Project Reports

With the support of the Inamori International Center for Ethics and Excellence, I completed my
international studies practice in Sydney, NSW, Australia. Accompanied by the medication
breakthroughs of direct activating antivirals for infectious diseases, the use of kidneys from
donors with past or active hepatitis C has gained increased interest as an avenue to address
the disparity between organ availability and transplantation demand. As an aspiring physician
with interests in public health as well as experience working in transplant patients and families
and those requiring renal replacement therapies due to end-stage kidney disease, I set out to
help quantify the risk of donor derived infections. In particular, I worked with clinicians,
epidemiologists, and statisticians at the Collaborative Centre for Organ Donation Evidence
(CODE) at the Sydney School of Public Health (SSPH) of the University of Sydney on a
systematic review and meta-analysis to elucidate the benefits and risk of transplanting kidneys
from patients with previous hepatitis C infection.

As soon as the academic year concluded, I departed for Sydney. I began by learning the
background clinical knowledge and research methodologies necessary for the project. For
example, I reviewed the clinical guidelines for transplants in Australia and New Zealand from
The Transplantation Society of Australia and New Zealand and familiarized myself with the
window and eclipse periods for various hepatitis C testing protocols. Along with my mentors and
colleagues, we completed the systematic review by conducting full-text reviews of the relevant
literature and chased down any additional publications that may be related.

The following week, I began extracting data from the identified papers, such as the number of
susceptible recipients. One challenge in particular was the varied reporting across studies, likely
due to the different geographical origins as well as a broad range of timepoints which led to
various virological tests. At times, it seemed that I was solving logic puzzles which required in
depth critical analysis as well as mathematical reasoning. I also had the opportunity to meet with
Dean Miranda, dean of SSPH, who shared invaluable insights into combining a career in clinical
medicine as a physician, how clinical experience informs public health research, as well as the
diverse work currently underway in Sydney. In addition to working with and learning from
Professor Webster and Dr. Waller, I met with Professor Snelling to learn about his work using
Bayesian Inference in clinical trial design and Professor Phongsavan and her team’s work in
bridging science and policy at the Prevention Research Collaboration. I completed a risk-of-bias
assessment on the included studies and commenced data-cleaning and the preliminary steps
for meta-analysis.

Working with a biostatistician, we overcame challenges to analyze the data using both R and
Stata. Although the studies originated from myriad countries, our preliminary results were
supportive of the current guidelines. Not only are we hopeful that our work informs the presently
available clinician decision tool based on donor and recipient characteristics, I am currently
working on a manuscript for dissemination. Furthermore, the opportunity to observe in the hospital helped to contextualize and compare Australian and American healthcare systems. The close partnership between academicians and policymakers at government entities highlighted the impact that groundbreaking research has on shaping policies that impact the lives of millions. Additionally, I met numerous research fellows, senior researchers, medical students, etc at various stages of their career while learning about their projects, including mental health and mental illness in transplants.

Without the unwavering support of the Inamori Center, this opportunity would not have been
possible. I look forward to applying the knowledge I have gained in my journey to enhance
equity in organ transplantation, broaden perspectives in global health, health prevention, and
health policy, as well as share my insights with fellow members of the Global Ethical Leaders
Society (GELS).

This summer, I had the opportunity to work remotely as a Complaint Investigative Specialist with the ACLU of Missouri. The experience has deepened my understanding of civil liberties issues within my home state. My responsibility was to oversee the complaint intake channel for the ACLU branch, receiving and assessing complaints from individuals claiming their civil liberties had been violated. Reviewing every complaint was important because I had to make informed decisions on whether to escalate the matter within the ACLU for further investigation or refer the complainant to relevant local legal and social resources. In this regard, this role called for gathering information, documents, and other evidence necessary in supporting the investigations of these various complaints.

The most significant challenge I faced in doing this was distinguishing between cases that posed a serious threat to civil liberties—which the ACLU could provide meaningful assistance—and those which would go to other organizations, where their expertise might be more relevant. I frequently reached out to my Team Lead during the first few weeks for guidance on this important distinction. The ACLU focuses on impact litigation, highlighting areas that involve significant civil liberties or civil rights issues or that present constitutional test cases with larger implications and the potential to affect large numbers of people. Additionally, their organization can only take a fraction of these cases to provide the services that they require. This meant that many of the complainants, who were often seeking general legal aid, fell outside the scope of the ACLU's primary mission. My job not only required me to gather all relevant information but also to refer these individuals to other organizations better equipped to meet the specific needs of each person. I chose to apply for the position to understand the issues in the area of civil liberties happening in Missouri, specifically in my hometown of St. Louis. I was also interested in how the ACLU kept track of the enormous volume of cases they receive every day and other social/legal resources that a person could turn to for help. This experience gave me insight into the civil liberties landscape of my state and the larger legal ecosystem that aids people with such challenges.

During the internship, I was informed that certain areas, such as voting rights, the school-to-prison pipeline, reproductive rights, trans justice, and public schools, were key focal points for the ACLU's work. These themes were very prevalent among the complaints I received. I came across many files that narrated alleged violations of rights in these areas. In doing so, I became aware of the deep-seated distrust that many people hold towards institutions that we all hope to protect us. Many of the complainants were incarcerated individuals who reported issues such as medical neglect and law enforcement misconduct. Additionally, there were students and faculty alike who submitted complaints of systemic problems within public schools and universities.

It is a role that enabled me to go into the detail of such allegations and hence allow me to review materials that opened up many layers of injustice these individuals faced. I was particularly struck by the evidence I came across, like body cam/surveillance footage of said violations and documents from earlier lawsuits, that brought into sharp focus what these cases were really about as well as their severity. It became clear that handling this material required not only care and sensitivity, but also a deep awareness of the positions and perspectives of all parties involved. The gravity of these situations and the responsibility of handling them with the necessary diligence were aspects of the role that I took seriously. I am deeply grateful to the Inamori Center, whose funding made this experience possible. Their help allowed me to make contributions toward the ACLU's mission and earn valuable experience regarding a difficult landscape of civil liberties defense. This experience has not only deepened my understanding of the challenges faced by individuals in my community but has also strengthened my commitment to advocating for justice and equity in all aspects of my future work.

