On this episode of Our Body Politic, guest host Karen Grigsby Bates talks with Virginia Kase Solomón, CEO of the League of Women Voters, about the threats and issues poll workers face protecting democracy. Karen then speaks with Melissa Murray, NYU law professor and host of the podcast Strict Scrutiny about some of the cases SCOTUS will hear this term. We round out the show with Karen discussing how to navigate medical bias with artist, author and doctor, Shirlene Obuobi.
Karen Grigsby Bates [00:00:04] Hey, y'all. We are so glad you're listening to Our Body Politic. If you haven't yet, remember to follow this podcast on your podcatcher of choice, like Apple or Spotify or wherever you get your podcasts. And if you have time, please leave us a review. It helps other listeners find us and we read them for your feedback. Here's what one of you had to say. Thank you for creating such an informative podcast. I walk away with more knowledge and feel empowered to take action in both my local government and at the federal level. Please keep going. Thanks so much for that review. We're glad you enjoy the show. You can follow us on Instagram and X, formerly Twitter @OurBodyPolitic, where you can sign up for our newsletter. Just click on the link in the bio. We're here for you with you and because of you, so keep letting us know what's on your mind. Thanks for listening.
This is Our Body Politic. I'm Karen Grigsby Bates, founding member of NPR's Code Switch team sitting in for Farai Chideya. If you've been following the show and we know you have, you already know a lot about how our democracy works. And you know what happens when it breaks down from January 6 to gerrymandering to political polarization. Now we're unpacking crucial issues you might not have considered. We turn first to what happens on Election Day itself. If you've voted in person in the United States, chances are you've interacted with a poll worker. Ahead of the 2022 midterms, the U.S. dealt with a shortage of poll workers, and today we're seeing alarmingly high turnover rates for U.S. election officials. With so many high stakes ballots across the country, not to mention the 2024 election, what's being done to address this looming crisis? Joining me now to unpack these issues is Virginia Kase Solomón, CEO of the League of Women Voters. Thanks for speaking with us, Virginia.
Virginia Kase Solomón [00:02:02] Thanks for inviting me. Excited to be here.
Karen Grigsby Bates [00:02:05] Before we get into all the challenges facing poll workers, talk us through the basics. Who are poll workers and what exactly do they do?
Virginia Kase Solomón [00:02:13] So poll workers are people who either are volunteers or people who are paid very small amounts of money to engage in their civic duty. And that is helping to ensure that the voting process works. So these are people who, when you go in on Election Day, they're welcoming you. They're helping make sure that you're registered, making sure that you're on the list, helping escort you to your polling site, whether that's a booth or however it's done in your state, and just really making sure that the voting process is run smoothly. They’re also folks who, because of mail in ballots and early voting and other things, they’re also people on the other side who are just counting ballots and making sure that everything is received on time. They're counting the ballots. People who are, in some cases curing ballots, which means say you got to the polling location and you realized that you maybe didn't have your ID or something or your polling location had changed. You can get something in many places called a provisional ballot. And they just make sure that you still have the opportunity to vote so that it gives you time to go back and get the information that you need. So they're just basically election assistance.
Karen Grigsby Bates [00:03:23] Yeah and in some cases, that's pretty critical out here in California, in Los Angeles County anyway. We moved a couple of years ago from punching our ballots to totally digital ballots, and it was the poll workers who saved a lot of us by saying, no, no, here's where you start. Here's how it goes. And so I don't know that we would have known anything if they hadn't been able to walk us through that. So we're grateful. Let's start with the issue that's getting the most coverage, though, the rise in threats against poll workers, which we saw quite vividly in the past like 18 months or so. What's happening here and where is it coming from?
Virginia Kase Solomón [00:04:03] So I think we have to just acknowledge that while voting is not partisan and should not be a partisan act, the people who are voting oftentimes are partisan. And so we've seen this rise in polarization across the country. People feeling like the election process is either not fair, some people are saying that it's been rigged. Right? We've heard all of these stories. And so people tend to look at those individuals that they see touching the ballots first and making accusations. We call it the big lie for those of us in the voting rights space, because we know that there have been lies and mis and disinformation that has been perpetuated that many people believe. Right? And so they believe that somebody is doing something wrong with the ballot. They believe that people are doing wrong things when they're working at the polling locations. And so it's a really sad moment because mis and disinformation has really ramped up people's beliefs that the elections aren't being cared for properly. And so it's a sad, sad occurrence. And I think it's something that we have to look at how do we continue to combat this and engage people in, you know, just basic civic education, how election administration works. Most people don't know. Right. So they're able to create this own narrative in their head. And unfortunately, in some cases, they've been listening to the wrong people.
