Understanding trauma and resilience through research, real stories and reality… my reality

I’m sure you are all well aware that social factors affect health. This framework was not unfamiliar to me when I first started working at Mountain Area Health Education Center (MAHEC). I understood that social experiences can influence health, but I didn’t realize to what extent until I began a research project at MAHEC on childhood trauma.

You might be wondering how traumatic experiences from childhood are related to clinical medicine? Trauma lives in not only the mind, but also the body. There is a rapidly growing body of evidence to support this. In 1998, Drs. Anda and Feletti published a study, which found a significant correlation between health outcomes and childhood traumas (referred to as “ACEs” or adverse childhood experiences”). Adverse childhood experiences include physical, sexual or emotional abuse, physical or emotional neglect, and household dysfunction, such as losing a parent or immediate family member to death, witnessing domestic violence, or having a parent with mental illness or substance abuse. Even when controlling for variables like socioeconomic status, the researchers determined that a person who has more than three ACEs has an increased risk for liver disease, diabetes, chronic obstructive pulmonary disease, and heart disease among other medical conditions.

After reading the 1998 ACE study, I asked myself, how does this happen? How do childhood experiences from 30 years ago have such a lasting physical imprint on a person? My curiosity prompted me to dive into the medical literature. I yearned for a scientific explanation. Luckily for me, since the initial 1998 study, scientists have made tremendous progress in understanding the physiology and neurobiology of trauma. A lot of the research has explored the role of the fight-or-flight response, which, as many of you probably already know, is an adaptive system in our bodies to help us in threatening or dangerous situations. This response sends energy to your muscles when you need to suddenly slam on the breaks to avoid a car crash. It increases your heart rate and respiratory rate when you see a bear in the woods and need to run. But imagine if that bear was your physically abusive father… imagine if you felt a sense of danger every night when “the bear came home from work,” explains pediatrician Dr. Burke Harris in her Ted Talk on ACEs. When a child is repeatedly exposed to trauma, his or her system of alarm will be continuously activated. The expert psychiatrist Dr. van der Kolk states, “Long after the actual event has passed, the body may keep sending out signals to escape a threat that no longer exists”. These excess hormones, like cortisol and adrenaline, can cause toxic stress and have a lasting impact on the brain and the body. ACEs are both a social issue and a medical concern.

Learning about ACEs flipped a light switch inside of me. I reconsidered my approach to medicine and  began to think about addressing the underlying cause of disease, which involves addressing trauma in many instances, instead of only treating the symptoms. I started seeing connections between childhood trauma and many other public health issues. During my time at MAHEC, I have witnessed the devastating impact of the opioid crisis on individuals, families and communities in western North Carolina. After I learned that opioids and other substances act on receptors in the brain and essentially numb the neurobiological effects of trauma, I began to examine our opioid epidemic with a different lens. What if we also have an ACEs epidemic?

My research on ACEs greatly influenced the way I approached my clinical work at MAHEC. I began to comprehend why people engage in certain behaviors. My mentality shifted from “what’s wrong with you?” to “what’s happened to you?” I began to ask patients more questions. I made a deliberate effort to learn about their backgrounds, to listen to their stories in order to understand. Hearing patients’ personal narratives transformed my abstract understanding of trauma into a tangible reality. ACEs were not a phenomenon in an academic journal anymore; they were real, raw human experiences.

After listening to some truly astounding stories, I felt overwhelmed and helpless. What can I do to address trauma? There isn’t a miracle medication to erase the past. Although there is no magic pill, I learned that experts have developed many specific strategies that can boost patients’ resilience and reduce the effects of trauma. There is currently a movement in public health to teach doctors and other allied health professionals about how to promote resilience strategies and provide “trauma-informed” medical care. Through MAHEC, I learned about an innovative approach called the Community Resiliency Model, which aims to educate not only the patient, but also the surrounding community about the effects of trauma and empower them with the techniques and skills to boost resilience. Some of these resilience techniques can literally reset the nervous system, mitigating the physiological effects of trauma. The Community Resiliency Model is based on the notion that “it takes a village” not only to raise a child, but also to heal one. Helping an individual recover from trauma requires bringing together community members to create a trauma-informed, resiliency-focused support network.

