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51 % The Women's Perspective

51% #1659: Female Healthcare Heroes

On today’s 51%, I visit a psychiatric ward in Cleveland to learn how one nurse reaches her patients with tea parties. And we’ll hear from one physician assistant who is trying to educate other healthcare professionals about racial and gender equity.

Remember that old riddle we all heard growing up? A little boy is wheeled into the emergency department and the doctor says, “I cannot operate on this boy. He is my son.” Then the riddler says, this was NOT the boy’s father. Who is he? And the huge reveal: It was the boy’s mother! Then we all had to feel ashamed for thinking only men were doctors.

How far have we really come from that riddle?

According to a 2019 study by the World Health Organization, in an analysis of 104 countries, women make up nearly 70% of workers in the health and social sectors.

But women in the health workforce are still making about 28% less than men -- and women are less likely than men to be in full-time positions.

The WHO report finds that, in most countries, male workers make up the majority of physicians, dentists and pharmacists, with female workers acting mostly as nurses and midwives.

During the first year of the COVID-19 pandemic, when PPE was scarce, the Centers for Disease Control and Prevention reported that of all the essential healthcare personnel in the United States who contracted COVID-19, 73% were women.

Which should come as no surprise because the people who work with patients the most are nurses. And according to the United States Census Bureau, of the more than 2.4 million nurses in the United States, and 1.2 million psychiatric and home health aides -- women make up more than 85% of workers. So women were exposed to the coronavirus first, and the most often.

And according to a 2019 Bureau of Labor Statistics Survey, almost a quarter of the female nursing staff in this country are women of color. They’re on the front lines of a deadly pandemic, and the largest civil rights movement since the 1960s.

Part I: Above And Beyond

Joann Hopkins, or as her patients call her, Jojo, is a registered nurse in the in-patient psychiatric unit at MetroHealth Medical Center in Cleveland. It’s a place where most people would be scared to work. The patients are prone to violent outbursts and there’s often a communication barrier that can wear a person down. But Hopkins says communicating comes naturally to her.

Joann Hopkins
Credit Jackie Orchard / WAMC
Joann Hopkins

“I've always been concerned about people,” Hopkins said. “I like talking. I listen, I'm a good listener. I guess I sympathize with patients well, but I also know that it helps a lot when you have somebody to talk to when you're going through issues.”

The rattling dishes you hear in the background are for a tea party Hopkins is setting up for the patients. Complete with cakes, cheese, and chocolate covered strawberries Hopkins made by hand.

Hopkins stayed up all night making hand-dipped strawberries for her patients.
Credit Jackie Orchard / WAMC
Hopkins stayed up all night making hand-dipped strawberries for her patients.

Hopkins says the patients in this section of the hospital are usually going through something traumatic, and they could stay in the wing for a few days, weeks or months. She says they deserve to be pampered, to be waited on like they’re at a restaurant in society. She says her tea parties, which she pays for out of her own pocket, are to lend the patients some normalcy and dignity.

“Basically, you know, they've been off their meds or you know, we have some patients with depression or suicidal ideations, schizophrenia, bipolar -- so we get them all,” Hopkins said.

Hopkins says sometimes patients are violent.

“You never know when it's gonna happen,” Hopkins said. “But you still try to watch what you're doing. You have to always be aware of your environment, your situation that you're in with the patient. Because sometimes patients can be unpredictable.”

Hopkins says she spends a lot of her day watching body language for warning signs.

“If the patient is walking around, and they're starting to walk faster and faster, if they start clenching their fists, if their affect changes to, you know, blunted if they're talking to themselves, if they're, you know, being verbally aggressive,” Hopkins said. “So, we look out for things like that, so that, and we try to catch it early, so that we can de-escalate the situation before it gets out of hand. And so we try to help the patient before that happens.”

The 20 patients in the psychiatric unit aren’t confined to their rooms most of the time. So, staff like Hopkins have to be in tune with their surroundings all day. Which is why I had to be escorted at all times.

The recreation room for the patients overlooks Cleveland.
Credit Jackie Orchard / WAMC
The recreation room for the patients overlooks Cleveland.

She says the patients often shout verbal abuse as well.

