When I sat down on the couch of her apartment, Juliana Morris handed me a mug of freshly heated Earl Grey, straight off the kettle. The living room of the apartment was modestly decorated: a couple of flower pillows on the sofa, a glass table with bronze legs and a wooden bookshelf with a bike leaning against it. She picked up her mug, smiled and asked, “So, was it easy getting here?” I could tell immediately that she had a natural bedside manner. She spoke to me as if she was catching up with a friend she hadn’t seen in a while.
Juliana Morris ’07 is a fourth-year student at Harvard Medical School. But her path to medicine has been anything but traditional. She became interested in primary care while working as an advocate and volunteer with undocumented Latino immigrants in Poughkeepsie during her Vassar years. This activist work revealed to her that institutional negligence can manifest in tangible ways: she was shocked by the barriers to basic health care that her community experienced. She saw medicine as a productive opportunity to not only treat the physical pains of her patients but also as a way to address larger structural forces such as racism and classism that are often ignored in the patient-doctor relationship. In medical school, she serves as a clinician with Crimson Care Collaborative and is a volunteer community organizer with two Boston-based, immigrant rights groups. She plans to pursue a career as a family medicine physician-advocate, providing clinical care and preventive health services to her community, while joining local, community-based organizations in campaigns for social justice. She’s a different and admirable kind of doctor, one who strives to synthesize political activism and clinical practice, one who can sense the systematic aches and injuries that can’t necessarily be detected with a stethoscope.
Primary care is such a broad discipline without a clear textbook definition. It’s so varied yet so necessary. So in your own words, what do you think primary care is?
I think it’s sort of controversial and I’m still figuring out what it means. The most basic sense is the medical attention and health care that people receive, or a whole population receives, and to nip any sort of health problem in the bud, whether it’s prevention or early detection, or just being that first face that your patient sees. But it’s controversial because a lot of the most important aspects of health care such as disease prevention and early detection occur outside the clinic’s walls. Our common perception of primary care is that there is a clinic. However, the future of primary care is figuring out how to do the same activities of the clinic out in the community. Health promoters and community health workers, as well as educators in the community also participate in this kind of care.
What specifically drew you to primary care?
First, I decided I wanted to be an activist for social justice. And then I had to figure out a profession that would allow me to do that in the most effective way. That is, a way that inspires me and keep me engaged. It meant asking myself, “What would I like to do day in and day out?” And then I thought about medicine and I realized that there would be a way to do medicine where I could be accompanying people in the community for the long term and witnessing the impacts of social injustices on their health. And then I was thinking creatively about how to address the impacts of these social injustices and how things are manifested in people’s bodies and how to engage the community in an empowering way. The bigger social issues initially inspired me in this soul-searching. And for medicine in general, I knew that medicine is a career where you have to be up on your feet, and it is intellectually stimulating, and to witness all aspects of my patients and intervene at that basic level, primary care is pretty much the only way to do that.
What has your experience with primary care been like as a student at Harvard Medical School?
Initially I was a bit anxious about what my primary care experience would be like at Harvard, because I knew that traditionally primary care has been devalued within large, academic medical centers. More recently, the reality of the situation and the really engaged and exciting leadership of people within primary care at Harvard have created a much more welcoming environment. You can see it changing. Now I think there’s more recognition, especially with the Affordable Care Act, to get creative about primary care. We see the need for strong leaders in primary care as opposed to the stigmas surrounding it, such as the fact that you are in primary care because you couldn’t make it into a specialty. With the Center for Primary Care, there is a space for all of that to flourish. I find that people have been super supportive. At first, I actually elected to not dive into that community in terms of doing a lot of activities and taking on a lot of leadership because I wanted to get involved with the local community and the local social justice efforts. The people I have met through my community work, even if they are not doctors, have been important mentors for me. I hear all the time about how people experience unemployment, troubled relationships and the different power dynamics that impact their health, and it’s just how people talk—and I am learning about how to be a good primary care doctor through that. And I’m also glad that I’ve maintained a relationship with them as well as with Harvard.
So about the community and social justice work you do. What intersections do you see between social justice and primary care?
Community organizing is about getting power in the hands of people mostly affected by the issues. If you can find a way to do that actively, and you are doing it at all levels, and rooting out oppression in the systems around you, then you are promoting health equity. What does that actually look like? It can be as simple as the medical visit itself: how is the physician empowering the patient in the room to take control of his or her health? Also, and this happens much less, what are you doing to raise the political consciousness of your patient? For example, if the patient is someone who is formerly incarcerated and has trouble finding work, and you ask how it’s going, and you ask how is your work, and the patient seems to have no clear analysis why none of these companies are asking that patient for job interviews, then that is a moment for you to get them talking about the political dynamics and the policies and the discrimination that incarcerated individuals face. A third step is asking yourself: How are you helping the patient connect to resources in their community so that they can be supported in what they are doing? So that’s the clinic visit, but then you think, how is the clinic itself organized? Who is employed and who has power and how are we avoiding the recreation of systems of oppression within our organization? Next, you can find ways to get involved in social justice issues and find ways to contribute and to bring together patients who are people in the community to work on things together: referring people from outside. And then you can use what you’re learning in the clinic to start talking to other people who are working in the clinic, and beyond, at the state, federal or global level. That’s how activism happens. If I notice everyone in a neighborhood saying that garbage pick up never happens, I could find a community organization that is working on this issue, and help mobilize people through the clinic to support their campaign. This can happen on lots of levels. I also ask myself: who am I accountable to? Who is most directly affected by these issues? How can I be accountable and work on the issue and actively participate in change efforts that are led by the people who are directly affected?
