Swedish partnership with UChicago Medicine trains young doctors in trauma care

In 2018, Selwyn O. Rogers, M.D., MPH, was tapped to lead University of Chicago Medicine’s development of the only level one adult trauma center on Chicago’s South Side. The center brought adult trauma care to a part of the city that had been left without the specialty for over a decade. Along with his team, Dr. Rogers is dedicated to unwinding the longstanding and catastrophic policies of social and economic abandonment of the largely Black and poor neighborhoods of Chicago’s South Side. As a public health expert and trauma surgeon, Dr. Rogers’ work addresses the disproportionate impact of violent crime on racial and ethnic minorities as well as the dearth of health and medical services that have for too long cost too many lives. 

 

We are faced daily with a stunning raft of national statistics: young Black and Brown people experience the highest rates of gun homicides; Black Americans are ten times more likely to die by gun homicide than white Americans; Gun violence is the leading cause of death among young Black men. Dr. Rogers insists we are not powerless. Throughout a career that includes leadership positions at health and education institutions across the United States, Dr. Rogers has worked to create multidisciplinary programs that address social and economic factors across the healthcare spectrum. A major piece of this is supporting the development of culturally and clinically competent doctors.

 

“It really requires people to be humble, exhibit humility in interactions, and be willing to say, ‘I don't know. What can you teach me as a patient? What can I learn from you?’” asks Dr. Rogers. 

 

In 2018, he and Marc Horton, M.D., FACS, director of Swedish’s General Surgery Residency Program, launched a partnership between Swedish and UChicago to train surgical residents in trauma care. The goal was to expose young doctors to the realities of trauma care, while supporting the high volume of cases at UChicago. The program was a success and to date has sent a resident to Chicago every year for the last three years. 

 

“I wanted Swedish residents to gain a better perspective of the disparities in the delivery of healthcare in or country, both racial and financial,” says Dr. Horton. “I wanted to increase their awareness of the travesty of gun violence in our country and the need for more research and better gun control legislation. I wanted to broaden their experience and make them more complete physicians, surgeons and people.”

 

Dr. Rogers visited Swedish in January. After his visit, we spoke with him to learn more about the unique partnership between UChicago and Providence Swedish and his dedication to addressing the violence that plagues many of our communities. This interview has been edited for clarity and length. 

 

I was born on St. Thomas and grew up on St. Croix in the United States Virgin Islands. I had the audacity of ignorance. I didn't know what I didn't know, but I knew that I loved learning and I particularly liked science. Initially, I thought that I was going to be a high school science teacher. However, probably through a combination of thinking about what would that mean, but also for me, curiosity, I opened an Encyclopedia Britannica to the letter M—medicine. Listed there were medical schools, including Johns Hopkins and Harvard. I said, “Well, that sounds an interesting way to go about using your science, to help people by becoming a physician.”  No one in my family was a physician. In fact, neither my mom nor dad went to college, I was charting a new course and it was really that audacity of ignorance that pushed me into a career path defined by making the most of opportunities; that and hard work. 

 

Having said that, what specifically got me into a career in trauma surgery is because I liked taking care of whole people, not just parts of people. I loved the idea that when you meet someone potentially on the worst day of their life—be it after a car accident, firearm injury, stabbing or assault—that your job was to create some sense of order from that chaos in their lives. And you take care of them in a holistic way, all of them, not just part of them. I was struck during my training in Boston, where I started and where I began my academics and eventually my professional career as a trauma surgeon in an academic medical center, that disproportionately, firearm-related injuries specifically affected people of color. People who look like me.

 

The Boston Globe had a story in the early 1990's with a hundred faces on the front page, and these were all people who had died of firearm-related injuries and all of them were Black and Brown faces. I asked myself why that was. And I committed my career to try to better understand, but more importantly, attack and fix that problem. And it's a journey that's continued throughout my professional life. In many ways I have prepared my entire career to be here at UChicago Medicine and to launch the Trauma Center at UChicago Medicine. This has been a long journey that started in 1989 when the UChicago Medicine first closed its doors as a level of trauma center for adults.

