Ep 77: Fighting Islamophobia in Medicine, Media, and Society

[00:00:18] Dr. Joanne Conroy: My name is Joanne Conroy, and I am president and CEO of Dartmouth health. And welcome to her story. It is my great pleasure to introduce to you, Dr. Suzanne Barakat. Suzanne is an Assistant Professor of Community and Family Medicine at UCSF, an executive director at the UCSF Health and Human Rights Initiative. And it’s our pleasure to have her here today. Her story appeals to a wide audience of listeners, many young women that are interested in starting their careers on the right foot and some experienced women that are just interested about learning about other people’s struggles. So it is a great opportunity for us to interview women leaders and actually share everything they’ve learned with the entire audience. So thank you, Suzanne, for joining us.

[00:01:15] Dr. Suzanne Barakat: Thank you for having me, Joanne.

[00:01:17] Dr. Joanne Conroy: Now, we like to really start with people’s background. So give the audience a little sense of where you grew up, where you trained, and your journey to UCSF.

[00:01:29] Dr. Suzanne Barakat: Yeah. So I was born in a little town called Salisbury, North Carolina, raised in Raleigh, ended up going to undergrad in Medical school at UNC Chapel Hill. I moved out here to the Bay Area to be with my husband and trained at UCSF, at San Francisco General Hospital in Family Medicine. And after doing some Per Diem work and full spectrum Family Medicine as a hospitalist and laborist and clinician, I came back to UCSF on faculty, working with residents and now also leading the Health and Human Rights Initiative.

[00:02:01] Dr. Joanne Conroy: Now, talk a little bit about the Health and Human Rights Initiative, what it stands for, and maybe a little bit about your personal journey to have that leadership.

[00:02:13] Dr. Suzanne Barakat: Yeah. Yeah. I think it makes sense to start with why I got to where I am. When I was so, it’s never easy to talk about this. My family was visibly Muslim growing up in North Carolina, and even training at UNC, I often rotated throughout the rural parts of the state for different clinical rotations. And I was often the only Muslim people had ever met.

[00:02:40] Dr. Joanne Conroy: Talk a little bit about that, Suzanne. It is something a lot of us don’t know a lot about, what is it like to grow up American and Muslim in the U.S.. And I think the rest of our listeners would appreciate hearing about that.