Several months into my fellowship, I gained a new perspective—a highly personal one— on trauma after my own adverse experience. During the fall of 2016, my older brother passed away very suddenly and unexpectedly. When I received the phone call, my fight-or-flight response was activated before my brain could begin to process what had actually happened. Trauma lives in not only the mind, but also the body. As I heard the words “he’s gone” uttered, I felt my heart rate rapidly accelerate. I began to hyperventilate inside the Asheville Target. It was the strangest thing because I had learned all about the physiology of trauma from my research on ACEs. I knew exactly what was happening to my body, but I couldn’t do anything about it.

The weeks that followed my brother’s death are still a blur to me. But one thing I distinctly remember is having a loss of words. When I tried to speak, nothing came out. There weren’t words that could fully capture the horror of what I endured. I thought back to something I learned from my research: when experts used neuroimaging techniques to analyze traumatized brains, they saw that Broca’s area, the part of the brain that controls speech production, was shut off. This happened to me. My brain physically could not produce words (on a side note, I have found writing this blog post to be an empowering way to reclaim my words).

I was a living example of everything I had learned about through work. As a result, I was better able to grasp patients’ experiences of trauma. I felt a deeper sense of empathy for them. I had an urge to tell all of my patients, “Your pain is valid. I recognize and understand your suffering and I’m so deeply sorry for your trauma.”

When I returned back to my life in Asheville, I struggled… a lot. I could barely concentrate on simple tasks at work. It felt like my brain was surrounded by a fog of trauma. My grief felt like a heavy backpack full of bricks, an unbearable weight that I carried around constantly. I would frequently break down crying during the middle of the day. Whenever it happened, I would say to myself: Get it together, Natalie. Control yourself. But I couldn’t always. Trauma and grief are incredibly powerful. I felt overwhelmed. Above all, I needed support from the people around me, but I felt guilty and embarrassed asking for help. I prided myself on doing things independently. I can make it through this on my own, I thought. I was also very accustomed to helping and taking care of others, so it was deeply uncomfortable for me to become the patient, to acknowledge that I needed to be healed and cared for. However, once I admitted this to myself, it made all the difference.

With the Community Resiliency Model in mind, I began reaching out to the people around me—to my community in Asheville. Once I asked for their support and help, my trauma became less overwhelming. There were more people to help me carry my heavy load of bricks. Why did I ever try and do this on my own? My community has been unbelievably supportive and kind. I will never forget the compassion I received during this time. I also started using the resilience techniques that I learned about on myself. Over time, it has become easier to breath. Although I am still profoundly sad about my loss, I feel more resilient and connected because of my supportive community. It took a village to help me on my path of healing.

My raw pain is now the underlying force that fuels my passion for medicine, health and healing. After learning about and living through my own trauma during my Davidson Impact Fellowship, I understand that both health and healing are complex processes. Given that social realities impact these processes, I recognize that my situation is one of privilege. It greatly disturbs me to think about the fact that there are so many people, especially young children and socially vulnerable individuals, who experience horrific traumas with less resources and support than I had. I am more determined than ever to combat this injustice and serve as a supportive resource to vulnerable patients; to be present with them on their journey towards healing.

Ultimately, this year has left me inspired to provide trauma-informed care to my patients and to educate my peers (why I chose to write about it in this blog post), colleagues, family and friends about ACEs and resilience. I hope that by spreading this message throughout my medical career, I can help my patients and my community become more resilient. It really takes a village—a resilient, supportive, connected village—not just a person with a stethoscope, to help people heal.

 

Simple, but Powerful Medicines: Patience, Listening and Trust

By the end of my time at Davidson, I had become so accustomed to immediate results. After a long evening session in the library, elegant graphs, lengthy Spanish sentences, and even chapters of my thesis would appear before my eyes. It was so satisfying to see my ideas and efforts rapidly crystallize into a tangible product (a metaphor for my organic chemistry professor, Dr. Stevens).

Thus, when I first began my fellowship at Mountain Area Health Education Center (MAHEC), I myopically assumed that I would instantly see “results” in all of my projects. I thought to myself, “I am going to make a radical impact, immediately”. How idealistic of me! My sense of time was completely skewed. It can be very difficult to change an individual, a community, a culture or a system. Difficult, but still possible. Through both my research and clinical roles at MAHEC, I have learned to embrace my work with a new sense of patience.