This summer, I had the privilege of being the 2023 Third Federal Summer Ethics Fellow through Case Western Reserve University’s Inamori International Center for Ethics and Excellence. I worked with MetroHealth’s Center for Biomedical Ethics and was mentored by CBME Clinical Ethicists Marcie Lambrix and Anna Goff. Both were excellent mentors and I feel very thankful to have learned so much from them about clinical ethics and their important role in patient care and community health at MetroHealth.

This fellowship allowed me to conduct my own independent research projects on Advance Care Planning (ACP) for the LGBTQ+ community of Northeast Ohio, as well as research on Crisis Standards of Care plans nationwide and the extent to which burn patients are included within CSC exclusion criteria. I created literature reviews and summarized my methodology for both projects.
I was also part of the planning and facilitation of community-focused events held by MetroHealth and CWRU’s Inamori Center to combat disparities in ACP status for LGBTQ+individuals. These events provided me the invaluable opportunity to meet and speak with fellow LGBTQ+ Ohioans and learn more about their experiences with healthcare. They also included presentations on the importance of ACP for the queer community of Ohio and ACP documents, including health care power of attorney documentation and living wills, which attendees could complete onsite with the presence of a notary public. This taught me a lot about community-focused health literacy efforts and health promotion through educational materials. The most important lesson I learned was the importance of connecting with communities by meeting them where they are and providing education and assistance related to health in a way
that is understandable and respectful of community values and priorities.

My participation in facilitating these events, along with my research on Advance Care Planning for the LGBTQ+ community of Northeast Ohio has led to a forthcoming publication which will be included in the Bioethics Network of Ohio’s BIO Quarterly, which considers the events held by MetroHealth and the Inamori Center and the growing role of clinical ethicists in promoting ACP to communities who have been historically disadvantaged by the healthcare system. Further, my research on Crisis Standards of Care plans and the extent to which burn patients are included within CSC exclusion criteria will be used to supplement MetroHealth’s
updated poster presentation, titled “When All Hell Breaks Loose: The Need for Specialized Burn Provider Expertise During Crisis,” at this year’s American Burn Association annual meeting. I am thrilled that my research work was useful toward this important presentation.
Throughout this summer fellowship, I was fortunate to be able to gain hands-on experience in the hospital setting by observing MetroHealth’s 24-hour clinical ethics consultation service, which includes rounds in ICU units and a variety of educational initiatives throughout the MetroHealth System. During rounds, it was inspiring to see the important work that Marcie and Anna, along with the team of clinical ethicists, do everyday for patients. The educational initiatives which we presented often included presentations on ethics in the hospital setting for groups of staff, unit- and department-specific ethics discussions, and Bioethics@Noon Grand Rounds, the monthly seminar by the CBME for the entire staff at MetroHealth.

This previous summer and continuing into this fall semester, I started research into what will become my eventual capstone project. The project is a Community Pilot Study of a Wrist Worn Hydration Sensor, which I was very excited to start and can help address a dire need for older populations and other vulnerable populations in the city. Dehydration, as its own diagnosis, has led to a myriad of hospitalizations that put large costs onto the hospital systems. In light of the increased heat exposure in summers as a result of climate change, the need for monitoring is prevalent.

Throughout the summer, my responsibilities were to submit and modify the IRB application. I created the IRB protocol, consent form, and made each modification throughout the summer. During which, I learned a lot about the research process, ethics, and the changing process in order to ensure the rights of human participants are upheld. For my project, as of now, I recruited four participants in the community as the IRB approval was granted on the 28th of July and DRINK device modifications have continued to occur. So far, we have very limited findings; however, participants have commented to affirm the ease of the device and low concern of dehydration. Associations of the cognitive exam and other broader aims of the project have yet to be interrogated.

Therefore, my summer consisted of collecting literature for the rising heat during the previous summers, the use of bioimpedance spectroscopy sensors, vulnerability to dehydration, and other related diseases associated with fluid volume management. Additionally, my commute to MetroHealth from the Case Western campus was 1 hour and 20 minutes long on the bus, so I was able to discuss my study with community members. Also, I experienced the hot commutes alongside days of poor air quality within Cleveland and witness many people needing to push through despite the environmental difficulties.

This experience has made me gain a larger understanding of the Institutional Review Board process. Its background, changes made throughout the process, and the different facets that researchers need to understand in order to ensure that human subjects are knowledgeable when giving consent to be a part of any project. With this study and throughout the summer, I worked with Physical Medicine and Rehabilitation at MetroHealth, medical professionals within the Emergency Department, and engineers from the TritonX company. In meetings, each of their perspectives were seen in discussions for DRINK band modifications to protect users and broaden accessibility for health care personnel. The project so far has been very interdisciplinary and I am lucky to be a part of it. I have now seen what is required to thoroughly request feedback as part of a project is using a STTR grant. Included in the grant requirement was the need to conduct 100 interviews with various health care workers with experience in fluid volume management for patients. I had helped with recruitment for the interviews. Even after its difficulty, the team remarked on gaining valuable information gearing towards future use of the DRINK band for patients and different modifications to be made for the device itself and the associated smartphone app. In aiding other ongoing MetroHealth projects using the DRINK device, I helped create a user guide for the DRINK device as a separate phase includes in-home monitoring of a larger cohort of participants.

My personal project had been delayed this summer due to the IRB approval process and device modification. From my initial proposal in March, I added the cognitive impairment testing at the suggestion of my mentor and broadened the respondent pool to various locations around Cleveland rather than restricting to transit locations. This was due to increasing feasibility of the project and existing information that dehydration has an impact on cognitive function.

