Why aren't there more Filipino-American Doctors?

 

Why aren’t there more Filipino American doctors?

A few weeks ago, a good friend texted me saying that she was asked a really thoughtful question during one of her residency interviews. The interviewer noted that my friend is Filipino and asked her, “I noticed there aren’t a lot of Filipino doctors, so how has your cultural background influenced your approach to patient care?”

It is true that we have an abundance of Filipino nurses in our healthcare system, but what about doctors? Filipinos fall under the larger umbrella of Asian Americans, who are not considered to be underrepresented in medicine, but Filipinos are an absent minority. According to AAMC’s 2019 Diversity in Medicine report, 17.1% of active U.S. physicians identify as Asian. However, only 4.6% of Asian physicians in the U.S. identify as Filipino. This underrepresentation is also evident in medical education. Filipinos consisted of 4.3% of Asian applicants to U.S. medical schools during the 2018-2019 academic year. This means that less than 1% of total applicants identified as Filipino.

This is the truth we face, even though Filipino Americans are the third largest Asian subpopulation and one of the fastest growing ethnic minorities in the United States. In fact, Filipino Americans make up nearly a quarter of California’s Asian American population, but only about 6% of the UC’s medical school matriculants. The majority of Filipino physicians in California are international medical graduates.

It is incredibly important for Filipino patients to have access to more physicians who look like them and understand their culture, language, and traditions. The world of medicine is extraordinarily difficult for patients to navigate but having a provider who identifies with their specific cultural needs can greatly improve healthcare outcomes. This is especially crucial since Filipinos suffer from diabetes at higher rates than non-Hispanic whites and have a higher prevalence of cardiovascular risk factors such as hypertension and obesity compared to other Asian Americans.

I’m proud to identify as a Filipino American woman who will be entering the workforce as a pediatric resident physician in a few months. I wish I could say that I had inspiring Filipino faculty or attendings who guided me along the way, but I didn’t. However, I’m thankful that I found a group of intelligent, kind, and like-minded classmates in medical school who also shared the goal of wanting to become culturally competent Filipino American physicians.

As for my friend, she effortlessly answered her interviewer’s question by talking about applying her parents’ immigrant values towards advocating for her patients and wanting to serve as representation for Filipino youth who may be interested in pursuing a career in medicine. I recognize that we have a long way to go, but I can’t help but be excited and hopeful for future nanays and tatays to see doctors who look just like them.

Briana Mancenido, M.D. Candidate
Drexel University College of Medicine Class of 2021

Sources:

https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018

https://www.aamcdiversityfactsandfigures.org/section-ii-current-status-of-us-physician-workforce/index.html#fig2

https://www.aamc.org/data-reports/workforce/interactive-data/figure-3-percentage-asian-alone-applicants-us-medical-schools-asian-subgroups-academic-year-2018

http://greenlining.org/wp-content/uploads/2013/02/ClosingDataGapsAANHPIUCMedicalSchoolDiversity.pdf

  Fuller-Thomson, R. (2017). Diabetes among non-obese Filipino Americans: Findings from a large population-based study. Canadian Journal of Public Health, 108(1), e36–e42. https://doi.org/10.17269/CJPH.108.5761

  Borja‐Hart, G. (2019). Atherosclerotic cardiovascular disease risk assessment and predictors of statin use in Filipino‐American Women. Journal of Clinical Pharmacy and Therapeutics, 44(4), 632–639. https://doi.org/10.1111/jcpt.12837

Postpartum Depression in the COVID Pandemic

In the advent of the Coronavirus pandemic, new and expecting mothers are facing increased levels of fear, anxiety, and stress on top of overwhelming social isolation. Postpartum depression cases, in particular, are rising globally as mothers are now navigating unanticipated challenges of delivering without a support person, being physically separated from loved ones (including newborns), managing their newborns without help, and grieving loss during a moment that was meant to be cherished.