Karen Grigsby Bates [00:05:29] Hmm. I remember back in 2020, I guess, a Georgia poll worker, Ruby Freeman, was targeted by President Trump. And that made national news. And a lot of people assume that Mrs. Freeman and her daughter, who was also targeted by the president, like that this was an anomaly. It next to never happens. And, you know, all this vitriol that was directed at them, that was just sort of a one off. But this past August, a task force at the DOJ charged more than a dozen people across the country with threatening election workers. So that would indicate that the threats are on the upswing.
Virginia Kase Solomón [00:06:08] I think you can safely say that the threats are on the upswing. And again, I think Ruby Freeman… I think what was really sad in that particular situation and why it got so much attention was because those threats, those accusations came from a sitting president with a base that is known to be at times violent. Let's be really honest and say the thing. I think what made it also worse and I think we have to name the fact that these were two Black women and Black women tend to be targeted differently than other populations. And so I'm not also convinced that there's not a deep connection to racial discrimination in that particular case. But I would also just say as a whole that, again, it's the climate, it's the vitriol, it's what we're experiencing as a country and the polarization that exists that allows bad actors to create a narrative that these individuals who are doing the poll work, who are working our elections, that they are somehow doing the wrong thing. And so we have to inoculate against that through really good, obviously, civics education and information, but making sure that we also don't let the bullies win because they have a motivation as well.
Karen Grigsby Bates [00:07:22] Mm hmm. Mm hmm. So that was one obvious challenge that people are still talking about, frankly. Tell me about some of the other challenges in recruiting and retaining poll workers.
Virginia Kase Solomón [00:07:33] Well, I think the one thing that a lot of people don't realize, or maybe they do, but every time you go in to vote, if you vote in person, you'll notice that the majority of those people who are supporting our elections are senior citizens. And so I think one of the things that contributed in 2020 was just COVID. It was a really scary time, especially because we didn't have vaccines at the time. People weren't sure if they were going to be safe. We saw so many people who had died. And so seniors in particular were most vulnerable to COVID. And people with health conditions were those individuals who often were the first to drop out of doing that work. It just wasn't safe for them. So I want to just make sure that we're separating out kind of the COVID piece to the threats and fears that election workers face. But as a result, and we saw the reaction that many had to 2020 trying to decertify the election, the big lie of what happened to Ruby Freeman, for example, that actually really created a chilling effect because people then started to say, it could happen to me as well. And so you had seniors once again who were like, I don't want to deal with that. I don't want to deal with those accusations. And so we saw a huge drop off in older folks for those two reasons. I think it's not just isolated to election workers, but we've seen, you know, plans to kidnap government officials like what we saw with Gretchen Whitmer and others. And so Jocelyn Benson, who is the secretary of state in Michigan, who has faced numerous death threats and other challenges. So I think just as a whole, people who work in the election space have found themselves going from being the people that everybody in many ways appreciated the most because they allowed our elections to run smoothly to positions that are actually much harder to fill. But we do have solutions for it. And I will say that despite the fear, people have stepped up, especially a younger generation, who have really taken on that charge. And that's kind of one of the things that I really am excited for in this. If there's a silver lining, we've seen a much younger demographic step up to do this work.
Karen Grigsby Bates [00:09:42] Yeah, in 2020 I actually went to vote in person and saw that there were a few younger people…and I mean considerably younger, who were being guided by older poll workers and were settling into the job. So that was nice to see because, you know, my question was, well, as people age out of doing this job, whether they're volunteers or whether they're getting paid this little bit of money to do this work, it leaves a vacuum that may or may not be filled. So what happens to our elections if there aren't enough poll workers?
Virginia Kase Solomón [00:10:19] Well, one thing I will say is that it creates greater stress, longer lines, more wait times. Right? So these are all things that, quite honestly, are really challenging, especially when you see there are times when people are standing in line for hours. You're in either very hot conditions, very cold conditions, the rain. Right? So we see this as another voter suppression tactic. Being able to intimidate poll workers means less people to do the work, which means longer lines. And it just creates a chilling effect on voters who say if they're waiting and they have to get to work, I don't have time for this. Right? So it really is a threat to our elections because. Less people vote. And that's at the end of the day, really what it means.
Karen Grigsby Bates [00:11:04] Well, and some states have apparently passed laws that forbid assistance to people waiting in line. So if you're 84 and you're waiting to vote, if I come up to you with a portable seat, a little cab seat and say, Miss would you like to see I'm liable to be arrested or fined because I'm not supposed to do that anymore. I'm not supposed to give water to people on a really hot day, which seems to be another form of voter suppression to me. So…
Virginia Kase Solomón [00:11:35] It is. I would say it is absolutely another form of voter suppression.