The summer research project was a great experience and opportunity for me. It had fallen short and exceeded my expectations in various aspects. I feel that the longer approval process had diminished the opportunity to gain feedback from the community as I had set out to do in March. However, I gained a lot of insight from the health care workers and discussion made by the research team associated with this DRINK device that feels invaluable. I am surprised about how much I feel I learned from the past few months regarding the steps to complete a project and ensure that human rights are protected. I would recommend a summer research experience and advise future undergraduate students to not be afraid of letting go of previous expectations – to learn in every stage of the process and soak up what you can.

Empowering Burmese American Youth through Self-Advocacy in King County, Washington

Aggregate data concerning Asian populations in the United States frequently fails to capture the diverse experiences of various ethnic subgroups. For example, Asians subgroups are particularly economically divided, with Southeast Asian communities like the Burmese having starkly low income compared to other subgroups. The Burmese American population in the US faces several interrelated challenges, including disproportionately high poverty rates and high school dropout rates. As a Burmese American myself, I wanted to leverage my skills and experiences to address some of these concerns within my local community in King County, Washington. This summer, with the support of many, I was able to develop and implement a program that would uniquely complement and support the existing efforts of local organizations to address these issues.

My goal was to empower Burmese American youth by teaching self-advocacy and nurturing sustainable leadership within the community. Through our program, we aimed to equip Burmese American youth with the skills and confidence required to advocate for their needs.

To lay the groundwork for the program, we undertook several outreach efforts. To better understand the needs of the local Burmese community, I attended cultural events and engaged in conversations with individuals in other community spaces. I also connected with existing networks and organizations to understand their ongoing efforts to support our community. By learning about existing initiatives, I sought to identify areas where our program could make a meaningful contribution. Furthermore, I actively engaged with community leaders, including organizers of cultural events, monks, and leaders of Burmese-specific organizations. Their endorsement and support of our work lent credibility to our project. Overall, this hands-on approach helped me further develop personal connections with community members, which was essential to establishing a program that could effectively support these individuals.

Based on the insights gained from community engagement, I designed a curriculum that would  teach public speaking skills and foster self-confidence among Burmese American youth. I created two distinct programs, one tailored to elementary school students and another for middle school students. For the elementary school students, we focused on building confidence and presentation skills by having students make an art project and present stories about what they made each session. For the middle school students, we focused on how to structure arguments and how to find and use evidence to support their claims, in addition to presentation skills. Besides the activities we did each session, one of their main projects was to research, write, and present a 3-5 minute persuasive speech on a topic they were passionate about.

The impact of our efforts has been incredibly heartening, with several positive outcomes. I was particularly proud of our students who grew from being apprehensive about introducing themselves in front of the class at the first class, to confidently delivering 3-5 minute persuasive speeches to the class and their parents at the end of the program. My students were not only able to apply the skills they learned in the preparation and delivery of their own speeches, but also began to give each other constructive feedback on how to better convey their points. In this way, our program was successful in building a foundation for students to further develop their public speaking and advocacy skills. I am also proud of the positive learning environment we were able to create. Students who were originally unenthusiastic about public speaking later confided to me that our classes were the highlight of their weeks. I am incredibly grateful for the personal connections I was able to form with my students as I supported their learning efforts.

Our project's success would not have been possible without the generous support of the Inamori Center, which provided vital funding that enabled us to carry out our mission effectively. The funding from the Inamori Center allowed us to acquire essential supplies such as a projector for presenting class content, notebooks, writing utensils for students, and art supplies for the elementary student curriculum. These resources proved invaluable in delivering high-quality instruction, free of charge. We also used the funding to provide food and snacks during each practice session. This not only created a welcoming environment for the kids but also served as a fun incentive for them to actively participate in each class.

I would also like to extend my gratitude to several individuals who played crucial roles in the success of this project. Miranda Li, Richard Li, and Edmunda Li worked alongside me as co-instructors. Our substantial instructing team allowed us to provide personalized instruction tailored to each student's unique starting point, fostering better learning outcomes. Additionally, Hazel Huang played a pivotal role as an translator who helped bridge language barriers in outreach efforts. Her support enabled effective communication with community members who primarily spoke Burmese, ensuring that our program was inclusive and accessible.

Our program, with the goal of empowering Burmese American youth through self-advocacy and leadership development, has yielded promising results. Through community engagement, a well-structured curriculum, and the support of dedicated team members and the Inamori Center, we have made significant strides in equipping our youth with the skills and confidence needed to thrive in their community. 

As we move forward, we remain committed to the ongoing development and expansion of our program as per the positive feedback we received. Self-advocacy extends beyond composing and delivering persuasive speeches. Spontaneous speaking, debate, and delivering emotionally powerful orations are examples of additional areas of focus that we would like to teach. Through these activities, we aim to teach skills essential to daily life; for example, communicating health needs to doctors, speaking with teachers, serving as peer and community leaders. We have gotten many requests to continue the program, and we hope to do so while expanding our efforts to cover other topics like physical and mental health. We are grateful for the support and partnerships that have enabled us to make a meaningful difference in the lives of our community members, and we look forward to building upon these achievements in the future, to foster positive mentorship and growth.

As a part of the medical brigade to Honduras to Global Brigades, my purpose was to help provide increased access for a rural community in Honduras. Specifically, we went to Chandala, Francisco Morazan, Honduras. Global Brigades Honduras formed a relationship with the community in the past through projects such as Proyecto Agua, which was a water project three years ago that provided greater access to clean water. Global Brigades Honduras requested permission to set up an elementary school within the community. Once approved, we set up stations for a three day clinic. The stations included: vision, to provide reading glasses, pharmacy, to provide access to medicine and other rapid tests, consultation with a primary care physician, dental, to provide tooth extractions and cleaning, and charla, a short education presentation from the students about chronic illnesses and mental health.