In bringing this perspective, what challenges have you faced in primary care?
I have met people who are underserved and who really don’t get good care. And they know that. It’s shocking to see the range. People are coming to the clinic, and you see that screenings haven’t been done, the provider is yelling, and a lot of this is structural as providers are trying to see patients in 5 minutes or less. It’s infuriating to see knowing that it’s possible to deliver really good care and in the clinic, we are doing our part sometimes. I feel that there is subtle racism and classism that allows that improper care to happen. To not be able to provide the test or referral that someone needed was heartbreaking. Some people can’t even get into the clinic, but maybe that’s less heart breaking for some providers since they don’t actually see those patients (Laughs). It’s just a challenge in seeing that, and keeping yourself from getting dull to that. It’s a reasonable defense mechanism that I see myself doing sometimes too. For example, today, there was a patient who died and I didn’t do anything to acknowledge that he had died. That is something that I would not have done two years ago when I just starting out. I would encourage people to not get dull to the human component and to see yourself going through that process and not lose your humanity. It’s awkward because it’s not that the doctors are taking a sterile approach (they are amazingly compassionate people), but you have to learn how to receive death and suffering more objectively. But it’s just as important to take a step back and be like “Woah, how do you do these things?” I think my point is that it’s hard to see so much suffering and not being able to do anything about it most of the time. It’s also hard to figure out how to operate in the medical world, where death is the reality and maintaining a strong sense of what is right and wrong is just hard.
Did you find that your experience at Vassar in any way prepared you to handle these experiences, or your medical journey in general?
So I came to Vassar, this white girl from the suburbs, and I didn’t really have a political consciousness. And I think there was something about being around a lot of students from varying degrees of political consciousness and a diversity of identities (I think Vassar could do a lot better, but compared to where I grew up, it’s super diverse), meeting people and hearing what their experiences were like, and this is what set me off to ask the questions later on: Where is this someone coming from? That really solidified my experience in the Green Haven Prison program of my sophomore and senior year, which was an amazing experience that Vassar provided. Having had very little exposure to the prison system and being able to go in and have it be always structured around learning and not community service, I knew that the professors and incarcerated individuals were really excited to teach us about how the system works. I needed to learn more about the people who were directly affected by the issues I was talking about. Vassar was also great in that I could do use work-study job on community service. I started sophomore year doing that—they empowered us to do that. Also, I took the LALS class about the U.S.-Mexico border, which was an amazing opportunity. When I came back, some people on the trip organized an event that demanded critical actions to raise awareness about the border wall. It coincided with that year’s campaign immigration reform, and I was like “Oh that’s pretty cool” and had to do something political. Also, when I was volunteering at the clinic in downtown Poughkeepsie, I did the May Day March. And I was like “Holy crap,” this is really cool to be marching with patients I worked with at the clinic.
Were you always premed?
I was vaguely thinking about medicine ever since my first advising session. I knew I wanted to help people and I liked science and math. I was passively pre-med. I thought about Environmental Studies but I ended up doing STS (Science, Technology and Society). Since I was good at science and I didn’t have to work hard at those courses, I just kept going. My second year, I was undergoing a transformation in learning about social justice issues and became more committed to doing that and then I decided to go ahead and do the pre-med thing. Since I started a little later, I had pre-med classes with people who were in the class below mine. I was getting more politicized and more angry at the policies that affected the people whom I cared about. But I still didn’t know if I was for sure going to go into medicine and I asked myself questions like: do I really need to be sitting in a clinic putting on a Band-Aid? I couldn’t really see why I was there and I said that I would do my MCAT just in case. So I spent three years exploring the different ways that you can do social justice work with AmeriCorps and other non-profit organizations. I first worked for a community clinic doing patient-driven programming and then I did a public health research human rights research project for a year, which was supported by the Maguire Fellowship that I got from Vassar. I did advocacy and medical interpreting for a year. Through all of this, I realized I liked working on the big picture, but that I also wanted a career where I could help people with their immediate needs. I wanted to do something in the moment. Sometimes, I do wonder though, if I had dedicated myself to activism, if I could have helped more and made more of an impact instead of spending all of these years in medical school. It’s tricky and it’s a balance.
That’s true, and it seems like you are constantly balancing these two types of work, which in a way, are both working to heal and care. What are some of the things that you have learned and encourage other people to learn?
Some questions that I’m always trying to answer are: what can health systems learn from community organizing? How does health impact community organizing? Health systems need to learn how to integrate and refer patients to community organizations. I am interested in how medical schools can teach health disparities—how can we be better? How can we learn skills of self-reflection, how we are racist and sexist and classist? No one knows how to do this and cultural competency is not enough. We need to learn the roots of health disparities at a deeper level. And medicine has not caught up with public health yet.
Juliana Morris lives in Boston. You can contact her here.