“I've been in this for 12 years,” Hopkins said. “I don't think anything is hurting my feelings right now. And you have to understand, you know, the patients, when they come to us, they're sick. So, the only thing they have is their voice. And they're gonna say whatever they need to say to kind of hurt you in that way. But, um, no, no, I think I’ve been [called] everything under the sun. And no, it doesn't bother me at all. I'm surprised. Now that I say it out loud. But no, it doesn't bother me. You know, they call you a name, ‘OK. OK.’ You know, you just have to let it roll off your back. You can't do this for 12 years and still keep your own sanity. I think you have to like what you're doing, you have to understand what you're doing and why. And I think that that's what I look at when I come to work and I deal with the patients. Why am I here? I think you just gotta have a good sense of understanding yourself. And then, you know, basically putting it into your work.”

Hopkins says the tea party can make a patient, who might be in a really dark place, feel valued.

“It opens them up more, it makes them smile,” Hopkins said. “And if they get nothing else from around here, I don't want them to feel that they have a bad experience here.”

She says the ritual isn’t about the snacks or the tea party itself – it’s the part where she goes around to each room and invites each patient, saying she wants to see them, specifically, at her party.

“During the day I walk around, and I tell him, ‘Hey, you gonna come to my tea party?’ You know, ‘Hey come out to my tea party, you know, blah, blah, blah, it's gonna be at this time.’ And so I send it out as like an invitation. You know, and then I make it fun. This is the spring setting. And so we're gonna have flowers in here and stuff, and they enjoy it,” Hopkins said. “And so, today, they had a good day. You know, so any day that I can make them feel that they had a good day, or they'll remember this when they go home, you know, and then they'll maybe smile about it. You know, they won't be depressed. So maybe it's just something else to give them to remember about their experience here.”

Because of COVID, the nurse staff is in masks and gloves and they have to make the snack plates for the patients as they walk in.

Some of the patients are wearing open hospital gowns, socks, and nothing else. Some won’t make eye contact. Some are friendly.

Hopkins prepares the table moments before the patients arrive for a tea party.
Credit Jackie Orchard / WAMC
Hopkins prepares the table moments before the patients arrive for a tea party.

Observing from the corner, watching the patients swap stories and laugh, I see that Hopkins was right. Everyone is enjoying just having some choices. The nurses fan out the herbal teas and let them select their favorites. Some of the patients are giddy at the idea of chocolate cake. And it’s a good turnout. 12 people show up and Hopkins guides them through a journaling meditation exercise.

Sitting in the high-tower room on the fifth floor, overlooking a cityscape of Cleveland, knowing there were three layers of locked doors between me and the outside, I was worried I would feel scared and stifled under the fluorescent lights.

MetroHealth Medical Center in Cleveland
Credit Jackie Orchard / WAMC
MetroHealth Medical Center in Cleveland

But there’s something very reassuring about having Hopkins in the room. When she speaks, the patients listen. When she tells them that if they put too much sugar in their tea they’ll get diabetes by the time they’re 30 they roll their eyes like it’s a lecture from mom. And when one screams at her, Hopkins doesn’t avoid eye contact or ignore the woman. She engages and listens. 

And Hopkins doesn’t seem to see herself as some kind of martyr, either. Even though the work is challenging, she says she doesn’t bring it home with her. Instead, she’s always walking the aisles at stores thinking, “How can I turn this into something fun for my patients?”

“When I go home I think about, ‘What can I do tomorrow at work? How can I, you know, bring something positive into the situation that I'm working in?’ And I just, I'm a creative person,” Hopkins said. “So I always like to think of something that maybe I can get them to do that I like to do. Like, I love tea parties, and I'm like, ‘Well, if I love them, they gotta love them.’ I haven’t found anybody that that didn't like them so far.”

Hopkins was a cardiovascular technician at the Cleveland Clinic for about 18 years before she went to nursing school. She has been working in this psychiatric unit for 12 years and she’s turning 63 in July. She has lived in Cleveland her whole life. She says she didn’t need to go looking for a calling. It’s right here in this psychiatric wing.