From my interaction with patients and community members, I learned about the importance of a consistent effort to provide support and collaboration with those being serviced. The community members had high praise for the water project a few years prior. A woman, who had allowed volunteers to use her home to sit and eat our packed lunches, explained how impactful it was to see forty men working for their expressed need and refusing to rest until it was completed for them. Similarly, another patient during consultation and while discussing her symptoms expressed her appreciation for continuing to return and the donations/investments that are given. Global Brigades in Honduras has continued since 2004 and, from my experiences, has gained a good reputation and understanding within the communities it aids as well as its staff. The physicians and healthcare professionals were Hondurans who had been working for Global Brigades for many years. Some of whom had worked for Global Brigades for their social service during their education and the mission and impact of Global Brigades has resonated with them. Importantly, the healthcare professionals return monthly to regularly check in, making the brigade not simply an isolated short term project, but a repeated effort and relationship built with community members. The trust and consent from patients and community leaders, furthermore, showed to be vital regardless of intention. For this trip, Global Brigades had originally planned to go to a different location and community, but as GB uses a school as a base for the clinic, that specific location had declined and they needed to find somewhere that had provided approval. This trust is needed in any relationship and that seems to be what Global Brigades is aiming for.

Due to the COVID pandemic, interaction with community members was limited, especially as I was in full PPE (gown, double masking with KN95, hair cap, and face shield). Unlike in previous years, where volunteers were encouraged to play with the children and talk with others, we had more limited interactions, but nonetheless were very informative and impactful. During charla, our group from Case Western Reserve University collaborated with Mizzou to present on various chronic illnesses and mental health. We practiced and presented in Spanish to many groups of 4-7 people. In our presentation, we talked about eliminating stigmas of mental health and talked about some tips to improve. We were also able to lead some yoga poses for them and it was exciting to see everyone who we presented to so involved in our discussion that we had prepared. Furthermore, we donated hygiene products in about 350 counts of packs consisting of toothbrushes, toothpaste, condoms, hand sanitizer, soap, and floss.

During the brigade, the physicians we shadowed were open and gave information about the healthcare system in Honduras as well as their individual journeys in their education. Their public medical education rates were very cheap and one of the physicians was studying for specialization in internal medicine abroad. During consult, the physicians gave clear instructions to the patients and later translated their interactions thoroughly in English. They gave an ample amount of time to each patient who walked through the doors. I was able to witness procedures such as a cortisone shot in a child who had stepped on a nail and pap smears. Also, a physician had helped out a woman with a pregnancy test and we were awaiting the results with her. She wanted it to be negative and we celebrated with her as she saw a single line on the kit. The physician had instructed her about the importance of other contraceptive methods and we were able to see and hear other bits of information, advice, reassurance, and support to the patients throughout the day from all the staff on the site.

It was a very beneficial experience to witness the disparities within another country and go to a community that had been physically far from needed health resources. The interaction with the physicians and community members was eye opening for me. The trust that Global Brigades had developed with people and recognizing their needs was amazing to be a part of.

Singapore’s current era of independence emerges from its history as a city within Malayan sultanates, European colonial empires, occupied Japanese territory during WWII, and most recently as a part of Malaysia. The city-state’s quest for building and maintaining a ‘global city’ in the wake of this history brings with it interesting questions surrounding post-war and post-colonial development in Southeast Asia, and what role, if any, the international community should play in that process.

With the assistance of the Inamori Center, Department of International Studies, and CWRU faculty, I spent three weeks conducting fieldwork on Singapore’s urban geography to investigate some of these questions. As a city-state primarily governed by a single political party since its independence in 1965, planned government projects largely define Singapore’s post-independence development. These urban projects include a widespread bus and Mass Rapid Transit (MRT) rail network, Housing Development Board (HDB) flats that house the majority of Singapore’s citizens, and a host of leisure spaces integrated throughout the city. I spent my time visiting and documenting these aspects of Singapore – particularly the city’s HDB flats and accompanying hawker centres.

As a part of Singapore’s Total Defence policy, development and security are closely intertwined, so that “strong bonds with different races and religions” and “the pride of being Singaporean” (read: a cohesive national identity) become a part of national security. As a highly multicultural society, this thrusts HDB flats and highly networked public transit into the middle of Singapore’s security strategy, as these two public projects work on providing access to and integrating the island’s large Chinese, Malaysian, and Indian communities. The positioning of HDBs and hawker centres reveals this concerted attempt at access and integration, as images from my fieldwork demonstrate.

Ultimately, my process of experiencing and documenting urban spaces in Singapore suggests that the government utilizes urban planning to facilitate its goal of promoting a unified national identity for its multicultural populace. But with one question answered, many others arise. With urban development so inextricably tied with the concept of Total Defence, to what extent do Singaporeans undergo securitization by the state? Does the sense of an omnipresent government, meticulously involved in the urban layout of their city, weigh on Singaporeans and their decision making? Do the shadows of colonization and war-time occupation drive Singapore’s government to follow this culture of Total Defence? If so, would the international community best support development in Southeast Asia by minimizing the threats of future conflict and occupation? Within these threats of conflict, is a greater
obligation put upon regional actors and ASEAN members to promote this stability?

Clearly, many questions persist when analyzing Singapore through the lens of urban geography. However, one conclusion is apparent. In the wake of decolonization and war-time occupation, Singapore's urban development should not be idealized, as its economic moniker as an "Asian Tiger" often implies. Issues and tradeoffs persist with the pursuit of 'Total Defence,' which the international community should keep in mind as it dictates funding schemes and development norms in Southeast Asia.

This summer, due to the generous contributions of the Inamori International Center for Ethics and Excellence, I had the exciting opportunity to travel to Managua, Nicaragua, to complete my Master of Public Health practicum.  I spent three weeks working with an organization, called AMOS Health and Hope.  Their primary objective is to expand primary care access to the rural communities of Nicaragua.  As a Practicum intern, I was able to learn about the inner workings of an international nonprofit organization and become familiar with their healthcare model.

