TUC Students Advocate For Healthcare And Education That Is Inclusive, Informed, And Humane

Perhaps nowhere is that struggle less known or even acknowledged than in the world of primary care medicine and healthcare in general. But for an entire segment of the population – the LGBTQIA+ community – the issue could not be more apparent and important.

At Touro University California, diversity and inclusion are much more than just buzzwords. So, it makes complete sense that it is on the TUC campus that a group of students - for whom the topic is intensely personal - along with faculty and university leaders are provoking thoughtful dialog and initiating change.  

“A lot of this conversation has been student-driven, which is great” said faculty advisor, Dr. Theo Smith (he/him/his) from the College of Osteopathic Medicine. “I feel like I’m taking the baton and running with them now.”

The students in question are members of the Rainbow Health Coalition (RHC), a student-led, TUC campus organization with the stated mission to, “Promote equitable health care delivery through awareness and education about lesbian, gay, bisexual, and trans (LGBT) health issues and disparities.” 

The inclusive, non-discrimination policy that has been central to TUC’s mission for many touches on RHC’s mission, but members of the group hope to expand past goals by tackling the issues – and fears - faced by LGBTQIA+ community members when they seek healthcare.  

Second-year medical student and RHC co-president, Gina Cho (she/her/hers), said she chose Touro University California specifically because of its inclusive policies and dedication to creating safe spaces for all students.

“When I arrived on campus, I was glad to see that Touro strived to foster equitable and inclusive healthcare, and structural competency,” Cho said. “But we wanted to do more; add our own ideas.”

Some of those ideas have included creating more curriculum changes that specifically address non-heteronormative healthcare through her work with the Marginalized Community Health Subcommittee (MCHS).

Both Cho and her co-president, second-year medical student, Alex Guevara  (he/him/his), said their own lived experiences have informed their knowledge, concern, and advocacy.

I’m queer and Korean-American,” Cho said. “I have personally experienced discrimination and witnessed non-inclusivity in a variety of ways.”

 After graduating from Smith College in 2017, Cho took four gap years to gain more primary care experience by working as a caregiver, nursing assistant, and medication technician. She also spent those years volunteering for the Los Angeles LGBT Center.

“I made phone calls to LGBTQIA+ seniors experiencing isolation following the start of the COVID pandemic in the U.S. in March 2020,” Cho said. “I helped connect them to resources and set up at-home food and prescription deliveries. Additionally, I tutored LGBTQIA+ youth at the Center.”

Cho said that she learned that half of Hollywood’s homeless youth population identifies as LGBTQIA+.

“I feel driven to specialize in providing LGBTQIA+ affirming healthcare as a future physician,” she said.

Guevara, who is Mexican-American and identifies as queer, has intimate and extensive knowledge of the issues non-heteronormative individuals face when seeking healthcare.

After graduating from UC Berkeley in 2014, Guevara took seven years off from school before being accepted to TUC’s DO program. Guevara spent much of his time off from school working at an LGBTQIA center in Orange County, California. There, he was especially taken with the plight of trans individuals seeking healthcare.

“We had a number of physicians we referred patients to,” Guevara explained. “But only two we felt were affirming and offered a safe space to send our trans patients.”

The consequence of few medical “safe spaces” for trans individuals during a global pandemic is obvious, but the same issues have long existed for all LGBTQIA+ individuals.

“Safe spaces are about building trust,” Guevara explained. “Things like using our correct names, noting gender marker change and offering respect build that trust and make us feel safe. We just want to break the cycle of trauma and live our truth.”

When Guevara decided to return to school and pursue a career in medicine, he considered several educational options, including TUC. During the interview process, Guevara said he had many questions about how welcoming and open to inclusive teaching Touro leaders and faculty were.

“When I heard how respectful and welcoming Touro was, I thought, ‘Touro it is!’ This is where I’m going,” Guevara said.

Both Cho and Guevara said that even as first-year medical students, they have seen how responsive Touro leadership is to student-driven change.

Dr. Theo Smith, who joined the Touro faculty in July 2020, has also been impressed with the ways in which TUC is working to achieve better outcomes for LGBTQIA+ students and produce physicians who are respectful of and sensitive to the needs of all patients.

“When I joined the faculty mid-pandemic, I was really impressed because on campus there was a lot of conversation about structural competency, health disparities, and about inequity in care,” Dr. Smith said. “And it was really exciting to join campus when those conversations were happening…and they’re still happening. They never really end…just begin.”

It wasn’t long after he joined Touro that RHC students, who knew Dr. Smith was openly queer, asked him to act as faculty advisor to their organization. Dr. Smith said he was more than happy to sign on.

Throughout the pandemic RHC members, along with Dr. Smith, planned events and continued working with LGBTQIA+ patients as well as doing advocacy work for inclusive healthcare throughout Solano County and beyond.