As a research fellow, I am involved in two projects. One project is a community education program for long-acting birth control, which aims to reduce unintended pregnancies in two surrounding rural counties in western North Carolina. Since the topic of birth control can be controversial, we recruited 15 local community members to help us design a culturally-sensitive birth control message and figure out appropriate ways to spread it. Although designing our own campaign is much more time-intensive than distributing existing posters from an established birth control campaign, our thoughtful approach will hopefully have a long-term impact because we are developing a culturally-specific message that will actually resonate with the people in our target communities. This project has shown me the vital importance of patience. My other main research project is a study on childhood trauma and the social determinants of health. I appreciate this research project because it has enhanced my understanding of the psychosocial factors and human behaviors that affect health.

As a community health worker, I get to apply what I’ve learned in my research and address some of these psychosocial factors and behaviors with actual patients. In essence, I help patients follow their treatment plans and engage in behaviors that positively impact their health. Helping patients adopt a healthy behavior, such as eating a more nutritious diet or quitting smoking, usually entails changing a deeply ingrained unhealthy habit. This aspect of my work has tested my patience in a new way. It may be one of the most challenging things I’ve ever done, given that humans are creatures of habit. During the first few months of my fellowship, I felt frustrated. I kept asking myself: “Why am I not seeing results? How do I motivate my patients to change their behaviors? Where does motivation even come from?”  I contemplated this last question for a while. When I asked Cathy, my wonderful boss and mentor, for advice, she encouraged me to take time to learn more about my patients’ interests, activities, goals and dreams. So, I started listening.

I learned about my patients’ lives. I listened to their stories. I learned what brings them joy and meaning. Although listening seems like a simple task, I have found it to be one of the most crucial clinical skills. After learning what things are important to to my patients, I am more effective in helping them adopt healthier behaviors because I can encourage and motivate them in a personalized way. This approach requires more time and patience, but it’s worth it. Additionally, I have observed a powerful side effect of listening — it builds trust; it demonstrates to patients that I am invested in their stories, instead of merely being interested in their medical progress.

I am especially grateful for my impact fellowship because it has enabled me to understand these lessons before I enter medical school and begin my career as a physician. In my medical school personal statement, I wrote the following sentence: “I grasped the power of listening and the importance of making patients feel heard.” From my work at MAHEC, I have learned that it is so crucial to not only listen, but also to make patients feel heard, recognized and validated; to bring compassion and to be really present with patients in the midst of their vulnerability, pain and illness. That is how a lot of the healing happens. Listening, trust and compassion are some of the most powerful medicines I’ve seen.

Adversity Against Adversity

When I walked through the doors of the Education building at MAHEC, I wasn’t sure what to expect. I had never done an employee orientation of any kind before. ‘It’ll just be an extended series of PowerPoint presentations… right?’ Well, little did I know that said presentations would have such a great impact on my future goals. The very first presentation focused on the mission, values, and structure of MAHEC and began with one phrase – Your Doctor. Your Teacher. Your Advocate. Contemplating these words over a matter of weeks struck me sufficiently enough to lead me to shred my first medical school personal statement and write something entirely new – a piece largely influenced by this simple statement. Yes, really… the root of my motivation to go to school for yet another 4 years had transformed by observing the essence of this statement first-hand every day.

My very first day of actual work began with a 2-hour discussion with Dr. Letson, my supervisor, and former Davidson Impact Fellow/new MAHEC employee, Cate Hendren. We went from Medicaid expansion to neonatal abstinence syndrome, then to the unique academic life at Davidson, off to ‘best-practice’ pun delivery techniques, back to Dr. Rishi Manchanda and upstream medicine… and back again. Needless to say, it was a relaxed and friendly conversation on the surface. But I’m sure my new colleagues could see the whirlwind behind my eyes, as though I was literally screaming, “There is so much to be done! Where could I possibly begin?!?!” Even now – three months in – narrowing my focus has not helped much in the complexity of these important problems. What has helped is meeting people who have dedicated their lifelong careers to trying. How do we end sexual assault for good? Completely eradicate the rampant spread of HIV in the Southern U.S.? Find a sustainable and effective way to close the health outcome gap between races and ethnicities? Well. You simply start by trying.

In my opinion, I am meeting the most extraordinary people this nation has to offer. A woman who goes to work to raise money for Planned Parenthood, knowing she will likely be met by an adamant pro-life protestor. A man living with HIV who leads community engagement to ensure access to medicine and frequent rapid testing to stop the cycle of transmission. A health system innovator who says that her work is informed by her deepest personal values. Almost every day, I meet a new person who inspires me to consider the breadth of what I could do as a Davidson Impact Fellow and (fingers crossed) as a future primary care physician. Instead of simply being a doctor, why not be a doctor AND teacher AND advocate each time I enter an exam room? Holding the responsibility of charting symptoms and advising treatments was never my dream job – it has always been more than that. I want to make people healthier and sustain healthy states, not merely cover-up symptoms. Most will need medications. Others will require knowledge on how to manage their chronic illness. And every patient deserves an advocate who will stand in their place in front of the legislator, the landlord, or the peer physician when their voice is being silenced.

