图片由马丁尼Geary-Souza提供

学校新闻

明矾将痛苦转化为进步，在医学教育中倡导创伤知情护理

在她最近在芬威澳门威尼斯人注册网站研究所实习期间，Martine geari - souza （SPH ' 25）撰写了一份政策简报，呼吁普遍的创伤知情护理，以更好地支持LGBTQ+患者。

马丁尼Geary-Souza (SPH’25) envisions a healthcare system that preserves the dignity and autonomy of its most vulnerable patients.

While completing her practicum as a research fellow at 芬威学院—one of the world’s preeminent 同性恋健康 and HIV research, education, and policy organizations—Geary-Souza authored a brief advocating for the widespread adoption of trauma-informed care (TIC) in healthcare settings. Titled 澳门威尼斯人注册行动中的公平：普遍创伤知情护理作为LGBTQ+患者的生命线, the brief underscores how disproportionately high rates of trauma exposure among LGBTQ+ people contribute to disparities in health outcomes. 它还详细说明了对歧视的恐惧——尤其是在跨性别和性别多样化的患者中——如何经常导致LGBTQ+个体逃避治疗，恶化结果并加强创伤循环。

在简报中，Geary-Souza呼吁各国采用TIC。 她的观点是在政治格局不断变化的背景下提出的，联邦政策的出台限制了对LGBTQ+身份的承认，限制了对艾滋病毒治疗和性别肯定护理的获取。 Geary-Souza敦促对医学教育和认证标准进行改革，以确保医疗专业人员在创伤的神经生物学影响方面得到培训，并具备满足患者应对当今社会政治挑战的复杂需求的能力。

“由于我们无法始终如一地确定谁经历过创伤，因此将TIC作为护理标准可以确保普遍实施并最大化其影响，”简报中写道。

作为一名童年性虐待（SA）的幸存者，Geary-Souza经历了一个更安全、更有支持性的临床环境，但她在高中被诊断为复杂创伤后应激障碍（C-PTSD）后寻求治疗的经历，大多让她感到被忽视和被忽视。

多年来，Geary-Souza遭受了一连串的症状，从虚弱的疼痛到无法解释的癫痫发作。 有时卧床不起，无法上课，她向无数医生求助，但收效甚微。 2019年，在布莱根妇女医院（Brigham and Women 's Hospital）住院一周后，数十项检查结果正常，并被诊断为功能性神经障碍（FND）。

她的医生告诉她，解释这种情况的最好方法是把大脑想象成一台电脑。 多发性硬化症和癫痫是计算机硬件的问题，这就是为什么它们会出现在测试中——另一方面，fnd是一个软件问题，因此实际上是看不见的。 他们告诉她，这种障碍似乎在PTSD患者中更为常见。

In 2022, researchers would gather enough 证据 to suggest a clinically significant trauma subtype of FND, linking PTSD and childhood abuse to neurologic symptoms.

“对我来说，这是非常有效的。 They used my C-PTSD not to say, ‘You need to go to therapy,’ but [rather], ‘There’s something that was dramatically altered in the way that your brain functions because of this,” recalls Geary-Souza. 她开始思考，如果所有的提供者都使用病人的创伤史来告知他们的护理，而不是忽视他们的需求，那会是什么样子。 她决心帮助其他幸存者在这个体系中生存下来，于是她继续在芝加哥大学获得了社会工作学士学位 塞勒姆州立大学。

As a social work student, Geary-Souza gained experience at both the micro and macro levels—providing one-on-one support as a therapeutic mentor to children and families at the 司法资源澳门威尼斯人注册网站研究所, an outpatient mental health serve provider to the southern New England region, and advocating for system-wide improvements at 波士顿儿童医院 to help the Department of Gynecology better serve vulnerable populations. 这两次实习让Geary-Souza意识到，她的力量和激情在于推动人口层面的变革。 换句话说，她说，“我真的只想做公共卫生。”

作为SPH的一名公共卫生硕士学生，Geary-Souza帮助其他幸存者避免困难的动力演变成了一个更广泛的目标：改变医疗实践的方式。 她开发了一个初步的课程来培训TIC的提供者，并向波士顿医疗中心推荐了这个课程。 虽然试点课程的资金告吹，但她仍然没有气馁。

Geary-Souza向SPH的活动家实验室寻求指导，分享了她的愿景，即成立一个全国性组织，与医学院和医疗保健系统就实施TIC进行咨询。 When she described her dream to 克雷格·安德雷德, associate dean for 实践, he responded: “You can’t give this to anybody else […] We need to figure a way for you to do this—so that it’s yours.”

