so my five-year-old came home about a
week and a half ago and said to me mama
I learned today that long time ago
people can be friends with each other
based on the color of their skin and so
she said that it made her really sad
because that means she couldn't be
friends with her bestie so she put her
hand immediately next to mine and sighed
with relief because we're pretty similar
in color and then I looked at her and I
told her how stupid that kind of
thinking was now before you judge my
parenting I used stupid deliberately
that's the S word in our family and so I
told her how her dad and I wouldn't have
been allowed to get married that we
wouldn't have had any kids and she and
her sister wouldn't even exist today and
so she teared up and said that makes my
heart really sad and it brings tears to
my body and then she whispered
I'm really glad it was a long time ago
cuz it's stupid even a five-year-old can
understand that that's the dumbest thing
to come between people yet somehow we've
managed to make a culture of it
structural racism is like an invisible
force that has spread its poison through
every conceivable part of society
including health care yet healthcare
professionals are not trained
consistently to understand the impact
racism has on health worse yet we're not
even having that conversation and so for
starters equity and equality are not the
same thing it kind of challenges the
very foundation of where we grew up
where we've learned that everybody
should be treated the same way equality
means applying the same rules for each
person and that makes us just and fair
people the idea of equality does call
for that but equity talks about meeting
people where they are that there could
be things inherently different about
individuals that are beyond their
control and so the idea about health
equity means that any person should be
able to attain the highest level of
health regardless of their social
position or any other socially
determined factor we know however
through a large body of evidence that
social determinants of health so places
where we live eat work and play all have
a huge impact on our health and part of
the reason this exists is because in
this country unfortunately we've had a
pretty long history of some pretty
racist policies all the way from
three-fifths of a human to suppose at
emancipation after the Civil War Jim
Crow laws redlining and do
segregation in schools all of this has
seeped into the fabric of the health of
our communities for example infant
mortality rates in black women living in
the u.s. versus white women are twice as
high and so what's interesting is that
even after researchers have adjusted for
socioeconomic status these disparities
keep showing up what I find interesting
is that African women coming to the US
have pretty comparable infant mortality
rates to those of white women and so it
begs the question when we start seeing
these disparities through other things
like heart disease or life expectancy
what are we to do as healthcare
professionals and when healthcare
professionals are ignorant to this they
make recommendations that really aren't
helpful to patients so they tell you to
make healthier lifestyle choices not
recognizing that one patient's choices
who has maybe mostly fast-food
restaurants accessible to them in their
neighborhood and one supermarket are
very different from another patient who
can choose between a very $11 bougie
water from Whole Foods and other gourmet
markets in their neighborhood whatever
we don't struggle with becomes invisible
to us and so how do we bring these
conversations to places where they're
not existing how do we break down the
barrier so these conversations can take
place at all so I've been doing this
work a long time before this topic
became sexy and what I realized was that
when I talk about structural racism most
people sort of just withdraw into their
own insecurities about looking or
feeling like a racist and they resist
these conversations and overcoming
resistance to have really honest and
brave conversations means creating
spaces so that we can show up with our
most authentic selves and examine our
own truths and confront our own
assumptions and so in pursuit of this if
I want my students to be responsible
clinicians understand structural racism
inequities implicit biases I need to
create the environment that allows them
to show up and have these conversations
and so we talk we talk about all sorts
of privilege we talk about
internalized racism and a lot of other
triggering words that I don't have time
to get into right now but in pursuit of
that I have learned three truths about
myself one I make people very
uncomfortable I drop words like racism
white privilege in casual conversations
about Game of Thrones or mass
incarceration super light topics I also
make them cry mostly through good things
and powerful transformations and I model
vulnerability again before it became
cool and so what I realized in pursuit
of this is something that I call the
darkroom methodology an iterative
process of self-examination where we
create the space and time to confront
our own truths so photography like art
there's no absolute truth in art each
artist sort of sees something they
experience something and based upon
their own experience they go to the
darkroom and develop a photograph now in
this darkroom is when they start seeing
that perhaps they want to overexpose
some detail or underexpose a detail they
can control that they may also see some
blemishes and imperfections some may be
good and very artistic and some not so
desirable
similarly telling your story or owning
your narrative as an art but you can't
tell a story unless you realize what it
is
and for this the darkroom serves as a
reflection piece my students can enter
the darkroom and understand that their
life is a series of photographs not just
one stagnant picture and the
circumstances that created these
photographs can often be complicated and
so in the darkroom you come to recognize
and appreciate those blemishes learn
from what they are and discover what
truth emerge you can see that your life
is a collection and evolution of sorts
from where you've come to where you are
all the narratives and the thinking that
kind of shape your brain and shape your
experience so that that's how you see
the world today and the people in it and
in the darkroom you also realize that
this process is not perfect you might
revert back to a technique you may have
mastered some but not so much so others
that you cannot change the photographs
of the past but you may be able to do
something about the ones in the future
and so in my own darkroom I've unpacked
a lot as the first-generation immigrant