I am exciting about my current projects and initiatives here at MAHEC and beyond as an advocate for women’s and children’s health and well-being. And I could not be more grateful that this opportunity has directly informed my future as a primary care physician.

Thinking Pink: Ladies Night Out and the World of "Breast Cancer Kitsch"

We’d talked for about a minute and a half when Wanda yanked an extra chair closer to her computer monitor (perched amidst hallmark figurines, inspirational slogan magnets, and family photos) in her gray health department cubicle. She pledged:

“Now this is guaranteed to make you cry.”

She was talking about Ladies Night Out, a monthly program that provides uninsured women below a certain income level with annual bloodwork, mammograms, and breast cancer screenings. The date was July 29th, 2014.

breast cancer nyt

From 2013 NY Times article “Our Feel-Good War on Breast Cancer.” Photo: PR Newswire, via Associated Press; Tom DiPace/Associated Press; Gabrielle Plucknette/The New York Times (apron, sunglasses, flip-flop); Simon Fergusson/Getty Images.

This week I’ve been thinking a lot about breast cancer.

About 1 in 8 U.S. women (12.5%) will develop invasive breast cancer in addition to about 1 in 1,000 men.*

It’s a devastating disease with devastating implications I’ve seen echo in the lives of colleagues, friends, and family.

Yet even as I contemplate all that loss, the dearth of pink-themed products from my last Google Images search floods my mind: water bottles, key chains, backpacks, hair straighteners, Kit Kats, flip-flops, eyelash curlers, perfume, iPods, pepper spray, margarita glasses, compact mirrors, M&Ms, charm bracelets, hairspray, and snuggies – all pink and be-ribbon-ed.

What does all this stuff have to do with breast cancer? Is this awareness? Is this fundraising? Is this exploitation?

Seeking answers, I turned to Barbara Ehrenreich’s essay Welcome to Cancerland. In an incisive consideration of her own breast cancer diagnosis, Ehrenreich explores links between breast cancer culture and industry, the hyper-association of breast cancer with traditional femininity, and the infantilization of women living with the disease. She expresses the fury she feels at being met with peppy slogans of hope and survivorship and an expectation to adopt them as badges of her unwanted membership in the breast cancer sisterhood.

You can read her article here, and I recommend that you do.

Barbara Ehrenreich. Photograph: Steven Voss

Back at the health department, Wanda clicked play on the YouTube video showcasing Ladies Night Out. Just like she predicted, I cried. And then I became a volunteer, translating once a month for the Spanish-speaking women who access the program.

Ladies Night Out is executed with an individual sort of aplomb that nearly a year in, I’m still grasping to understand – a juncture of gooey sentimentality, straightforward conviction, and needed services. There is not an ironic bone in the body of this operation – “Ladies! Flowers! Pink!” the program seems to shout, self-assured in its style and its mission.

When a “lady,” the name reserved for all program clients, arrives, a volunteer hands her a pink flower and a reusable pink bag. Sandwich boards with program information feature hot pink text and decorative stars. The satisfaction surveys are often printed on pink paper. Volunteers all don the same cotton zip-up printed with pink ribbons.

They’re the kind of details that make me roll my eyes in solidarity with Ehrenreich, but predictably, it’s just as my eyeballs have nearly finished their dramatic arc that I catch sight of a woman who’s grinning from ear to ear and staring at the carnation in her hand. It’s at that moment that the woman who I’ve just translated through a mammogram tells me how much she loves Ladies Night Out.

There’s a distinction to be drawn between “breast cancer kitsch” and the lived experiences of people. There has to be. Otherwise we’re left with a choice between either affirming merchandise in order to affirm the women who find comfort in their pink flowers and newfound sisterhood or disparaging real people in order to criticize an industry – a choice which seems as artificial as it is unkind.

The women who use Ladies Night Out are deeply grateful, and the volunteers and staff are deeply committed. I love translating here, and you’ll find me at Ladies Night Out next month, too.

Still, I’m not sure what to do with all this pink.

