Helping Others and Building Change Grace Anne Holladay '21 has a conversation with Dr. Kelli Jarrell ’12, who was recently named the national emergency fellow of the year
“I think service learning is especially valuable in pre-med students interested in serving vulnerable populations because it gives you insight into the social determinants of health and how they impact your patients outside the health care system.”
~ Dr. Kelli Jarrell ’12
Editor’s note: In this series, current students in the Shepherd Program for the Interdisciplinary Study of Poverty and Human Capability at Washington and Lee interview alumni of the program who are working in a field that interests them. In this installment, Grace Anne Holladay ’21 has a conversation with Dr. Kelli Jarell ’12, a fellow in the Department of Emergency Medicine at the University of Cinncinatti College of Medicine. Earlier this year, Jarrell was named National Emergency Fellow of the Year by the Emergency Medicine Residents’ Association, an association that represents more than 16,000 students and medical professionals. According to the UC website, the award “recognizes a member who has demonstrated significant dedication in promoting EMRA goals and objectives at local, state and national levels and has a record of creativity, enthusiasm and accomplishment in addressing issues pertaining to emergency medicine.”
Grace Anne Holladay ’21 is from Nashville, Tennessee. She is majoring in biochemistry and minoring in mathematics and poverty and human capability studies. She pursued her Shepherd Internship during summer 2019 in Camden, New Jersey, where she worked with the Camden Coalition of Healthcare Providers. Through this internship, Grace Anne worked in emergency room and clinic settings, where she spoke with patients about health-related social needs such as housing, food insecurity and transportation. She then connected patients with local resources to meet these needs. This internship further fueled her professional goal of combining her medical interests with her desire to care for underserved populations and address social determinants of health. Grace Anne will take the next step of her academic journey next fall when she begins medical school.
Q: What personal experiences and interests drew you to social emergency medicine?
One thing that most people know or remember about me is that I grew up in West Virginia. I am really proud of the people and places I grew up around and among, so I talk about them all the time. The area I am from has faced a lot of challenges in the wake of the decline of coal mining in the region and has been disproportionately impacted by the opioid epidemic. These challenges are exacerbated by issues of access faced by rural populations everywhere. Seeing them play out in real time over the course of my childhood and early education definitely impacted what I am interested in: barriers to access, substance use and social determinants of health.
But the reason I talk about my home is not because it influenced my academic interests. I see service and leadership lived out in my home; those who have little give to those who have less. Communities rally to support their members when they face hardships. I was in Tanzania when the travel ban was announced last year, and despite being literally thousands of miles away, my parents’ friends and my friends’ parents were reaching out to offer their help. This is why I wanted to practice medicine and why I ultimately found my way into social emergency medicine: the desire to help others and build change from within a community.
I was interested in social emergency medicine before it was a “thing.” One of the main things that drew me to emergency medicine was the way in which the social context of the patient impacts their care. Emergencies are the great equalizer – heart attacks, strokes and gunshot wounds are managed the same way regardless of whether they belong to a CEO or a homeless person. However, emergency providers are also incredibly sensitive to the social context of their patients when they need to be. For example, a person without a home cannot store medications that need to be refrigerated.
The emergency department is also the most accessible point of the health care system for a variety of populations. It provides a place to “meet” patients that the rest of the health care system does not “see.” This gives emergency providers the unique opportunity to leverage this interaction to support vulnerable and high-risk populations. When I applied and matched into emergency medicine, “social emergency medicine” was not a term yet. The work that now constitutes this new and growing subspecialty has been ongoing for years but has only recently been named and organized. I consider myself really lucky to be finishing residency and starting fellowship right around the time the thing I have always wanted to do became “official.”
Q: You created your own social emergency medicine fellowship. How does this fellowship differ from a traditional emergency medicine fellowship?
This is a tough question to answer succinctly. There are a variety of fellowships that people in emergency medicine pursue with a variety of different structures. A critical care fellowship, for example, is going to look very different from a global health or international emergency medicine fellowship, which will in turn look very different from an administrative or operations fellowship. Residents choose to pursue fellowships in order to gain specific clinical skills, like ultrasound, or dedicate time to developing their academic work in a certain field, such as social emergency medicine.
Many fellowships that fall into the latter category have a similar structure in terms of duration and clinical work and then differ in the opportunities fellows choose to pursue with their time. For example, my fellowship is a two-year program. I work clinically in the Emergency Department, am completing my masters in public health, and work on a variety of projects within the Emergency Department. So in terms of structure, my fellowship is very similar to a lot of existing fellowships in other areas of emergency medicine, like operations/administration or global health. This structure allows flexibility to maintain clinical skills, pursue a graduate degree and still complete a meaningful project within the community or department.
