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Partnership Comprehensive Care Practice Meet Rachel Fox, PA-C MHS AAHIVS

Rachel Fox, PA-C, MHS, AAHIVS

What made you want to become a Physician Assistant (PA)?

I knew from a young age that I wanted to work in the medical field and after learning about the history of Physician Assistants, I immediately felt connected to the mission of the profession. The whole purpose of the PA is to provide medical care in underserved areas. Although the official concept of the PA was created after the U.S. surgeon general declared a health care personnel shortage in 1959, the profession really got its start in the 1940s from a man named Henry “Buddy” Treadwell who lived in a small, rural town in North Carolina. Mr. Treadwell was trained by the town’s only physician to work in his practice as an assistant, and he eventually practiced fairly independently. Additionally, the PA profession has historically focused on primary care. An increase in medical specialization following WWII caused shortages of primary care providers. As a result, many of the early PA programs specifically engaged students in primary care training. As someone who strongly believes health care is a human right, I was drawn to the idea of being part of a creative solution to a health care access issue.

Why did you choose to specialize in infectious diseases?

PAs don’t specialize in the same way that physicians do, but I have always been fascinated by pathogens. For me there is something awe-inspiring about viruses and microorganisms, similar to the awe we feel about other natural wonders – a starry sky for example, or otherworldly landscapes like the Grand Canyon. As very tiny pieces of the universe, humans often like to look beyond ourselves and remember how connected we are to everyone and everything around us. I also like the overlap of infectious disease and public health; It’s satisfying to think about ways to improve the well-being of the community.

How did you become interested in HIV care?

When I was in middle school, a motivational speaker came to my summer camp and spoke about his experience as a gay man with HIV during the late ‘80s and early ‘90s. He was the first person living with AIDS and the first LGBTQ-identified person I can remember meeting, and I was deeply moved by his story. The emotional connection I felt to him led me to spend time learning about the history of HIV, and I became inspired by groups like ACT UP and the organizing strategies that were born out of the AIDS crisis. The story of HIV activism is one of the best examples of how social movements and mutual aid can step in when society’s institutions fail. HIV is strongly impacted by social determinants of health and structural oppression; therefore, caring for people living with HIV will always be rooted in social justice.

I have so much respect for my elders and those who survived the early years of HIV – both patients and providers. It’s an honor when they share their stories with me and a privilege to serve my community in this way. Unfortunately, many folks have had traumatic encounters with the health care system, so part of the reason I chose this work was to hopefully help people have better experiences.

Your research focuses on novel approaches to HIV prevention for sex workers and people who use drugs. Can you tell me about that?

Currently, I work with Dr. Alexis Roth’s team in the Health Equity Advancement Lab (HEAL) in the School of Public Health looking at pre-exposure prophylaxis (PrEP) acceptability and uptake by women who inject drugs (WWID) when paired with syringe exchange services. Unfortunately, PrEP is underutilized in certain populations. Medical providers are less likely to offer PrEP to cisgender women and people who use drugs than to men who have sex with men (MSM) and transgender women. Further, the only option for PrEP currently is a daily pill, which often does not fit into people’s lives – especially for folks struggling every dayfor basic needs like housing. As medical and public health professionals, we need to come up with better options instead of blaming patients for not being able to adhere to specific medication regimens. Options could include things like long-acting injectables or implants, further research on on-demand dosing, medication vending machines, and better access to harm reduction supplies like needles and syringes.

How long have you been with Drexel? What made you want to stay at Drexel after earning your MHS at the College of Nursing and Health Professions?

I just started working at the Partnership in July, so I am still new. Prior to this position, I worked at a federally qualified health center a couple blocks away. But, having gone to PA school here, I have a connection to Drexel. It was devastating for me to see Hahnemann University Hospital, where I did most of my training, close due to a broken, profitized health care system. Hahnemann was a historic hospital that had served poor and working-class people in Philadelphia for decades. The Partnership is strongly tied to the legacy of the hospital and staff here are dedicated to continuing to care for those populations.

You've also conducted presentations on addressing patients' substance use disorder in primary care. Can you tell me about what addressing substance use disorder looks like as a primary care provider, and what you'd like people to know about it?

Clinically, substance use disorder treatment doesn’t look very different than other common primary care conditions. However, one difference is the ways that criminalization, stigmatization and discrimination negatively affect the health of people who use drugs. Unfortunately, this is an issue where the law often contradicts medical ethics. For example, criminalization of paraphernalia reduces access to harm reduction supplies in the community, leading to increases in infectious diseases like HIV and viral hepatitis.

Additionally, despite the media focusing on the opioid overdose epidemic, we need to ensure resources are given to folks who use other substances like crack cocaine, the synthetic cannabinoid K2, and meth, and we need to center the voices of drug users whenever we are creating policy and programs. There are lots of really innovative things happening in Philadelphia thanks to local grassroots advocacy – a drug users’ union, various harm reduction mutual aid projects, and, hopefully in the near future, an overdose prevention site. The Partnership also just started a mobile van program, called Drexel HOPE (Health, Outreach, Partnership, Empowerment), that will allow us to provide substance use treatment, street-side medicine, and harm reduction education in West Philadelphia.

You said in your bio that you want to provide anti-oppressive medical care. What does that mean in theory as well as in practice, and why is it important to you?

Anti-oppressive medical practice recognizes that the health care system contains the same structural oppression that exists in the rest of society – racism, ableism, classism, fatphobia, homophobia, transphobia, etc. – and works to challenge these inequalities and equalize power imbalances between social groups.

In practice, this involves moving away from the historically paternalistic patient-provider relationship and towards a partnership with our patients that empowers them to have informed bodily autonomy. Trusting our patients to be experts about their own bodies and recognizing that their expertise is as important, if not more important, than our expertise in medicine is vital to having a good health outcome.

Personally, this means doing the internal work to recognize what power and privilege I bring with me into the exam room and how my words and actions may perpetuate oppression.

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

 
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