Postpartum depression is a perinatal mood disorder that develops within four to six weeks of delivering a newborn due to neurobiological factors and environmental stressors. The disorder is characterized by at least two weeks of severe depressive symptoms and must be differentiated from postpartum blues, which is known to self-resolve. Unlike postpartum blues, postpartum depression requires a combination of antidepressant medication, psychotherapy, and a significant amount of planning. Postpartum depression is associated with an increased risk of preterm delivery, reduced mother-infant bonding, and delays in cognitive development of the infant; it is crucial to recognize and manage symptoms early on. These symptoms include depressed mood, excessive crying, difficulty bonding with the newborn, withdrawing from family and friends, fatigue, insomnia or hypersomnia, irritability, hopelessness, or feelings of worthlessness, shame, guilt, or inadequacy.

Prior to the recent pandemic, approximately 14 percent of women have suffered from pregnancy-related anxiety and 20 percent of women are said to experience postpartum depression. Those most at risk are women who have a history of depression, bipolar disorder, postpartum depression from a previous pregnancy, difficulty breastfeeding, weak support systems, or financial troubles. Unfortunately, despite the prevalence, postpartum depression cases are often underdiagnosed and undertreated – especially in the African American patient population who are more likely to be infected or die from the virus compared to the Caucasian population.

Perinatal psychiatrists are working towards creating COVID-19 maternal well-being groups, which allow patients to share their concerns, seek support, and grieve together. These groups are particularly helpful as affected women are forced to also think about specific scenarios that may not have medical guidelines. For instance, if a patient or her partner is a health care worker, what precautions should she take? If she is balancing other kids at home, can she send them to day care? If she has a limited support system, can she rely on help from her own parent who is at high risk? These decisions can cause added stress for mothers and are difficult to make without the guidance of medical professionals and the availability of social support. Additionally, a public health intervention to battle postpartum depression includes reaching out to families with prior mental health concerns to address issues proactively.

The pandemic unveils a new mental health crisis and has been shown to disproportionately impact women. For this reason, it is crucial for new mothers to monitor symptoms and seek medical support during these challenging and uncertain times.

Sitara Soundararajan

M.D. Candidate

Drexel University School of Medicine

Class of 2021

Reducing Teen Pregnancy with Comprehensive Sex Education

Sex education in the United States is currently regulated on a state level. Each state has funding and resources from the federal government but has the autonomy to make its own policies and curriculum. Some state curriculum teaches abstinence only while others combine abstinence with comprehensive sexual education that includes medically accurate information on contraception and STDs. A study in 2005 showed that states with abstinence only education average 73.24 per 1,000 teen pregnancies per year for girls aged 14-19 and states that promoted comprehensive sex education in conjunction with promoting abstinence averaged 56.36 per 1,000 teen pregnancies per year. Additionally, this data accounts for confounding factors such as socio-economic status, education level, and ethnic differences. 

Currently, a bill titled The Real Education for Healthy Youth Act (REHYA) proposed by Senator Cory Booker and Congresswoman Barbara Lee has been introduced in House. The goal of the bill is to create a holistic approach to sexual health and provide adolescents with accurate information to make healthy decisions. The bill includes topics such as: basic anatomy and physiology, growth and development, pregnancy prevention, STI prevention, dating violence and sexual assault, and bullying and harassment. Research has shown that students exposed to a safe dating curriculum were 60% less likely to perpetrate forms of dating violence against a partner. Overall, preventing teen pregnancies can help expand communities by empowering teens and allowing these youths to become stronger contributors. It is most important to introduce accurate information and allow young minds to make their own informed decisions. Evidence-based data should be the driving point of all medically related education taught in schools, and the teachers should be up to date, bias-free, and have appropriate training and education themselves. In order to implement changes in each state, there must be change on the federal level.