[00:02:56] Dr. Suzanne Barakat: There was a very clear and sharp difference between pre-9/11 and post-9/11 for Muslim Americans. Pre-9/11, it was mostly ignorance. And people just hadn’t met a Muslim before. We make up 1% of the American population and then post-9/11, it turned into fear and hatred. I’ve had friends with their scarves pulled off, shoved into lockers the day after 9/11. Someone pulled down their window and gave me the middle finger and said, go back to your mother-f’ing country, not knowing that I was born and raised here. And training in North Carolina wasn’t that different. I had patients refused my care altogether. Patients cussed me out and no one really standing up and coming to my defense. Attendings, who I was working with, who would go into full blown debates about the superiority of their religion and why mine was horrible– conversation I never started. And I had learned throughout my time to, and my childhood and my adolescent years, to just smile, because for many people I was just this unknown, scary thing. And I carried the burden of representing a billion Muslims on my shoulders, an unwanted burden. And then I was in training. I was in the middle of my intern year at UCSF. I was on call in the Pediatric Urgent Center. And. Whew. I learned that my brother, his wife of six weeks, Yusud and her baby sister Hazan were murdered in their Chapel Hill apartment. Dio was a dental student at UNC at the top of his class. Yusud, who had just graduated and was getting ready to join him at UNC Dental School, had just moved in with him. And their neighbor professed to disliking the way that she looked wearing a hijab like mine and her mom, as she was moving in, had told her, you know, be kind to your neighbor. With time, he’ll get to know you, and he won’t be as belligerent. But we didn’t realize that this hatred would turn into fatal violence when this neighbor, who had shared elements of white supremacy, had barged into their apartment and executed them in the back of the head, one by one. American kids, and there wasn’t a blip in the media about this. And I, in my scrubs, got on a red eye, went home, not knowing what had happened. The police had released a premature statement, taking the words of the murderer, saying he did it over a parking dispute, when we know now, even with footage that Dio took on his cell phone, that there was no dispute, and he was belligerent and came in and killed them. And all of a sudden I was thrust into the spotlight to address the media that we had demanded for coverage. And gave a press statement and ended up demanding that this story be covered and to be investigated federally as a hate crime and to correct this false narrative and this double standard. And, you know, had it been three white kids who were killed, and had the murderer been Arab Muslim, South Asian, it would’ve been everywhere, and it would’ve been called a terrorist attack. And yet, this was almost shy of a mass shooting, all addressed at my family for being Muslim, and yet not a lot of people still know about it. That happened my intern year, and I became vocal against the rising tide of Islamophobia in this country and the political climate we were in, and political gains that politicians were reaping off the backs of Muslims. And fast forward two years later. And I’m in my third year of residency and my cousin, who was a journalist who was also born in Raleigh, North Carolina, and her mom who was a political activist, had been vocal against that Saudi regime in Syria. She was a prominent journalist in Istanbul, Turkey, where they were both assassinated, presumably by the Asad regime, after calling and speaking with journalists and saying that she had, they had evidence to the presence of crematoriums in Assad’s prisons before this was public knowledge. And that just thrust me into flexing the muscles that I had gained before in some of the contacts, demanding meetings at the White House and the State Department, and demanding that something happened about this. And so I became this reluctant activist on the side of also still being a trainee. And when I graduated residency, I was doing a mix of my clinical work, full spectrum family medicine with underserved patient populations and refugee health, but also doing this activism work. And so when I joined UCSF, this position as the executive director for the Health and Human Rights Initiative has really allowed the combination of the clinical work with the policy making and the advocacy for human rights violations.

[00:08:03] Dr. Joanne Conroy: You know, your story is so impactful. And through stories, we start to understand how it appears for other people. We went through that as we went through the Black Lives Matter process when they talked about white privilege, which was something that you don’t realize you have until you realize that other people don’t have it. And people have no concept of how people walk into the room with preconceptions that are not based in any fact. But how do you live and function and thrive in an environment where you first have to spend a lot of time educating and you were doing this when you were, what, 25?

[00:08:49] Dr. Suzanne Barakat: Yeah. It’s exhausting, to be honest, to carry that burden. And I guess I should say, I no longer feel like I have to carry the burden of educating. That moment in February 10th, 2015, with the murders of my family members, there’s a clear shift in my approach from smiling with the hopes that it would change hearts into action and using my voice to hold accountability and justice. Because that same rhetoric, that fear that people had of Muslim Americans is the exact rhetoric that killed my family. And when you lose life, when you lose your beloved loved ones to the same stereotypes that people assign to you, but still see you as the threat it’s maddening.

[00:09:39] Dr. Joanne Conroy: Yeah. Yeah,

[00:09:41] Dr. Suzanne Barakat: And so, I walk in and I see patients who still refuse my care here in San Francisco. I was asked recently by a patient, are you even allowed to be here, because you’re a Muslim and American and doesn’t the Quran prohibit woman from being educated, which is completely blatantly false. Or, have been told by patients that I’m a terrorist when I’m providing them care, exceptional care. And no one saying anything. So in many ways what’s been really frustrating even with the political climate we’re in is that Islamophobia is still very much a socially acceptable form of bigotry. In a way, that the tide is turning, but still not enough with BLM, with LGBTQ Rights, Islamophobia is still not on people’s radar as something to be aware of or to counter.

