A scholarship essay...

I'm in the middle of finals for the summer semester currently. Having little time but a strong desire to post something, here's an essay that I wrote this spring for a scholarship opportunity. Enjoy.

Each time I sit down to write these short words on cultural competency, I am struck by how difficult it is to put my thoughts to the page in such a way that they do not appear contrived and insincere. As a blond haired, blue eyed, pale skinned, middle class, female medical student, I fear I do not have the features that the public associates with a champion for issues surrounding race, class, or ethnicity. However, many life circumstances have compelled me to take a special interest in interracial and interclass dynamics.

As a white student in the Texas public school system, I was by-the-numbers a minority student in both my middle and high schools. Because of this, I quickly learned the existence of cultural and class differences, the labor required to bridge them, and the blessing of doing so. Following high school, I moved to New England to attend a liberal arts college, which desperately attempted to convey the reality of systematic injustices that contribute to the make-up of its mostly white, upper class student body. It was Wheaton’s curriculum, as well as a semester abroad, that helped to contextualize my past experiences and led me to move into inner city Springfield, MA, after college to work with a non-profit organization that has racial reconciliation as one of its main objectives. Ultimately, the social experience of my educational upbringing persuaded me to choose an osteopathic medical school due to the profession’s emphasis on accounting for the physical, mental, and social conditions when planning patient care. Since the practices of both cultural competency and humanistic medicine rely on the fundamental tenet of interconnectedness, it is my opinion that osteopathic physicians should be leading way in the pursuit of excellence in both areas.

Cultural competency can be simply understood as knowing oneself, knowing another, and acting accordingly. For a physician, this entails knowing her own cultural norms surrounding health as well as those of the patient and thereby appropriately providing care. Cultural competence in the medical setting is usually concerned with race or ethnicity; however, I believe there is also a need for competence when working with patients from different economic classes and diverse educational levels. In today’s fast-paced healthcare system, cultural conflict arises when physicians overlook the impact of fundamental beliefs, behaviors, biases, and stereotypes in the patient-doctor interaction and when we as physicians see our professional expectations reduced to proper diagnosis and treatment. In order to be a culturally able physician in a diverse world, one must nurture the capacity for empathy as well as expand her knowledge of the implications of race, class, and other social determinants of health.

In the last year, I have taken two tangible steps toward strengthening my skills as a culturally competent osteopathic physician. First of all, I became a pre-doctoral fellow in the OMM department, which facilitates the honing of my manual medicine skills and has allowed me the opportunity to earn a dual degree (DO/MPH) in public health. Studying medical sociology and medical anthropology has taught me that an individual’s health is largely an expression of the health of the population to which she belongs. The vital signs of population health include socioeconomic standing, public works infrastructure, environmental conditions, political stability, and access to healthcare; it is within the framework of these and many other social and historical circumstances that a health culture is born. Being a physician that formally understands issues surrounding these determinants of health will enable me to more readily and sympathetically understand the context of a patient’s health as well as recognize the health implications of political and social change. Thus, through my public health training, I am learning that it is incumbent on me as a physician to work with and advocate for better public health services in order to both diminish the underlying social and cultural causes of poor health outcomes and maximize the delivery of quality, culturally appropriate clinical care.
In addition to initiating my masters in public health education, I have launched a growing book club composed of 1st, 2nd, and 3rd year medical students. Through the generous funding and unending emotional support of TCOM’s medical ethics department, we read and discuss medical narratives that creatively exhibit the human experience of being a physician. With consideration for the nuance of each clinical case as well as the physician-writer’s existential experience, these texts demonstrate the struggle for physicians to exhibit competence in complex situations. Many of our books, including “The Spirit Catches You and You Fall Down” by Anne Fadiman and “Suffering and Healing in America: an American doctor’s view from outside,” by Raymond Downing, brilliantly present case studies in the importance of practicing culturally competent medicine in today’s diverse social context. It is my goal that by reading these stories of those who have gone before of us into the exciting field of medicine, we will meld our individual experiences as budding physicians with the seasoned experience of others and thus discover a deep capacity to respond with caring knowledge to the medical needs of our diverse patients.

In conclusion, I firmly believe that one of the most overpowering forces that physicians must contend with is the culture we inherit through our training. In order to survive years of bearing the decisions in life and death experiences, doctors in training learn to think of patients in terms of pathology while anaesthetizing themselves from the emotional component of disease. However, regardless of the simplicity of the disease, to the suffering patient of any culture a simple bout of the rhinovirus is more than annoying symptoms. It is an infringement on her capacity to fully participate in life; it is an encounter with mortality, from which she seeks relief when she visits our offices. We must remember this. We must remember that our humanity and ultimately our mortality connect us despite the starkest of differences.