 

[Why was that allowed to happen] is a great question and one that books will be written about in the future. In 1989, UChicago Medicine got out of the adult trauma business. It continued to do pediatric trauma, so patients 16 years old and younger could be treated, but the hospital got out of the adult business. Prior to 1989, there had been two level one trauma centers for adults on the south side of Chicago. After 1991, [one of them] was purchased and stopped its level one trauma service center. After that there were none. South Chicago, an area that covers about 650,000 people, was a relative trauma desert. Patients who were drastically injured from a car accident, fall, gunshot wound, assault or stab wound—basically any form of force that causes damage to the body physically and leading to injury—were transported to one of the other level one trauma centers across Chicago, which is a municipality of 77 neighborhoods and the third largest city in the United States. 

 

I also need to give you a little more backstory on this. In 1984, there was a very famous high school basketball player in Chicago named Benjamin Wilson, who was on track to play college basketball at the highest level prior to hitting the NBA because he had that type of talent, generational talent. Leaving school with his girlfriend, he bumped into two teenagers also his age; an accidental brush of two human beings crossing the same space at the same time, led to an altercation, led to an escalation, led to one individual pulling out a gun and shooting Benji Wilson twice, he was taken to the nearest hospital, which was a rule at the time. The nearest hospital, a community hospital, didn't have a surgeon on site or blood banking to the extent that needed multiple transfusions of blood. There was a several hour delay for Benji Wilson to get to the operating room. When you have the worst type of trauma that puts you into hemorrhagic shock, meaning you're bleeding to death, time matters, not measured in hours, but measured in minutes, and it took too long. And so, by the time everything was mobilized, and you went to the operative room, Benji Wilson died. Benji’s death led to the creation of a rule that if you are the most severely injured, you must be taken to an adult level one trauma center, not the nearest hospital.

 

Fast forward August 2010, there's another Black kid, 19-year-old named Damien Turner, who is also well known in the community as a community activist, advocating for rent control equity. Damien was a social activist before that became popular nomenclature for young people who want to see systemic change. He was shot in the back, literally four blocks from the nearest UChicago Medicine. And because of the rule, the Benji Wilson rule, if you will, he was taken to Northwestern Hospital, which was about eight miles away, and he died. His mother the next day got on television and said, if my son were taken to UChicago Medicine he would still be alive. While that's debatable because he had probably a lethal injury, [Damien] would've gotten the best chance of survival had he gone to the nearest trauma hospital, which was not at the time, University of Chicago Medicine. That led to community activism by many, many, many groups. Fearless Leading by Youth, South Side Together Organizing for Power students, University of Chicago students and faculty, and community groups across a wide range of affiliations, religious identity, proclivities, preferences, platforms, all working together for one and one thing only: an adult level one trauma center on the South Side.

 

From a public health perspective, it's about identifying risk factors, identifying protective factors, and preventing harm. So that's why we’ve made such remarkable progress in the 20th century with respect to life expectancy; we’ve developed clean water, clean air, those two things contribute to diseases. For example, a child getting an infectious diarrheal disease, dysentery, if you don't have cleaning water, a whole bunch of kids will get dysentery. If they clean up the water, less kids with dysentery, more kids living productive lives. Another analogy is the river analogy where you have people being thrown in the river, rapid falls, taking them downstream, and you are trying your best to pull people out of the river downstream, but you can't get them all, and some end up dying. What if we attacked this problem upstream before people were thrown in the river in the first place? That’s what informed me about pushing for my role, not just being the founding director of the trauma center of the UChicago Medicine, but also executive vice president of community health.

 

Intersectionality is about how genetic, social and environmental factors and our lived experiences affect the manifestation of who we are as human beings. We all acknowledge the classic genes or nature versus nurture theories; having said that I will submit that nobody comes out of the womb violent, nor does anybody come out of the womb racist or elitist. Those are constructs that are infused into us based on our lived experience and built environment. So, with respect to this concept of intersectionality, violence is harm to an individual by another individual or community or system that can be verbal, physical, or spiritual, but leads to the same thing: deprivation and loss. We often think of violence in the basest way: a physical injury, be it a knife or bullet that goes through a gun or a semi-automatic weapon or a fist that goes to one's base as violence. But there's another larger category of violence that we call structural violence. That's how systems are in place that disproportionately [harm] one group over another.

