“Every person deserves the right to their own wellbeing regardless of their path in life,” says first-year Geisel student Louisa Chen. Her perspective on community medicine is grounded in deep sense of compassion that took root during her childhood. Chen’s family moved frequently, rarely settling in one country for long—Australia, China, then America. Wherever she lived, it was clear to her that one of the cruelest forms of injustice was health care disparity.
“In China, illness and health issues were not seen as misfortune, but were instead viewed as though they reflected one’s own inherent personal failures,” she says. “As a child, I was berated by family members for acknowledging the suffering, and even the presence, of people living on the streets. I was to understand I could not do anything to improve other’s lives or change how an ignorant society treated people. I grew up feeling powerless and voiceless.”
As an undergraduate student at the University of California, Irvine, in Orange County where Chen discovered deep pockets of poverty within a county known for affluence—the veneer of wealth cloaking the evident social disparity. In this, she saw a need for not only free healthcare, but for a harm reduction program. As an undergraduate working alongside medical students, she initiated two ambitious projects to help the disadvantaged—Crescent Clinic and the Orange County Needle Exchange Program—projects that had power to change people’s lives.
“I felt empowered for the first time in my life,” Chen recalls. “This was when I realized I could truly do something to affect another person’s wellbeing—that I could actually make a difference. It was an incredible realization.”
Crescent Clinic caters to the medically underserved, immigrant, and undocumented populations in Orange County. Over the course of her undergraduate years, Chen held many jobs, eventually managing the clinic, and she describes those years as one of the most defining and influential experiences of her life. She was particularly struck by the way the clinic’s volunteer doctors worked. “They weren’t there just to treat patients and prescribe them medication—they were there to listen to patients’ stories, advocate for them by helping them locate resources, and educate them so that they could have a chance at living a better life,” she says.
Working at Crescent Clinic further exposed her to the county’s prolific opioid crisis. At the time, Orange County was the only county in California without a needle exchange program. The county’s political leadership consistently resisted clean needle distribution based on the prevailing opinion among the largely conservative demographic that it would lead to increased drug use. On the contrary, studies have shown that needle exchange programs do not encourage drug use, but rather lead to decreased transmission of blood-borne pathogens. The goal of the Orange County Needle Exchange was to properly dispose of used needles, distribute clean needles, and educate about safe usage in order to prevent transmission of HIV, Hep B, and Hep C. In other words, keeping users healthy and alive.
“Establishing the needle exchange was an uphill battle,” Chen explains. “Because of the political landscape we bypassed the county and applied directly to the state, otherwise we knew the application would be immediately shut down.” California rejected the application, but the students persevered and reapplied. After overcoming numerous political hurdles, a year later they received permission to open Orange County’s first needle exchange program.
“On our first day we set up in Santa Ana where there’s a large population of homeless people with histories of drug use—news of our arrival at the Civic Center quickly spread,” Chen recalls. “Every week we were there, we would dispose of thousands of used needles in a few hours and give out thousands of clean ones.”
Partnering with a local grief group consisting of mothers whose children had died from opioid overdose, Chen and her colleagues embedded a Naloxone (also known as Narcan) distribution program within the needle exchange. Naloxone is an overdose reversal drug, given via injection, that can save the life of someone who has overdosed if it is immediately administered. The students distributed the drug to users’ friends and family along with kits containing information about what to do in the harrowing event of an overdose. “We taught them to recognize the signs of overdose, who to call, and how to avoid arrest. This was somewhat controversial because there is a history of conflict between the police and this population,” she says.
According to Chen, there have been hundreds of overdose rescues to date. Though she has left Orange County for Hanover, she says it is heartwarming to know the project is still going strong and moving forward.
The needle exchange taught her that public policy and advocacy have power to help large populations improve their health. In addition to collecting and providing clean needles, the exchange had resources readily available for those who wanted to enter a recovery program. When it comes to quitting, every person has their unique journey, Chen says, and if you aren’t personally in that situation it may be difficult to understand why users may not be ready to stop.
“They have walked down a different road in life. Judging them or forcing them to change isn’t going to help anybody in the long term,” Chen notes. “So our ultimate purpose was to give people a space to feel accepted and safe. A lot of drug users are in hiding and afraid of the police and it doesn’t help to criminalize their behavior—it won’t help them get away from drugs. But if we give them clean needles and prevent them from contracting serious diseases, we give them another chance.” Through the needle exchange, she formed friendships with the civic center community creating a bond that allowed her to better help those in need.
“For me, the personal connection is more important than anything else. Being a doctor means making that same connection with my patients and empowering them to improve their lives,” she says.
It’s the reason she chose Geisel.
Recalling her first campus visit, Chen says she felt as though she belonged here—surrounded by people who felt the same need to make a difference. “It was something I think I’ve been seeking for a long time,” she says. “I knew I’d be happy here.”