“I've always said, ‘Oh, I want to be a nurse because I knew I wanted to help people.’ But then when you get into that role, you see, wow, I really got to do something,” Hopkins said.

She says no one can save the world. But anyone can throw a tea party. So she’s starting there.

“Maybe you can help somebody maybe a little bit more,” Hopkins said. “Everybody’s needs are different. And you can't come into it judging anyone. You know, they’re patients, they need our help. And that's what you focus on.”

Part II: The Hardest Minds To Change  

Pamela Young is a physician assistant in the emergency department at Albany Medical Center. She works with attendings and nurses to care for patients in a level one trauma center. Because many patients use the emergency department as their primary care, she handles everything from mass casualties, car accidents, strokes and heart attacks -- to dental pain.

Pamela Young, a physician assistant in the emergency department at Albany Medical Center.
Credit Jackie Orchard / WAMC
Pamela Young, a physician assistant in the emergency department at Albany Medical Center.

“So it really depends, but I'll tell you, the secret of emergency medicine is, and I say this when I teach people: don't sleep on anything,” Young said. “Because I've had patients come in with dental pain, who turned out to be mumps who became septic. So it's what we call zebras. And you know, you can never tell.”

Young says many of her patients end up here because they don’t know where to turn. She says most don’t have health insurance. COVID-19 spotlighted the health disparity in America.

“You know, you may have Medicaid, but people don't want to accept Medicaid because it pays at such a much lower rate,” Young said. “You know, so people often say I have ‘good’ insurance, or they don't have their co-pays, or they can't get into the primaries, particularly with COVID. But even before then, you know, there's a significant lack of health care providers in the country. And particularly in this region, or sub specialties, you know, we get a lot of people who need follow-up for psychiatric care, or pediatric psychiatric care, and there are none. So you know, all roads stop at the emergency department.”

Young says Albany Med is what’s called a “safety net hospital.”

“We don't turn anyone away,” Young said. “And if you have no insurance, and no money, we'll still treat you and give you, what I believe, is excellent care. And then our patient program will help you with finances afterwards. So it all kind of congeals into everybody comes to the emergency department.”

Dealing with underserved communities every day, Young has given the idea of socialized medicine quite a lot of thought.

“A lot of other countries have other types of general, government-founded health care, and they do quite well,” Young said. “I also understand the other aspect of it, they pay quite a bit less. The amount physicians make in America compared to the amount that a physician may make in Canada is significantly different. And the cost of our loans because there are a whole bunch of other government funded subsidies that lead you down that path, you know, their universities cost less than, you know, there are more grants. You know, there are physicians who are graduating with $600,000 in debt, and they want to start a family. And to be told that ‘Well, you know, under a government led subsidy I'm going to just universally make less,’ is difficult.”

But Young says she sees the injustices of America’s current system as well. She brings up Martin Luther King, who said at a Convention of the Medical Committee for Human Rights in Chicago in 1966, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Growing up with government funded health care on Long Island, Young says she used to wait for hours to see her physician once a year.

“It's ridiculous that people can't afford their co-pays,” Young said. “And we don't have enough centers to offload that. So, back to your question, if we had a government subsidized health care system for everyone, it would help but the reality is unless it's universal, and mandated, there still going to be people who opt out. And it's such a partisan topic that I don't see them being able to force people to see. So we'll still have the equivalent of Medicaid in New York state where you can go to three centers over here, but they're spread far out and if you live rural, or if you live in downtown Albany to wait list to get into Whitney Young, our safety net center, is months long, while people who continue with their private health care can see whomever they like.”

Before Young formed her opinions on socialized medicine, before she could be seen leading students down hallways like a mother duck, explaining procedures along the way, and before she could be found stitching up trauma patients – she was a young Black woman trying to be seen. Trying to be taken seriously as she made her way into healthcare. Young grew up with her grandmother. She says they had “less than no money.” She says she hadn’t ever seen a female doctor, even in the hallway of a hospital, until she came to Albany Med and she didn’t see any people of color until she wound up working in the kitchen.