“The pandemic just highlighted everything,” Dr. Smith said. “It just showed us the system…well, it’s not broken, the system is designed this way! And in order to change it, we have to really break down a lot of the structure that is there.”

Having experience seeking healthcare as queer patients, Cho, Guevara, and Smith knew the scenario is often fraught with trepidation and the ever-present possibility of the physician mis-gendering, misunderstanding, or simply being mis- or uninformed about their particular needs.  

“Prior to moving to California, I was coming to my doctors’ appointments with more information about my specific healthcare as a queer individual than they would know. They just didn’t have that training,” Smith said. “For me, it’s all about education. I’m a firm believer that education is liberation.”

That kind of liberation is exactly what students involved in TUC’s Rainbow Health Coalition are attempting to foster. And faculty’s willingness to listen and address the inadequacies in many clinical settings has been critical to what TUC has been able to achieve and to the things for which RHC has so fiercely advocated.

Early conversations Dr. Smith had with faculty and staff determined to create a culture friendly to LGBTQIA+ students led to new learning opportunities on the subject. But he gives most credit for changes being made to students who have been vocal advocates for themselves and their peers.

“We knew that over the years Touro had been responsive to student-driven change,” Guevara said, “and we’ve really found a lot of allies and support among faculty and our fellow students.”

Such support is what led to establishing a program known as “Safe Zone Training,” which is primarily taught by members of RHC.  

“I call in LGBTQIA+ 101,” Smith said. “It’s: here’s the terminology, here’s how we talk about people. We try to avoid assuming someone’s pronouns, their gender. We try to respect their identity.”

Discussions include topics such as making sure patient intake forms include inclusive language and by using non-gendered diagrams, asking about pronouns, speaking in terms of gender-identity rather than only asking about sex assigned at birth, including broad and inclusive definitions of family, and more.

Currently, leaders at TUC are working on plans to expand trainings offered to medical students by including such topics as trauma-informed care, sexual assault awareness, and expanded Safe Zone training.

Touro’s dedication to serving all segments of the population carries particular weight and urgency given the Nation’s current political climate. Indeed, thus far in 2022, state lawmakers across the United States have introduce more than 240 bills that would limit the rights of LGBTQIA+ individuals. More than half of those bill specifically target transgender people.

After working with the transgender community in Orange County for so long, Guevara is especially sensitive to the fears these individuals face in even seeking out healthcare.

“It’s very frightening for a trans person to not know how they will be treated when they go into a doctor’s office,” he said. “If non-traditional, self-identifying options are available on intake forms, or if the doctor and office staff use correct names and gender markers – that makes people feel safe and respected. It allows individuals to live their truths.”

Dr. Smith wholeheartedly agrees and stressed the critical importance of such actions.

“We have conclusive evidence that trans youth being able to access health care saves lives. It reduces depression. It reduces suicide,” Dr. Smith said. “As more states seek to deny healthcare to trans individuals and especially trans youth, it’s going to become an actual healthcare emergency. I believe we are training a generation of healthcare professionals to combat that emergency.”    

This pending emergency is at the heart of TUC’s work toward diversity and inclusion. It is why, for instance, COM leaders introduced a class called “Structural Competency” to the standard curriculum. The class addresses some of the social issues surrounding LGBTQI+ healthcare as well as racial and other inequities in medicine.

Many current inclusion efforts have grown out of student ideas and concerns. But Cho, Guevara, and Dr. Smith all agree that the efforts of the Rainbow Health Coalition as well as other student groups only serves to highlight the welcoming and supportive environment developed by TUC leadership.

“Student diversity, including LGBTQIA+, is one of the great strengths of our campus,” said Provost and Chief Academic Officer Dr Sarah Sweitzer. “It is key to connecting with the communities we serve in a deep and meaningful way and lays the foundation for reducing health inequities and improving community wellness.”

Yet, the inclusivity doesn’t stop at the Azuar Drive gates. Rather, the entire idea is to create a wave of informed, sensitive, and caring healthcare professionals that then washes over and compassionately envelops not only patients, but other professionals who did not have the benefit of a Touro education.

There has been a lot of trauma in the LGBTQIA+ community surrounding healthcare,” Guevara reiterated. “But I think of what we’re doing at Touro like this: when my class graduates (in 2025), I know we will be sending 130 doctors out into the world who will be more understanding, more caring, and more able to help and understand my community.”

That level of hope and understanding at TUC is no surprise to Dr. Smith. He believes joint student and leadership commitment will only continue to grow.  

“I want everyone to look at Touro California and say, ‘Their students are the most compassionate, conscientious clinicians that we see.’” Dr. Smith said. “That reputation is what we’re striving for.”