 

Happy Valentine's, Darling?

From November 2014:*

I’ve spent the last week eyeballs glued to the computer screen editing a grant application. Which. In the long run could be a very big deal for my community. Which. In the long run would mean victims of sexual assault and domestic violence would access live-saving services better. Which is inspiring and needed and worth working for.

Which. In the short run means sculpting a true and compelling story out of 500 character slots and a budget question. Which means writing 1,500 words of stories you love and then deleting all but the four sentences you need to prove your claim. My day is spent ruthlessly slicing adverbs and eliminating oxford commas.

In some ways, editing is amazing. Sometimes it feels like archaeology: scraping away until this thing full of meaning emerges. Sometimes it feels like magic: well, mysterious, arduous, time-consuming magic, anyway.

The adage “Murder your darlings” comes to my mind.

Often attributed to William Faulkner, the advice most likely comes from writing expert Arthur Quiller-Couch in his 1913-1914 Cambridge lectures “On the Art of Writing.” Quiller-Couch proffered, “If you here require a practical rule of me, I will present you with this: ‘Whenever you feel an impulse to perpetrate a piece of exceptionally fine writing, obey it—whole-heartedly—and delete it before sending your manuscript to press. Murder your darlings.” (See more here.)

I usually hear this phrase in my mother’s voice. As a research attorney turned yogi, she’s got a wide-ranging arsenal of maxims. Much to the chagrin of my adolescent self, this expression has stuck, perhaps because it’s the exact advice I struggle to put into practice, and perhaps because the image the phrase evokes is so alarming.

The notion, too, is arresting: the very phrases you’re most proud of yourself for conjuring up are most likely the ones you’ll have to, you should delete.

This seems especially true in grant-writing, which as I’m learning is not really about you the writer or your ability to create apt analogies and use GRE-worthy words. It’s about the narrative you can immediately and concretely convey. It’s an important skill that I’m glad to be building… but I’m also really enjoying not doing it right now.

In comparison, blog posts feel luxurious – here I have no mission except to process my experience and share with a hypothetical audience. What freedom! Look at how many adjectives I am using (Some of them even mean the same thing; they’re repetitive and inefficient! I might even make some up.); earlier I ended a sentence with a preposition. Here, you will find no vision statement or action plan. Weep on ye masters of succinct, practical writing: it’s grant season, and I aspire to develop your skills, but today’s post is full of darlings, alive, well, and decidedly un-murdered!

valentine baby

*I wrote this post in December and then delayed publishing it for another two months thinking that:

1). It echoes many of the same thoughts expressed by Catawba Lands Conservancy fellow and dear friend, Rebecca Mckee in her post, Writing Post-Davidson. (If you haven’t read her reflection yet, start there. My favorite of her observations begins, “Unsurprisingly, writing grants is a little different from writing that essay I wrote on the metaphorical significance of Lorca’s Yerma and my research paper on the adverse health effects of exposure to the pesticide, 1,2-Dibromo-3-chloropropane.”)

2). Who quotes hundred-year-old writing advice?

Then I decided that Rebecca wouldn’t care and that who am I kidding – this is a Davidson audience, a group uniquely equipped for a pithy remark from Academia. So … Happy Valentine’s Day, Darling!

Upstream Doctors

waterfall

Three friends are strolling in the woods by a broad, rushing river when they see a child being swept downstream in the water. Aghast, they rush to pull a flailing toddler from the surging current.

Then they see another child.

Then another.

And then another.

The water is full of children.

One friend races to scoop up kids right before the river surges into a steep drop ending in jagged rocks. The second friend grabs a long stick to give several children something to hold onto while he pulls them from the river. The third dives into the water and begins swimming upstream. When her friends ask her where she is going, she replies, “I’m going to find out who is throwing all these children into the water.”

This oft-used public health parable becomes the titular analogy in Dr. Rishi Manchanda’s book Upstream Doctors, and he deployed it when he spoke at MAHEC and Mission Hospital’s 2015 Spirit of Dr. Martin Luther King, Jr. Award Program on Thursday, January 22nd.

During his speech and his popular TED Talk (see link below), Manchanda cites the case of Veronica, a patient whose excruciating headaches repeatedly brought  her to the emergency room, threatened her ability to work, put stress on her family, and finally pulled her to the clinic in South Central Los Angeles where she met Manchanda and his team. After a medical assistant asked about her home, Dr. Manchanda noticed signs of her chronic allergies (see the allergic salute), and a community health worker helped Veronica eliminate the mold in her apartment that was making her sick, her symptoms decreased by 90% in two months. Veronica no longer went to the ER; she didn’t miss work, and she could care for her family whose health also improved.