Karen Grigsby Bates [00:11:39] Yeah, I'm using my rarely exercised diplomatic muscle when I say it seems to be. So now that we know more about the scope of this crisis, what do we need to change in order to be ready to vote?
Virginia Kase Solomón [00:11:53] So a few things. First, I would say we know what the crisis is, but I would love to talk about the solution first, and that is obviously getting people to sign up as a poll worker. And so the League really focuses on poll worker outreach, getting folks to sign up. There's a site called Power the Polls, and we are a partner with them. And so just to give you some examples, in 2022, we recruited 4057 poll workers just through that site. And then in 2023. Obviously, this is not a midterm or a presidential, but we've already signed up 2147 people. So there's legislation that has been passed to help protect election workers. I think the challenge here is that there's the federal piece, and we know the federal government and especially Congress, has just not been very functional these days. So the passage of federal voting rights legislation could even help improve and build upon this. More importantly, though, every state has different election rules. We don't have election rules that are uniform throughout the country. And so state by state, different states have different rules. They have different protections in place. But as far as blanket protections that everybody has? One of the sad things is that we truly do not have full protections yet for poll workers. There have been minor pieces here and there, more as punishment or a deterrence to people who engage in that. Sure. But really, beyond that, there is nothing that really blankets and protects folks in the way that we think would be appropriate.
Karen Grigsby Bates [00:13:32] Being a poll worker sounds like it can be a pretty thankless job between the long hours, the low pay if you even get paid. I know some people do volunteer and the increased number of threats, a lot of poll workers are receiving either explicit or implicit. So given that, why do you think people still sign up to do this job, this critical job?
Virginia Kase Solomón [00:13:57] I will say I can tell you why I've done it in the past. And it really is for me just being able to feel like I was contributing back in some way to my community. I have a lot of young first time voters. I've had experiences with older voters and there is something as hard as it may be on some days, cause yeah, the hours are long. There is a fulfillment seeing people who have just been naturalized and all of a sudden this is their first election. The joy that you see on people's faces and being able to cast their ballot is like, I can't explain the happiness that it gives you in a way that they feel like this is something that and in many places, especially if you're naturalized, maybe never had access to in a fair way. Right? Or people who… when you're a young person and you're frustrated, what's going on with the political process? We see what's happening all over the country and how young people have become more and more active. And so young people seeing that enthusiasm or seniors who were saying, this could be my last election and I'm going to make this vote count. All of those things, you see all of that when you're working the polls. And it is just a very joyous experience. And so if there's nothing else, it's just we all need a little bit of joy right now with everything that's happening in the world. And that is one thing you can do that will really bring you happiness.
Karen Grigsby Bates [00:15:19] You know, in grade school and I guess in high school civics, they always talk about seeing democracy in action. This really is, isn't it?
Virginia Kase Solomón [00:15:26] It is. It is. And it's you know, it is for many, I feel like you can look at it as a thankless job or you can look at it as the most important job that you can engage in as somebody who is a citizen in this country.
Karen Grigsby Bates [00:15:41] I'm betting you've inspired more than a few of us. If someone wants to become a poll worker, what should they do?
Virginia Kase Solomón [00:15:47] Okay, you can still go to Power The Polls. That's the first thing. And so our code, our source code, is LWVUS. so people can go to Power The Polls. They can sign up, they will immediately get connected. Somebody will follow up with them, they'll get the information they need and they'll be able to sign up as the poll worker in their local community.
Karen Grigsby Bates [00:16:09] Virginia Kase Solomón, CEO of the League of Women Voters. Thanks so much for joining us today.
Virginia Kase Solomón [00:16:15] Thank you so much for having me.
Karen Grigsby Bates [00:16:23] The Supreme Court began its new term on Monday, October 2nd. And while the case is on, his docket on the surface are not hot button issues like student loan forgiveness, access to abortion or LGBTQ rights. If you look closely and depending on the court's rulings, these cases could impact everyday life no matter which side of the political aisle you're on. Joining me now is NYU Professor Of Law and co-host of the podcast Strict Scrutiny, Melissa Murray. Welcome back to the show, Melissa.
Melissa Murray [00:16:52] Thanks so much for having me, Karen.
Karen Grigsby Bates [00:16:54] There are a lot of administrative law cases on the docket this year. Why should people be paying attention?