“And at the time, that's where you found a lot of people of color, we were all in the basement in the kitchen,” Young said. “It was almost comforting when I got here to go to the kitchen, and there were all these Black people and West Indian people and, you know, Middle Eastern and, and you know, just ‘cus I'm from downstate, this cacophony of voices that was comforting to me. But when I went to levels up, there was one or two women, one or two women of color walking through the halls. Now fast forward 20 some odd [years] later, there's more, but it's still not enough. In my department, I'm one of one of one -- I'm the only Black physician assistant.”

Young says that’s why she does community outreach, speaking at local high schools and connecting with young women.

“To say, ‘Hey, you may not have a doctor in your family, like this person over here does, but consider it,’ because we found it makes a difference,” Young said.

Young is on the Diversity Equity and Inclusion Task Force, which she says focuses on community outreach and also teaching a predominantly white staff how to relate to patients.

“So we're trying to educate our staff about inequities in medicine and really having that sort of empathy with the patient you're taking care of,” Young said. “Because the reality is, our staff is overwhelmingly white, a small subset of Middle Eastern or Eastern or southern Asian people. But in general, you know, almost no, there are no Black residents. There are two Black attendings and one PA, and same for nursing, but our patient population is overwhelmingly either lower income or people of color, BIPOC people.”

I tell Young that my sister is in medical school in Ohio, and she can’t help but notice that all of the doctors are white and all the nurses are people of color, and the two groups do not seem to like each other. I tell Young my sister, who is white, says the racial divide in the hospital feels uncomfortable, even shameful. I ask Young if resentment builds up.

“I'm gonna have to ask you to get out of my email box and stop reading my mind,” Young said. “Because clearly, you're looking at all of the meetings on my inbox, and you got to stop. So that's another taskforce. That's another set of meetings. So as part of the DEI taskforce we sent out a survey to our department and in some of the things that came up with those type of inter-division stressors. Here, there are very few Latina, Black, LatinX nurses, mainly their techs, and the patient access people, so there's a huge divide.”

Young says another divide is that most of Albany Med’s patients come from the city, but most of the doctors live in nice suburbs.

“There's the inter-division divide that unfortunately exists between doctors and nurses, nurses and techs, providers, and patient access, who are the people who take your insurance information and register you. Between them,” Young said. “And then there is a divide of, ‘I live here and I live next to the people you're taking care of while you go home to your suburbs or your farm country. I still have to live here.’ How do we address that?”

She says the best medicine for the division is conversation.

“The big thing I think, is respect. We're all stressed,” Young said. “There are days I come in, and I can feel the weight of whatever on my shoulders. But if I take my stress out on you, and either recognize it and don't care or don't recognize it, there is no way you and I can be a team, right? But if I come in and I say, ‘Hey, good to work with you today, let's do this.’ I'll say, ‘Listen, I'm having a really rotten day, but we're still gonna get through this like rah rah,’ then it works better. So teams jell better. So we're trying to force that team atmosphere. Historically, unfortunately, doctors have been seen and some doctors have set an example of setting themselves on a pedestal. I work with physicians now who are like, ‘No, no, we're a team.’ And I think that's how you bridge that divide.” 

Young says to be a Black woman in healthcare is a proud responsibility, but also a weight on her shoulders.

“I was walking through the hallway and a woman was waiting to be seen. And she was like, “Sis, sis,” and trying to get my attention. And I'm like, she goes, ‘I need you to take care of me,’ because she was she's like, ‘I'm so proud of you.’ I've never met this woman before in my life,” Young said.

Young says it’s not just the patients who need to see someone who looks like them, but the staff as well.

“I feel like I can't fail,” Young said. “I have to do more, be more in order to -- not just for Black women or women of color -- but women in general in a leadership role. I have to do more, be more because you know, years from now, hopefully, we won't still be having this conversation.”

According to the Association of American Medical Colleges, in 2019 56% of active physicians in the United States were white, and of those 64% were white males. But there is some hope in the data: among the youngest subset of active physicians, those aged 34 and younger, women outnumbered men in most racial and ethnic groups.

But AAMC also found that medical school faculty is predominantly white at about 64%, 59% of whom were white males.

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

Young says you can’t overstate how important it is for people of color to see people who look like them in healthcare leadership roles.

