COMMUNITY GRAND ROUNDS
Speaking Our Truths:
Medical Racism, Trauma, and Neglect
Traditional Grand Rounds
In medicine, doctors are required to continue learning even after they complete medical school. To remain licensed, they must complete continuing education credits. These credits can be earned in a variety of ways from attending seminars and conferences to taking classes. Most often, however, they are earned through regular attendance of departmental or clinical offerings called grand rounds in which the particular condition of a given patient or patient population are presented, usually in a one hour lecture or discussion based format.
Grand rounds has an extraordinary history of exploiting patients, at one time even “exhibiting” patients without meaningful consent. Early on, it was not unusual for a patient to be displayed on a gurney in an amphitheater, subject to description and discussion as an object of study.
Grand rounds today typically avoids the most egregious practices. But even when patients aren't physically on display, they are metaphorically the object of discussion rather than experts who know their own bodies and life experiences.
What are Community
Adding the word "Community" to grand rounds shifts the expertise from medical professionals to the people who access care. In this instance, residents of the Tenderloin Community are offering health care professionals and students deeply engaged, highly impactful learning experiences through direct dialogue with people who are living with the consequences of medical racism, trauma, and neglect. Through video testimony and live discussion, we confront structures of harms and seek collaborative avenues changing those structures. During Community Grand Rounds, community residents take their rightful places as experts in the harm that has been perpetrated by the medical system through institutional practices and individual interactions.
Community Grand Rounds models the spirit and practice of holding space for healing. For some this is called restorative justice; for others it is akin to holding a circle for healing. We open our time together with a moment to center ourselves and prepare to listen to one another. After that, we center the voices of community residents as experts in the harms so many have experienced.
Providers (doctors, nurses, residents, etc.) also experience harm within the healthcare system through institutional structures like time limitations and understaffing. Community grand rounds is an opportunity for healthcare providers, regardless of their roles, to set aside the mantle of professional authority and listen with their whole essence. In doing so, they can acknowledge the whole range of harms that our healthcare system perpetrates. In this way, speaking of lived experience and the experience of harms becomes an act of solidarity through a momentary disruption of traditional power relationships.
Community grand rounds is designed to fit different time blocks from 60 minutes to 2 hours. Longer timeframes allow for greater engagement and deeper discussions.
Regardless of timeframe, the overall format remains the same. There are three parts to each engagement:
Part 1 Opening: This involves first an acknowledgement of the original peoples on whose land we stand. Then we offer an exercise to bring everyone into the space followed by an introduction to the community experts.
Part 2 Video Testimony: This is a 15 to 18 minute video of stories of medical racism, trauma, and neglect. These stories have been collected from Tenderloin residents in spaces where each person could feel heard and their stories held with respect and compassion. Each video also contains insights from providers and other community members into the structures of oppression, the impact of these experiences, and questions about how change can happen.
Part 3 Dialogue and discussion: Community residents and healthcare participants enter into a facilitated conversation that moves our stories from testimony to engagement. In this portion of our work together, we enter the realm where deep personal reflection engenders visions for deep social and institutional change.
What you can expect to know, do, and believe differently
after attending a Community Grand Rounds presentation
1. Through storytelling and open dialogue, everyone present better understand how institutional practices perpetuate racism, trauma, and neglect. (Know the ways that institutional practices matter)
2. Through direct engagement with medical racism, trauma, and neglect, each person can identify and acknowledge the impact of institutional practices on different people, depending on how they enter the institution and the ways institutional practices wield power over them and what power they, individually and collectively, have to change institutional practices and norms. (Believe in their own power to make changes--small or large)
3. By inverting assumed structures of expertise, the potential for relationships between community members and healthcare professionals is surfaced and the potential for powerful alliances becomes visible. (do--create collaborative relationships for change)
To cover the cost of these presentations, we suggest:
$3,000 for existing presentations
$5,000 for custom presentations
We never let money be a barrier, so if you need a different compensation structure please let us know. We do, however, ask that you examine your institution's resources and commitment to addressing health equity as you develop your budget for this presentation. As community partners, we have taken on the cost of supporting community experts (financially and socially) and developing these materials. We are asking that our institutional partners share the expense of doing this work.
What does the suggested
compensation structure cover?
Community experts expose painful and traumatic experiences in each presentation. They do so to improve the quality of care other people will receive and to prevent future harms from happening.
Their expertise is rooted in years of preparation and community building. Without community relationships and the support of the people who walk with them in this process, they risk triggering trauma responses and renewed harms.
Addressing past harms and creating new, equitable practices requires financial support for:
Appropriate compensation for each panelist commiserate with their status as experts.
Community Support: Skywatchers provides weekly programing that supports and enhances community experts in developing presentation skills, story telling, and community building. Community experts access trauma resilience care and other services through Faithful Fools. Without these resources, community experts are at risk of being re-traumatized and experiencing further exploitation.