In the week after George Floyd was killed in Minneapolis, LaShyra Nolen was asked by her professors each day how she was doing.

To share how she was feeling, the first-year student at Harvard Medical School shared a poem on Twitter, explaining that she could no longer pretend to be okay. In her verses, she drew attention to the disproportionate impacts of the COVID-19 pandemic on communities of color, systemic racism, and police brutality.

The truth is Black students are NOT okay, she wrote.

Nolen, who is the first Black woman to serve as student council president at the institution, is no stranger to advocating for social and racial justice. The Harvard student told Boston.com she believes it is her responsibility to make sure she uses her growing platform in the medical field to fight for health equity and to help tell the stories of communities whose voices are not being heard.

In June, Nolen announced she and her classmates had launched a petition to rename the Holmes Society at Harvard Medical School, named after Oliver Wendell Holmes Sr., citing his promotion of eugenics and violence toward Black and Indigenous peoples.

The same month, the medical student had an essay published in the New England Journal of Medicine that laid out the need for increased representation of Black people and minority populations in medical training, providing examples from her own training.

In one, she noted that her CPR training used mannequins with white male bodies. In another instance, she recalled that during a discussion about Lyme disease in a microbiology class the professor showed photos from the Centers for Disease Control and Prevention of the red bulls-eye rash on white skin, only noting that it is more difficult to see the rash on melanated skin in response to a students question.

If medical students and trainees are taught to recognize symptoms of disease in only white patients and learn to perform lifesaving maneuvers on only male-bodied mannequins, medical educators may be unwittingly contributing to health disparities instead of mitigating them, Nolen wrote.

The California native said she knew since she was in third grade that she wanted to be a doctor, but her dedication and interest in addressing inequities stems from when she moved from Compton to the suburb of Rancho Cucamonga at the age of 10.

It was a completely different life, she said.

The roads were different, the access to basic needs everything was just so plentiful, and that was so different from my experience in Compton and in L.A. she said. That was when I really started to think about differences and race.

She continued to question the disparities she saw between the suburb where she lived, which was predominantly white, and her old neighborhood, which was predominantly Black and Latinx. Those questions took on another layer of urgency when she was 15 and a family member passed away from what she called a preventable death, from complications of obesity and diabetes.

It wasnt until she got to college and learned about the social determinants of health that she began to be able to articulate what shed grown up witnessing, she said.

I started to get a lexicon for all these different things that Id experienced in my childhood, Nolen said. Why we have these differences, how those differences then go on to impact your health, how that impacted my family. All of those things came together, and that is what really inspires my passion because Ive seen it personally. I still continue to see it.

Below, Nolen speaks more about the importance of activism in health care and the changes she hopes to see occur in medical institutions to address systemic racism.

The interview has been lightly edited for clarity and length.

Boston.com: The country is now in a moment of addressing two public health crises COVID-19 and racism. How does it feel to be a medical student right now, and what concerns do you have as efforts to address these two crises move forward?

LaShyra Nolen: Its such an interesting time to be a medical student, and I think its an especially interesting time to be a medical student at Harvard. Because here I am getting this amazing education Im learning about ace-inhibitors, Im learning about the pathophysiology of COVID-19. But even if I get the best education, even if I become the best surgeon, theres still a huge possibility that my patient could walk outside of the clinic and be stopped by a police officer. And if they move too quickly, they might end up losing their life. Or, its very possible that my patient will go back to a community where they dont have access to the basic needs that they need to live out a healthy life.

I think those are the conversations that were starting to finally have. Because it doesnt matter how good medicine gets at finding cures and doing research and pushing the envelope in the biomedical realm, [if] theres still going to be systemic inequity in our society.

If we dont address that, then were never really going to be able to help our patients have the best outcomes that they deserve. As a medical student, Im learning all this science, which is so key for treating your patients. But theres also work that needs to be done outside the clinic it cant stop there.

What were you hoping people would take away from the poem you shared on Twitter, and what was the response that you received after you shared it?

That poem came from a place of all of this turmoil around us being laid to bare. In one context, we have this global pandemic, COVID-19, ravaging through Black communities, Latinx communities, indigenous communities. Then concurrently we have this other pandemic that weve always known to exist systemic racism.

Were seeing so many Black peoples lives being taken on screens, being shown across the country, across the globe. And I was expected to come to class, and I was expected to pretend that everyone was OK. I was expected to just learn the pathophysiology, recite the things that I had studied the night before. That isnt just an experience of medical students its the experience of all Black professionals and all Black students. We have to separate our Blackness from our experience as students and professionals so often. And that was me just saying, Im not OK, and instead of you asking if Im OK, I want you to educate yourself and learn about why Im not OK and make sure that you arent complicit in the system that is contributing to the reason why Im not OK.

Thats really where that came from, and the response that I got from it was really positive. What always surprises me when I speak out is how much feedback Ill get from people who are higher up in the medical hierarchy. Residents and folks who are professors, and they say, Thank you for saying that. Because they dont have the space to say that and be vulnerable and feel comfortable and feel like their jobs arent going to be jeopardy if they say, Hey, Im not doing OK, and, You guys really need to address these issues that were experiencing. It just goes to show how the hierarchy of academic medicine can be harmful.

