ASCLS Today Volume 34, Number 5

Emilia Marrero-Greene, M Ed, MT(AAB), MLT(ASCP)

Author Emilia Marrero-Greene with her daughter and husband.

The recent deaths of George Floyd, Breonna Taylor, and Rayshard Brooks at the hands of police gave rise to important conversations in our nation. The ASCLS Board of Directors and the Diversity Advocacy Council pledge to focus on discrimination and disparities that people of color face in the United States. As a medical laboratory scientist for more than 10 years, and as a member of the Latinx community, and mother to a biracial/black child, I feel I would be remiss if I did not share my story, as well as my hopes for the future of our profession.

ASCLS, and certainly our profession as a whole, has a unique opportunity to be a voice for the voiceless. Martin Luther King Jr. once said, “Injustice anywhere is a threat to justice everywhere.” While our profession is certainly an example of diversity and inclusivity, there are still many opportunities for improvement. These opportunities go beyond merely speaking out against police brutality. ASCLS continues to commit to addressing the inequalities people of color face within healthcare, as well as provide education to its members to ensure we provide equitable and quality care. While these are important first steps, I believe there is more we can do to demonstrate that, to our profession, black lives matter.

At the memorial service for George Floyd, Reverend Al Sharpton said, “What happened to Floyd happens every day in this country, in education, in health services, and in every area of American life. It’s time for us to stand up in George’s name and say, get your knee off our necks.” Black and brown people do not want or need favors. We want the same opportunities that our white male counterparts receive. I have no desire to revisit this same, tired conversation of inequity in 10 or 20 years, as my own daughter begins her journey in America. I want her to enjoy the bounties of equal access to opportunity that are often taken for granted by her white counterparts. So how can we laboratorians begin to ensure fairness and equality among our kind?

“As our Society moves to end systemic racism, we must also pledge to listen to each other, speak up for each other, and encourage our members to be vocal in their own experiences.”

Healthcare workers are a diverse group. In my career as a scientist, I have worked with and learned from white Americans, black Americans, the breadth of the Latinx community, people from throughout the Caribbean, and Asia. Our laboratories are a cultural mosaic, and our field presents many opportunities for people of color and other global citizens.

Despite our impressive diversity, there are areas in which we can improve. While you may see people of color in supervisory and management positions within the laboratory, they often earn less than their white male counterparts. Studies completed by the U.S. Census Bureau and the U.S. Department of Education provide concrete data to these disparities. In healthcare, women are paid 71 cents for every dollar men earn, regardless of their education level. Across all professions, black men employed full-time tend to earn 76 cents for every dollar that white men earn. For every dollar that white men earn, black and Latina women earn 61 and 53 cents, respectively. While salaries among mid-level management are not generally discussed, I can confidently disclose that I, too, am a victim of wage disparity. As a laboratory supervisor, I was paid less than a white male counterpart who had the same level of education, yet less laboratory experience.

I implore ASCLS to use our legislative voice to help facilitate substantial change in our profession. Our Society should support policies that prevent employers from retaliating against employees who discuss wages and make it easier to demonstrate when discrimination has occurred. We should advocate for healthcare companies to provide more transparency in their hiring practices. We should also seek to prohibit these same companies from screening job applicants based on salary history. The COVID-19 pandemic continues to show the public what we laboratorians already know—laboratory workers are vital members of society and whose work saves lives.

Finally, while my story might mirror the stories of so many others in our field, many voices continue to go unheard. As a white-skinned, New York-born Puerto-Rican woman, my experience in America and in this profession will be vastly different than the experiences of the white women, the Haitian men, and the Filipino students that I work among. As our Society moves to end systemic racism, we must also pledge to listen to each other, speak up for each other, and encourage our members to be vocal in their own experiences. We’ve pledged to care for our patients. Let’s continue our pledge to care for each other.

Emilia Marrero-Greene is MLT/MLS Program Faculty at Keiser University in Orlando, Florida.