Kristy Hou

Drexel University College of Medicine

Class of 2021

Sources: 

Philip, J., & Marr, A. (2016) The Real Education for Healthy Youth Act. Advocates for Youth. Retrieved from: https://advocatesforyouth.org/resources/policy-advocacy/the-real-education-for-healthy-youth-act/ The Real Education for Healthy Youth Act (REHYA) (2017, Sept) 

Sex Ed for Social Change (SIECUS). Retrieved from: https://siecus.org/resources/the-real-education-for-healthy-youth-act-rehya/ Stanger-Hall, K. F., & Hall, D. W. (2011). 

Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S. PloS one, 6(10), e24658. https://doi.org/10.1371/journal.pone.0024658

Remembering Ruth

This morning I began the day with a cup of tea, drinking out of one of my favorite mugs with a quote on it from an inspirational woman: Women belong in all places where decisions are being made. I am reading this quote on the morning of one week after the passing of Ruth Bader Ginsburg, originator of this quote, trailblazer and consistent champion for reproductive rights and gender equality. Stories of her life and memory have flooded news outlets, being laid bare for us to get the chance to say thank you for her work and acknowledge where we must all pick up and continue the fight for gender equality.

I wanted to reflect on some of the ways that her civil rights work has made life more equitable for women and girls. Even before she joined the Supreme Court in 1993 and established important precedents and decisions regarding reproductive rights, she co-founded the Women’s Rights Project at the ACLU, an initiative that was devoted entirely to gender equality. She fought fiercely to make sure women’s rights were seen as an essential part of human rights. She may not have gone into law school intending to fight gender discrimination, but her experiences as one of only nine women at Harvard Law School in 1956, being turned down for law jobs despite graduating tied for first place in her class from Columbia Law, and facing unequal pay for equal work while serving as faculty at Rutgers Law School in 1963 set the stage for laws she would help create and cases she would bring to justice.

During her time on the Women’s Rights Project with the ACLU, Ginsburg pushed to have pregnancy discrimination recognized as a form of sex discrimination, fighting against an Air Force policy in 1972 that automatically discharged pregnant officers unless they terminated their pregnancy. Ruth Bader Ginsburg believed that, "The decision whether or not to bear a child is central to a woman's life, to her well-being and dignity. It is a decision she must make for herself. When the government controls that decision for her, she is being treated as less than a full adult human responsible for her own choices." In cases such as Whole Woman’s Health v Hellerstedt (2016) and June Medical Services v Russo (2020) she reinforced the essential nature of abortion and reproductive care as part of healthcare and protective of women’s bodily autonomy and equal status as citizens in this country. She expressed in multiple dissents the need for separation of church and state with regard to contraception coverage, a logical response since numerous studies show decreases in STIs, teen pregnancy, and abortions with comprehensive sexual health education and access to contraception over abstinence only education and restrictions placed on access to contraception and abortion. Ginsburg paved the way for women to obtain financial independence through the Equal Credit Opportunity Act passed in 1974, having downstream effects of everything from decreasing their risk for being trapped in abusive relationships to realizing their talents and dreams. Finally, she helped the world see that sex discrimination is damaging for both men and women through representing Charles Moritz in 1968, ultimately proving that men are entitled to the same caregiving and social security rights as women.

Ruth Bader Ginsburg made space for women to be in all places where decisions are being made building on the work of other trailblazing women before her, and I am grateful for all the ways that she has shaped my ability to be in my final year of medical school irrespective of my sex. In medical school, we learn about social determinants of health and how they affect our patient’s wellbeing and overall physical and mental health. Societies inequalities, gender based discrimination included, have many implications on health and I am happy to continue working toward gender equality alongside the generations of feminists Ruth Bader Ginsburg has inspired.

