Author: Carey Jackson, MD

Dr. Carey Jackson is a professor in the Department of Medicine and an adjunct professor in the Department of Global Health at the UW. At Harborview, he serves as medical director of the International Medicine Clinic, Refugee and Immigrant Health Promotion Program, the Northwest Health and Human Rights Coalition, and Interpreter Services Department. He is a co-founder of the Community House Calls Program and EthnoMed website, and is also an affiliate investigator at the Fred Hutchinson Cancer Research Center.
Viral Swab Oromo Screenshot

Medical Routines and Just In-time Interpretation

Posted on | by Carey Jackson, MD

Most medical care takes place outside of the physician-patient encounter. Phlebotomy in the lab, “clean catch” urines, EKG’s, colonoscopy preps, mammography, and nasopharyngeal swabbing all happen when the physician is busy elsewhere. If there is a delay between the order and the completion of this task then the interpreter for that encounter has often moved on to the next encounter. Each site (i.e. the lab, the MA, radiology) then calls an interpreter for very routine tasks that are discrete, quick, and often require some demonstration. 

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Taking History of Torture

Political Violence as Health Disparity

Posted on | by Carey Jackson, MD

Among the health disparities prevalent among asylum seekers, refugees and immigrants is a history of political violence in the form of imprisonment, war fare, interrogation, threats and torture.  You will find that this experience is shared by Vietnamese survivors of the re-education camps, Egyptian students, gay men from Pakistan, Ethiopian shopkeepers, Angolan obstetricians, and the political opposition from Congo. In the diversity of occupation, gender and ethnicity is a shared experience of a violent suppression of democracy that plays itself out in their lives through dislocation, chronic pain and disease, sometimes for decades. 

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Coronavirus

Covid-19 in Immigrant Communities

Posted on | by Carey Jackson, MD

Being poor can be like treading water with the waterline right under your nose. The slightest ripple and you choke, a wave will submerge you. The novel coronavirus pandemic is a tsunami for those living in poverty. As a recent New York Times article illustrates, communities living in crowded conditions, with uncontrolled chronic diseases like diabetes and hypertension, marginalized by the lack of comprehensible health information, and mistrusting the current systems to treat them fairly will be disproportionately ravaged by Covid-19. We have seen this in the past with tuberculosis, HIV, and hepatitis B. But the novel coronavirus acts faster and in some cases more aggressively and so reveals disparities even more dramatically.

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The Planet Earth

Environmental Justice, Global Warming and Global Conflict

Posted on | by Carey Jackson, MD

Migrants exist in two worlds simultaneously: one in the country of asylum and the other through their calls, connections, and visits, to the people back home. Global warming is changing both worlds; in fact it is why many have been forced to migrate. Recently, world representatives met in Poland to coordinate efforts to address climate change. As they acknowledge it is almost too late, many realize the stakes are far too high to trust politicians alone to handle the broad cultural changes needed to address environmental collapse.

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Immigrants Protesting

Patient Trust Threatened by U.S. Immigration & Customs Enforcement (ICE)

Posted on | by Carey Jackson, MD

With co-authors Maggie Cheng, Staff Attorney, Northwest Immigrant Rights Project and Elizabeth E. Dawson-Hahn, MD MPH Attending Physician, Harborview Medical Center and Seattle Children’s Hospital.

The trust between physician and patient is a core tenant of the medical profession. By extension, trusting relationships with nurses,technicians, hospitals and clinics are where this relationship plays out. This trust is now threatened by U.S. Immigration and Customs Enforcement (ICE). In a startling breach of precedent, ICE agents have begun to target clinics and hospitals to enforce immigration policy. It is our opinion that these enforcement actions actively jeopardize patient care.

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Race, Ethnicity and Language Data

Posted on | by Carey Jackson, MD

Fourteen years ago the Institutes of Medicine published Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Among their recommendations was the observation that to find disparities in care, health systems must first collect Race, Ethnicity, and Language (REAL) data at registration. Many health systems across the country began to make this effort. But then in 2008 the economy collapsed and health systems found themselves launching a rearguard effort to shore up their IT and EMR departments as budgets were cut and IT work forces downsized.Since then, the Affordable Care Act was passed and equity became a pillar of care. Electronic medical records were enhanced and since have evolved to facilitate the sharing of medical information.

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Sign saying immigrants and refugees welcome

Anti-immigrant Sentiments Affect Immigrant Health

Posted on | by Carey Jackson, MD

The rhetoric around immigration has again reached a fever pitch. It did after 9/11, it has repeatedly, and it has again. Migrant children fleeing intolerable gang and domestic violence in Central America have crowded the Southern border. Refugees fleeing Syria are swarming over Eastern Europe and a chronic flow of migrants from East Africa stream north and cross the Mediterranean in precarious flotillas. The West feels under siege and frightened. There are many with distinct political agendas that capitalize on this fear and propagate unwarranted anxiety for their own ends. We see this in national political debates and we see it daily in local politics.

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Research spelled in scrabble pieces

Health Disparities and Clinical Research

Posted on | by Carey Jackson, MD

This year the Vietnamese remember the end of a long civil war. Many of us who are old enough know exactly where we were 40 years ago when we were told that Saigon had fallen. So many Vietnamese lives in the North and the South were lost in that war, so many French and then American lives were spent fighting that war. In the chaos of the immediate aftermath of the war, and then for years to come, there was an exodus of Vietnamese to the West. The U.S. received over 1,000,000 Vietnamese refugees when all was said and done, and then the Vietnamese-American community has grown from there. In the first decades after the war it became evident that there were a number of conditions disproportionately prevalent in the Vietnamese community; diseases such as tuberculosis, hepatitis B, liver cancer, and cervical cancer to name a few.

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Sign saying "We are not criminals, we are hard workers"

Profiling Populations and Health Disparities

Posted on | by Carey Jackson, MD

“There it was: AIDS as the litmus test for nurses and physicians, a means of identifying who would and who wouldn’t. I had seen this before in Boston…..

“So,” I asked, “is this kind of stuff still going on now, with Gordon?”

“Hell yes! Except they know who is and who is not willing to take care of a patient like Gordon. I am willing. Mary is willing. And quite a few others. But I don’t think they should take advantage of us for that reason. It’s convenient for them. Because if they bitch and moan and if they don’t take care of the patient right, then I feel like I have to step in. I can’t let that happen.”

Verghese, Abraham. My Own Country: A Doctor’s Story. Vintage, 1995.

Through this exchange with a nurse, Abraham Verghese recalls attitudes in the 1980s among medical staff engaged in the care of the first HIV patients in rural Tennessee. His remarkable memoir of his years as an Infectious Disease specialist during the early days of HIV recaptures the palpable possibility that contamination with HIV was a death sentence faced by many in operating rooms and on medical wards, a belief held by some among medical professionals and civic leaders. In repeated vignettes Vergesse describes how these attitudes affected the resources and care gay men received.

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