Young says if you walk into a room as a person of color, and there is only one other person of color in that room, you feel an immediate kinship, even if you have totally different backgrounds. And that kinship can make you feel less alone in a room of white faces.

She says that kinship – it’s shared history, which leads to shared trust.

 

bar_chart_two.png
Credit https://www.aamc.org/data-reports/workforce/interactive-data/figure-20-percentage-physicians-sex-and-race/ethnicity-2018

  

“So there have been numbers of untold things that have been done to people -- forced sterilization, the Tuskegee trials, HeLa cells, Henrietta Lacks -- that, you know, have followed people generationally that make people have a distrust because it's been passed down from generation to generation,” Young said. “I knew that my grandmother, who was thank goodness, very healthy, and died in her 90s. But she said, I'm not going to the doctor, because if I go to the doctor, they're gonna inject me with something, if I let them take something, they're going to take it and use it for something. This, as far as we know, has never happened to her. She died, as I said, in her 90s and lived a healthy life. But it's that feeling that if the white person is going to take advantage of me, so walking into a room and seeing a person who looks like me, sounds like me talks like me, understands my frame of reference, comes from where I am, is comforting, because maybe you feel like, okay, I can trust this person a little bit more.”

Young says working with mostly white colleagues has its own set of challenges. She says if Black people, like her, are going to give each white person a clean slate upon meeting, then white people need to do the same, and be allies in tough situations. She says she has some strong allies who have stuck up for her in racist moments, like if a patient demands to see a white male doctor, which she says happens often, but there are still other colleagues who need to do more.

“As a female Black provider, when patients get angry, the first thing they do is call me out my name,” Young said. “I am all sorts of racial slurs the minute they get angry. The number of times patients have demanded to see anyone but me. ‘I want to see a white man.’ I'm working on this DEI initiative with an attending who, when I was very new here, I had a patient who was very angry and violent and screaming and demanding he had the right to see a white person. And she came over and she said, ‘I'm the white person working today. And you have the right to be seen by my provider who's excellent. Or leave. So I have been blessed in that the providers I've worked with have backed me up.”

Young says even though there are white allies, micro-aggressions are everywhere.

“Everyone assumed one of the white men that I work with was my boss,” Young said. “He would go to meetings with me, but he would go to one or two and then leave. And I would be there every day, all day. And they would say, ‘So, the lead PA,’ and they would say his name. And I’d say, ‘He's not the lead, I am. So, I finally had to start putting a title at the end of my emails because people were like, ‘OK, but when’s he coming?’ So, I finally had to get a title and put a title on my emails because everybody assumed that the man in the room was the boss. And he, to his credit, never told them that and he often deferred and said, ‘You probably should ask Pam, it was her idea in the first place.’ But for years, everybody assumed that he was the boss and before him another guy. And they both were like, ‘No, that was Pam's idea.’ Nobody ever thought it was my idea. Conversely, every time something bad happened though, it was, ‘Didn’t Pam have something to do with that?’ And Pam wasn't even working that day. I don't know why you think it was me.”

Young has also had Black patients who have come to her claiming their white doctor is neglectful.

“I've had patients who said, ‘Sis, this person's not taking care of me, I need you to come and help.’ And so then the burden becomes if I know that colleague truly is taking care of them, but we're laboring under that burden of distrust, now I've got to mediate,” Young said. “I've got to say, ‘No, no, no, you know, this person is a good doctor, this person is a good PA,’ you know, I'll help them. But I can't let that distrust, I can't foster it. I can only bridge it. Because otherwise, I'm not here every day. I'm one of one. So the likelihood that they're gonna see me tomorrow or next month or next week is slim to none. So I need to bridge that divide and say, ‘No, we're gonna give you good care. We don't care that you have Medicaid. We don't care that you're Black. We just want to take care of you.’”

Young has faced instances of racism and micro-aggressions her entire life. She says she always worked two or three jobs to put herself through school. She tells me about a time when she was working toward a bachelor degree in Africana Studies at the State University of New York at Albany. She was working part-time in a department store to pay for school.