I think Cincinnati is what makes my fellowship unique. I work at a large quaternary referral center that serves an underserved urban population as well as including a large rural catchment area. We have a robust public health research group in place already and have very supportive department leadership, and a long tradition of innovative fellowships. This provided adequate support and structure so that I could have a meaningful experience but allowed me the flexibility to customize my experience.
Q: What would you say are some of the most pressing public health barriers facing your patient population?
If you can name a public health barrier, it impacts our patient population. It’s impossible to answer this question in 2020-21 without mentioning the COVID-19 pandemic. One thing I think is really important about COVID-19 is how it has exacerbated most (or all) of the existing public health barriers. Some of the issues our department and the residents in my social EM elective have been working on recently are: substance use; housing insecurity; language barriers; lack of access to primary care; resources for victims of violent crimes, including domestic violence and sexual assault; human trafficking; refugee health; and LGBTQI+ health resources. Mental health crises and barriers to access to care and case management is something else we see a lot in the Emergency Department that has also been impacted by COVID-19.
Q: You have traveled to Tanzania and Guatemala. Tell me a little bit more about your work abroad. How does your interest in global health affect your day-to-day work?
I have been to Guatemala once and Tanzania twice during residency. As I alluded to, my most recent trip to Tanzania was cut short by COVID-19. In Guatemala, we worked with an organization that is dedicated to providing care to native Mayan dialect speakers in their native language. This really changed the way I view language justice and the importance of culturally competent care. In Tanzania, we work with a partner organization that provides a variety of services to a number of villages. While there, we hold field clinics and bring supplies to the health center in one of the villages.
The thing that strikes me about my experiences in Tanzania is not the differences, although there are many, but the similarities. I remember a patient encounter where I saw a young woman, and as I was assessing her medical history, she began telling me about her boyfriend. She and the interpreter leaned their heads closer to me, our heads bent together over a desk in the schoolroom that served as our makeshift clinic. As the interpreter translated the patient’s words, she blushed and smiled and we all giggled. I was struck by the universality of this moment. Many of you would recognize it. Three young women, heads bent over the table at lunch in the sorority house, or giggling over the dinner table in their house on Randolph Street. Our clinic and resources look nothing like my hospital in Cincinnati, but the experiences of being a patient, of needing help, and of finding a sought-after resource are universal.
By the same token, global health is local health. Just because a person presents to the ED in Cincinnati does not mean they have the exposure and risk profile of the infectious agents and lifestyle habits of Southwest Ohio. Because the ED is a readily accessible point of care, we see global health in our backyard.
Q: You have been working with the Test and Protect project to improve equitable access to COVID-19 testing in underserved communities. What has this work entailed?
The Test and Protect project involved field and health care testing. My work was operationalizing the field testing, meaning testing outside of the existing health care system in Cincinnati. We partnered with community organizations interested in hosting testing events. We stood up a number of drive-thru and walk-up testing events throughout Hamilton County. Our goal by the end of 2020 was 35,000 tests in the field, which we surpassed.
Q: In your opinion, how has COVID-19 impacted pre-existing public health issues that disproportionately affect vulnerable populations?
COVID-19 has exacerbated a lot of existing health disparities. Limited access to care did not improve in the midst of a global pandemic. Existing mental health issues did not improve during lockdowns. It is impossible to quarantine or work from home when you have no home. I think COVID-19 has exposed truly how vulnerable some of our most vulnerable groups really are.
Q: How did the Shepherd Program and your time at W&L help shape your career path?
The Shepherd Program laid the groundwork for my interest in social emergency medicine. My Shepherd internship was my first introduction to patients in psychosocial crisis and ultimately led me to emergency medicine, where providers are need-blind and deeply in tune with their patients’ socioeconomic circumstances. The community-based research I completed for my capstone was the basis for my interest in community partnership and public health, which has been a fundamental component of TaP COVID testing. Community engagement is a crucial component of linking emergency patients to needed services. The interdisciplinary nature of the courses and the program prepared me to work daily with multidisciplinary teams in the Emergency Department, in my public health courses, and in the community.
I would also be remiss not to mention specifically the advising I received from Dr. Erich Uffelman, my pre-med advisor who recommended Poverty 101 and encouraged me to pursue the minor, and Dr. Harlan Beckley, who is well known to those who know the Shepherd Program. They helped me take the first steps on this path.
Q: What advice would you give to pre-med students passionate about serving vulnerable populations?
I would advise anyone interested in working with vulnerable populations to look for the overlap of their passions and opportunities. I advise pre-med students frequently to pursue what interests them. I think service learning is especially valuable in pre-med students interested in serving vulnerable populations because it gives you insight into the social determinants of health and how they impact your patients outside the health care system. I would advise W&L pre-med students to take Poverty Studies courses and consider a Shepherd internship. I specifically recommend taking Health Economics with Professor Tim Diette and Economics of Social Issues with Professor Art Goldsmith for those interested in working with vulnerable populations within the health care system.