By Courtney Suciu
Is it possible to fight infectious disease like COVID-19 – and create a more just world in the process? The founders of Partners In Health, a nonprofit social justice organization with experience treating infectious disease outbreaks globally, will tackle this question – and more – in a free virtual event hosted by ProQuest and documentary curator FILM PLATFORM on October 22.
We couldn’t wait to learn more about the organization’s world-changing approach to health care, education and human rights – especially at a time when all our lives have been deeply impacted by COVID-19 and ongoing racial injustice – so we recently spoke with Joia Mukherjee, Chief Medical Officer of Partners In Health and professor of global health and social medicine at Harvard Medical School.
Our conversation prompted a deeper understanding of the organization’s inspiring work, mission and message of hope – and how we can all contribute to changing the world.
According to Mukherjee, one of the first things to know about Partners In Health is that “we are practitioners of social medicine.”
Unlike the more traditional biomedical approach, which looks exclusively at the biological causes of disease, social medicine emphasizes the social determinants of health, or what Mukherjee said the organization prefers to call “social forces, because forces have a direction and a magnitude.”
For example, she explained, if a person doesn’t have a home, or if their crops have failed and they can’t eat, or someone is addicted to drugs, these are all social forces that have impact on whether a person is more vulnerable to illness, and whether they will get well.
“What we say is the biomedical is an important piece of healthcare, but it is only one piece,” she said. “What we see is that no one gets sick in a vacuum,” she elaborated. “All of us are well or not depending on how these social forces hit us.”
Various people might all have pneumonia, she noted, but the cause of their illness can be very different. “One cause might be tuberculosis contracted because they are living in an overcrowded place. One cause might be a heart infection because they are injecting drugs. One cause might be HIV related,” according to Mukherjee.
Those are all forces that can be changed – and when they are, the barriers to health can be broken down.
In contrast, Mukherjee explained the biomedical public health model “is really focused on prevention and behavior change.” When it comes to the COVID-19 pandemic, for instance, that approach doesn’t factor in the social forces impacting populations like farm workers. Partners In Health currently has a team working in Immokalee, Florida with such workers who live together in crowded trailers.
“They can’t socially distance,” Mukherjee pointed out. “They can’t work at home.” So, Partners In Health is working with this community on an approach to prevention and care that takes these factors into consideration.
In doing so, in looking at why certain resource-poor communities struggle more with infectious disease, Mukherjee said healthcare workers become advocates for those populations.
Partners In Health’s activism doesn’t stop with bringing medical care to vulnerable communities. The organization also takes an academic approach to healthcare and social justice.
Mukherjee described this “academic activism” as “documenting the linkages and interplay between biomedicine and social forces, and what we can do about it.”
“As we’re looking at these factors, we’re doing research and documenting what we are doing to show what works,” she said.
For example, she explained, “We know TB patients do better if we give them food. So, we map out why food insecurity and why overcrowding are such important factors in disease and what needs to be done to get people well, and sometimes it’s not just medicine.”
These findings are published in prominent medical journals and international reports to promote awareness and scholarship, but they are also used to inform the teaching component of the organization’s activism. As a professor of global health at Harvard, Mukherjee incorporates case studies based on their field work into her graduate-level classes.
Additionally, Partners In Health focuses on the history of medicine in teaching. “We’ve been hearing about the doctor who is doing hysterectomies in ICE detention centers,” Mukherjee noted, and that calls to mind the kinds of medical experiments practiced on African Americans in the past.
“Unfortunately, medicine, like law, has been a tool to often perpetuate racism and the status quo,” Mukherjee said, and as a result, “the suspicion in communities of color to the medical establishment is real and it is very much justified. Doctors, nurses and health care workers need to be sensitive and take this into consideration when working with many populations.”
“The last thing we find very important in our pedagogical work is to teach in the field,” she continued. “Activism comes from proximity – we always lead with service.”
This means Partners In Health has rotations for medical students from Harvard and from around the world. Mukherjee explained that many students who go into medicine come from elite backgrounds, “so they have never really been faced with the kind of material poverty” they will find in places like rural Haiti or Navajo country.
But it’s not only medical residents who are instructed in this grassroots teaching. Mukherjee said 11,000 community health workers, and hundreds of doctors and nurses have come through Partners In Health.
“The people we’ve trained in the field might work in finance or are doctors in a hospital or are community health workers,” she said. “We insist that everyone goes on home health visits at least once or twice to see the materiality of suffering.”
She added, “I always talk about the parable of stone soup when I teach. As a doctor you have the stone, but you don’t really have the other things. A community health worker might have the carrots. A good driver provides the beans – because if you don’t have a good driver, you could die on the road. You need the little bit of meat the cooks provide,” she explained.
In other words, everyone plays a critical role, and everyone has a something to teach, as well as to learn. Mukherjee said, “Approaching health as holistic team sport is something we try to teach by example and in writing about it.”
Mukherjee explained that out of this “platform of service, teaching and research, we then try to change policy and we’ve done it successfully in lots of areas,” she noted, pointing to the impact Partners In Health has had in advocating for resource-poor communities struggling with diseases such as HIV, drug-resistant tuberculosis, cholera and Ebola around the world.
“Part of what we are often advocating for, besides mitigating social forces, is just basic humanity,” she said. “We don’t believe there should be a totally different standard of care for a Black person, an African, a Haitian, a migrant worker – and we don’t just accept that care is not possible.”
Mukherjee acknowledged that not everyone is on board with this approach, “but I don’t have a lot of time to deal with the very resistant,” she said. “What inspires me is meeting people who want to be activists and who want to change the system and helping them have the tools and the framework to do that and learning from them.”
She believes most kind, caring people become interested and invested in advocating for change when they are exposed to poverty and can experience the humanity of those who are suffering.
“Change happens in dark times,” Mukherjee said. “Change doesn’t happen when everything is going well.”
“For many of us as middle-class Americans, this is the first time we’re feeling the kind of angst many people have been living with for a long time. Climate catastrophe, racial injustice and infectious disease outbreak – for many of us, this is the first time we’ve been directly faced with these kinds of crises.”
This means now we have an opportunity to better understand and empathize with the struggles many people have long endured, and to consider how as educators, librarians, content providers, students and researchers we might also have a part in advocating for human rights and social justice.
“It means,” according to Mukherjee, “now is a good time for solidarity.”
Courtney Suciu is ProQuest’s lead blog writer. Her loves include libraries, literacy and researching extraordinary stories related to the arts and humanities. She has a Master’s Degree in English literature and a background in teaching, journalism and marketing. Follow her @QuirkySuciu