Hear Me Out

As a Health Educator at Howard Brown's sexual health clinic, I can be sure that no two days look alike. From a skills based, clinical standpoint (especially for a geeky pre-med like myself) my position is really cool--I've learned how to draw venipuncture blood samples, take and understand a patient's blood pressure and other vital signs, process lab orders, run and interpret HIV and STD tests, and more. I always found a strange sense of wonder and euphoria in neuroscience, microbiology and anatomy lectures at university, learning about disease processes from a biological standpoint. The human body is truly a living embodiment of magic; I thought medicine was a sleight of hand, the tapping of a wand that would fix a spell, a corporeal being, gone awry. Boy, was I wrong.

From my service, I have seen how medicine is inexorably intertwined with behavior and social determinants of health. Lifestyle changes--like taking a pill every day or changing one's diet and fitness regimen--can't be taught in a textbook, and are very difficult to integrate consistently. When a patient is in visceral agony, they do not care about biomolecular cascades--they want direction on how to make the pain go away so they can resume their life. And if this pain happens to be absent, our capitalist society urges us to work harder, as if there's no need to check up or fix what isn't already broken beyond repair. I've learned that we need more than magic to fix the systems that surround us because these, and not our bodies, are what's truly broken.

Serving clients, particularly in reproductive health, highlights the interplay of social factors in wellness. From a very young age, we are told that our bodies and our sexuality are a source of shame, especially if you are queer, femme, trans, brown, disabled, or--just imagine!--an intersectional mix of these and others. We are repeatedly silenced, and this deeply ingrained silence can echo all the way into my clinic room. Clients often do not seek services until they are showing symptoms, and are frequently uncomfortable disclosing those intimate symptoms or details even to a healthcare provider, for fear of being judged.

And so I'd argue that the most rewarding part of my position, far from its more technical elements, is the privilege to fully bear witness to another's story. Most practitioners go into the medical field citing a desire to help others, but in a hyper-paced field that also includes charting and paperwork components, a patient interaction is too often reduced to a timestamp. Building trust and fully attending to one's story is imperative to not only identifying the changes a patient needs to make, but in strategizing an attainable, sustainable way to realize these changes. Sometimes I get really stressed out by the precarious nature of this balancing act, trying to fully serve each person's needs while keeping an eye on the clock and staying mindful of the people that are still waiting. It seems impossible, callous, to conceive of a time limit when someone is disclosing sexual assault, when they are unpacking their cognitive dissonance in hating condoms, when they are stressed out about a partner having herpes, or when they have just received a reactive HIV test result.

I doubt this balancing act will ever be easy, but my year of service has given me practice and perspective in using my time more effectively. Though I'm termed as a ‘health educator' I now prioritize listening and tailoring my responses to what has been expressed, as opposed to ‘educating' or spreading information per se. While I still cover a lot of sexual health content, I hold a particular emphasis on making this relevant and attainable for the client. Oftentimes, this means putting our training script and my personal judgment, however well intentioned, on the back burner. If a patient, for example, absolutely refuses to use condoms, or engages in needle sharing behavior, I'll talk about alternative strategies, behaviors they can use to reduce their risk--using lube, getting tested routinely, safer injection procedures--instead of attempting to persuade them into unrealistic, undesired, unsustainable changes, potentially intimidating them away from ever receiving health services again. I've learned to trust and value my patients' words, meet them where they're at, and always invite them back for more, if and when they are ready. I've learned that people do not want answers in and of themselves--they want hope. They want choices. They want to feel empowered. And most importantly, they want to feel heard. If there's one thing I hope to contribute to the people I serve, it'd be the knowledge that their bodies, their stories, are not a source of shame, but of power.

This blog post was written by NHC Chicago 2018-19 member Chitra Iyer.

Chitra is a Health Educator at Howard Brown Health - 63rd Street.