Melissa Murray [00:17:00] Well, as you say, these are not the kinds of cases that draw a lot of public interest because these are not hot button issues. But under the surface, the administrative state is an ever present feature of our lives. These are the administrative agencies like the EPA, like the passport bureau that we rely on, rather than having one of the other branches of government like Congress or the executive, do these things for us. So the way the administrative state works is that there is usually a statute that Congress has written delegating some of its authority to the administrative agency, which is housed in the executive branch, to administer the scope of the statute. And that gives the agency a lot of range to move. So administrative agencies do legislative functions. They make rules regarding the administration of these statutes. Sometimes they enforce the statute. So they do a lot of different things. And their hybridity has actually raised a lot of questions in recent years, as some on the right argue that the Constitution doesn't specifically provide for an administrative state. So the administrative state has become really a target of the right in recent years. And there are a number of cases this term that give the conservative legal movement a rare opportunity to take aim and really hobble the administrative state.
Karen Grigsby Bates [00:18:20] So we may not be paying attention, but we may feel what happens if we don't.
Melissa Murray [00:18:27] That's exactly right.
Karen Grigsby Bates [00:18:28] Yeah. Well, we've got a lot of ground to cover. But first, I want to get into the CFPB versus the CFSA case. The Consumer Financial Protection Bureau, or CFPB, is a federal agency that's designed to protect consumers from unfair and abusive practices by banks and lenders and other financial institutions. Then there's the Community Financial Services Association of America, or CFSA, which describes itself as, quote, the leading national association representing non-bank lenders that offer small dollar credit products and other financial services. First, can you share why the CFPB was formed and how its sustained today?
Melissa Murray [00:19:12] Sure. So Congress created the Consumer Financial Protection Bureau in the wake of the 2008 financial crisis. And the idea here was to give this newly created agency the power to enforce a range of federal consumer finance laws to basically protect the little guy from the kinds of economic shocks that many of us weathered during the 2008 financial crisis. And to help ensure that the agency was independent and insulated from political control, the CFPB purposely received its funding from the Federal Reserve. So that's the real question for this case; this question of an external funding structure as opposed to a direct appropriations from Congress, which is more typical for administrative agencies, but not atypical necessarily.
Karen Grigsby Bates [00:19:56] So the external funding was a provision to kind of buffet it from political winds in other direction.
Melissa Murray [00:20:04] Exactly.
Karen Grigsby Bates [00:20:05] Now, what about the Community Financial Services Association of America, which is a mouthful… What's their main function as an organization?
Melissa Murray [00:20:13] Well, I had to laugh a little when you described them as a purveyor of non-bank small consumer credit options. These are payday lenders. These kinds of lenders target, in many cases, minority communities, individuals who may be skeptical of traditional financial services and more importantly, may not necessarily have the financial cushion to be able to take advantage of more traditional financial services, resources with lower interest rates and things of that nature. And so it's really important to note here that these kinds of lenders were exactly the kinds of consumer lenders that the CFPB was set up to regulate.
Karen Grigsby Bates [00:20:52] So then what's being argued on the CFSA’s behalf? In this case, it would almost seem indefensible.
Melissa Murray [00:21:00] This consumer industry group is basically arguing that the external funding structure that characterizes the CFPB is not only unusual and atypical, it's unconstitutional. And specifically, they argue that the funding structure violates Article One, Section Nine of the Constitution, which is known as the appropriations clause, and it provides that no money shall be withdrawn from the Treasury but in consequence of appropriations made by law. And the industry group is essentially arguing that this means that all appropriations to administrative agencies like the CFPB have to come from Congress. So when the United States stepped up to the lectern to defend the CFPB’s funding structure, one of the things that the Solicitor General, Elizabeth Prelogar, did was note that this kind of external funding is not that unusual. There are other federal agencies that do this. Namely, the Federal Reserve, the administrative agencies that deal with Medicare and Medicaid and Social Security, for that matter. Those programs are all funded through payroll taxes, not directly from Congress. So those are external funding structures as well. And if you call into question the CFPB as being unconstitutional under the appropriations clause, then the Federal Reserve and a raft of other federal agencies and federal welfare programs are also going to be called into question. And indeed, some scholars have argued if this case succeeds in dismantling the CFPB’s funding structure, the Federal Reserve is up next. And this could have a convulsive effect on the American economy, perhaps even precipitating another Great Depression.
Karen Grigsby Bates [00:22:36] Wow, that's a scary thought, especially after having lived through 2008 where we were told, well, it wasn't quite as bad as in 1929, but it could get worse. It could get worse to take some measures for it. Mm hmm. So another case you have on the docket where the court has on its target, Loper Bright Enterprises versus Raimondo, which will now be argued alongside Relentless INC v. Department of Commerce. And it calls into question whether or not federal agencies should be allowed to interpret their own legal authority. The Supreme Court should be looking more closely at these cases in January 2024, but both are essentially meant to challenge legal doctrine known as the Chevron deference. First, Melissa, would you please tell us what the Chevron deference is and how it came to be and then tell us why it's relevant to what's happening in these cases right now?