I was very excited to learn from AMOS, as Nicaragua is a country with universal healthcare.  This means that all people have access to the health services they need, when and where they need them, without financial hardship.  Inaccessibility to healthcare is a policy issue as well as a moral issue.  In the rural communities in Nicaragua, many people live hours-long car drives away from the nearest health clinic.  Oftentimes, a hospital is even further, and most people in these communities do not have a personal vehicle.  AMOS works to alleviate issues of healthcare resource allocation and remove barriers to healthcare access by bringing healthcare TO these communities.  In addition, they train members of the community to become “health promoters,” or promotores, that act as the point of care for their community.  My task with AMOS was to update the training manual for the next generation of health promoters.

The first week that I was in Nicaragua, I spent a lot of time learning about the healthcare model of the AMOS organization.  I met with the Director of Health Programs, Emile Olivieri, and the Director of Rural Communities, Lester Lorente, to talk about the structure of this new training manual.  We decided it would contain vital information about the organization, as well as basic primary care skills.  These skills include knowledge of human anatomy and physiology, vital signs, and how to perform physical exams.  In addition, there was extensive training about common diseases and infections, as well as training about when to refer members of their community to a doctor.

During my second week in Nicaragua, I had the opportunity to visit one of the rural communities in the mountains, called San Jose de las Mulas.  We traveled about six hours by car from Managua, where AMOS headquarters is located, and about ¾ of the trip was dirt road, up impossibly steep hills and mountain sides, and across rivers.  The people of the community were incredibly nice, cooking us food for us every day and brewing fresh coffee.  I got to work with two new health promoters-in-training, observing their training process and taking notes about what I could add in the manual I was writing.  On the second day, we made a visit to a house to check up on a mother and her newborn baby.  In order to get to this house, we had to trek about forty minutes on foot trails, up the sides of the mountain, across rivers, under barbed wire fences, and through fields of roaming cows.  It was truly one of the most difficult experiences I have ever had.  I had no idea just how difficult it was to get to each house, and the health promoter of each community does this exact process for every household.  I was absolutely mind blown.  I would never have been able to fully understand the work of AMOS and the importance of a health promoter without actually seeing it for myself.  This trip to the rural community completely changed my viewpoint about what it actually means to be able to access health care, and just how important it is.

My final week in Nicaragua consisted of writing my training manual, which turned out to be 98 pages in total, completely in Spanish.  I cannot imagine a better experience for my MPH Practicum, and I am so grateful to the Inamori Center for supporting me, allowing me to fly to and stay in Nicaragua for three weeks to truly understand the types of barriers those in developing countries face every day.  I hope to continue to help make primary care accessible to all.  AMOS Health and Hope performs lifesaving work, and I am so thankful that I was able to learn from them.  This could not have been possible without the generous support of the Inamori Center, and I will forever be grateful.

JD Harrison

During my time working alongside Councilwoman Howse and her Executive Assistant, Rajzia Whitley, I learned a lot about the workings of city government; the role of the city council in passing new legislation, what departments are to be contacted for help with particular resident complaints, how residents can influence the ordinances being passed, what programs the city funds for residents, and how power is balanced between the courts, city council, and the mayor. This was a particularly informative and useful part of the fellowship for me as a Cleveland native, because I was able to gain and share knowledge about how to get involved with and get help from city government that I never knew about before, despite spending my entire life here. 

While the internship took place primarily at Councilwoman Howse’s City Hall office, some of the most memorable and impactful pieces of the internship came from when I was fortunate enough to have time out in the community. I learned from older residents how the neighborhood has changed, how city government served the area differently throughout time, and what they believed they were lacking from their community and those who serve it. In the process, I was able to learn about the rich history of Cleveland through the eyes of those who had spent generations here and form bonds with people who I would normally not have the opportunity to speak with. While helping conduct surveys, facilitate meetings, and distribute materials on community resources, I fell in love with people in the community in a way I never suspected I would. Prior to this experience, I was not entirely sure what I would do with a degree in Philosophy, but thanks to the Third Federal Ethics Fellowship, I can now say that a fulfilling career path will be oriented toward serving and organizing disadvantaged communities.

Learning about some of the ways the community and community leadership has changed from the residents also exposed some of the failures and shortcomings of city government. An insufficient amount of staffing in the Councilwoman’s (and many others) office meant that sometimes urgent concerns of residents went unanswered for weeks or months at a time, and even when concerns were finally gotten to, the arbitrary distinctions between the roles of each sub department in city hall made for a very sisyphean task when attempting to get answers or solutions for the residents. There were programs for the elderly or disabled that included things like grass cutting, certain housing repairs, and tree cutting that had such a long wait between application submission and approval that some residents complained of having been waiting for nearly a year, and that their property had fallen into worse condition because of it. Additionally, I saw how many lower income residents were skeptical of new building projects and how well they were able to ask developers the right questions during community meetings to ensure that they would not be pushed out, despite having never worked in city government or development, simply because they had a lifetime of experience of displacement in the name of development. These are some of the reasons why the fellowship steered me more toward community organizing and direct service instead of a career in city government or city planning. 

Oftentimes developers have to sacrifice the wishes of the residents in order to make the development profitable, and the limitations of the city government﹣due either to design or individual inadequacies﹣makes it too inefficient to meet the immediate needs of the community it serves. However, I have seen beautiful displays of community between those in Hough who have lived there long enough to get to know the people in their neighborhood. Community centers being run by community members where people can get food, vaccines, and access to other programs for free; a neighborhood mom who was unemployed who was paid by her community members to watch their children and grandchildren while they were at work; younger residents who would cut grass or do minor repairs for elderly residents when the city wouldn’t help them. I think the community knows what it needs better than representatives who have to compromise between resident wishes and funding, and I would love to help community members build stronger relationships with each other so that, where the government fails, the community can still help and sustain itself.