Cara Bushmaker, MLS(ASCP)^CM, 2019-20 ASCLS-Montana President

Montana is known as the “Last Best Place.” As I thought about the topic of diversity, I would not have described Montana as a diverse place. I would venture that the feeling I have is largely due to our limited population. I felt my own hesitance echoed by my peers as we talked about our individual perspectives on the pandemic response in Montana and our state’s diversity. I struggled with knowing the limited scope of our patient diversity, society, and population in general, as well as how I could possibly contribute to a topic like this. Those feelings only intensified after a weekend of protests and unrest around the country, and increasing concerns around the transmission of COVID-19. The longer I reflected on our situation and listened to the stories of those all over the United States, I began to gain a little footing. I realized my own perspective on diversity should not be equated to a percentage or data set or, most importantly, the numbers I look up on the Montana Census website. My reflection on diversity is in sharing our story and how it makes us unique and yet still united.

Tribal reservations outlined over the Montana Public Health Laboratory Coronavirus Cases by County as of 6/01/2020.

We have just over one million people in our large state. Each individual resident spread out across the land would have six square miles of separation from another person. Six. Square. Miles. That number is probably as astounding to some people as a metropolitan city dealing with a pandemic is to me. That space makes us unique, unlike few other states. Our population and the description of our “wide open spaces” will sometimes deem us as “safe.” Surely, we have to be safer from transmission of COVID-19 because of all that space. In many aspects, we are much safer than an urban area is right now. I am fully aware of that. But being safe also assumes that we have the resources and abilities to implement necessary protections. That we have the “space” to act before it gets too big to handle. Or, that we have the resources to take care of our at-risk areas.

The Big Sky State is many things, but our population is not what we are known for. I have learned throughout my life that, as a Montanan, I am often perceived differently due to where I live. This rural state I have known my whole life is comprised of just 6 percent Native Americans. That 6 percent is our largest source of diversity in the entire state. We are home to seven Indian reservations that also happen to be one of our at-risk populations during this pandemic. Those include the Blackfeet, Chippewa Cree, Confederated Salish and Kootenai, Crow, Fort Belknap, Fort Peck, Little Shell Chippewa, and the Northern Cheyenne tribes.

“We will not be spared by borders or lines in the sand. The spread that we see is a slow burn that we hope does not turn into more.”

Our government addresses resources and allocations to our reservations through our Tribal Alliance agreements. I often wonder about this through the lens of the lab. Do they have the trained professionals to use these resources? Do they disperse them to people effectively? Are they worried, like I am, about a lack of weapons to fight this effectively? I don’t have the answers. Even though we are rural, we are still at great risk from COVID-19 for a variety of reasons, space being one of them.

Recently in one of our tribal counties, local health set up a drive-through sample collection site to test for SARS-CoV-2. The call for mass testing had not been widespread in Montana due to lack of reagent and preservation of supplies. This collection site opened and immediately our state data took a very different turn. We went from a model state to reflect the reopening process, to a steady rise in cases. This rise reflected my own worry of what this will do to our current situation and how we will be able to handle it. These Native American reservations with invisible walls will still be at great risk for infection in our state. We will not be spared by borders or lines in the sand. The spread that we see is a slow burn that we hope does not turn into more.

June 1 started the first day of Phase 2 for Montana’s reopening plan, and we watch daily as our numbers start to inch higher again. We take this time we have, and we focus on what we have learned from places like New York, New Jersey, and the other hot spots of Coronavirus. We are learning from those people on the front lines.

We were implementing PPE preservation plans and responding to material shortages along with the rest of the nation even before we had a positive case in our state. We disseminated the latest research on proning patients in our facility without having had a positive inpatient. I, as well as others, was shedding my work attire before coming home to my family long before we ever cared for a positive inpatient in our facility. We used the information we had and adapted.

We held on to what little science we could find, BUT we still have barriers. SO, we deal with less. We worry about all the same things that people around the world are worrying about. We are uniquely diverse in a different way, yet so connected with the global issues as well. The sad reality is we are all just as exposed to this novel threat. The realities of our state are laid out in resource allocation, supply wait lists, at-risk population statistics, and space, lots and lots of space.

I still feel we don’t have an adequate testing strategy, along with many laboratorians all over the world. I worry, along with the rest of the country, as we reopen, will we be able to handle it. I know we need to reopen for many reasons, but as a healthcare worker, I hesitate. I worry about our perception of diversity here in Montana and how it affects our supply, our ability to test, and our ability to maintain our PPE. At the end of the day, I write protocols to answer the questions. I focus on the answers I know, based on the data and science available to me.

