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Yahel Alumni Advancing Social Change: Health Professionals

Today we will focus on Yahel alumni who have chosen a career in the health professions. We reached out to alumni in various health professions and asked them to tell us about their career choices, about successes and challenges, about work under COVID-19 circumstances and how their Yahel experience has influenced their career.

For this piece we spoke with the following alumni:

-- Jodie Guller, medical student at Keck School of Medicine of University of Southern California, Yahel Social Change Fellow, Lod 2015-2016.

-- Rebecca Lee, Occupational Therapist at Haaksma Speech Pathology, a home health agency serving individuals ages birth-21 in the Denver, Colorado, Yahel Social Change Fellow, Gedera 2012-2013.

-- Amelia Loewensohn, studying for Bachelor of Speech and Hearing Science at Macquarie University, Sydney, Australia, Yahel Social Change Fellow, Lod 2017-2018.

-- Arielle Gur, studying for MS in Speech-Language Pathology, Northeastern University, Yahel-Onward Israel New York Service Fellowship, Jerusalem, summer 2015.

What led you to choose your professional field?

Jodie: I plan to specialize in family medicine. I always wanted to be a primary care doctor in a clinic where I could see my patients and connect with them over a long period of time. One of the biggest privileges of my career is getting to hear people’s life stories and caring for entire multi-generational families at all stages of life. Family medicine is a specialty that is very much focused on primary care and preventative medicine, and there is a lot of focus on health justice and health equity. It is a specialty that values taking care of people and not just taking care of diseases, and encourages developing longitudinal relationships and work within communities.

(Pictured left: Amelia with Yahel partner Amal Abu Alkum and her daughter, in Segev Shalom.) Rebecca: I learned about occupational therapy when I was working as a nanny for a child with autism. Part of my job involved driving him to and participating in his therapies and I fell in love with occupational therapy. He worked with an amazing OT who was able to take him from screaming to sitting calmly in under 10 minutes using swings and other sensory activities. It seemed like magic at the time and I knew I wanted to understand it better. Amelia: I was initially interested in social work (which I still might come back to, possibly as a MA program) but decided I wanted something a little more hands-on and practical. I was then interested in occupational therapy but found the science a little too intimidating. I think speech pathology is a happy medium where I can feel like I'm directly helping people (rather than helping people find services or resources) but without the very heavy science content of occupational therapy. I also found that the things that interested me most when working with children, especially children with various needs, were their styles of communication and linguistic delays or impediments and how this affected their behavior. Arielle: Most of my life I wanted to be a teacher. After spending time in a classroom, I quickly realized that the current school curriculum (Common Core) would have been something I struggled with as a child. That coupled with the large and impersonal class sizes threw me off of teaching. I accidentally took a psychology of language course and realized that speech therapy was much more personal and still a way to be involved in the school system.

Tell us about your role. What are the things that you’re most proud of and what are the parts you’d like to change in the healthcare system that you’re exposed to?

Jodie: One of the things I’m proud of is that I do a lot of my training at the LA County Hospital, which is set up as a ‘safety net’ hospital, meaning that anyone can obtain healthcare there regardless of their ability to pay. At the ‘safety net’ facilities we take care of homeless people, people who are incarcerated, people who are undocumented and others. Many of the professionals working in these ‘safety net’ systems are extremely dedicated to providing high quality healthcare to folks who wouldn’t otherwise have access. At the same time, it’s very frustrating to work in a healthcare system that is oftentimes not designed to provide quality care to people, but rather to be a profitable business. The insurance companies are all for-profit and a lot of healthcare systems, and even individual professionals, are driven by the desire to make money. The end result is that many people aren't getting particularly good care, if any at all. For example, many of our patients can't afford their medication because the government doesn’t intervene enough to make the drugs affordable for all. Additionally, there is now more conversation around the evidence showing that systemic racism has influenced everything from people's ability to access healthcare to our medical knowledge on specific diseases. Rebecca: I am currently employed as an occupational therapist in pediatric home health. I live in Colorado where children/young adults are eligible for home health services until the age of 21. I currently have a caseload of children ages birth-18 with a variety of needs and diagnoses. In the fall, I made the decision to switch from the nursing home setting to pediatrics, which was my original passion and I'm so happy I made the switch. When working in nursing homes, I experienced burnout early on after repeatedly having to push patients in rehab when I felt that they would have been better served with end of life or comfort care. There seemed to be a shortage of practitioners willing to discuss end of life options and I was considering training to become a physician’s assistant so that I could be an advocate for patients at end of life. In the end, I decided to pursue pediatrics again and my husband and I relocated to Denver from the Boston area. I love the home health setting because I work daily with kids and their families in their natural environments. I love having the opportunity to empower families to promote their children's development and help them meet their goals. Amelia: In addition to my studies to become a speech pathologist, I am currently working at a school for children with autism. Something I'm really interested in at the moment is how multilingualism affects our perception of children with autism. I noticed that a lot of multilingual children at the school I work at would speak in their native language and would be assumed to be speaking gibberish. I am very interested in studying further how this affects their confidence in their communication styles and how best to manage this challenge. I’m also very interested in how different communication aids are used in the classroom setting. Arielle: Once I finish my studies I hope to work in a school setting with elementary aged children. For me, I love hearing the difference in a client's speech, and I love how proud they are of themselves.

Something I'm very interested in is how multilingualism affects our perception of children with autism. I noticed that a lot of multilingual children at the school [for children with autism] I work at would speak in their native language and would be assumed to be speaking gibberish.