Andrade connected her with 肖恩·卡希尔, director of health policy research at the Fenway Institute, who invited her onboard to research realistic avenues for universal TCI implementation to benefit the LGBTQ+ community. Geary-Souza与SPH谈到了合作和她正在进行的倡导工作。

你是如何熟悉创伤知情护理的概念的？你是什么时候意识到教育医疗服务提供者其原则的重要性的？

我想我从高中的时候就知道它是什么了，虽然我还不知道它的名字，因为长期以来我对医生的看法就是这种被解雇的感觉。 When I was in high school, I disclosed my abuse, and shortly thereafter, alongside my mental health, my physical health just fell apart […] And throughout all of this, I would wager about 90 percent of the doctors that I saw in that four-year period looked at me and went, “This is in your head. Go to therapy.”

There were two instances in high school that I [can] point to clearly and say, “Oh, my goodness. This doctor saw me, heard me, validated me, and did something about it.” That’s my primary care physician who, thank God, he […] always had my back. Then, there was a surgeon that I connected with […] he saw me and within 10 minutes said, “I am pretty confident that you have endometriosis. I’d like to schedule a surgery.”

这就是我开始真正理解那篇澳门威尼斯人注册创伤的文章的地方。 At that point, my history as an abuse survivor was in my medical history because I disclosed and because I’d been formally diagnosed with C-PTSD. [The surgeon] saw that and immediately said, “I see that you have PTSD. Can you talk with me a little bit about what would be helpful for you during surgery, so you don’t get triggered?” He said, “Usually, there’s a gas mask that we put over you to try to help you go to sleep, but we have something else that we can use because I know that a lot of [SA] survivors don’t want something over their mouth, that this makes them panic, so we have another device that wouldn’t go completely over your mouth and if you want to use that, we can.”

I’d been to a million different specialists for so many different things, and nobody had taken the time to really sit down with me and ask, “What parts of this could be changed to be more comfortable for you?” 这让我的脑子开始转动起来。 Imagine if, instead of having to fight to be heard in a medical office, you’re having this incredible collaborative partnership where you genuinely feel like the provider understands your pain, wants to help you, understands the impact that trauma has had, not just on your mental health but on your body, and [they’re] educated in ways to help you find a way to manage that. 这应该是我们得到的。 And in the research that I’ve done, the providers that I’ve talked to, almost all of them want that too, but they don’t have the training or the education to prepare them.

祝贺你即将毕业！ 现在你已经完成了你的学位，你期待你的公共卫生教育做什么？

这么多! 我正在注册一个有限责任公司。我有一个标志是由我高中的一个好朋友设计的，他是LGBTQ+空间的倡导者。 Then, I’m fielding a couple partnership and collaboration offers with a couple different medical institutions across the country to see what a good pilot site could be to carry out the implementation plan that’s outlined in the brief. Also, I will still be working with 丹尼尔(哈利) on the 艾滋病澳门威尼斯人注册网站研究中心 pilot study that we presented at the [创伤和心理健康中心 fellowship showcase]. I’m really excited to keep doing qualitative analysis with her on that. She’s also offered me the opportunity to author that paper with her.

（我）很高兴终于能专注于做我一直想做的事情，从2021年开始，你可以说，但老实说，比那要长得多，（这）改变了我们对待创伤的方式，我们如何支持创伤幸存者，以及我们如何进行医疗保健。 Because the reality is that if trauma-informed care is implemented on a universal level, it doesn’t just improve care for survivors of trauma. 它改善了对每个人的照顾。 I’m really excited to dive full-on into that and try to make that a reality.

您最近发表的简报详细介绍了创伤知情护理如何改善LGBTQ+社区的健康状况。 作为社区的一员，骄傲月对你来说意味着什么？

没有多少人知道这一点，但“骄傲月”也恰逢“创伤后应激障碍意识月”，我认为这非常合适，尤其是因为LGBTQ群体遭受创伤的比例如此不同。 我认为这份简报出来的时机非常好，因为现在很多LGBTQ群体，尤其是跨性别群体和性别多元化群体，都面临着如此高的风险，面临着如此多的歧视和暴力。 不幸的是，在接下来的几年里，创伤率只会上升。 This year [during] Pride Month, I am excited to have this out there and to be [positioning] myself very clearly as an advocate saying, “No, we’re going to do better. We need to do better.”