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It is hard to believe that my time in New Orleans is coming to an end. Over these past seven weeks, I have tasted some of the best seafood I’ll probably ever get to eat, enjoyed the live jazz music that this city is so well known for, and witnessed the sights and smells of varying degrees of pleasantness on Bourbon Street. Despite the at-times unbearable humidity and public transportation system that operates with a nonchalance that is foreign to this native New Yorker, I wouldn’t trade my experience in the Big Easy for anything. More than any other place I have visited, New Orleans is a city of contrasts that reflect its unique culture and complicated history. The Uptown area where we currently live is full of beautiful multimillion-dollar homes and famous (not to mention pricey) restaurants like Commander’s Palace. However, New Orleans is also a place of astonishing levels of crime; the city’s homicide rate places it in the top 5 nationwide, for example. Even a seemingly casual night out can display the city’s dichotomy in terrifying ways. The rowdy groups of drunken tourists sipping on hand grenades downtown are largely ignorant to the plight of the young female dancers who work in the street’s countless strip clubs, many of whom are victims of sex trafficking and drug addiction. While it is difficult to grasp the complexity of these issues during our short stay here, our weekly group reflections and visits to locations like The Covenant House, a shelter for young adults, have helped us understand how education level, race, homelessness, and other factors intersect to contribute to the various inequalities found throughout the city.

As a hopeful doctor-to-be with a particular interest in how health systems function, I am especially grateful for my participation in the DukeEngage NOLA program because of its emphasis on public and community health.

As a hopeful doctor-to-be with a particular interest in how health systems function, I am especially grateful for my participation in the DukeEngage NOLA program because of its emphasis on public and community health. My work this summer will help to fulfill to the Experiential Learning Activity of my Global Health major. Duke’s interdisciplinary Global Health major requires students to spend 8 weeks full time completing fieldwork, research, or a global health-related internship in order to apply what we have learned in our courses and get a glimpse of what it means to mitigate health disparities outside of the classroom. At first, despite my absolute excitement to spend the summer in New Orleans, I almost felt as if I was taking the “easy way out” by completing the requirement domestically instead of visiting a country with seemingly more pressing health needs. While some of my classmates were traveling to Central America to provide basic care in rural clinics or completing fieldwork in Haiti or Kenya, I would be living in an comfortable apartment with air-conditioning and wifi while getting the chance to work in an renowned medical center. If we’re being totally honest, making a tangible impact in 8 weeks is nearly impossible regardless of a community’s level of need or lack of resources. I knew that no matter where I fulfilled my global health experience, I would barely be scratching the surface of dealing with longstanding health inequities and other issues that deserve our attention. Even so, I spent my spring semester wondering if I was being selfish or halfhearted in my passion for global health by choosing to spend my summer in a location that, albeit quite different from Long Island and Duke University, would still be much more comfortable for me than traveling internationally.

While it is obvious that my experiences in New Orleans will ultimately be extremely different from those of my peers who completed international fieldwork, my summer has made it clearer to me than ever that one doesn’t need to cross borders to witness health disparities, a lack of access to care, and health systems in need of fixing.

As in many parts of the United States, world-class care for complex medical problems is available in New Orleans, if one can afford it. Even before Hurricane Katrina destroyed many of the Gulf Coast’s hospitals and clinics, Louisiana suffered from one of the highest health uninsurance rates nationwide. In New Orleans, many of the city’s uninsured, who belong to a disproportionately poor and minority population, received care at Charity Hospital. This hospital provided over 80% of all uncompensated care throughout the state and was also the primary center for substance abuse and psychiatric care in the area. After suffering immense damage during Hurricane Katrina in 2005, Charity Hospital ceased to reopen, shifting the burden of providing care for insurance-lacking patients to other hospitals throughout the city. The trauma of the event further increased the need for mental health services, and the billions of dollars in destruction caused many to lose their jobs and in turn their employer-sponsored health insurance. This perfect storm scenario, in which the need for care increased simultaneously with a decreased ability to provide it, continues to plague New Orleans as it struggles to provide health services to its poorest and most vulnerable populations. These health inequities combine with varying levels of access to education, employment, affordable housing, and other factors that allow some individuals to prosper while others are stuck in an inescapable spiral of poverty.

The story of Charity Hospital is just one of many that has influenced the present-day health care climate of New Orleans. If I’ve learned anything this summer, it is that there is more than meets the eye to any situation, especially societal issues like crime and inequality. It is easy to blame individuals for committing violent acts or failing to move put the economic ladder, but these dilemmas don’t occur in a vacuum. Reducing crime isn’t as simple as implementing stop-and-frisk policies or increasing the number of police officers who patrol the French Quarter on weekends; we can’t see improvements until we take a long, careful look at access to health care and education.

This reflection has been a bit long-winded, but if I had to cite one of my biggest take-aways of my time here this summer, it would be that global health is local. The issues that affect the United States health care system — a lack of universal coverage and stratospheric costs, to name a few — are certainly different from those that affect countries in the Global South. However, this does not mean that pursuing health-related work domestically is less honorable or valuable than participating in global health work that requires traveling thousands of miles away. As we’ve all observed in the recent heath care bill debates that have consumed the news cycle this summer, even our (supposedly) intelligent and qualified elected officials cannot come up with a way of tackling the costly and disjointed beast that is our health care system. An immense amount of work needs to be done, by those not only working in medical field, but also individuals in the fields of education, criminal justice, and policy. Being able to learn about the multifaceted dilemmas that impede the supplying of health care in the New Orleans area and throughout the United States in general has made me more interested in tackling the challenges that accompany my future profession,  regardless of how far away (or not) my work takes me.