What are some of the interesting programs, cases or patients that you’re working on right now? Jodie: My current rotation is called Health Equity. I join a street medicine team and do rounds at a hotel housing homeless people who are living there temporarily to prevent the spread of COVID-19. ‘Street medicine’ is a growing international movement where healthcare teams go out into the streets carrying backpacks with medical supplies, find people where they’re living and provide primary care for them where they are. It is a really interesting model that I think provides much better care than our traditional system for these people, who often have tremendous barriers to accessing traditional clinics. It’s been especially inspiring to see what some of our patients at the hotel are doing now that they don’t have to worry about housing, food, bathroom or water. Many are now motivated to make changes for their healthcare in terms of treating chronic conditions, addressing mental health needs or trying to work on substance use disorders.

Yahel is one of the main reasons why I’ve been steadfast in my desire to work with vulnerable populations and have a community based approach to medicine. It was also a big part of my decision to get a Master’s in Public Health. I saw how much my patient’s health was influenced by the environment they live in and their socioeconomic status, and not just our encounters with them in the clinic or in the hospital.

Rebecca: Over the past 2-3 months, I have gotten several referrals for children placed in foster care. This has brought a new challenge of navigating dynamics between the birth families and the foster families. When I initially started working with the foster children, I tried doing research on strategies to promote healthy attachment with the foster families to assist with the adjustment and the children’s development. I was able to find a lot of information on helping to support children and families going through the adoption process but no information on supporting children and foster families when the plan was for the children to return home. If I decide to go back for a doctorate, I would like to work on putting together resources for foster families and birth families to assist with the transitions between the homes. Arielle: I am currently working with a tele-therapy company developing content and activities for school aged children with speech and language disorders.

(Pictured right: Arielle on a Yahel Seminar)

How has your work been affected by COVID-19? Jodie: As a student I’m not the provider for any COVID-19 patients directly, but otherwise everything seems to be impacted by COVID-19. My last rotation was in internal medicine and there were times when half the patients on our team were COVID-19 positive. Even the patients who don't have COVID-19 are tremendously impacted because no visitors are allowed. People aren’t able to grieve with their loved ones either. We had a patient with metastatic cancer that had progressed who was in our hospital for about 2 weeks before she was placed in end of life care. She was in profound pain because of her cancer, and was alone in a hospital room because of COVID-19. Luckily as a medical student I had more time on my hands and I was able to call her aunt regularly to give her updates, but even that isn't always possible. It’s tough for the patients and it’s tough for their families, especially when patients don’t have smartphones or are too sick to use them without assistance.

(Pictured above: Rebecca with young adults from Friends By Nature, a Yahel partner community organization.) Another issue is the massive introduction of tele-health. Many people are having visits with their doctors via video or phone - which in some scenarios is great because they don’t have to take as much time off work, or travel far or get a babysitter to see their doctor. But we can only do so much from afar. A lot of preventative healthcare is falling by the wayside. People aren’t getting their regular vaccines or physicals and some people are afraid to go to the doctor’s office at all. These are all things that will ultimately have a definite negative impact on our community’s health. Rebecca: I started my current job in December of 2019 and was just getting comfortable working as a pediatric OT when COVID-19 hit. We transitioned to tele-therapy overnight, which came with a whole new set of challenges. I had to develop three very important skills in order to succeed with this new service delivery model: I had to become even more resourceful, I had to learn how to observe and listen to families even more carefully when doing evaluations, and I had to learn to be clearer when explaining exercises and activities. After 5 months of tele-therapy, I can say that I mostly know what I'm doing. I have worked to develop activities using household items (toilet paper rolls are surprisingly useful for OT sessions). I have done several new evaluations on tele-therapy and have a large part of my caseload that I've never seen in person. Most of my families understand what I'm asking them to do with a little demonstration. My bosses keep telling us that we will be better practitioners after going through this and I sincerely believe that's true. The transition to tele-therapy brought the attention back to empowering the families, rather than simply going into the homes once or twice per week to provide services and leave. Amelia: Thankfully, because the school I work at is considered essential services, my work has experienced very minimal interruption due to COVID-19. Arielle: I am in school still and COVID-19 has prevented me from gaining more in person experience.

How did your Yahel experience influence your career choices and your everyday experience in this field? Jodie: I had already planned to be in the medical field before doing Yahel, but it has had a big impact on my choices within the field of medicine. I started medical school right after I finished the fellowship, and it is one of the main reasons why I’ve been steadfast in my desire to work with vulnerable populations and have a community based approach to medicine. It has impacted my specialty choice and continues to impact my priorities as I’m about to choose a residency training program. Yahel was a big part of why I decided to get a master’s in public health as well. I saw how much my patient’s health was influenced by social determinants of health - the environment they live in and their socioeconomic status - and not just our encounters with them in the clinic or in the hospital.

(Pictured right: Jodie at a community event in Lod) The ability to make personal connections with patients from backgrounds that are very different than mine - despite language barriers - is something that I still carry with me from Yahel. My students at the school in Lod spoke Arabic while I spoke none when I first arrived, and yet we still fostered relationships, learned a lot from each other and enjoyed the experience.

Rebecca: I come back to my time with Yahel every time I think about going into a family's home. During my time at Yahel, I volunteered with the ‘Homework at Home’ program, which was designed to empower families to be able to support their children's learning at home. We were told not to bring our own items into the homes and to use whatever space and items the families had available. We worked with families to establish routines and workspaces to facilitate the students' education. We were also taught to be aware of the fact that when entering homes, we were entering families' most private spaces. I think of that every time I go into a home. A lot of families are self-conscious about their homes and uncomfortable letting people in and I always try to be sensitive to that. Amelia: Yahel definitely had a huge influence on my choice as it allowed me to narrow down further my particular interest in the field. I knew I wanted a 'helping career' before Yahel but I think Yahel taught me the value of having a practical skill you can bring to the table.

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