[00:10:29] Dr. Joanne Conroy: Yeah, let’s talk about this kind of environment of hate. For the last eight years, it felt like we unleashed people that spewed vitriolic hate against people that weren’t like them. And I think you’ve identified many kind of segments of the population that have been the recipients of it. Number one, have you any insight in terms of what caused this? Can we put the genie back in the bottle? Or is it really, we’ve got to move to something else? And how do we do that? My expectation is that’s probably part of the Health and Human Rights Initiative at UCSF. But what are your thoughts on how we actually move past this and become a better society?

[00:11:18] Dr. Suzanne Barakat: I spent many sleepless, crying nights trying to comprehend why someone would walk in with a gun and execute three kids. Why? Like how much hatred do you have to have in your heart to do that for your neighbor? And I looked through the literature and researched and really came down to understanding. The Pyramid of Hate was a really helpful concept to review. And it starts with our implicit biases, which, you know, it’s like a buzzword; we all use now, and we’re trained in, but really to try and understand our unconscious biases, the stereotypes that we have of people and that leading to microaggressions, leading to acts of biases, leading to Systemic Racism, the criminal system, and ultimately at the peak of that pyramid, after you have acts of violence, like murder and rape, is genocide. Because when you ask also about groups of people who are killed without any accountability, it starts with that level of otherization. And really when you allow yourself to otherwise a group, and you can’t relate to them, you dehumanize them. And when you dehumanize them, you can justify violence against them. And I think that’s really at the crux of it. When we see other people as so different than we are that we can’t feel their pain, we can’t empathize with their hearts and their minds when we’re actually all the same. And I think that’s a lot of what draws me to my work, in seeing the downtrodden of our society who are fleeing for support and for safety, from persecution, from torture, from violence, and knowing that they are just as valuable and important and worthy and deserving, if not more deserving, given what they’ve been through than you and I. And I think when we’re able to see that, when we’re able to look into one soul and you’re able to make eye contact and see, I see you and me, then all the policies will follow.

[00:13:21] Dr. Joanne Conroy: Yeah. It’s interesting that we are on a journey here for diversity, equity, inclusion, and belonging. And we’ve just hired a new VP who actually comes from a family that is firmly entrenched in urban leagues across the country and very committed to social justice and allowing people’s whose voices may not be heard to be heard. But as we talk about how we start, because we’re like in the beginning stage, it does start with stories, understanding and respect. And they feel simple, but if you look around your organizations, we don’t always emphasize the importance of those and expect everybody to respect the people with whom we work and we care for. What have you been able to do at UCSF, understanding that the Health and Human Rights Initiative is young. But what are the things that you hope to accomplish there?

[00:14:24] Dr. Suzanne Barakat: Our biggest program, right now, is providing pro bono Forensic Medical Evaluations for asylum seekers. So we have asylum seekers who are referred to us from attorneys who ask for basically a medical legal affidavit that can support their case in court in obtaining asylum and not being deported. And so what we do is we listen deeply to the stories of our clients, of their trauma, their torture of the persecution, whether for their religion, their race, their sexuality, domestic violence and we document, we do a full physical exam, we look at the scars on their body, and we can corroborate their stories and also do the psychological evaluations with suggestions of diagnoses of PTSD and depression and how that can impact memory. And we put that into a document and an affidavit that supports their court case. And when an asylum seeker goes to court with an immigration attorney, they have a 30% chance nationally of obtaining asylum. When you add a Forensic Medical Evaluation that are done at a handful of these human rights clinics that are student run across the country, that number goes up to about 85%, maybe 90%. And at our clinic so far, we’ve had a 100% asylum grant rate for adjudicated cases, which we’re really excited about. But in addition to doing those cases, what we’re really doing on a national level is building a standardization of how to do this field of asylum medicine. That’s really kind of siloed right now. So we’re doing national modules together with all the national leaders who are doing this work. We’ve developed a digital tool to standardize data input and using that data to then inform advocacy and policy changes, so we can move away from this politicized conversation around immigration policies and actually use the data and science that we can collect to make more meaningful change.