And this wasn’t just a big deal for Veronica. It marked a larger shift as well. With Veronica’s case, the clinic established a system that made her wellness replicable, that meant other patients would find solutions, too.

Manchanda is one of a growing number of physicians and other public health experts emphasizing the importance of social determinants of health. They argue that doctors ought to address the origins of their patients’ problems, not just the illness their problems produce. We can prevent children from being flung into the water, and we can clean moldy buildings.

Social factors, instantiated in the mold invading Veronica’s home, account for over 60% of all premature deaths in the United States.

In Dr. Manchanda’s neighborhood, substandard housing and food insecurity shape his patients health. In Western NC where I live and work, among many other issues, we struggle with food insecurity and transportation.

Zip code, as it turns out, matters more than genetic code.

Dr. Manchanda talks about his parents' immigration to the US and the world's "inescapable network of mutuality," a phrase taken from Dr. Martin Luther King, Jr.

Dr. Manchanda talks about his parents’ immigration to the US and the world’s “inescapable network of mutuality,” a phrase taken from Dr. Martin Luther King, Jr.

Manchanda hooks listeners with memorable stories and persuades us with hard data, but in this speech he went one step further and tied his cause to the drive for equality championed by Dr. King.

A quote printed on the program bulletin read:

“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”

Dr. Martin Luther King, Jr. – Second National Convention of the Medical Committee for Human Rights – Chicago, March 25, 1966

Manchanda contended, we can’t set health care right without addressing social determinants of health, but we also can’t do it without recognizing health care as a right.

Watch Dr. Rishi Manchanda’s TED Talk here.

A Day in Court

I enter the new county court house, a shiny downtown number that has been open for less than a year; floor-to-ceiling glass windows line the hallways, and the floor gleams like it’s just been waxed. A motley assortment of stoic and grinning police officers greet me as I shuffle through the metal detectors and make my way to the second floor where I will be observing domestic violence court proceedings for the day.

At the top of the stairs there is a waiting room set aside for those who have been victims of domestic violence. Here they can request emergency restraining orders and wait with their families before their cases are heard in court. I tap on the waiting room’s thick glass windowpane, and my host Susan buzzes me in. Susan is a Presbyterian minister and courtroom advocate for Helpmate, Asheville’s domestic violence agency, and today she is my host. Susan ushers me into the office with a welcome and a reminder that I should not open the door for anyone.

The room is filled with women, mostly, though a few men dot the walls, too. Some are alone, others with a mother, father, or friend close by.  A few start conversations with me, asking me to look up an address on my phone or comparing jobs (one is a nursing tech. at the hospital just a few blocks from my office). Some wear graphic tees and sweatpants; others expensive slacks and freshly pressed blouses. One speaks Spanish, another Thai, many more with the sweet twang that marks them as long-time residents of Western North Carolina. They have names that rhyme. Marla. Carla. And names that don’t. Tanya. Janet. Maria.

I am awkward, wanting to help but unsure what my role here is supposed to be. Do people want someone to talk with, or do they want privacy? Am I intruding in what is already for many victims a harrowing experience? My face feels rubbery, my arms artificially stiff as I grasp my responsible-young-professional notebook and pen.

Domestic Violence Court cases are heard en masse every Thursday with forty to sixty cases on the docket. Today, however, there are seventy-one.  Increasing national awareness and a new comprehensive plan developed by Buncombe County to address domestic violence has increased the number of people seeking services and judicial recourse. The paradox of this situation is obvious but true: It’s a good thing that so many people are here; it’s a horrific thing that so many people are here.

The actual courtroom experience is a bizarre combination of wrenching and utterly boring. One woman shakes visibly as Susan rubs her back.  Several men file in handcuffed, brought directly from their jail cells to face charges. One defendant yells an impassioned speech that no one understands, and the judge orders a psych evaluation. Still, it’s hard to hear: judges and lawyers rarely raise their voices, and people are constantly shuffling in and out of the courtroom slamming a heavy latched door as they do. Most of the conversation is about procedure, not Atticus Finch-esque orations on the nature of justice.

Two things stand out:

1)     The courtroom is confusing, and

2)     Most of us need legal representation to navigate it.

