Screening for health

Yesterday as I was driving home from a long bike ride with my son—during which I indulgently stopped dozens of times to pick up rocks, played the announcer as he whizzed down the path on his new shiny red Schwinn,made sure he wore his hat, and gave him lots of water — I heard this story on NPR, about teenage girls and incarceration.

It turns out that most girls who are in juvenile detention have been victims of abuse. Furthermore, having health problems only increases their chance of recidivism.

Incarcerated girls […] are “one of the most vulnerable and unfortunately invisible populations in the country,” and up to 90 percent have experienced physical, sexual, or emotional abuse, according to Catherine Pierce, a senior advisor at the federal government’s Office of Juvenile Justice and Delinquency Prevention.

The health statistics are particularly grim: 41 percent of girls in detention have signs of vaginal injury consistent with sexual assault, up to a third have been or are currently pregnant, eight percent have had positive skin tests for tuberculosis and 30 percent need glasses but do not have them, according to research from the National Girls Health and Justice Institute.

The story hit me hard because it made me think about the inequalities that are all around us.

The parents and neighbors and aunts and sisters I know  think that we work hard to keep our children safe. We don’t let them walk to school alone. We do our best to make sure that they don’t end up around creepy strangers. We make them wear a helmet when they ride their two-wheelers, and worry if they don’t eat enough vegetables or if they watch too much television. We have resources: support systems, houses that are not infested with mold, enough food to eat every night. We have cars that aren’t constantly breaking down. We enroll them in Capoeira and tap dance, and soccer camp. Juvenile incarceration is not high on our list of worries.

But there is a whole subset of children who do not have this luxury, whose health and safety is under constant threat. Children who face persistent abuse, neglect, poverty. And too often, these children end up in detention.

What stood out to me about this story though, is not the horror show that is the poverty-to-prison pipeline, but the public health initiative that was being highlighted.

Leslie Acocoa, a psychologist based in California, developed the Girls Health Screen in response to what she saw as a system that was failing these girls.  The survey consists of 132 questions designed to identify urgent health issues, issues which are often not identified using the standard screening tool. The best part is, that it can be administered on a computer screen, providing an level of privacy that is rare in most intake interviews.

Why is this important?

Imagine you’re  a 13 year old girl, pregnant from sexual assault. Imagine you are being locked up for not showing up to court. Imagine that you’ve just entered the facility, and now a nurse is asking you a series of questions about your period, and pregnancy, and sexual assault. Now imagine the door is left open, and male guards are walking past.

I’ve never been in this particular situation, but I have often had health screens that I find difficult to endure. Most recently, I went for a free pap test in a cramped office with a huge dentist chair crammed into the corner, and florescent lights blinking overhead. The hallway was filled with overstuffed fileboxes and the carpet was dingy and worn. A very young, very perky nurse practitioner in training sat down and asked me a series of very personal questions.

Let’s just say, it brought out all my contrary instincts.What are you using for birth control? How many sexual partners have you had? How often do you go the dentist? I growled out the answer: I’m gay, none of your business, I don’t have any insurance– how often do you think I go the the dentist? It was unpleasant, and partially because I felt keenly aware that I was a charity case.

In reality, I have nothing to hide or to be ashamed of.  I’m highly educated, but I’m a freelancer and this shit healthcare system means I can’t afford insurance. No biggie.  I take responsibility for my health, and though I may not have a lot of money, I have plenty of resources. I don’t have a history of sexual and physical abuse. I’m an adult.  And most importantly, I’m not about to be incarcerated. But I still found it difficult to answer those questions honestly and difficult to feel like the providers  really cared about my answers.

If I was a pregnant 13 year old who had gone through all kinds of hell? I’m sure it would have been many times worse.

The creation of an excellent, relevant health screening tool is not the kind of initiative that tends to get a lot of attention. Screening tools are glamorous, and they’re not like an exciting robot arm that you move with your mind. But creating these tools is the kind of thing that public health can do well, and the story was a reminder of the importance of public health iniativies, that the population wide approaches can make such a difference.

What do you think? Have you ever had a really good health screening? Or really bad? What questions do you think doctors should ask that they don’t? Are there other effective public health initiatives that you’d like to see highlighted in the media?

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