Anna Braginskaya M.D. Candidate, Class of 2021 Drexel University College of Medicine

IBD and Pregnancy

The intersection of women’s health and gastroenterology gives way to an interesting discussion of sexual, reproductive, and mental health. Most inflammatory bowel disease (IBD) is diagnosed between 15-26 years of age or later in life between 50-80 years.  The first peak of onset comes at a critical time for women’s sexual and reproductive health. For example, 1306 women with IBD enrolled in the Crohn’s and Colitis Foundation of America, were surveyed about vulvovaginal symptoms including vaginal itch, burn, discharge, dryness and pain (Ona et. al, 2017). Women with constant or frequently active IBD have increased odds for vaginal discomfort (OR 2.01, 95% CI 1.46, 2.78), vulvovaginal discomfort, decreased interest in sex for 55% of women, or ability to have sex in 47% of women surveyed (Ona et. al, 2017). From an early age, gastrointestinal health can significantly impact quality of life for many individuals. 

There is a spectrum of considerations when it comes to discussion of IBD in pregnancy, specifically. A study conducted at Icahn School of Medicine at Mount Sinai found that mothers with IBD often have gut dysbiosis during pregnancy that is reflected in the offspring’s gut microbiome (Torres et. al, 2020). Specifically, they often have lower alpha diversity during the first and second trimester of pregnancy and different beta diversity during each trimester compared to mothers without IBD. Offspring of these mothers presented with reduced bacterial diversity that persisted from the first week of life through 3 months; this includes a reduction in Bifidobacterium which usually aids in maturation of the immune system and protection from colitis (Torres et. al, 2020). The infant microbiome profile varied with infant exposure to antibiotics, feeding and delivery method. Interestingly, Caesarean section and exposure to antibiotics during pregnancy and early life have been shown to increase the risk of IBD. On the other hand, breastfeeding is shown to be protective against IBD (Torres et. al, 2020). This data lends itself to investigating how to promote gut microbiome diversity in mothers with IBD and indirectly offspring.  

Research shows that mothers with IBD are at a small but significantly increased risk of new-onset psychiatric diagnosis during the postpartum period — specifically mood/anxiety disorders and substance-related disorders — when compared to their non-IBD counterparts (Vigod et. al, 2019). Furthermore, mothers with Crohn’s are at higher risk than those with ulcerative colitis (Vigod et. al, 2019). This information is consistent with the American Gastroenterological Association’s ‘Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway’ that calls for a multidisciplinary model to include MFM physicians, IBD specialized gastroenterologists, family planning and behavioral specialists who address the increased risk of psychiatric illness in mothers with IBD. This collaborative approach helps the expectant mother navigate IBD-specific items, including finding therapies safe in conception, pregnancy or lactation, as well as the higher risk of miscarriage, small-for-gestational-age infant, premature delivery, poor maternal weight gain, and complications of labor and delivery in IBD.  

Roshni Singh   DUCOM 2020

Mahadevan, U., Robinson, C., Bernasko, N., Boland, B., Chambers, C., Dubinsky, M., Friedman, S., Manthey, J. , Sauberan, J., Stone, J., Jain, R. (2019). Inflammatory bowel disease in pregnancy clinical care pathway: a report from the American Gastroenterological Association IBD Parenthood Project working group. Gastroenterology, 156(5), 1508 – 1524. 

Ona, S., James, K., Long, M., Martin, C., Chen, W., Mitchell, C. (2017). Prevalence of vulvovaginal discomfort in a cohort of women with inflammatory bowel disease. American Journal of Obstetrics and Gynecology, 217(6), 740.  

Torres, J., Hu, J., Eisele, C., Nair, N., Huang, R., Tarassishin, L., Jharap, B., Cote-Daigneault, J., Mao, Q., Britton, G., Uzzan, M. Chen, C., George, J., Lrgnani, P., Maser, E., Loudon, H., Stone, J., Dubinsky, M., Faith, J., Clemente, J., Mehandru, S., Colombel, J., Peter, I. (2020). Infants born to mothers with IBD present with altered gut microbiome that transfers abnormalities of the adaptive immune system to germ-free mice. Gut, 69(1), 42-51. 

Vigod, S., Kurdyak, P., Brown, H., Nguyen, G., Targownik, L., Seow, C., Kuenzig, M., Benchimol, E. (2019). Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study. Gut, 68(9), 1597-1605.