Melissa Murray [00:23:31] Sure. So about 40 years ago, the court decided a case called Chevron versus Natural Resources Defense Council. And in that case, the Supreme Court ruled that federal courts should defer to federal agencies’ interpretations of ambiguous statutes so long as the agency's interpretation is reasonable. So under the Chevron Doctrine, where there's ambiguity, the agency gets deference. It allows agencies to essentially have broad regulatory authority over a range of regulated industries, including the oil and gas industry, fracking, financial services, all of that. A lot of places really that want broad latitude to be able to do business as they like without the agency's shadow over them. And so these two cases actually present some very, very sympathetic petitioners. If you've seen the movie CODA, then you're probably familiar with the facts of this case. CODA involves a family of fishermen who are really vexed that they have this federal monitor that has to be aboard their fishing ship, monitoring whether or not they over fish in the waters in which they are doing business. And that requirement of a federal monitor ostensibly comes from an agency interpretation of a broader federal statute dealing with overfishing. And so that's essentially the facts of this case and already has been a movie. Now it's before the Supreme Court. Life imitating art, as you will. And so here the federal agency, the Department of Commerce, has interpreted the statute to require the fisheries to pay for and host a monitor aboard their ships, who then monitors whether or not they're overfishing. And so the question here and what the fisheries are arguing is that if Congress wants to put a federal monitor on our ships, Congress has to say so in the statute, The agency can't make those interpretations. And the problem, of course, is that Congress is often writing laws, sometimes with real specificity, but also sometimes in anticipation of problems that it doesn't even really have a clear idea will arise. So, you know, when Congress wrote the Clean Air Act back in the 1970s, it imagined smog in L.A., but it didn't necessarily have in mind the kind of existential climate change crisis that we are experiencing right now. So Congress is writing statutes, but often writing them broadly for a future where it cannot at the moment anticipate what is coming down the pike. And that's the kind of thing that will really be difficult going forward if this argument is upheld and the court overrules Chevron as it is being asked to do, and limiting the agency's discretion to make these kinds of interpretations that keep the statute up to date with current problems and things that are happening in our economy and in our world.
Karen Grigsby Bates [00:26:23] Okay. So we're going to be waiting to see what happens there. While we do that, let's take a look at gun rights. The Second Amendment case, United States v Rahimi. Tell us about this case and why it's so important.
Melissa Murray [00:26:38] Well, Rahimi is a really interesting case that gives the Supreme Court an opportunity to clarify what it meant in its last major gun rights ruling, which was in 2022. They announced New York State Rifle and Pistol Association versus Bruin, in which the court struck down New York's handgun licensing scheme. When the court struck down that handgun licensing scheme, it said that going forward, the way to understand whether gun safety regulations were constitutional was to determine whether or not the regulation could be fit into a broader history and tradition of firearms regulation in the United States. And so with Rahimi, the court has an opportunity to really clarify it. The case involves a man named Zaki Rahimi, who was involved in five shootings between December 2020 and January 2021, in February 2020, after his alleged assault of his girlfriend, a protective order was imposed that specifically barred Rahimi from having a gun. Now, after these five shooting incidents, Rahimi was charged with violating a federal law that bars anyone who is the subject of a domestic violence restraining order, as Zaki Rahimi was, from possessing a gun. The question here is whether that federal law is constitutional. Zaki Rahimi argued that it wasn't constitutional and he asked two lower courts to dismiss his indictment under those charges. In both cases, a federal district court and then later the Fifth Circuit initially upheld that federal law that disarmed those who were subject to a domestic violence restraining order. However, after the court announced its decision in Bruen in June of 2022, the Fifth Circuit went back and said, hey, wait a minute, let's look at this again. And they reviewed the case again and determined that because there was no federal analog for a law disarming those subject to a domestic violence restraining order, this particular federal law was unconstitutional under Bruen. And so here the court really has an opportunity to safeguard those who really are in vulnerable positions vis a vis those who actually are armed. And the United States government who stepped in here to defend the law, argues that this federal law, although it has no precise historic analog, is part of a larger tradition of disarming people who, like Zaki Rahimi, are not law abiding, responsible citizens. And so it's going to be a real question whether the court takes that broader view or whether it's going to require a precise historical analog.
Karen Grigsby Bates [00:29:19] Finally, how do you suggest our listeners, Melissa, especially those who aren't as familiar with judicial processes, stay current with these cases and the rest of the cases being decided this term?
