{"id":10335,"date":"2017-03-07T09:27:07","date_gmt":"2017-03-07T17:27:07","guid":{"rendered":"http:\/\/depts.washington.edu\/medex\/?p=10335"},"modified":"2017-03-07T09:27:07","modified_gmt":"2017-03-07T17:27:07","slug":"if-you-dont-accept-something-you-have-to-speak-out","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/test\/if-you-dont-accept-something-you-have-to-speak-out\/","title":{"rendered":"If You Don\u2019t Accept Something, You Have To Speak Out"},"content":{"rendered":"

S<\/span>epideh Makouei<\/span><\/strong> (pronounced SEP-ee-dah Ma-KOW-ee<\/em>) is in her second year of the MEDEX Northwest physician assistant training program. There are over 60 providers working at the UW Medicine Neighborhood Northgate Clinic in Seattle where she\u2019s fulfilling her 4-month family practice preceptorship. Among them are attending residents as well as physicians, PAs and nurse practitioners with many years of experience.<\/p>\n

\u201cI like it,\u201d Sepideh tells us. \u201cI like an academic environment anyway. My parents are teachers, so I understand the difficulties\u2014the goods and bads\u2014in a teaching environment. I get so many different views on treating just one single problem, because of the views of various practitioners and their different approaches.\u201d<\/p>\n

For generations in her native Iran, Sepideh\u2019s family had worked in medicine\u2014her uncles, aunts and cousins. \u201cBut not my father. I think he\u2019s the only person in the family that\u2019s not in medicine.\u201d Her mother worked as a school principal.<\/p>\n

Now, Sepideh is resuming the family tradition.<\/p>\n

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\u201cA<\/span>s a kid, I wanted this,\u201d<\/span><\/strong> she says. \u201cEverybody on my father\u2019s side of the family was in medicine with different specialties, so it wasn\u2019t unfamiliar to me. I knew how it works.\u201d<\/p>\n

In August of 2017 Sepideh will graduate from MEDEX and, upon passing the national certification exam, add the credential PA-C to her name. Still, it\u2019s been a long path to become a medical practitioner, with lots of obstacles along the way.<\/p>\n

\u201cThe era when I grew up, it was a hard time. There was a war during my childhood.\u201d<\/p>\n

Sepideh is referring to the war between Iran and Iraq from 1980 to 1988. \u201cIt took eight years of our lives,\u201d she says.<\/p>\n

To set the context, the Iranian Revolution came to power in 1979 with the overthrow of the Pahlavi Dynasty and the Shah, long supported by the United States. The government was replaced by the Islamic Republic under Ayatollah Khomeini, supported by various leftists, Islamist organizations and student groups.<\/p>\n

\u201cI<\/span>t was a hard time,\u201d<\/span><\/strong> she explains. \u201cThe Revolution happened, and the country was under sanctions from many European countries and the United States. There were different ways in which Iranians were working to influence the direction of the country.\u201d<\/p>\n

<\/a>
Sepideh carefully listens to her patient at the UW Medicine Neighborhood Northgate Clinic.<\/figcaption><\/figure>\n

Among them were Communists, championing a new direction in response to oppression. Others were known as Lefties, operating in the interests of individual rights. The most radical position was held by the Islamists.<\/p>\n

Sepideh\u2019s parents were nationalists. \u201cThey believed in everything that makes a country flourish and be a best nation,\u201d she says. They had supported Mohammad\u00a0Mosaddegh, a famous Iranian political leader of nationalist principles. As the democratically elected Prime Minister of Iran from 1951 to 1953, Mosaddegh wanted oil profits to go to the people. He nationalized the Iranian petroleum industry, which had been under control of the English.<\/p>\n

As nationalists in a time of revolution, Sepideh\u2019s parents were not seen as good citizens of Iran. Islamic fundamentalism clashed with the modern era, and ordinary citizens felt the impacts. Sepideh\u2019s mother was prosecuted in court for her views.<\/p>\n

\u201cShe didn’t believe in covering herself with a hijab,\u201d Sepideh tells us. \u201cShe was a principal at a school in my home town Makou, and didn’t believe in forcing people to cover themselves with a headscarf after the revolution.\u201d<\/p>\n

A<\/span>t that time this was considered a serious offense<\/span><\/strong>, one that held consequences for any woman who dared veer from the prescribed path. \u201cIf you didn’t cover yourself, they would cut your face, throw acid on your face or ankles if they were showing, or you had on nail polish.\u201d<\/p>\n

Sepideh was raised knowing that she could voice her opinions. \u201cWe grew up knowing that you have to talk. You have to. If you don’t accept something, you have to speak out. So, I was against all that.\u201d<\/p>\n

Sepideh was raised knowing that she could voice her opinions. \u201cWe grew up knowing that you have to talk. You have to. If you don’t accept something, you have to speak out. So, I was against all that.\u201d<\/p><\/blockquote>\n

Because she was seen as being in opposition to the government, Sepideh herself was jailed for a time, as was her brother. The problems started after she got into the University of Tabriz where her major was biology, with a minor in botany and two years of research on genetics.<\/p>\n

\u201cAt the university, I had a hard time proving to them that I was actually a person who could educate herself and become something,\u201d she says. \u201cBecause of my opposition to the government, I was given a hard time by religious groups at the university.\u201d<\/p>\n

