“I could hear the breathing from the door without my stethoscope. Do you know what it sounds like? It’s like the sound of broken glass rubbing against itself.” An ICU nurse sat across from me, the emotional baggage visible on her eyelids as she stood six feet away. I held the N95 mask by the strings and placed it in a paper bag, careful not to expose the interior, then invited her to sit down. She came to me during a graveyard shift when I was alone training hospital personnel on the extended use of personal protective equipment. In spite of the unnerving risk and countless hours she labored due to the imbalance of providers to patient volume, she was resolute. The more she shared, the more reminiscent her descriptions of the ICU were of the “Blue Death,” otherwise called the Spanish flu of 1918, which claimed more lives in two years than AIDS has in decades. Then she said she was from Romania. I couldn’t help but wonder if a century ago she would have been in a position to assist against the grandfather of pandemics due to her status as a foreigner. Immigrants and minorities have often been the cornerstones for waging war against infectious disease. It was the renowned African American physician, Dr. Charles R. Drew, who innovated blood storage techniques that enabled large scale blood transfusions, which saved the allied forces during WWII. Although he resigned from the Red Cross because they insisted on segregating blood by race of donor, they continued to capitalize on his work which ultimately saved numerous lives. Just this past month, my generation was called to donate blood to replenish the diminishing supplies. Dr. Salk and Dr. Sabin, pioneers of the polio vaccines that effectively eradicated the disease, were of Jewish descent, and Sabin himself was an immigrant. I hate to think about how prevalent polio would be and how many would have suffered the sequelae that confined Roosevelt to a wheelchair if a quota system enabling Jews to enroll at New York University had not been employed. These are only two influential physicians who are responsible for sustaining the health of our communities. Yet the quandaries they faced are the same as some physicians endure today. It was also a Hispanic student nurse, Lupe Hernandez, who invented hand sanitizer in 1966. Nowadays, Purell is a commodity when it is usually commonplace in healthcare settings and available in surplus at supermarkets. It is thanks to her that we have a convenient method to minimize infection daily as medical teams round through multiple patient rooms. Today, a small amount of her invention will disinfect any pair of hands, though no amount can purge the prejudice marginalized yet essential healthcare workers like herself face. It is no secret that we started off combating COVID-19 with disadvantages. Lately, news is rampant with coverage of the paucity of ventilators, hospital beds, and N95 masks. But it is important not to forget the deficits in our workforce. Last year, the American Medical Association estimated that our nation faces a projected shortage of up to 122,000 doctors in the next decade. In the midst of this, 27,000 physicians are DACA recipients, and a myriad of international medical graduates suffer the disquiet of whether or not they will get timely visas or green cards. As I think of these doctors, some of whom are my own colleagues and are fellow minorities in medicine, I cannot help but consider the repercussions to public welfare if their status was rescinded. In various parts of the U.S., fourth-year medical students are graduating early, and specialists are being pulled to the internal medicine floors to keep up with the burgeoning patient load. This month, I was one of many students that volunteered at my medical school to train providers on new guidelines for the use of personal protective equipment to relieve nurses from this duty so that they could focus on ICU care. As my peers and I donned and doffed PPE to train over 2,000 employees, I pondered on how ousting foreign workers like the nurse I met would dispossess hospitals of vital support and the public of care. During times such as these, we can delegate some duties, but we cannot replace the skill and intellectual heft necessary to care for our sick. More than once in our history, diseases that decimated populations were described in colors. The bubonic plague was called the Black Death. The influenza of 1918 was called the Blue Death. I do not know what color we will call COVID-19. My hope is that we do not continue to discriminate and create barriers that will serve as a fast track to the spread of disease. If we are to heal our nation, we must take measures that will buoy longevity. For this, it is critical that we do not place our workforce in the margins when they are needed at the frontlines, and that we embrace talent from all avenues, even if the paths taken are undocumented. Natalie Moreno is a medical student and can be reached on Twitter @NatalieAMoreno1. Source