Melissa Murray [00:29:31] So one, you could listen to our podcast Strict Scrutiny, we talk about the Court every single week. We go over all the oral arguments that the court is hearing and we talk about the different arguments that are being made both in court and that the justices seem to be making in their oral arguments. And we talk about all of the decisions as they come out. But we have to understand that in our current environment, the Supreme Court wields a lot of power. So it is to our detriment to ignore the court. There's lots happening at the court right now. We've seen the travel ban fall in the court. The question about the census fall in the court. We've seen Roe versus Wade fall in this court. So for good or for ill, the court is having major, major impact on the lives of everyday Americans and we ignore it to our peril.
Karen Grigsby Bates [00:30:16] Melissa Murray, NYU law professor and co-host of the excellent podcast Strict Scrutiny. Thanks so much for joining us today.
Melissa Murray [00:30:23] Thanks for having me.
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Karen Grigsby Bates [00:30:36] Welcome back to Our Body Politic. I'm Karen Grigsby Bates, sitting in for Farai Chideya. In an already complicated U.S. healthcare system, unfair treatment by your medical professional can make access to good care even harder. Last year, the California Health Care Foundation found Black Californians often adjust their behavior or appearance out of fear of bias and discrimination in care. So how can we eliminate biases embedded in our healthcare system? Joining me now is writer, artist and doctor Shirlene Obuobi. Shirlene is a third year cardiology fellow at the University of Chicago, where she completed a residency in Internal medicine. And she recently became a contributor for Well And Being with The Washington Post. Shirlene published her debut novel On Rotation, which tells the story of Angie, a Ghanaian American, enrolled at an elite medical school. Welcome to the show, Shirlene.
Shirlene Obuobi [00:31:33] Thank you so much for that wonderful introduction, Karen.
Karen Grigsby Bates [00:31:36] We're really happy you're here. Do you have a lot of different roles and specializations in your title? Tell us a little bit about your background and how you got here.
Shirlene Obuobi [00:31:49] For sure. I always say that I am a doctor, artist and author in no particular order, because I think all of those seemingly unrelated titles actually mix very well and inform each other very well. I have been drawing and writing to express myself since I was a little kid. Actually, in my medical school admissions essay, I wrote that I wanted to be able to use my writing and my storytelling skills to help address healthcare inequities, because I had a belief at the time that being able to craft a story is integral to being a good physician.
Karen Grigsby Bates [00:32:25] Your contributions in Well And Being for The Washington Post are on a wide variety of topics. You write about fat shaming, patient bias and cardiology. Where do you come up with the topics and who are you hoping to reach?
Shirlene Obuobi [00:32:41] As a physician, I'm also a patient too often, and I move between these two roles all of the time. I'm also a Black woman. I'm a Black woman in a mid-sized body. And I have to navigate both the professional aspect and the personal aspect of that. And so some of those interests are just interests that I have, but a lot of them are issues that I have seen my own patients face. I want to confront issues that I see patients talking about online or to me that I hardly ever see health care workers really interfacing with. So my… I call myself almost more of a canary in a coal mine. I like to bring issues to light and to start conversation.
Karen Grigsby Bates [00:33:21] Can you give me a couple of examples of what your patients have responded to talk to you about bias or that you've maybe observed it yourself as you've gone through your workday?
Shirlene Obuobi [00:33:31] Yes. So the article I wrote about fat shaming was really inspired by a number of patients who have come to me to the office and have either expressed that they had not been listened to, that their symptoms were not being worked up or they had been repeatedly been told to lose weight. And later we would find out that say they had a rheumatologic disorder or potentially I remember one woman actually had a abdominal catastrophe happen, she needed to have surgery. She had gone to two other ERs and nobody had bothered to do a CT scan. They just basically told her that she was fat and having a bellyache and sent her home. You see these issues of bias in medicine where, you know, we are missing sometimes very straightforward diagnoses because we're clouded by judgment. And now as a medical professional, I'm also having to often interface with a lot of the systemic issues of health care. And I also come with a lot of empathy for myself and for my colleagues. A lot of us are really pushed to our limits and expected to perform well and at our best and most empathetic with very little support and very little attention to our own physical needs. All that being said, patients are still being harmed. And I think I want us to be able to address that and prove that and talk about it.
Karen Grigsby Bates [00:34:49] I hear a lot from doctors that things have gotten exponentially worse since COVID reared its ugly head. Do you feel that way now? And is that also your opinion? And in what ways have things gotten worse in terms of your ability to serve your patients?
