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INCLUSION AT ICO, IN OPTOMETRY AND IN HEALTHCARE
ICO has a long-standing commitment to serving a population that has suffered from lack of access to care. As the years have unfolded, and the makeup of our neighborhood has changed, with rent and mortgage prices rising, the Coronavirus pandemic and recent social unrest has made it clear that in the U.S. there are still socioeconomic inequities that affect everyday life and well-being. There are still huge gaps in our country both in terms of access to care and access to higher education, and in particular for ICO, who ultimately receives a doctorate in optometry. These events require us to ensure that our institution continues to serve our community well.
With our patient population hovering around 50-55% African American and 30-35% Latinx, there is clearly a need for ODs and students who can easily cross cultural divides. According to data from ASCO, rates of Latinos pursuing an optometry degree have gradually increased, from 3% to 10%. However, the national average of African Americans pursuing an optometry degree continues to hover around 4%, with the highest percentage of applicants actually occurring in 2009-2010. This needs to change.
We sat down with Lester Efianayi ’21 and Randi- Jo Francis ’21, two fourth-year optometry students, as well as Dr. Leonard Messner, Vice President for Strategy and Institutional Advancement and the head of the DEI task force, to discuss both ICO’s role in the Bronzeville community as well as areas of improvement for ICO. Note: These interviews were held separately, but for ease of reading, have been combined. Interviews have been shortened for clarity.
What role do you see ICO playing in the Bronzeville community?
Dr. Messner: The Illinois Eye Institute has been a center of excellence for eye and vision care in Bronzeville and related communities for many many years. It’s not unusual for us to have four generations of patients visiting the IEI. The patient population is loyal to us because we are loyal to them. We do the absolute best we can to take care of them.
Randi-Jo Francis: We play such an important role in the Bronzeville community. Our patients rely on us a lot. Actually, just today, I had a patient who had previously been diagnosed with a systemic condition by one of our attending doctors. Years later, this patient still remembered that attending doctor. When he saw the doctor today, the first thing he said was, “You were the very first person to identify this condition. I am treating it today in part because of you.”
It's not just eye exams that make us an important part of the community. Before the Coronavirus pandemic, I remember working the security desk, and we would hold events in our lecture hall – both events related to general care (the diabetes support group), but also, we served as a space for the community to convene. For example, they held a middle school graduation ceremony in our lecture hall. I think it’s so wonderful that we open up our facilities for those events as well.
Lester Efianayi: My connection to Bronzeville and mindset about Bronzeville has just completely changed from first to fourth year. Having been here now for four years and having seen so many patients in the clinic, I have gone from being completely immersed in the ICO community – soaking up as much learning as I could – to
being very involved in the Bronzeville community both through community service and through relationships with community members. I feel now like I’m part of the community, not just someone who goes to school here.
With this patient population, we find a lot of different conditions, a lot of different people who walk through the door. So, you have to make sure you remind yourself to be relatable to the patient while at the same time being in control as a doctor because you always want to have their best interest in mind.
"One thing I would like to note, I think representation is important, but I also think it’s important that students exercise good cultural competency. No matter what race you are, the most important thing is to relate, to educate and to hold conversations."
Randi-Jo Francis ’21
What has ICO done so far in terms of access to care?
Dr. Messner: One thing, perhaps not necessarily directly related to students but of great importance to patients, is the passing of the Affordable Care Act which has significantly improved access to care. The Affordable Care Act has been a huge leveler. After ACA was passed, we went from 15% uninsured to 5% uninsured. That's enormous. A 10% decrease is huge, especially for our population.
Access to healthcare is better after the Affordable Care Act was passed, and President Obama is largely responsible for that. And, you know, we'll see what happens as things evolve, but there are still issues – Medicaid, for example. So much of what our patients need is not covered directly through Medicaid.
That’s one of the reasons we work so hard to garner support from foundations and individuals to try to bridge the gap between what Medicaid will pay for patient care and what it costs to treat the patients.
Why does representation matter? And how has our patient population affected you as a clinician?
Randi-Jo Francis: Having someone in front of you that looks like you really does matter. I can connect with many of my patients because I have family members who have diabetes, hypertension and other diseases that are endemic to many Black communities.
The patients have had such a large impact on how I have grown as a clinician. It’s not often that they see a Black student as a clinician. The sense of appreciation I got from our patients made me want to work even harder. They really are the force that drives me to be the best clinician I can be.
When I leave the exam, they often end the exam with words like “Best Wishes” and “I’m praying for you.” It’s great to hear those types of words of encouragement.
Lester Efianayi: Seeing is believing. When I was a kid, the only role models I would see on TV were either in the entertainment industry or athletes. Without role models serving as inspiration, it’s hard to imagine yourself in a certain position or in a certain career. If you don’t have anyone that you can relate to in that field, how likely is it that you will end up there?
We have such a strong impact on patients. There just aren’t many Black male optometrists. There are so many times when I have been in clinic and the patients tell me how appreciative they are to see a familiar face. It really does impact the community seeing people that look like them as future doctors.