moving to the US growing up in
Washington Heights before it was a hit
musical Thank You lin-manuel Miranda I
learned that it was okay for me to blend
in the culture I was born into and the
culture I grew up in they called me the
indie Rican slash
Dominican I learned that it was okay to
be me and be the generic brown women who
learns how to navigate through
circumstances blending in wherever I can
but also speaking up even if I'm the
only voice in the room I've learned that
it's okay to be scared that my brother
once again was gonna get shoved up
against the wall and interrogated for
something he did not do just because
he's brown I've also learned that I as
much as I made it in life that people
around me looked very different and felt
very different and sometimes my voice
was crushed and sometimes my voice was
emboldened I've learned that when I
navigate these circumstances on fear of
being deported or arrested somehow for
something I didn't do that it was okay
for me to embrace this feisty attitude
and this bold attitude that I have and
for that I have created an amazing
amount of mentors and friends from
around the world who still support me to
this day when I go to my darkroom I go
to them no matter what how many years
I've been teaching or how many years
I've lived on this earth I go to them
with my own vulnerabilities because
that's my support network and as an
educator I offer that to my students and
my students I hope will pay it forward
they will attest to the fact that when I
bring them into these conversations I
challenge them pretty explicitly I
challenge them to confront their own
isms their own vulnerabilities their own
biases and from my white students this
means really having tough conversations
unpacking what white privilege is what
it's meant for them what it means today
and how they want it to mean for them in
the future you see before you do any
critical reflection structural racism is
just a concept it's very easy for it to
be impersonal for it to have no value or
meaning for people but if I want my
students to be responsible clinicians of
tomorrow I need them to have these brave
conversations I need them to talk about
this and confront their own truths and
for this and very deliberate and
creating some of the brave spaces where
we have these discussions and what I
found is that when I do this there's
some factors that are super critical to
having this conversation one my students
are provided with the judgment free zone
see my students know that when they come
in to have conversations with me about
vulnerability that they're at liberty to
speak their minds
and so I create that space for
vulnerability ulnar ability for them if
I want my students to be able to feel I
need to show them that I also feel and
so we discussed very frankly about the
way I grew up about the way my students
have grown up all of our unpacking in
the darkroom blemishes and all
vulnerabilities welcomed and it allows
us to embrace vulnerability as a
strength so that we continue to show up
as our most authentic selves
consistently in every plan behavioral
theory in public health the one thing
you'll keep hearing is self-efficacy and
you can see history for this yes we can
the idea that if change is going to
happen on an individual level somebody
needs to really believe it and so I use
positive psychology to bring my students
into this conversation I tell them the
truth I don't lie to them but I show up
with compassion and sometimes those
truths can hurt but I need to make sure
that I'm there to support them through
this darkroom because otherwise they
will not evolve with that process I also
tell my students to embrace a lack of
closure racism was not built in a day
and we certainly won't be tearing it
down in one but what we need to know is
how we can steer this conversation for
the future so that it's in our control
to move this forward and that discomfort
that my students feel I tell them to
embrace it because discomfort is where
growth and learning happen the most
important thing that I've learned in
creating this brave space for my
students is that I not only need to
accept but actually encourage failure
and mistakes our students get judged on
a lot of things and this is not a space
where I want that to happen I asked my
students to show up and they can say
incorrect things by creating this face
they're more likely to feel it evolve
with it and actually be able to correct
it better yet they catch it in
themselves and in others the most
beautiful part of this journey has been
that my students have started speaking
up in spaces where sometimes they're the
only voice and in spaces where they
never spoke up before and it has been
incredibly powerful to see this
transformation now you can imagine as we
have these vivid conversations things
are going to come up that you don't want
to hear and sometimes we're going to
have really strong reactions to it
I've had students tell me I don't want
to be white and any brown person was
like I'll take it I've had students tell
me that I didn't get anything handed to
me I've worked really hard so I don't
know how to grapple with this cognitive
dissonance I've had students be scared
to bring this up with their families
where they can't have an open
conversation about this fearing that
maybe they'll discover something about
their family they don't want to I've had
students come to me and feel helpless
like I'm only one person how am I going
to do anything about this stuff and so
my favorite is when my students come
with that fear I promise I'm really not
racist and all of these statements these
sentiments stem from a place of
insecurity and fear and like all
teachers I remind my students in a dark
place we find ourselves and a little
more light and knowledge a little more
knowledge lights the way I have to
remind our students that we are all part
of a collective that's bigger than
ourselves part of a revolution of sorts
the resistance perhaps and I have to
remind them that rather than letting the
darkness and fear alienate us we need to
connect with it and feel it and evolve
with it so we can consider how to bring
out our own light that connects with our
humanity and only then can we actually
start dismantling some of the structural
racism and start having conversations
that don't talk about encouraging people
to beat the odds let's change the odds
in the first place
so although my past has taught me that
we need to talk about equality and
currently we talk about equity for our
future five-year-olds our children or
society our community the patients that
we serve to truly do that let's actually
talk about breaking down those barriers
altogether so we can actually move
towards liberation thank you
[Applause]