What do you see as the responsibility you and medical professionals have when it comes to activism? What role do you think doctors or health care professionals should be taking on when it comes to advocacy and social justice, and why do you think its important they are involved?

I think its extremely important. Number one, because I think physicians and health care providers should care about all things that affect their patients health. There have been numerous studies that have come out and shown that access to housing, access to education, access to basic human needs are what folks need to have the best health outcomes. All of that is so inextricably connected to sociology and history and psychology.

We cant continue to just stay in the realm of medicine, because our world gets the benefits from medicine. Almost 20 percent of our GDP comes from health care spending and costs. So we cant just pretend that medicine isnt a political issue, or that its completely separate. Its extremely important for us to not just stay in this lane of medicine because thats just the beginning. When we give the patient the medicine, we have to make sure that theyre able to afford it, we have to make sure that the pill bottle is in the correct language for them to understand, we have to make sure that theyre able to have transportation to get to the clinic. Its so important that we engage in activism because its going to be a huge part of maintaining our patients health and thats essentially what were supposed to be doing as healers.

Given the petition to rename the Holmes Society and your piece in the NEJM, can you speak more to the importance of health professionals addressing institutionalized racism within the institution of medicine and how that can be done?

These are the perfect examples of two buckets that I view advocacy and activism in. One bucket is the inward facing activism. The Holmes Society changing its name is an example of that, because here we have this society where students go to learn, students go to build relationships and form some of their fondest memories of medical school. But the namesake of this institution is someone who was a eugenist, someone who was known to be racist and was actively violent with their words towards indigenous and Black communities. When we have an individual like that representing this space thats supposed to be so wholesome and a safe haven, that can be really dangerous. That work needs to be done so that students of color Black students, indigenous students, Lantinx students can thrive and feel comfortable in these spaces. We cant continue to just recruit students of color and then not protect them when they get to these institutions. Protection goes beyond just evaluations and making sure that they feel like they can thrive academically and arent experiencing micro-aggressions. Its, Who are the people on our walls? How are we allowing violence to be perpetuated silently by who we allow to take up space in these institutions? That is why changing the name of Holmes is so important.

The New England Journal of Medicine piece came out of this idea of more outward facing activism. Even though its a change that needs to happen within the medical institution, if were graduating physicians who dont even know how to recognize key symptoms in patients of color or if we dont graduate physicians who understand the nuance of doing CPR on a person with breasts the fact that you have to take off that persons shirt and how uncomfortable that might be for that individual and talking about issues of consent its just so much more nuanced to the different things were learning. But we just ignore it. They call it the reference man we always use men as the reference, particularly white men. Thats so problematic because that can go on to perpetuate health disparities in the communities that we seek to serve.

If were going to be institutions that are mission-driven and we want to increase diversity within our medical school and we want to help mitigate health disparities, we have to look at the small insidious ways that we might be actually doing more harm than good. The worst part is that often Black students, the marginalized student, is often the person that has to put themselves out there to ask that question. And I think that in itself is a really big issue because why is that my non-Black peers didnt raise their hands and say, Hey, how would I recognize this in a patient with darker skin? Because those are going to be their patients, too. Thats the direction we have to move in this antiracist movement it shouldnt be that its always the responsibility of the marginalized person to stand up for the marginalized group. It should be a collective effort that we all value the humanity of all patients. And I really hope thats the direction that we go in.

In a speech last August, you addressed young Black girls, saying You cant be what you cant see when it comes to diversity in medicine. Can you speak to more of what you meant when you said that medicine will not progress without the diversity of having young Black women going into the field, and what changes do you want to see taken to ensure theres greater diversity?

I think it will play a very important role in the future. I personally did not see a Black doctor until the summer of my freshman year of college. I had gone through my entire life with this dream of becoming a doctor, and the reason why that dream was kept alive is because I had a grandmother and a mother who believed in me endlessly, even though they had never necessarily seen a Black doctor before. They just believed in me and they just breathed life into my dreams, but it wasnt until I saw that Black doctor that it all clicked, and I said, OK, it seems like its possible to actually achieve this dream. We have to start exposing youth to the sciences early on, and beyond just exposing youth to the sciences, we also have to mitigate the different forms of structural racism that are embedded in society. We have to think about, How is that when I build a new building for my medical school, that Im then taking tax revenue away from the city? And then, How is that going to affect how schools are able to invest in educational programs? We have to think about how we as institutions are complicit in systemic racism beyond just having these pipeline programs. We have to have a two-fold approach to addressing this issue of representation, but then also making sure that were doing the work to mitigate systemic racism.

Is there anything else you want to say or want people to know?

Antiracism has to be an every day, every moment work. It cant be something that only lasts this summer, it cant be something that only lasts in 2020. It has to be something that people are actively engaging in every moment of their life, because racism is so deeply embedded into the fabric of America and into the fabric of our everyday lives that we dont even realize it. Therere many different ways people can mitigate this, but its going to happen through uncomfortable conversations, speaking out against the ways that systemic racism has silently been able to fester in our academic environments, among other things. This work is uncomfortable and its ongoing, and we should never stop.

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LaShyra Nolen is pushing for change within Harvard Medical School. Heres what she wants you to know. - Boston.com