How do we ensure that ICO is looking at patient care holistically?
Randi-Jo Francis: Given the cases we see in the IEI, we need to be looking at a patient’s overall wellness rather than treating one specific issue. We are often educating beyond just eye issues. We work with patients who have diabetes or hypertension. So, we are also teaching them about blood sugar levels and high blood pressure. We’re often working with primary care providers. With all the information we need to give, it’s even more important to relate to the patient – not only in terms of their ocular health, but also just focusing on a patient’s overall well-being.
One thing I would like to note, I think representation is important, but I also think it’s important that students exercise good cultural competency. No matter what race you are, the most important thing is to relate, to educate, and to hold conversations. We can’t just be doctors trying to get XYZ done. We have to see the person in front of us.
Dr. Messner: Over a decade ago, we were actually the very first optometric institution to be awarded a Robert Wood Johnson grant – specifically because of the type of care we provided at the IEI. Working with a population that is often under or uninsured, we can often find serious cases even during routine checkups. These patients may come to us because they believe they need a new prescription (if you have blurry vision, it’s very hard to work effectively.) But ultimately after the eye examination, we identified the patient’s blurry vision as being due to diabetic retinopathy or some other ocular manifestation of systemic disease. Because many of these patients had not seen a primary care provider for many years, many of these cases would have gone unnoticed without our involvement. Through something as innocuous as a vision screening, we were able to identify underlying systemic medical diseases that needed to be addressed by the healthcare system.
We were often the ones who connected patients to primary care providers. Because of that, we built partnerships with health centers throughout Chicago who were then willing to accept our patients, even though this before the Affordable Care Act (ACA) was passed which meant that nearly 15% of our patients were uninsured.
"Without role models serving as inspiration it's hard to imagine yourself in a certain position or in a certain career. If you don't have anyone that you can relate to in that field, how likely is it that you will end up there?"
Lester Efianayi ’21
Are there ways ICO has already committed to improving diversity at ICO?
Dr. Messner: In the past year, we have begun working with the Morten Group a Chicago-based Black-owned firm, and we have gotten a much better understanding of the state of things in the College. We have all gone through a round of mandatory training sessions and now ultimately, we are developing a multi-year strategic plan based off of both those surveys and suggestions from the newly-formed DEI committee. I cannot stress this enough; this is not a hollow exercise for us. We want it to be something that is embedded within our institutional culture and that will continue to evolve, prosper and improve over the years. The DEI committee will be the driving force that will push our institution forward.
Randi-Jo Francis: One important aspect from the student side is that the class above us started the Black Student Union. When we first arrived on campus, they reached out to us. It was just so nice to have a group of students who could relate to us in literally all aspects of life – optometry school, even just socially. It was important for us to have that support group. We’ve continued that tradition – as soon as new students arrive, we reach out to them and welcome them to the BSU. It’s good to have that connection and support.
Lester Efianayi: ICO’s Focus on Your Future Programhas served as a pipeline for students of color in underrepresented populations that have interest in the field of optometry. Many past participants of the program have shared that it was this experience that served as a major deciding factor in applying to ICO. Similar to how many schools of optometry participate in dual degree / articulation agreements with private undergraduate institutions, I believe that it is equally if not more important for the same institutions to invest in extending opportunities to individuals in communities of color. I can personally attest to there being a lack of exposure and representation in such communities.
While there is much work that needs to be done at both the local and national level, I believe ICO is heading in the right direction and should continue to be active in its approach towards achieving a true melting pot within our community.
Are there ways ICO has already committed to improving diversity in the IEI?
Dr. Messner: The Clinical Leadership Training Program is one example of where we have been able to promote from within and really ensure that we promote those who are best for the job.
We saw that often our best administrators were those who were brought up from entry-level positions. These people had the raw talent to move up from those positions to important upper or mid-level administrative positions. I am really proud of how well this program has run.
How have you seen ICO change over the years?
Dr. Messner: When I graduated from optometry school, I was part of a landmark class because one-third of our student body was female. At that point, that was unheard of. For a long time, the optometric student body was very homogenous. Over the years, our school has moved forward as our student population has changed. As more female students joined ICO, our female faculty expanded as well.
We need to continue to look for ways of diversifying our upper-level management. I think I speak for every Vice President and the President of our institution when I say that getting doctors and others into the highest levels of leadership is something that is very very important for this institution.
If you look at how we have changed in the last 50 years, you can see significant growth. We will only continue to grow. We take students’ requests seriously because they reflect the growing demands in society.
At ICO, we’ve heard a lot of stories about how students found optometry, but the story we hear most often is that of an optometrist who served as a pillar in their community and who saw and believed in our future optometry students. Today’s optometrists build the optometry classes of tomorrow. Let’s make sure that when we do see those younger patients, we encourage them to do well in school, to continue striving for the best.
If they come in regularly, as they do at the IEI, mentor the patients you see. Help them reach their dreams and be important influences in their lives. Role models and mentors come from all over the place, but the one thing we know for certain is that they are essential for great success.