The purpose of my fellowship was to help the Cuyahoga Office of Early Childhood and Invest in Children organize the racial justice components of proposals from Pre-Kindergarten programs. Contrary to the preschool systems that I grew up in, these programs put in a conscious effort to ensure that they are racially equitable. Among the schools, I identified four major themes - training, hiring, programming, and a task force. Many programs ensured that their staff is trained to understand racial differences. They also gave the staff an opportunity to reflect on how they can do better when it comes to recognizing individual differences. Hiring means programs had their staff reflect the community served by advertising open jobs within the community and online. In terms of programming, many programs led community discussions and hosted community events to form a stronger bond with community members. The task force made sure the goals of racial equality were turned into action. Racial justice was also addressed in the school’s curriculum. Schools utilized diverse materials so kids saw themselves represented in class material engendering pride in one’s own culture. Teachers could adapt the curriculum to the uniqueness of each class. To my surprise, the preschools and proposals addressed issues of lead poisoning. It was gratifying to see programs addressing a problem that has plagued the health of those living in Cleveland.  Ultimately, it was wonderful and astonishing how much positive change preschools had made in the short time since I was last there, especially in the disenfranchised county of Cuyahoga. This fellowship allowed me to work hand and hand with the people fighting for racial equality instead of solely learning of the racial injustices today. The fellowship provided me with improved communication and time management skills that I am forever thankful for. 

Megan Wong

My name is Megan Wong, and I am a graduate student in the Master of Science program of medical physiology at Case Western Reserve University. The purpose of my research,
community outreach, and future goals was to help make healthcare more equitable, reachable, and culturally sensitive. In the past, I had studied the impact and implementation of health literacy programs in racial and immigrant minority populations, and carried out laboratory research in pancreatic cancer, vaccine development, and genetic therapies for neurodegenerative diseases (all huge issues in developing countries and communities of low socioeconomic status across the nation). This summer’s socially conscious research in medicine presented opportunities to build bridges between science and community by giving the power back to communities through the means of health education and improved quality clinical care, treatments, and procedures bespoke to the prevalent issues that are personal to each underserved and underprivileged demographic. My work as a researcher, advocate, and future physician contributed to the efforts in being an ethical leader, providing tools to both help give a voice to the lesser heard, and providing quantitative and qualitative tools to improve the success of health care implementation and patient service.

My current research project team was a collaboration of research fellow volunteers and practicing physicians in Cleveland’s University Hospital system. We focused on the intersection of multiple issues that include analyzing health disparities through the lenses of risk scores for mortality, readmission rates for various demographics, transplantation allocation, and creating care paths for both cardiac and general surgery. Black men, immigrants, and low-income individuals across all age groups were more likely to observe higher rates co-morbidities, post-operative complications, and mortality rates during cardiac and general surgery compared to their white, affluent counterparts. Because patients from racial and ethnic minorities experience higher mortality after cardiac surgery during early postoperative and long term phases, we wanted to explore the determining factors that would cause such outcomes, such as biological differences, comorbid health conditions, socioeconomic background, and quality of hospital care.

As of this year, we have established the foundations of clinical research projects in the fields of cardiac surgery and bariatric surgery by creating database collection software, R studio computer science programs, and patient data pools to analyze healthcare variables more efficiently. We gained training in statistics programs for patient data analysis, pour time and effort into interviewing patients and collecting medical information, perform extensive and well-rounded background research on our subjects at hand, and worked on developing programs that would work well with the local community to uplift and empower patients to have better surgical results and take charge of their health. We are continuing to work on retrospective studies throughout the summer of 2022 as we move onto case studies and pilots that implement novel programs for patient care.

Thus far, we have found that a major determinant of high mortality in black and ethnic minorities undergoing cardiac surgery is their over-representation in low-quality hospitals (from the different hospital care systems that we have gathered data statistics from). To ensure that clinical outcomes are not dependent on skin color, all patients must be ensured the same access to high-quality care with healthcare that is consistent and standardized across all hospitals. For society, eliminating causative factors of poverty, improving health literacy, improving employment (and therefore healthcare insurance) opportunities, and therefore broadly uplifting disadvantaged social minorities needs to be at the heart of this change. It is also important to create easy and seamless interactions between patients and healthcare workers to remove obstacles towards equitable access. Having locally appropriate and culturally sensitive community level interventions like care navigators and coordinators would also serve as liaisons to increase accessibility for better care across all hospital departments. Lastly, preventative measures such as efforts towards improving early detection before advanced disease stages occur can avoid complications and improve perioperative care with focus on managing comorbidities and risk factors: significantly improving outcomes in minority demographics. Continuing to identify the specific factors and biological statistics in the community and in the individual that affect surgical outcome have and will serve to better the health of a huge group of underprivileged and neglected demographic groups.

These research projects helped my team join the global conversation through the efforts to bridge gaps in healthcare that are causing large differences in treatment and medical care results within racial, immigrant, and socioeconomic minorities compare to those with more cultural and financial wealth. We sought to contribute towards sustainable strategies for health issues plaguing international and national urban and rural populations through optimizing surgical procedures and creating treatments that are personalized and specific to the needs of underserved communities. These projects served to help providers and hospital systems at large learn more about the communities that surround them while allowing them to help their patients with greater and more successful impact. We continue to work on our studies in hopes that they will connect to the wider world in a meaningful and respectful way. Through our research that directly impacts local communities in Cleveland, the CWRU campus community has hopefully benefited from greater scientific impact and opportunities for student involvement in publications and conferences on both an undergraduate and graduate level.

Mai Segawa

To help introduce children to ethics and living with purpose, we wanted to provide 5 sample ethical values in sticker form: Stay Humble, Always Be Kind, Believe in Yourself, Give Thanks Often, and Make Today Great.