Shirlene Obuobi [00:35:05] I agree that things have gotten worse. I think there are a few reasons why. Number one, people are sicker than they were before. We don't fully understand the effects of COVID yet. We do know that people were ravaged by the pandemic. We lost a lot of people, and the ones who are left behind have symptoms and we don't fully understand those. So that's one aspect of it. The other is that the powers that be realized that we could do with less. During the pandemic, when healthcare workers were being lauded as heroes, we were often asked to stretch our resources extremely thinly. We did more things online. We managed patients over video and threw in basket messages. We had massive shortages. And what this taught a lot of hospitals and a lot of the administration is that we can survive on that. But it was not meant to be sustainable and it was not meant to take care of a population that is as sick as it is now.
Karen Grigsby Bates [00:36:04] And in the middle of all of this. You were also writing fiction and nonfiction, as I understand it. I'm wondering how your creative writing and your art fit into or contrasts with your professional life. You know, on the one hand, you're rooted in science and technology, and on the other hand, you have this very creative spirit that feels the need to express yourself in a completely opposite way almost,180 degrees opposite from the evidence based scientific part of you. Are they complementary? Is there this tension? How do you manage that?
Shirlene Obuobi [00:36:49] I think there's sometimes tension because sometimes the evidence isn't humane. Sometimes the things that I care about from a scientific level might not be what my patients care about or even I care about as an artist or as a human being. I'm in a field that really values evidence based medicine. I mean, if you look into cardiology, we have studies for everything, every drug, every procedure we speak in terms of, oh, is this a randomized controlled trial? Was this evidence strong enough? Right? Despite this, we still use, for example, race as a scientific variable, which is something that sociologists and geneticists in the seventies first said was unacceptable. The tension that is there mostly arises when I am trying to figure out how to communicate a topic that I feel is emotionally charged for a lot of patients that maybe is scientifically based for a lot of physicians. For example, certain medications, like I'm a cardiologist, I like statins, I prescribe statins all the time. The evidence behind statins is vast, and they are cheap and readily available and they prevent heart attacks. But there is a lot of emotion. If you go online, you'll see all of this information about how they're terrible for you and how people have had horrible experiences. And as a scientist, I want to say, you know, you're wrong about this, right? The evidence speaks to the contrary. As an artist and as a human, I understand why people are hesitant to put an unknown chemical in their bodies that sometimes makes them feel bad. I understand why people are called to anecdotal evidence over scientific evidence. I think in trying to bridge that gap, I try to use anecdotes to speak to the science so that I can kind of help people better understand or at least relate to what they might be hearing in the doctor's office. You know, I think before we started speaking, you asked me, how do I manage my time, how do I fit writing in? And the answer is at least for On Rotation. When I was walking around the hospital, I would write on my phone, sometimes that's a quarter mile from patient rooms. And so I wrote most of On Rotation on my phone. I think that it is very easy to develop compassion fatigue in healthcare and that forcing myself to constantly reflect and to step back helps me maintain my empathy. It helps me put myself and my patient’s shoes even when I am in extremely frustrating situations and helps me retain my humanity. And in the a lot of the work that I do, I want to highlight the humanity of not only patients but also the people taking care of them. I want people to walk away from my work having learned something, having been given the opportunity to reflect as well, and to think about how the issues I bring up in my stories and in my art may impact to them or speak to their own experience. And I want them to understand a little bit about how the sausage is made as well.
Karen Grigsby Bates [00:40:18] Let's talk about your debut novel On Rotation that follows the story of a Ghanaian American going through her medical training. How much of it is fiction and how much was inspired by your own real life experience? Which I found myself wondering as I went through the book.
Shirlene Obuobi [00:40:37] So what I always say about On Rotation when I get asked this question is that, you know, my whole life I grew up reading about white women authors from upstate New York because most authors are white women from upstate New York who maybe are writers and work in publishing. And I wanted to write a story that reflected my experience, the experience of a Black woman in medicine, a dark skinned woman, which is one that is not frequently told…Angie is not me. I often have to preface that, but she does have a lot of experiences that I've had, which is why I think it was important for me to write the story. When I was building her character. I wanted to write about the immigrant experience. I wanted to write about this incredibly pivotal period and the third year of medical school, which is when medical students go from being mostly in the classroom to actually interacting and interfacing with patients. And I wanted my character to really inform readers what it is like to move through the American healthcare system as a Black professional, but also as a Black professional seeing Black patients. So I am at University of Chicago, which is in the South Side of Chicago. Most of my patients are Black. Most of them are African-American. One thing that happens so often as a Black trainee, I see, and I'm expected to become the spokesperson for my Black patients. I have a comic that showcases my avatar talking to her team, and the team wants to call CPS on a patient because she brought her daughter in with burns on her back.
