What Inspires a New Approach? A Reflection on the Origin of the Original Identity Program to Address Health Care Disparities

Lucy image

Model of “Lucy” the first fossil ever found of Australopithecus afarensis discovered in 1974 in Afar Ethiopia by former Cleveland Museum of Natural History curator Dr. Donald Johanson. Photo courtesy of Laura Dempsey and the Cleveland Museum of Natural History.

Editor’s Note: This post is one of two pieces on the Original Identity program. Read the other post here.

By: Laura Clementz, MA, MS

L. Clementz is training administrator, Center of Excellence in Primary Care Education, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.

I note the obvious differences
between each sort and type,
but we are more alike, my friends,
than we are unalike.
Maya Angelou, Human Family

In our recent Academic Medicine publication, my coauthors and I describe a short program, called the Original Identity program, which addresses health care disparities as part of the Louis Stokes Cleveland VA Medical Center’s Center of Excellence in Primary Care Education  – Transforming Outpatient Care (CoEPCE-TOPC), one of seven VA CoEPCEs around the nation. We developed this program in collaboration with the Cleveland Museum of Natural History (CMNH). In contrast to some of the traditional approaches to health care disparities, our program starts with humans’ shared biological heritage to focus on how we are similar rather than different.

Reflection on the program’s origin
As part of my role as training administrator within the CoEPCE-TOPC, I worked with faculty to develop learning sessions within the culture and health curriculum. Over the years, I became very aware of the challenges of addressing culture in medicine and the possibility of adding to or reinforcing the stereotypes, assumptions, and negative biases of health care providers by covering a multitude of individual cultures during learning sessions. Within the same curriculum, I also worked with museums to deliver sessions that covered teamwork and patient-centered care to our learners; we are fortunate to be located in an area where multiple museums are within walking distance of our medical facility.

After presenting with museum faculty at a conference that focused on creativity in medicine, I had a thought that it would be an excellent opportunity to work with our closest neighbor, the CMNH. In thinking about what kind of activity or session would be successful in that setting, I immediately thought of “Lucy,” the model of Australopithecus afarensis located in the Human Origins Exhibit at the museum. With my background in philosophy, I continued to approach the idea from a conceptual point of view. I thought about the challenges a clinician might face if Lucy was their patient. Upon looking at the model can anyone really identify the age, race, or sex of this early human ancestor? How would they communicate with her? Would they be able to examine her? What assumptions would they make? And unlike a dated description of a culture from a different location, Lucy would be in the room with the learners and common to everyone.

Only the beginning
Of course, this was only the very beginning. At that time, I had no idea about the complexity and depth of the conversation that was about to ensue. As such, it was to my pleasure to be able to continue by working with and learning from the outstanding faculty from the CMNH and our team, who had the expertise to further unpack this initial concept by covering topics such as how humans evolved yet have a genetic makeup that is 99% similar1,2 and the biocultural construction of race and its implications for diagnosis and health outcomes, as well as to provide just the right patient scenarios to follow through with components of health care disparities and clinical application. In doing so, I feel we have met the goal of delivering a program that takes the learners on a story “through time.” Framing the program around how humans are similar provides the foundation for a new biocultural anthropologic framework that underscores all that we have in common, which then allows us to focus on the “real” things that make our patients unique individuals.

References

  1. Mersha TB, Abebe T. Self-reported race/ethnicity in the age of genomic research: Its potential impact on understanding health disparities. Hum Genomics. 2015:9:1.
  2. Rotimi CN. Are medical and nonmedical uses of large-scale genomic markers conflating genetics and ‘race’? Nat Genet. 2004;36(11 Suppl):S43–S47.

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  1. Further Reflection on the Original Identity Program: (Un)usual Collaborations | AM Rounds
    April 24, 2017 at 7:00 AM

    […] Editor’s Note: This post is one of two pieces on the Original Identity program. Read the other post here. […]