The children are able to choose which intention they want to live their life with. Abstract ethical life values such as respect, kindness, integrity, gratitude, and responsibility are incorporated in these kid friendly stickers.

The idea is to teach children that we must lead with these ethical values in all parts of our lives, in each category, not just one. Thanks to the Inamori International Center for Ethics and Excellence, I have been able to create an activity for our patients that serves as an introduction to goal setting and personal values.

Annie Du

As a volunteer at Give Essential, I facilitated email matches between essential workers and donors. Donors purchase essential items and curate individual care packages for essential workers. The essential items that donors can donate fall within the categories of:

• Cleaning supplies (ex: disinfectant wipes/disposable gloves/dish soap)

• Masks (cloth or homemade/face shield/surgical or disposable)

• Personal hygiene products (ex: soap/lotion/shampoo)

• Feminine hygiene products

• Kids’ activities (ex: board games/puzzles/electronics)

• Gift cards (ex: for gas/groceries/restaurants)

I wanted to help alleviate the difficulties families face when they are forced to choose between providing the next meal (as an essential worker) and keeping their family safe. 

Lotus House, Inc. is a women’s shelter located in Miami that shelters over 500 women, youth, and children every night and over 1000 annually. Besides providing a means of housing for these individuals, Lotus House is also committed to advancing the status of women and children by providing multi-faceted comprehensive supportive services, including access to medical and mental health care, parenting education, counseling and parent/child therapy, life skills and educational advancement, job readiness training, and a host of enrichment activities from art and acupuncture to yoga and meditation offering alternative pathways to healing. Their financial transparency, wide expansion of supportive programs, and robust presence in the community solidified our decision to donate essential items to Lotus House.

I wanted to be as mindful as possible towards fulfilling the needs of Lotus House by providing the items they were truly in need of.  I was able to purchase and donate:

• 20 packs of diapers (1020 diapers total) from ABBY&FINN

• 24 boxes of pads/liners (228 pads total) from LOLA, and

• 20 toddler training bundle (toothbrush + toothpaste), 20 fluoride toothpaste (adult), 10 kids’ strawberry toothpaste, 10 toothbrushes from Hello Products

Ethical Consumerism: Ethical consumption is a practice I try to integrate into daily life. During the service project, I strove to be mindful of the types of products I purchased and which retailers or companies I purchased from. I spent a considerable amount of time researching various companies that emphasized a practice of sustainability and advocacy, with a focus on supporting smaller companies.

Grace Zhang

I would like to thank the Inamori Center for Ethics and Excellence for supporting our Phone-A-Friend initiative to support isolated senior citizens in our community. The funding provided by the Inamori Center of Ethics and Excellence supplemented our projects to expand our local chapters and diversity our activities. With this funding, Phone-A-Friend has been able to augment our initial endeavors to provide social relief for the elderly via bi-weekly phone calls, grocery runs, and prescription pick-ups with monthly book clubs, newsletters, and holiday presents.

Grant Activities: In response to state mandates to enforce social distancing, a group of friends and I gathered out of concern for isolated seniors in our community in March 2020. Together, we created the volunteer network, Phone-A-Friend, to provide community-based COVID-19 relief for the elderly. While our origins were humble, in the past ten months, we have been able to expand local chapters and diversify our goals beyond check-in phone calls and grocery runs. Understanding that social isolation and loneliness are associated with premature mortality, our team supplemented our care to include monthly virtual book clubs and weekly newsletters—care that centered on the mental and social wellbeing of the elderly. This past holiday season, we’ve also enhanced our care by providing contactless drop-offs of food kits for Thanksgiving and small presents. Many of our seniors were isolated from their families this past holiday season and Phone-A-Friend wanted the opportunity to bring joy and relief where we could. Caring for our seniors is an increasingly important, albeit overlooked aspect of humanity, and my experiences have prepared me to give hope, empathize with circumstances, and advocate for compassionate care. It’s times like this where I recognize that understanding the pandemic means looking into patients’ eyes just as much as it means looking into microscopes.

Outcomes and Impact: Now nearly a year into the coronavirus pandemic, many of the elderly seniors we converse with weekly have a hard time envisioning a “new normal.” Initially, Phone-A-Friend was established as a relief and empathy system, to assist the vulnerable and socially isolated. Before the disease outbreak, the vast majority of community-dwelling older adults actively participated in social activities. However, due to lockdown policies, many services and programs are no longer available. These restrictions have increased social isolation and the feelings of loneliness of older adults. In the context of COVID-19, social isolation may be especially detrimental to family caregivers being that the majority are older adults themselves and are already at increased risk of stress, anxiety, and depression. Mortality is no longer an abstraction for those who have seen friends and relatives die of COVID-19.

Our initial bi-weekly phone calls to combat social isolation for our community’s elderly quickly expanded to grocery shopping, dog walking, and prescription pick-ups as many of our newfound friends and neighbors revealed fears of catching the virus and plans to follow strict social distancing precautions for the indefinite future. Based on the death certificates of data retrieved and coded by the CDC National Center for Health Statistics, 78% of COVID-19 related deaths in the U.S. occurred among older adults aged 65 and over.  These chilling statistics are only amplified by news broadcasting hospital beds, PPE, and ventilator shortages. Together, these aspects of our society are accumulating into a culture of ageism that makes compassion and empathy for our elderly counterparts even more difficult to exercise. Existing stereotypes, prejudice, and discrimination based on age enhance existing inequalities and prevent effective countermeasures. Further, the assumption that all older people are frail or dependent is not only inaccurate but also harmful. Hearing the stories and the challenges these seniors have faced and overcame is not only encouraging but inspiring. As a society that has appeared to remove the voices of the aging population, the projects at Phone-A-Friend have continued to reveal to me the intergenerational geriatric ethics issues—how there is still work to be done to remove the effects of agist policies and actions.

