the aims of ActiveNewham is to reduce health inequalities in the borough of Newham. With services free of charge to all participants, residents are not held back by financial obligations to the programme. The programme is commissioned by Newham CCG and local authorities. ActiveNewham works closely with general practitioners in the borough to refer individuals who are at risk for heart disease or diabetes. Professionals at ActiveNewham perform an initial assessment to get to know the patient through motivational interviewing. Motivational interviewing encourages people to be more open and elicit more information to get to the core of issues discussed. After this assessment, the professional will match the patient with a suitable physical activity ranging from gardening to chair based activity to Zumba to yoga to salsa. There are a variety of activities available to participants! The patient will attend the activity once a week for a span of 12 weeks and then receive another assessment from ActiveNewham. After the assessment, the patient goes through the final 12 weeks of the programme, attending the activity once a week, and returning for a final assessment at 24 weeks. The assessments not only include motivational interviewing but also physiological measurements. I was impressed by the programme but had two reservations about its services.
1) I believe diet AND exercise are important for weight management. I understand this programme is trying to increase physical activity; however, I think there should be some type of education on nutrition to provide a holistic approach.
2) At our meeting last week with Newham CCG, we saw a map illustrating the gentrification in the borough as well as a heat map of diabetes. The ActiveNewham office is located in a part of the borough undergoing gentrification where the risk of diabetes is not as high as it is in other parts of the borough. Is this programme reaching those who need its services the most? Is the location of the office accessible to potential and current participants?
Overall, I enjoyed the presentation and appreciate the work of this programme in the community. ActiveNewham does not focus on blaming the individual for the presence of health conditions but rather blaming the system and where it has failed citizens in delivery of services.
One Hackney and City is a programme under Hackney Council for Voluntary Services (HCVS). It uses a collaborative approach to engage health and social care professionals to deliver services to socially isolated individuals in the borough of Hackney. Stakeholders (general practitioners, occupational therapists, social workers, care planners, HCVS employees) come together at meetings to discuss referrals and decide on a care plan on an individual basis. One Hackney and City connects their clients to different organizations to meet their needs from transportation to home care to food delivery. A general practitioner can refer individuals to One Hackney and City if they are concerned for the individual’s well being. This criterion includes overuse of health care services (seeing the general practitioner several times a week) or misuse of health care services (missing appointments).
Appointments with general practitioners are ONLY 10 minutes, and no more! I was surprised to hear this and cannot comprehend how general practitioners can grasp an individual’s life circumstances or need for social services in such a short time period. Many of the organizations we have spoken to rely on general practitioners to inform their patients of existing programmes in their communities from the third sector. How knowledgeable are general practitioners of these programmes? How are third sector organizations engaging practitioners who may not refer patients? What is happening to the patients who could benefit from services of which they are not knowledgeable?
Culture has also crossed my mind in my reflection for this week. We have heard from different organizations how they handle cultural sensitivities or cater programmes to different ethnic groups living in an area. However, the majority of these narratives have been shared by white people who are not the target of these initiatives. How can we adequately assess if organizations are mindful of language barriers and ethnic backgrounds if we do not hear the voices of the receivers? Who is defining culture within the organizations and structuring programmes on a socially constructed entity?
As our program and my time in London is quickly evaporating, I am reflecting on how I will utilize what I have learnt in London toward my studies and future career in health care. I have learned a great deal from both my placement and enrichment activities; I am still digesting the material and wrapping my head around alarming statistics. So now what? How can I make an impact on my community in the United States based on the impact I have seen others make in their communities in London? I will consider these questions throughout the week and find some answers in my last blog post.
Blog Post Six:
Week Six: The Future Looks Bright and Promising
Before I began writing my first blog post for the program, I read over reflection questions that Dave created for us and he ended with a quote from Rainer Maria Rilke. I found the full quotation online and it resonated with me immediately. Little did I know then how much I would “live the questions” over the next six weeks.
“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.” – Rainer Maria Rilke
Live the questions now…I have challenged myself to ask difficult questions to my peers and my supervisor, and during our enrichment activities. Some of the questions I have posed in my blog posts have been questions I have asked or questions that I had after sessions were over. I have learned tremendously by asking these questions because it has caused me to think and critically analyze the information presented. I have learned not to take things at surface level but to dig deeper and draw connections where I can. However, most of my questions have been left unanswered. If they had easy or simple answers, someone would have solved them by now. Nevertheless, in the words of Rainer Maria Rilke, I hope to “live along some distant day into the answer”.
I can begin to answer one of my questions: How can I make an impact on my community in the United States based on the impact I have seen others make in their communities in London? The first step: continue to educate myself because I am always learning. Analyzing health services in London has sparked an interest to study universal health care systems in other parts of the world. My major at Vanderbilt is Medicine, Health and Society and I am hoping to get approval for an independent study for Spring 2017 so I can study these health systems formally. I want to see if Health = Wealth holds true in other parts of the world. I want to determine the access to health services in universal health care systems because as I have learned in London, universal does not necessarily mean accessible. Many public health issues are not exclusive to certain communities or parts of the world. They exist everywhere. They are global health issues that are engrained and would require systemic change. I’m not sure what the second step or following steps will be but I think this is a good start in shaping my role as a future health administrator.
Thank you to all who have made this experience possible – family, friends, teachers, mentors, OACS staff, Mr. and Mrs. Nichols, my supervisor Nurun, and Social Action for Health. I am so grateful to have served in London for the summer. It has been the opportunity of a lifetime. May I continue to put love in action through my education and future career in health care. This is not the end, but only the beginning of something extraordinary.
Thank you for reading and for joining me on my service-learning experience.
All my best,
Mary Isabel Casey