“And I remember buying my then boyfriend now husband, a pair of shoes, using my discount, I'd worked there for a year I was in a cash office,” Young said. “And a security officer staying after work one day, just he and I alone in the building and confronting me about stealing the shoes. And I showed him my receipt because I knew this was coming. And then he confronted me about using my discount, mind you, everyone else had bought stuff for their families for Christmas, I bought a single pair of like $19 shoes for my fiancé and boyfriend and used my discount and… the intimidation. Right? So and I can still see him. He was like a 6-foot guy who's the head of security. It's he and I alone in an empty department store. And he's leaning over me saying, ‘you stole those shoes,’ and I didn't steal them I paid for them, ‘you used your discount inappropriately, you can only use it for your husband.’ And just, and I'm looking around like… I was maybe 20 you know? And so at the end, I gave him back the shoes and I walked out in tears. It was like 11 o'clock at night, caught the bus home. And I went back to work the next day. Because what can I do? I gotta pay my way through college.”

It didn’t stop there. She says despite her best efforts and good grades, she was relegated to positions where people of color were often sent.

“Even when I first came here, I said, ‘I think I want to do medicine,’ and the community service agency I was working for said, ‘Oh go to the big hospital Albany Med.’ I'd never heard of it,” Young said. “I'm from the Bronx and Long Island. And I went into human resources and I said, ‘I want a job. I want to take care of people, can I be a tech because I think I want to go to medical school. And they're like, ‘No, but you can work in a kitchen.’ I said, ‘But no, no, you know, I'm a college student and I went through the book and I'm like, ‘Can I apply for this? Can I apply for this? Can I apply for this?’ And he says, ‘No, but we have an opening in a kitchen.’ And I found out later all the Black people went to the kitchen. All of them. And as I said in the end, I found a position of comfort. And I worked my way up from the kitchen to data processing. And you know, but I had to start in the kitchen because even though I was very clear, and I tried name dropping people, people who worked with me, they were like, ‘No, you can work in a kitchen.”

Young says a huge barrier to young women of color entering healthcare is the cost of schooling. But she wants young girls to know there’s always a way.

“So the first thing you have to do is set your mind, right,” Young said. “You have to say, I'm going to do this. The best revenge is success, right? So anybody who ever told you, ‘you can't,’ you don't have to yell scream, but 10 years from now, like in my head, I'm doing to the people who did things well, where I thought, ‘you're holding me down.’ Now I can say, ‘oh, but it didn't work.’ So first, set your mind. Make a determination, that's first. And then once you do that, keep your grades up. Because academic scholarships are everywhere. You just have to put the time in. And with the internet, it's a lot easier than when I had to go to library and flip through book after book after book. There are research engines, there are free apps to help you. There's guidance counselor's reach out to people around you. Do extra things and those extra things will lead you to building contacts that can help you. At the end of the day, you can take loans. There are also grants if you're willing to come back to your community and work there. The National Institute of Health has programs there are grants and programs out there. But if you start out by saying there's no way, then there's no way.”

Young says her best advice is to overcome your own doubts first, and keep going no matter what happens.

Young says the world of healthcare has a long way to go, not just in terms of having a healthcare staff that reflects the diversity of its patients, but also making women equal to men in the field. She says the only way for this to happen is for older white men to gut check themselves. Daily.

“There's a concept called allyship,” Young said. “And it's basically learning about the other community, educating yourself and then forming a relationship and then Once you form that relationship, advocating speaking up when you see something wrong, and putting forth ideas to make things better. My current department chair is a great ally.”

She references the summer of 2020 following the death of George Floyd in Minneapolis Police custody, when there were both peaceful Black Lives Matter protests and riots at police stations.

“You know, over the summer when the riots were happening, and we were seeing community violence every day, he said to me one day, ‘Pam, how are you doing? And we had a conversation,” Young said. “And I think the fact that he was willing to ask, and then when I said, ‘Well, I have an idea.’ And he said, ‘Let's do it.’ That's how you become an ally. And he will often say, ‘I don't know, about X, Y, or Z. But I'm willing to listen, if you tell me.’ So, I think for men, it's opening your ears and hearing your colleagues, and hearing what the women in your lives are saying.”

Young says once you’ve educated yourself, you are obligated to speak up.

“If somebody is giving you credit for something you didn't do, give credit to the right person,” Young said. “And if your colleague is in the room, and speaking, give your colleague the floor.”