Future Plans and Sustainability: As the pandemic rages on, it’s clear that while the virus may not discriminate, societal inequalities—the sturdy pillars of prejudice— lead to differing health access and outcomes. I see the marginalization of the elderly when I offer to make grocery runs on their behalf or use Phone-A-Friend to provide relief for isolated seniors. Today, the world waits for mass vaccine distribution. But a vaccine will not remove institutionalized barriers to health care; the ignorance that funded the disease; nor the inequity against the elderly that our country has amplified and reanimated. We have been witnesses to the appalling effects COVID-19 has had with the deaths of elderly people, in nursing homes and hospices, having been considered “acceptable” losses. The right to health care and dignity should never be in question, and in light of the pandemic, we must find the compassion to invest in our communities.

In Cleveland, we are now instilling a local Phone-A-Friend chapter for the Cleveland community, and my continuing service with the Indianapolis Phone-A-Friend has taught me what works and what still needs work. I hope to also use the lessons I learn this winter to foster dialogue with the rest of the GELS members during general body meetings regarding the value of life, geriatric ethics, and bioethical dilemmas. As the Cleveland Phone-A-Friend arises, I hope to ultimately engage GELS members in the Cleveland Phone-A-Friend as a long term service opportunity to GELS members that will continue after the pandemic is over.

We live in an age and diversifying country where societal barriers limit healthcare access that leads to poor outcomes. Addressing these disparities by improving community health and encouraging education is essential to bettering the future of health and equity. Continuing our space for dialogue and platform for action is what I hope to further at Case Western Reserve University. Here, I am eager to work with like-minded and passionate students from around the world to advance the frontier of ethics. Yet, I also want to set the stage to share difficult conversations about our current healthcare system and the vulnerable populations left behind as our country advances. Now, more than ever, our compassion needs to bridge conflicting perceptions, interpretations, and values to bring people together; we cannot enjoy the luxury of opinion without the responsibility of reflection.

Salma Shire

For 25 years, my family — just one family in a vibrant Somali community of 80,000 — has called Columbus home. Both as a student and resident, I've had the privilege to serve this community in the forms of advocacy, research, and clinical service. What I've discovered is the vastly different experiences that individuals from minority and under-resourced backgrounds endure. These preventable differences in health linked to social, economic, and or environmental disadvantages are known as health disparities.

The neighborhoods where I grew up, included families from low-income or financially unstable households, much like my own. This early exposure sparked an interest in health inequity that I had the opportunity to explore as a student scholar for the ASPIRE Medical Research Program at the Ohio State University. During my time in the program, I developed a geographic mapping project that addressed social determinants of health in the zip code regions I lived in. I researched the many factors impacting health in my community, including the high unemployment rate, poverty, infant mortality, the abundance of food deserts, and more. Shaped by my experience identifying health disparities as an undergraduate student, my values compelled me to influence educational inequities that broadly affect the underserved.

As the COVID-19 pandemic has continued to spread around the world, so has the tremendous uncertainty and fear concerning the origins, treatments, and prevention methods regarding COVID-19. With three vaccines available in record time, much of the evidence needed to fully inform the public of positive outcomes were unavailable, making COVID-19 uniquely vulnerable to disinformation, misinformation, and medical mistrust (“Disinformation, Misinformation and Inequality-Driven Mistrust in the Time of COVID-19”). Thus, it was essential to raise awareness about the risks of misinformation around COVID-19 (and the vaccines) and encourage healthy practices that follow CDC guidelines to ensure prevention and safety for all.

One gap that stood out during the pandemic was disruption to education systems — this has disproportionately affected students from disadvantaged backgrounds, further exacerbating pre-existing educational inequalities. To alleviate the burden imposed by COVID-19, I coordinated with Case Western Reserve University Inamori International Center for Ethics and Excellence to donate personal protective equipment, supplies, and clothing to students and faculty at the International Academy of Columbus.

To address the glaring disparity in educational access, I held Health Education Sessions on COVID-19 for middle school students. As a graduate student studying the molecular and cellular basis of diseases, I used my background in the pathophysiology and transmission of the COVID-19 to guide our sessions. Through innovative programming, I was able to deliver a virtual community-oriented curriculum to under-resourced students on COVID-19. Specific topics I covered included the new mRNA vaccines from Pfizer and Moderna Medicine, how the mRNA vaccines work (in basic terms), the safety of the vaccines (briefly cover allergic reactions), and common myths about the vaccine.

Additionally, I recognized how the worldwide pandemic could have long-term consequences on mental health, with youth having limited access to recreational activities and social interactions. To tackle this issue, I had middle school and high school students engage in an interactive learning environment consisting of Kahoot questions, friendly competitions (on COVID-19 transmission, prevention, or vaccine), and gifts marking the end of the semester-long program. Through safe practices and factual information, I hope to create a lasting impact on students by positioning them as changemakers in their lives, families, and communities.

Following the educational sessions, I became aware of the socio-economic gaps that exist in Columbus and the state-wide need for accurate COVID-19 information. I plan to integrate this experience into GELS and the CWRU community in the future, by providing similar COVID-19 vaccine educational sessions for vulnerable communities here in the Cleveland area, whether that be virtually or through phone calls. In doing so, I hope to promote ethical leadership by addressing misinformation/mistrust on the COVID-19 virus (and vaccine) and how it leads to health inequity.

To conclude, this pandemic has taught me the role of medicine extends far beyond ER rooms and hospital beds. Understanding the contexts driving disease distribution and burden requires collaboration between policymakers, scientists, educators, and even students. As I work toward my goal of becoming a physician, I hope to continue to broaden my understanding of community concerns and health inequities among marginalized populations. I would like to thank the Inamori International Center for Ethics and Excellence for providing me with the opportunity and funds to explore ethical challenges through these lenses of health care.