Karen Grigsby Bates [00:42:25] We should say here in many states, CPS is Child Protective Services. In Illinois, CPS is called the Department of Children and Family Services.
Shirlene Obuobi [00:42:34] And her daughter got these burns because she dipped her synthetic braids into hot water to set them. The team doesn't believe that this makes any sense. And so in that moment, I have to become a cultural broker to prevent this woman from losing her child. In On Rotation, I show other incidences. One very pivotal thread is that Angie wants to study Black patients and is told that she should not do this, that it will harm her career because it will pigeonhole her as just another Black medical trainee looking into health disparities. And I wanted to highlight this because many of us are affected by health disparities, and yet within the medical field, it is considered a lesser area of interest, and it actually could affect her career negatively to investigate them. When I started using my profile to talk about bias and disparities, one of the most common bits of feedback that I would get from my attendings was that I was very brave to do so because medicine does not like to look inward. We are still a very conservative and paternalistic profession. We have an entire history that is, you know, outlined very well in Medical Apartheid in which we have been the contributors and perpetrators of attacks, a significant amount of harm. And we don't like to face that. We like to consider ourselves as adhering to evidence based practice, but often will ignore evidence when it comes to issues of race or gender, pushing against that and saying, Hey, but maybe we don't do everything right, maybe we can do better is controversial.
Karen Grigsby Bates [00:44:16] Mm hmm. It's making some people uncomfortable, I would think.
Shirlene Obuobi [00:44:20] Yes, exactly. It makes a lot of people uncomfortable.
Karen Grigsby Bates [00:44:23] You've talked about the medical profession having a hard time looking inward to examine its own bias. Is there something that's missing in training doctors that would allow them to take a long distance look at themselves and how the system’s serving its patient population, if they've just spent decades just ignoring it? Is there something that they're doing now or that you think they should be doing now that they weren't doing, you know, ten, 20 years ago?
Shirlene Obuobi [00:44:59] I think the biggest issue is representation. I think this has gotten better because representation in medicine has improved. I am a Black woman in cardiology and I'm also an African immigrant, so I'm from a self-selected group of people who already have a lot of advantages considering they were able to come to the United States in the first place. If we look at the percentage of Black physicians period who are American descendants of slaves, that number becomes atrocious, right? Then if we look even at the number of people who come into medicine, who have chronic illnesses, who come from low income backgrounds, who really reflect our patients, we'll see that there are very few of them. Something like 75% of medical students come from the top two quintiles of income in the United States. So how can you understand the difficulties of taking care of your health as an average American if you don't come from a family who has ever had to deal with that, you then have to expect people to have deep reaching empathy, which a lot of people do. But it isn't necessarily something that we should assume people will have. I also think that medical training itself is invested in making us less empathetic. You see more patients, you do more procedures, you make more money for the hospital or for yourself. So actually thinking and caring about and spending time with patients is not profitable for anyone. It doesn't help anyone but the patient who's right in front of you. And very few people care about the patient who's right in front of you. So I think we need to really adjust our incentive structure within healthcare entirely to really get to the point where people en masse invest in eradicating biases in medicine.
Karen Grigsby Bates [00:46:49] I think that shows that you're juggling all these things just beautifully. We have your 2022 book. Is there a sequel or is there a different piece of fiction that's maybe coming down the pike in your copious free time?
Shirlene Obuobi [00:47:05] There is actually… my second novel, Between Friends and Lovers is going to be coming out in July of 2024, so keep an eye out for it.
Karen Grigsby Bates [00:47:15] That's just what the doctor ordered. Some romance in these very dark times. Doctor Shirlene Obuobi, artist, writer, author of On Rotation. Get It, Go Read It, and Cardiology fellow at the University of Chicago. Thank you so much for joining us today.
Shirlene Obuobi [00:47:33] Thank you so much, Karen. It was a delight.
Karen Grigsby Bates [00:47:38] Thanks for listening to Our Body Politic. We're on the air each week and everywhere you listen to podcasts. We'd also like to invite you to sign up for our newsletter where we share additional insights and resources for the OBP community. Check us out on Instagram @OurBodyPolitic and click the link in our bio.
Our Body Politic is produced by Diaspora farms and Rococo Punch. I'm today’s host Karen Grigsby Bates. Farai Chideya, Nina Spensley and Shanta Covington are executive producers. Emily J. Daly is our senior producer. Bridget McAllister is our booking producer. Andrea Asuaje and Ann Marie Awad, Natyna Bean, Morgan Givens, Emily Ho and Monica Morales Garcia are our producers. Amelia Shandwick and Monica Morales Garcia are our fact checkers. Our associate producer is David Escobar. Our technical director is Mike Garth with engineering help from Carter Martin.
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