[00:16:12] Dr. Joanne Conroy: That’s wonderful. And that’s an accomplishment that you should be very proud of, and I’m sure that the people that are fortunate enough to find your services are incredibly grateful.

[00:16:24] Dr. Suzanne Barakat: Honestly, being at a place like San Francisco General, where you are surrounded by like-minded people, who are just as committed and passionate about the work, it makes it very different. The institution and the organization you belong in and everyone’s hearts is in this so much. Everyone is so invested. This work is done pro bono, and we’re trying to find ways to systematically make it more sustainable, so it’s not just medical students and faculty donating their time to do this.

[00:16:49] Dr. Joanne Conroy: Now what’s been the support from the community because I know efforts like this start on shoestrings, but if they need to be sustainable you need a broad platform of support. I’ve got to believe there are a lot of like-minded people across California, but they need to know about you. What are you trying to do to elevate the recognition?

[00:17:09] Dr. Suzanne Barakat: Let me take it a step back and say, I think not until you’re in a room listening to a story of a client, and all it takes is one person, and you hear the power of the journey that they’ve been on, what they’ve endured, the resilience that they carry, the humanity that brings to you and the glee when they are told they are now safe in the U.S., and they will not be forced back, to start their lives to work and the children that they have, and it’s when you see that, and you realize that even for that one client, this work was so important. And there’s a gap right now in our healthcare system and in our political system to take care of this demographic that are crossing the border. In recent time, it’s been unaccompanied minors that have been coming through. And so we’ve opened our first pediatric clinic in the country to do these human rights clinical evaluations, forensic evaluations, and, we are looking for money. You know, we have seed funding from the university, which speaks volumes to the priorities that it’s setting as an institution, but we definitely need to identify more foundations and private donors. And we’re looking at research grants, and our budget isn’t that huge, you know. It’s really just to cover the faculty time to do this work. And, you know, in medicine, if you’re not generating an RVU, it’s hard to cover that work. And trying to identify that ROI for patients who are not paying patients is really challenging. And yet what is more important than human life that’s coming to us asking for assistance. And so if anyone out there has ideas on how either to support this or to build and scale that model, as we’re trying to do nationally to sustain this, ideas are welcome.

[00:19:01] Dr. Joanne Conroy: We need to get some people to help amplify the stories and your story. One question about UCSF and San Francisco General. I’ve been focused a lot on the culture, you know, how do you change a culture? And I feel like over the last six years, our national culture has shifted in not in a great way. And we need to shift the culture back to really thinking about respect and kindness and supporting each other. But you started a microcosm, like how do you affect the institution where you currently are? I have met with a lot of our Muslim residents and faculty, and I was worried about some of their religious restrictions on when they can eat and what they can eat and the impact that it has on them and their work and their life here at the institution. And it’s incredibly important to really understand that. Have you been able to get UCSF to move in a direction where they appreciate the probably large number of Muslim, both employees, faculty, residents that they have working at any given day in their health system?

[00:20:12] Dr. Suzanne Barakat: One of the first things I think institutionally as a responsibility is ensuring that there’s diversity in their workforce that represents the patient demographic they’re serving. I give this talk and it’s not uncommon where you have 80% of the clinicians are white while 80% of the patients are black. That discordance is going to lead to bad health outcomes. And we’ve seen that. It translates into quality of medical care. And so ensuring that even in leadership positions, you have diversity of thought and representation. And again, with that, the policies follow, and ensuring that there’s representation. Things that I’ve done at UCSF you know, we’ve had like a coalition of students who would go to leadership and say, or trainees, things like you need to ensure that there is proper OR, gowns and caps for your hijab wearing students, for example. It shouldn’t be on the student to try and figure out finding a sterile cap, right? Or the discrepancy of how we allow surgeons to wear their caps from home but Muslim trainees can’t wear their scarves, they’re surgical caps that are not sterile, or things like providing a space for the Friday Prayer that can be consistently used by people. But honestly, it’s even more important than that. It’s feeling valued. It’s feeling supported, and having a safe and anonymous way to be able to report violations. And this goes for everyone where there should be places for accountability, for trainees to be able, or even faculty, to share when something inappropriate happens. And it not to be brushed under the rug as, oh, they’re just ignorant or they’re racist, but no, what are you going to do about it? The weight and the burden that people of color and minorities carry is a lot. And it is on institutional leadership to ensure that we do something about that.