The number one reason that you would be admitted to the trauma center at the UChicago Medicine is if you've been shot. That's in the top 1% of all trauma centers in the country. And that is damning for the city of Chicago, for the State of Illinois and for our country. [Gun violence] disproportionately affects men of color between the ages of 17 and 30. Knowing that the numbers were going to be high, we searched locally for resident physicians [to build our teams], which were always the backbone of the surgical care team.  We had enough attendings, but to have the resident teams and not have them be overpowered by the sheer volume, it was clear that we needed a partner. I got a cold call from Dr. Horton and the program’s associate director Ryan Martinez, M.D., FACS. I listened. We talked, we identified that we had shared values and we had a shared sense of what's possible. And then we dove in. Initially in a tentative way, with a contract for three years. The residents at Swedish are in Seattle. They have different backgrounds. They look different than patients from the South Side. They see the world differently than the South Side of Chicago. This may not be exactly what they signed on for, but they need this critical experience. They need operative trauma experience. I think this could be a win-win. So, Marc and I agreed, shook hands and got all the paperwork signed, and literally solved the problems that both of us had: Swedish residents needed experience and I needed residents who wanted to train in trauma. On May 1, 2018, Oliver Bellevue was the first Swedish resident at the Trauma Center at UChicago Medicine. It is exceptional and we would not have been successful as a trauma center without the partnership of Swedish.

 

We retain a Swedish resident for the entire year. Residents do seven seven-to-eight-week rotations, depending on the number of total residents in a year. Some have come back for more duty because they want to do trauma. In fact, I think before this experience, very few Swedish residents went into trauma critical care as a specialty choice. And we've had a number who have, and others who didn't go into trauma found that the experience made them better doctors, which I’ve always fundamentally known helps you become good at taking care of sick people. You become good at dealing with emergencies. You become good at dealing with diverse populations. I mean that in every way: race, gender, gender identity, ethnicity, language—everything. It really requires people to be humble, exhibit humility in interactions, and be willing to say, “I don't know. What can you teach me as a patient? What can I learn from you?” My take, beyond the technical, is that the Swedish residents have really gotten a lot out the program in terms of being humanistic physicians—meeting people, who they otherwise may never have met, where they are.

 

I think there's an incredible opportunity for us to think collectively that this, what we're trying to do here is not unique to Chicago because the world is increasingly a global place. And the fact of the matter is what happens in Angola, or as we saw China, or in the case of Ebola, Ivory Coast affects us all and in an increasingly global environment called the world, the more we can interact with others and meet them where they are without bias, without atomist, the better we are as a world and not just as a health system or as a hospital clinic. So that's my grand vision, my really big idea—to make it a goal of all healthcare and the intersectionality of healthcare, to maximize the value of all people. And obviously if you don't have safety or you don’t have your health, it's hard to maximize the value of people. And as we said before, health is not to just term by my ability to prescribe an antihypertensive or an antibiotic, it's all about the social determinants of health. When we don't maximize the value of all people, we miss out on human potential. 

 

I think it's incredible what Dr. Horton, Dr. Martinez and Providence Swedish have pushed forward. I think it's a model for what other places should do. Somewhere around 5% of all physicians are African American, about 5% or 5.7% of all physicians are Hispanic. As you know, African Americans make about 13% and Hispanics, about 18% [of the U.S population]. Again, you can fact-check me on those numbers, but obviously we don't represent, we're not represented in the same numbers as the general population. Having said that, you don't need a Black doctor to take care of you necessarily as a Black patient, nor do you need a Hispanic doctor to take care of you as a Hispanic patient or Chinese or Korean or Japanese or ethnicity. But what do you need? You need someone who hears, or you need someone who listens. You need someone who is not culturally competent necessarily because I am not culturally competent with every Black person I meet, but someone who's culturally dexterous and someone who's culturally curious. But that takes humility. It also takes patience. That goes a long way to build something that is foundational to health care delivery: trust.

 

I think that's a secret sauce with programs like the Providence Swedish partnership with UChicago and Meharry Medical School/ Providence Swedish Partnership—they build trust. That is true for trusting medical students in their education. That is true for trusting relationships between medical students and residents with the patients that they come to serve. That is true for when they become attendings. How can they be in an environment where they feel trusted and listened to? And that ties in with the fact that African Americans and Hispanic Americans are more likely to serve Hispanic and African American communities disproportionately compared to other communities. It’s not necessarily one-to-one, because you're not cared for by a person’s race in the United States, you’re cared for by a person, but if I'm walking by the emergency department, and there is an eight-year-old Black boy whose eyes are bugged out of his brain because he's never seen, a Black doctor in a white coat. And I say, "Hello, son. Yes, I am a doctor." That was the most impactful thing I did that day: I allowed him to see something that he could not imagine before seeing me.