We are rural, but not alone.

On behalf of ASCLS-Montana, I thank all the men and women working hard on the front lines during this pandemic. We can’t describe how much your efforts and knowledge have helped us. Thanks for all you are doing and for sharing our work.

Cara Bushmaker is Technical Supervisor at Marcus Daly Memorial Hospital in Hamilton, Montana.

Terese Abreu, MA, MLS(ASCP)^CM, ASCLS Region IX Director, 2017-20

Photo by Jason Leung on Unsplash

During my lifetime I have seen many protests, including the one that is in the book I am reading right now, regarding preservation of old growth forests. The book begins with roots, and as a biology major, I find it fascinating to consider what is happening beneath the surface, hidden from sight. It reminds me also of the documentary I saw recently, Tracing Roots, regarding Alaskan native spruce root weavers and DNA connections of a woven hat discovered in a glacier. Weaving is a deep-seated tradition that grounds and defines many Native Americans. Our roots are important to us and provide a means to see how we are connected to one another. The promise of discoveries found in the results of DNA testing fascinates those searching for their roots.

The medical school in my community, rooted in the homelands of the Yakama Nation, has developed a program called “Roots to Wings.” This program is addressing disparities in healthcare in our diverse community of Native Americans and Mexican-Americans through a co-mentoring program where medical students collaborate with youngsters in the local middle schools, in various ways, to stimulate interest in further education and possible careers in healthcare. In turn, the medical students have a chance to understand the real issues of the population they are training to serve.

In ASCLS, our roots (our members) provide great diversity, yet we struggle to fully understand the issues that each of our members face. We work in different types of healthcare facilities serving very diverse local populations, struggling to remain effective and relevant under various state requirements, geographical, cultural, and ethnic challenges.

In root basket weaving, finding, collecting, and preparing the right roots is critical to success in weaving. A strong, healthy root system supports the growth of 100-year-old trees and the life of the forest they live in through seasons of drought, floods, fire, and hurricanes. As a grassroots organization, our purpose and direction reflect the shared problems and solutions of its members.

“The roots of ASCLS, our members, bring great diversity to our organization and have allowed us to survive and be successful despite changes that some were sure would destroy us.”

So, how can ASCLS members leverage our roots more effectively and efficiently so that we can move our organization forward in this time of decreasing membership and volunteers? The ASCLS Board of Directors has come to realize the journey forward has to start somewhere. Each of us, as members of ASCLS, have responsibility for the success of our organization, and we all must be willing to do our part.

The board read three books to guide us on our journey forward. Start with Why, by Simon Sinek, led the board to consider how we could think and act together to inspire others to action in the hope that members will follow because they want to do so. To get there we had to determine our “WHY.” Why does ASCLS exist? There is great power in a common goal.

Race for Relevance by Harrison Coerver and Mary Byers helped us to see that as an organization, we simply cannot be everything to everyone; it is just too broad a focus. Our members have diverse skills, but limited time to donate, so it is not possible to do everything. It falls to the elected volunteers to determine what would bring the most value to ASCLS members and then determine which volunteers are best qualified, or possess the skill sets needed, to accomplish the work and do so quickly enough to maintain the organization.

The Will to Govern Well put out by ASAE, The Center for Association Leadership, illustrated to the board we must make decisions based on factual knowledge, rather than opinions, and that leaders must have the respect and trust of those they represent if they are to be successful. This in turn motivates and inspires volunteers to continue to lend their limited time and valuable skills for the benefit of our organization and our members. ASCLS needs to be nimble and move quickly when needed.

A perfect example of nimbleness and the power of a common goal within our organization, our membership, and our profession is on display for all during this frightening and stressful time of SARS-CoV-2. Our Joint Annual Meeting had to change, our work had to change, our schools had to change, we had to change, virtually overnight.

The roots of ASCLS, our members, bring great diversity to our organization and have allowed us to survive and be successful despite changes that some were sure would destroy us. We are passionate about our profession, our patients, and the communities we serve. Focusing on our common goal, and demonstrating trust, support, and respect for each other are critical to having the healthy roots that will lead to the growth and success of our professional organization.