Young says we all need to ask ourselves in the workplace: Am I being biased? Is everyone being held to the same standard? Especially when it comes to salary.

“You know, there are two areas in medicine, academic medicine, where we really lag,” Young said. “You know, there was a study that showed that women at an executive level still get paid at a lower executive level. So they get paid, an Associate Professor gets paid as if they're an instructor, even though they have the higher title, whereas a man at an associate professor level gets paid two to three times more, doing the exact same job comparably. So looking at those numbers and saying, am I paying everyone what they're worth, equitably? Or did I somehow give someone else a little bit more. If men gut check themselves, and make those small corrections, and have those conversations, and invite more people into the room, that will go a long way. Particularly the older men, because older men like to listen to older men. So, you know, and those are the hardest minds to change.”

Part III: This Is Your Shot

The coronavirus pandemic has moved healthcare into the heart of our communities in an unprecedented fashion. Mass COVID-19 vaccination clinics have distributed hundreds of shots a day. Albany County Health Commissioner Dr. Elizabeth Whalen gave me a behind the scenes tour of how she’s managing such a daunting task.

The Albany Times Union Center, normally a venue for roaring sports fans and concert-goers, is transformed into a real-life choose your own adventure book. Except, instead of exploring caves or solving mysteries, you’re answering screening questions. Under the age of 60 and able bodied? Have an appointment? No symptoms? Turn right and take a ride up the escalator. Over the age of 60 or in a wheelchair? Straight ahead, on the fast track.

Albany County Health Commissioner Dr. Elizabeth Whalen walks me through the opening sequence, where staff ensure you’ve signed up for the clinic and that you meet eligibility.

“You might be asked to show a license for your age,” Whalen said. “Or if you’re an essential worker, you have to kind of show her a work ID, and then you come through. So once you check into that area, you come through here to where we're currently standing, which is the main part of the auditorium.”

Whalen shows me the arena floor. In this hulking venue, the superstars aren’t in jerseys or costumes – they’re in fluorescent yellow vests layered with masks and face shields, scurrying trays of syringes and raising orange flags to indicate they’re ready for another patient.

But the massive space doesn’t just look cool. Whalen says it’s needed so that they can move large numbers of people through while maintaining social distance.

“As you see, we have people working solely on flow,” Whalen said. “And after every single POD [point of distribution], we debrief and say, ‘How can we improve the next time? How can we make it better? How can we make it a smoother experience for people that are coming through?’”

About 60 stations with colored flags and “vaccine assistants” dot the floor.

“And their job is to take the information and ask some medical questions for screening for everybody that comes in for the vaccine,” Whalen said.

For example, they might ask about the medications that you take or any health conditions you might have.

“And if there are any concerns, we have medical evaluators who are usually MDs or pharmacists here to come and speak to those that are being vaccinated, answer any questions that they might have, and then we go forward with vaccine,” Whalen said.

Every table has a nurse or doctor, as well, certified to give the vaccine. Like DarciJean Sprague, a 64-year-old retired critical care nurse who volunteers at the clinic at least once a week. She moves between three tables all day, telling patients what to expect and verifying they can come back for dose number two.

“I am so happy to be part of something to get us all back together,” Sprague said. “I retired last year and so this gives me a purpose.”

The volunteers, many of whom are retired doctors and nurses, work 8-hour shifts, mostly on their feet all day. But they keep smiling.

“Now you’re back out there in the field,” I said.

“I am,” Sprague said, “And loving every minute of it! They have asked me to come back and do vaccinating and I’m going to do that part-time.”

The far end of the arena houses physically distanced rows of folding chairs, where patients sit to ensure there are no serious side-effects of the vaccine.

“This is just in case anyone who might manifest any signs or symptoms of an allergic reaction,” Whalen said. “Or, sometimes people get a little woozy when they're taking a vaccine. And it gives us an opportunity to keep an eye on them. Anybody that has a history of allergy, particularly those with histories of anaphylaxis to any previous vaccines or other things, we ask them to wait about a half an hour here.”

Lloyd Ballou volunteered to speak about his experience.