Fear and Principle

Over the July fourth weekend, I spent my first weekend with Barrett's family. He is the youngest of 4 brothers and 1 sister. We stayed in the lake cabin that he and his family literally built with their own hands. While I was spending my every middle school and high school weekend playing soccer all over Texas, he and his family spent every weekend commuting from the mega-metropolis of Houston to built this home and subsequently utilize it as their base when hunting, fishing, horsing around on their adjacent ranch. Having never done any of these activities nor met this family I've heard countless stories about, it turned out to be quite a weekend.


Much of the weekend was spent enjoying the cool breezes on an adirondack while reading "Into the Wild" by Jon Krakauer, a story about a idealistic young adventurer who dies in a bus in the Alaskan frontier. This book along with the setting spurred my curiousity for primitive survival techniques. I would lump the Cromeen family skills into this category, so I joined whenever they headed out to the ranch. The most interesting (probably because I think I could easily replicate it if need be) endeavor of the weekend was putting out 'trot lines' to catch catfish in the river that runs through their land. I view fishing as an altogether lazy activity so when Barrett confessed that trot lines are the lazy-man's way of fishing, I chuckled. The basic idea of this form of fishing is to string bait over the width of the river by tying rope to trees on opposite sides of the river and hanging small fishing lines along it. Over the course of a day, you'll come to check on the lines multiple time to see if you've caught anything and to restock the bait. The best times to check are at dawn and early night. I joined the boys for a few of their runs to the trot linea. Of note, I joined them during their night run.


Before leaving the cabin to check the lines the first evening, Barrett asked me to not stand right at the shore line when we got there. I said ok in that way you do when you want an explanation as to why, and he replied sheepishly, "Now I don't want you to be scared, but this river is known to have aligators, and at night, they can see you but you can't really see them, so, I just want you to be safe." At this warning, I grew a tiny bit wary of going at all but refused to let on, so I said fair enough and headed out. We made our way to the river via pick-up truck then traversed the small wooded area leading to the water by the guidance of our lone flash light. Once we reached the small boat used to check the lines, I was instructed to hand over the flashlight so they could see while on the water. I was reluctant but did so. Ben, Barrett's brother, then said in a very matter of fact way, "just yell like crazy if anything happens." Then they left.

It was pitchblack, stars littering the sky magestically. Natures orchestra hummed with birds, frogs, and rustling of trees. And, I was all alone, with no tools, and 5 yards from an allegedly aligator infested river. Every new sound or change of barely distinguishable shadow made me back up a few inches toward the steep ridge. As Ben and Barrett moved further from me, my fear grew more and more. I have never been as scared as I was that night.

My imagination went wild and I considered the worst possible scenarios...death by aligator, being forced into the river by a rabid wild pig, snake attacks, etc. I cursed myself for choosing reading material that had enhanced my knowledge of the ruthlessness of the wild.

I prayed and tried logic to relieve my anxiety: I've lived in a neighborhood known for crime and prostitution, and travelled through foriegn countries alone, and I've never had a problem. God has protected me everywhere I've wandered. But I began to realize, my logic cannot calm an aligator nor can it always calm fears. In those moments of intense internal panic, without skills or sight, I wanted a gun.

On principle, I generally despise weapons. I become really nervous just being near them. These days, weapons are too often used to violently injure another human being and have all but lost their utility for protection against or hunting of animals for food. Watching Barrett and his brothers kill wild hogs and poisonous snakes gave me a new respect for the guns, though I still hesitate to endorce them because it is all to easy to use them against humans when they are readily avaliable. More even than my fear on the shore, the direct attack by someone or something has the ability to negate principle and lead to violent self preservation in even the most passionately non-violent individuals. This is a troublesome truth to discover present in oneself. I am humbled by this discovery and continue to work it out.

Within a few minutes of my deepest fear and deepest prayers for protection, Ben and Barrett returned with a couple of catfish and grins on their faces. I had never been so happy to see two people in my life.

The light (literal) and companionship they embodied relieved my fears the way that vision and knowing you're not alone always do. These two things along with divine provision are more life sustaining than elimating threats.

I survived the river. I survived the weekend. Now, I must survive myself as I ponder just how capable I am of violence.