Eagles are sacred to Native Americans. Eagles soar! They represent honesty, truth, majesty, courage, wisdom, power, and freedom. If we take the time to understand the real issues, and move past preconceptions, we can see that ASCLS is moving forward and doing so with increased relevance for all of us. Roots to wings.

Terese Abreu is Director of the Medical Laboratory Science Program and Assistant Professor at Heritage University in Toppenish, Washington.

Mary Ann McLane, PhD, MLS(ASCP)^CM, ASCLS Past President

Author Mary Ann McLane has been teaching her neighbors in her retirement village about the difference between antibody and molecular tests, as well as teaching them how to use Zoom.

Such an unprecedented spring and summer! COVID-19 certainly has radically changed forever this generation’s definitions of “shelter in place,” “social distancing,” “essential services,” “PPE,” and “curbside pickup.” As one of the youngest (at 71 years old) members of Westminster Village, my retirement residence in Dover, Delaware, I find this experience has provided me with a different perspective on many things, including my favorite mantra, “Provide the Face.” My neighbors living here with memories of the last pandemic in 1919 were only babies at the time, so the situation is truly a new one for us all.

Anyone suggesting to me all of this healthcare frenzy is just a bunch of hype will have me point across the driveway from my apartment in Independent Living to the building listed on our campus as “HealthCare,” housing those needing skilled nursing services. To date, we have 18 residents in HealthCare who have tested positive, with nine deaths, and seven active staff cases. Thankfully, no one in Independent Living, Assisted Living, or Memory Care has shown symptoms. This has, however, allowed me to spend literally hours since the March lockdown, explaining the difference between antibody and molecular tests for SARS-CoV-2, and FDA vs CDC vs EUA vs LDT to my neighbors here, not to mention repeatedly emphasizing that “testing” sites are not really doing testing at all, but rather doing a step in the pre-analytical phase!

It is a strange feeling to be now labeled as a member of a “vulnerable population.” Being in good health, I nonetheless have needed to interact with clinicians in my new environment, but now with a mask on constantly. This gives me an empathic admiration for those MLS/MLT colleagues who need to be at the bench these days, for entire shifts, with masks on. When our governor called for those in retirement with clinical expertise to consider volunteering for the effort, of course, I seriously gave it a thought. “I should be able to help out in some way,” I reasoned to myself, until I realized that the strict quarantine for this Westminster Village vulnerable population would force me to rent a hotel room for the duration since I would not be allowed to return to my apartment on campus for fear of bringing the virus back. I had to consider my disappointment of not being able to help as my gift to this new community of mine, providing my face only “here” rather than “there.”

"The days of picking up a pipet may be over for me, but the opportunities to highlight our critical role in healthcare never end, for all of us!"

I have been helping many residents to provide their face by teaching them how to set up and use Zoom. What a Godsend for decreasing the loneliness and isolation faced here without visual and tactile contact with friends and family, especially when a husband is in Independent Living while his wife is in the HealthCare building. Having four Zoom meetings in a row on one day can be a bit much, but I am still very grateful for the technology that has also allowed the spring school semester to at least have a semblance of continuing, albeit very creatively.

Months before Medical Laboratory Professionals Week, I applied to get a Governor’s Proclamation. Of course, the nicely scripted parchments could not be personally delivered as I had hoped, but their digital versions were emailed to the education program directors at the University of Delaware and Delaware Technical Community College, to the lab staffs at the Delaware Public Health Lab and Christiana Care Health System, so everyone could share the special “whereas” about our being crucial for handling COVID-19 testing in the state. I also proudly displayed that proclamation, plus my own, in my apartment building’s lobby at Westminster Village.

It continues to be a joy and a privilege to “Provide the Face” of our profession. I am even explaining lab test results to those village residents who accept my offer to do so. I am giving Zoom lectures to MLS and MLT students in Region II and serving as an external reviewer for an MLS colleague’s academic promotion in Jamaica! The days of picking up a pipet may be over for me, but the opportunities to highlight our critical role in healthcare never end, for all of us!

Mary Ann McLane is happily retired in Dover, Delaware.