People can be appointed free lawyers in criminal cases, but not in civil cases, which all these cases were.  Multiples times, the judge had to re-explain the process to the plaintiff or defendant. For example, the judge would tell the plaintiff, “You can request a continuance if you are not ready to proceed at this time,” and the plaintiff would respond, “Yes your honor, I would like to continue and resolve the case now,” not realizing that requesting a stay would mean the opposite of resolving now. Both used the same word, but they were not speaking the same language.

It’s confusing for anybody, but this system is particularly trying for those who are experiencing abuse. A victim often experiences symptoms of trauma such as difficulty concentrating and memory loss that make accessing any services difficult in addition to any coercion leveraged by their perpetrator (threats if the victim presses charges etc.). Add to this a system as complex and intimidating as the one I saw, and the need for legal aid becomes obvious.

Here in Western North Carolina, an organization called Pisgah Legal Services provides free legal help to low-income people on issues of housing, immigration, and domestic violence among others.  Those who have their help look noticeably relieved. In 2013, Pisgah closed 1,305 domestic violence cases.

I know six hours in a courthouse paint an incomplete picture, but they do paint a powerful one. That Thursday I felt the fear victims knew in facing their abusers; I saw their resolution and reliance in the same moments.  I sensed the comfort given by court advocates’ presence and the importance of legal representation for people when they are most vulnerable.

Again, all I can think of is obvious and contradictory. It’s a good thing that so many people are here; it’s a horrific thing that so many people are here.

If you think you or someone you know is experiencing abuse, help is available. Please call the national domestic violence at 1-800-799-SAFE (7233). Get tips on how to help a friend or family member here.

 

The Job Description (and highlights reel)

This is the spiel I’ve found myself repeating in response to the ever-prevalent post-grad prompt, “So what are you doing now exactly?”

As a woman’s health advocate at the Mountain Area Health Education Center (MAHEC) in Asheville, NC, I have two main jobs.

Hill_cJackWhitephoto-200x300

Anita Hill

One is supporting the work of a women and children’s safety coalition of local organizations including the hospital, care providers, Asheville City Schools, the YWCA, Pisgah Legal Services, Our Voice the local sexual assault organization, and Helpmate the domestic violence agency. We are working on eliminating sexual assault, domestic violence, and child abuse in our community in order to make Buncombe County, as my boss often puts it, “the safest place in the universe for women and children.” I know this tagline might sound like a comic-book thought bubble, more like the kind of thing a superhero says after nabbing the bad guy than a community group mission statement, but in this case it is also an earnest goal in which this group believes. And they’re (now, we’re!) doing important work to get there. More on those efforts to come in future posts… (Did I hook you yet?)

The second aim of my fellowship is to develop an advocacy portfolio of top issues affecting the health of Western North Carolina women. In addition to scouring news articles and databases (an activity in which I’m well-versed – thank you, liberal arts education), I am reaching out to professionals working in women’s health in the region, asking them about the issues they see in their work. Eventually I’ll have a top five (or so) list of issues and compelling ways to talk about them combining data and personal stories.

So that’s my mandate. Some of my most memorable experiences so far include:

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My Turn on the Rope Swing

  • Helping Our VOICE, Asheville’s sexual assault resource center, host a lecture by Anita Hill. She’s best known for accusing Justice Clarence Thomas of sexual harassment during his nomination hearings for the Supreme Court in 1991 but is also a law professor in women’s studies at Brandeis University.  If you don’t know about her or have forgotten, please google this amazing woman!!
  • Talking with the Asheville doctor who provided abortions to women for decades: whose building was bombed and threatened with package supposedly containing Anthrax, whose patients loved her (they often said, “We didn’t expect you to be so nice”), and who closed her doors in July.
  • Visiting Davidson graduate, peace-corps alum, and community activist, Monroe Gilmour who invited me to his home in Beautiful Black Mountain to talk about women’s health, to eat lunch, and to have a go on the rope-swing in his backyard.
  • Attending an HIV/AIDS conference in Winston-Salem!
  • Helping throw a fashion show in which local designers created pieces made from
    condoms (below are a few of my favorites).

Big thanks to the many people supporting Davidson Impact Fellows including, in my case, the Community Foundation of Western North Carolina. Be sure to keep checking out this blog to see what my fellow fellows and I are up to as the year progresses.

Condom Clothing 3

Dorothy Poses

One of the Most Popular Dresses

 

 

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