Last week, I signed a petition denouncing the behavior of the Yale Delta Kappa Epsilon fraternity pledge class on the night of Wednesday October 13, 2010. Under the instruction of the leaders of their fraternity, the DKE pledges marched through Yale’s Old Campus chanting, “No means yes! Yes means anal!” I was dismayed and embarrassed when I heard of this event at my alma mater. I am a medical student now, but my four years at Yale College served as the foundation for my premedical education. There I learned how frogs reproduced, how to balance chemical reactions and how balls drop. Most importantly though, college taught me to be an advocate for vulnerable populations because social justice is the most significant determinant of our general health and well-being. The behavior of the DKE pledges represents a ghastly ignorance of the far-reaching consequences of a careless attitude towards violence against women.
October is Domestic Violence Month, a short month assigned to call to attention to a year-round issue that affects one in four women. Domestic violence costs our health care system 5.8 billions of dollars annually. Despite this large figure, monetary cost alone is not an accurate record of the health effects of domestic violence because most cases of domestic violence are never reported. The stigma of being a victim of domestic abuse is a formidable obstacle that effectively blocks women from accessing care after a violent event. Even insurance companies know that victims of domestic violence are at high risk for needing medical attention; before the Affordable Care Act was passed this past March, insurance companies in eight states and the District of Columbia were able to classify domestic violence as a pre-existing condition.
I run Women’s Health Day at the Vanderbilt student clinic in Nashville, Tennessee. We recruit women from local shelters to come in and receive well woman care. Our biggest obstacle is encouraging women to agree to medical care because they are afraid that just the act of agreeing to medical care will stigmatize them. They are often victims of violence, and many have not received care since the incident of violence. The time period between the incident and their readiness to receive care and be tested for STDs can span up to years. When working with these women’s case workers and with the shelter staff, the best advice these administrators gave to us students about working with these women was normalize medical care to be something that everyone deserves and should receive. Our goal, they told us, was to change the language of the discussion.
There is a lot of good that can be done if we are able to impart this advice to a broader audience. Our words are game changers. Just as the words of the DKE pledges had the ability to tear at the heart of a progressive academic community, a language that respects and cares for all populations has the ability to construct worlds of safety, care, and health. The task of shepherding our nation through a health care overhaul includes addressing the issues that shape the social determinants.