“It was very well organized,” Ballou said. “Went upstairs, they check your temperature, you come back down, they check your ID, you come in you get your shot and that’s pretty much it.”

But, what we all want to know… Did it hurt?

“No, not at all,” Ballou said. “I didn’t even feel it.”

Paula Young also decided to spend her 15-minute recovery talking with me.

“I’m very impressed because it’s very calm, the people that are working here are very well marked as to what they do, everyone is very nice, there’s a lot of volunteers here, it’s great,” Young said.

Whalen received a degree in psychology in 1987 from Fairfield University in Connecticut and went on to complete medical school at The National University of Ireland, Galway in 1992. In 2012 she added a Master’s in public health at the State University of New York at Albany. She put in about three years as a primary care physician, then nearly seven years as the Medical Director at the Albany County Department of Health, nearly 3 years as the Medical Director for Medicaid at a local health insurance agency, and has been the Commissioner of Health for Albany County for about six years now.

Whalen says in her entire career in public health, vaccinating the population against COVID-19 has been her happiest moment.

“Because you really do see a tremendous amount of relief that people have, when they get that shot in their arm,” Whalen said. 

County health departments train for this scenario. Whalen says the county’s clinics are going exactly as planned.

“What's been a little bit different is how the vaccine has been allocated and rolled out,” Whalen said. “I think we had planned originally that it would be the local health departments that would take that lead role. And now it's the regional hubs, but that collaboration is working well. And we know that there are many partners now that are involved in vaccination, it was never just going to be the local health department. So this is a good thing.”

Whalen and her frontline staff were vaccinated. She got the Moderna shot, which has become known as “the one that makes you sick on the second dose.” Whalen says the vaccine is activating your immune system, which may not be fun but is actually a good sign.

“We do find that, you know, usually with the first dose, it's kind of a priming response,” Whalen said. “So people don't necessarily get any kind of side effects from that. But sometimes the second dose, when your body is primed, you start to make antibodies and your body does develop a little bit of an inflammatory response. So sometimes people do have little low-grade fever or may be laid up for a day. But this is short-lived. This is your body making what it needs to fight COVID. And it's controlled. And we have not had anyone hospitalized and certainly, you know, haven't had any of the serious effects from this that we see with COVID.”

As vaccine eligibility expands, Dr. Whalen says sites are ready to move more people through. And she encourages everyone eligible to get the shot. If not out of concern for your own safety – for an elderly family member who might not fare so well with the disease.

And, most importantly: You get a sticker.

“Yep! We do have stickers,” Whalen said. “Our first couple of clinics we had quite a few people saying, ‘where are our stickers,’ and we didn’t have them so we got them! People like to get their stickers when they get vaccinated no matter what age they are!”

A worldwide shortage of about 18 million healthcare workers is projected by the year 2030. The World Health Organization suggests this shortage, a consequence of anticipated demographic changes and economic growth, could be mitigated by gender equality initiatives.

The report says, to meet the growing demand of healthcare workers globally, we will have to remove barriers that prevent women from joining the health workforce -- or that confine women to its lower tiers. Barriers like violence and sexual harassment in the workplace, traditional expectations that women bear the greater burden of family responsibilities, and limited support for maternity and paternity leave.

In the United States, any progress that was being made seems to have been stunted by the COVID-19 pandemic.

According to The Center for American Progress, over the first 10 months of the pandemic, women, particularly women of color, lost about 5.4 million jobs during the recession -- nearly 1 million more job losses than men. This lead experts to dub it as not just a recession, but a “she-cession.” The data indicates that when the going gets tough, pandemic tough, men are protected in their careers while women are expected to return to the home to care for the children.

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Credit https://www.americanprogress.org/issues/women/reports/2021/02/01/495209/women-lose-jobs-essential-actions-gender-equitable-recovery/#fn-495209-18

It boils down to three main areas keeping women out of the workforce: the lack of affordable child care infrastructure, lack of equal wages and strong workplace protections against harassment.

Women in this country, particularly women of color, will continue to work longer hours, for less pay, while expected to also be the rock for their children at home. And if the women we met today are any indicator, they’ll do it with grace, patience, creativity, and a smile.