My grandma called while we drove from Jaltenango to San Cristobal. Cell signal was inconsistent as we wove between the mountains and I initially decided to let the call go unanswered. Then I reconsidered; she knew I was in rural Mexico, and rarely called out of the blue. I found a spot with poor signal and called her back. Her words were choppy and the conversation was brief, but I understood the Spark notes: there’s an active shooter near the Temple University Medical School campus in North Philly who they haven’t caught yet and my dad is under lock-down in a building two blocks away. I texted my dad, asking him to keep me updated, to which he replied, “about what?” to prevent me from worrying. I texted my mom to ask if she was alright. Eight hours and six police officers with non-fatal gunshot wounds later, the man was forced out of his house with tear gas and taken into custody, and my dad rode his bike home (to my mom’s chagrin).
On the second day of boot camp we did an activity called Theater of the Oppressed. Invented by the Brazilian theater practitioner Augusto Boal, the activity is used as a means to promote social and political change. Audience members are active, called “spect-actors.” They are given a theme and asked to create scenes that demonstrate that theme as a way to analyze and transform the reality in which they live. The theme given to us was violence. Our group was composed of primarily U.S. physicians and the violent scenes we depicted were centered around gun violence. The person leading the activity was a Mexican physician. When he led the same activity with a Mexican group their scene portrayed domestic violence, and a Haitian group’s scene portrayed violence related to natural disasters. We did this activity days before my grandma’s phone call.
I could write many more blog posts about my experience in Chiapas, the enormous health disparities, the impact of migration at both the Southern and Northern borders of the country, the maleficence of Starbucks on local coffee growers, and the ways in which the Mexican pasantes have to “do the extraordinary to achieve the ordinary” (quote from Hugo, former CES director). As James did in his lecture given to the group in Chiapas, I decided to focus on a story highlighting a domestic component of global health. Stories similar to the phone call I got from my grandma are all too familiar to those of us living in the U.S. Some of the Mexicans I spoke with in Chiapas are scared to visit U.S. cities like Chicago and L.A. because they are afraid of being shot. (My family was worried I’d be kidnapped for ransom in Chiapas. One of my favorite benefits of traveling is disintegrating some of the fear of the foreign/unknown.)
One of the main takeaways I learned from the PIH/CES approach is the extent to which they attempt to address social determinants of health to improve physiologic health. In the same vein, I think it is impossible to extract gun violence from health outcomes in the U.S. and around the world. I learned later that the gunman’s lawyer spoke with him on the phone during the lock-down and used motivational interviewing to convince him that his best option was to surrender to the police rather than fatally shoot officers or himself. This would shorten his sentence and allow his daughter to visit him in jail, rather than at his grave. The lawyer mitigated what could have been at least seven lives ended.
Beyond asking whether my patients have a gun at home, I have no formal training in gun violence prevention. If a patient says yes to owning a gun, the most effective response or action is unclear to me. Mitigating gun violence has not historically been a part of medical training. As disproportional rates of imprisonment in the U.S. continues to rise and recreational ownership of high-capacity guns continues to kill, I would argue that we as medical professionals need to find ways to integrate violence prevention into health maintenance. While I’m certainly not an expert on how to go about this, one of the participants of the global health boot camp has an interesting community-based approach through his organization Trap Medicine (https://www.trapmedicine.org/ourmission). Perhaps some of the activities we did in the boot camp can be used as tools to train providers as well. This is an issue that necessitates our attention, and perhaps we can adapt methods of approaching social determinants of health from international contexts to our own communities in the U.S. To quote Paul Farmer, “the idea that some lives matter less than others is the root of all that’s wrong with the world.”