[00:22:04] Dr. Joanne Conroy: We have had a focus on training our leaders how to actually speak up in the moment, not afterwards, right there. And it’s an ongoing journey. We have some that are just fabulous, and we have no problems encouraging people to seek their care elsewhere. We have a zero tolerance for that. But people need to speak up in the moment. It’s not as powerful if they say it after they leave the room.

[00:22:29] Dr. Suzanne Barakat: And what’s really fascinating with that concept, I had just given a grand round at UCSF called Challenging Islamophobia. And here I was amongst my team. I was the senior on round with my attending and a team of medical students and interns and residents. And when a patient called me at terrorist and no one said anything, it was kind of that moment, okay, I just finished preaching to the choir about what it means to stand up in the moment. And you realize that it happens to all of us. We’re silent because we don’t think bigotry is acceptable. We’re silent because it makes us uncomfortable. And one of the things exactly, as you said, priming ourselves, and the phrase that I use when I talk to people about this is say, Hey, that’s not okay. And it can prime you for just a couple moments to think about that particular situation and come back to what just happened. But you paused that conversation in the moment to acknowledge that it wasn’t okay. And that form of allyship contributes so much to the culture of belonging.

[00:23:26] Dr. Joanne Conroy: The incoming COO for Henry Ford, I was on a call with him earlier, and he had a great three words that he uses to describe the allyship. He says the first is curiosity. You just need to be very curious about the situation that you find the other person in and just be positively curious about it. The second thing is courage to actually speak up in the moment. And the third thing is commitment, meaning speaking up once is necessary, but not sufficient. It needs to happen again and again, which means you have to be committed to constantly doing that. And it was actually just a very succinct way of saying these are the things that are going to epitomize leadership in really addressing hate. We do have some questions about your leadership, and I know we’re close to our time, but what is the one characteristic do you think has given you the edge in your career?

[00:24:35] Dr. Suzanne Barakat: I don’t know that it’s one thing, but I do think back to the words my dad used to tell me as a kid. I was often otherized and told that I didn’t belong, but you know, there’s that little song, “anything you can do, I can do better. I can do anything better than you.” And that as a kid, that’s what prompted me to say I’m deserving and I’m going to work hard, and I want to take care of my family and I want to take care of humanity, and just a lot of hard work. And at the expense of probably some self-care and taking time, which is what I wish I had told myself back then, that it’s okay to slow down the pace, the work will always be there. But then also I think having the courage to speak up. I could have coiled into a ball and never shown my face after what happened to my family. But in many ways I was primed because of having been the only Muslim American many people had met that it almost felt like a responsibility. My brother didn’t leave me a choice. I wasn’t going to let his brutal, violent death just get washed away in the news as something that wasn’t it. People needed to know what happened. People needed to know that hate took his beautiful life away. And that this is preventable. And we should do better. And there should be accountability. And there should be justice in this, and that trickles for everyone.

[00:26:03] Dr. Joanne Conroy: Well, your story is inspirational, sad, tragic, all at the same time. I think we all expect that you’re going to make a real impact on people across the country. You’re starting with California, but your passion the way you in such an articulate way identify the problem is incredibly powerful. So it’s been an honor to interview you here for Her Story.

[00:26:33] Dr. Suzanne Barakat: Thank you, Joanne.

[00:26:34] Dr. Joanne Conroy: I want to thank you so much for everything you bdo every single day.

[00:26:37] Dr. Suzanne Barakat: Thank you. Thank you so much.