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I<\/span>n her last semester<\/span><\/strong>, Sepideh was informed that she was ineligible for graduation because her behavior was unacceptable. The university dropped her research, and informed her that she would have to be reeducated before being eligible to graduate.<\/p>\n

\u201cI had to take like two or three classes in religion, on how to behave in Islam as a Muslim woman. So, that was the last straw. I graduated and left.\u201d<\/p>\n

That was in 1993, but Sepideh didn\u2019t come directly to the US. The first 10 years after leaving Iran took her to several different regions: Southeast Asia, Europe and South America. \u201cFor those 10 years I basically had a sense that nowhere was safe,\u201d she tells us. \u201cYou protect yourself. Even today, I\u2019m a little bit reserved in that respect, and not really that open.\u201d<\/p>\n

\"\"<\/a>
Sepideh Makouei in 2001 with her two children in Brazil after having left Iran.<\/figcaption><\/figure>\n

By 2002 Sepideh settled in the United States. She had two small children, essentially functioning as a single mom because their father had moved back to Iran. \u201cHe wanted to experience the new era of the country,\u201d she says.<\/p>\n

Remaining in the States with her children and elderly parents, Sepideh couldn\u2019t find a job. \u201cI hadn\u2019t worked in 10 years, so I decided to study something.\u201d The Lake Washington Medical Assistant Program was attractive because it offered a part-time study option. \u201cWith two small kids I needed to be flexible with my time.\u201d<\/p>\n

Reflecting back on her university education, her early decision not to go into medicine was deliberate. \u201cBy the time I got to the age when I could choose, the war had just finished,\u201d Sepideh says. \u201cI was under so much stress. I didn’t want to see another person in pain. So, I decided not to go into medicine at that time. Seeing so many dead people, and people with injuries all around us, it was just heartbreaking.\u201d<\/p>\n

B<\/span>ut now, years later and in a new country<\/strong><\/span>, entering the profession of her father\u2019s family seemed a good choice. She graduated from the MA program. To start, she worked at a nursing facility and as a nursing aid in Redmond until settling into two part-time jobs\u2014one in private practice, and one in Urgent Care at Evergreen Hospital. \u201cBy the time I started seeing patients, I was like, \u2018Okay, this is what I want to do, this is what I would like<\/em> to do.\u2019 Really, it gave me lots of joy to talk to people, to try to understand their pain or what their problem was medically. So I started looking around to see what is going on in medicine, and if there was something more I could do.\u201d<\/p>\n

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Sepideh looked into PA programs. \u201cOne of the people who actually saw me for my migraines was a PA. I became very curious about PAs and applied to the MEDEX program in 2008.\u201d<\/p>\n

She was granted an admissions interview but, unfortunately, got sick that year. \u201cI couldn’t make it, and then it took me some time to recover. I had complications after my surgeries and treatments.\u201d It took Sepideh another seven years to return to the program when she reapplied in 2014.<\/p>\n

At the time of her 2014 MEDEX interview, Sepideh had another option in place just in case PA school fell through. She was in her first quarter of nursing school at North Seattle College. \u201cThen I got the MEDEX phone call and I thought, \u2018This is what I really want to do\u2019. You go to the interview thinking this is what you want, but you don’t know if you’re going to get in.\u201d<\/p>\n

Sepideh took an attitude of whatever happens is going to happen. \u201cIt wasn’t really the only option for me because I had nursing school in the background. I wasn’t scared, but I knew it would be the last time that I would apply. Honestly, it was like this: if I don’t get it, I don’t get it, I won\u2019t pursue it anymore.\u201d<\/p>\n

\u201cBut I’m so happy that I got in,\u201d she tells us.<\/p>\n

D<\/span>espite the fact that the Northgate Clinic<\/span><\/strong> was the first assignment of her clinical year, Sepideh has duly impressed her preceptors. Bryna McCollum, PA-C has heaps of praise for her abilities and cultural competence.<\/p>\n

<\/a>
Sepideh Makouei with her preceptor at UW Medicine Neighborhood Northgate Clinic, Bryna McCollum, PA-C.<\/figcaption><\/figure>\n

\u201cShe\u2019s done a wonderful job getting up to speed at this rotation,\u201d says Bryna. \u201cUW Northgate can be a challenging site because there are so many different preceptors. It takes a student who is really on top and proactive in their learning. I’ve really seen Sepideh come a long way, and her skill set, too. This is her very first rotation, and there\u2019s been a lot of growth. For instance, she hadn\u2019t done a lot of pap smears. I remember that was tricky when she first started. Now she\u2019s a pro at it. It’s really fun to see the growth of her physical exam skills, and becoming more competent with assessments and plans too. Her language skills are amazing, I think that will be an asset to her in clinical practice as she speaks five languages.\u201d<\/p>\n

For the record, that includes English, Farsi, Turkish, Indonesian and Portuguese.<\/p>\n

Bryna McCollum goes on about Sepideh. \u201cShe’s very empathetic, and she really has an excellent rapport with patients. Students come into PA school with a lot of life experience, and that really helps with empathy. I think that is really an asset when you’re relating to patients in a clinical situation. I teach a lot of medical students too, and they\u2019re often younger and just haven’t had that life experience yet.\u201d<\/p>\n

W<\/span>ithin her study group at MEDEX<\/span><\/strong>, Sepideh has shared some of the details of her immigration path. \u201cWe\u2019ve gotten close, and I\u2019ve shared some of this with them.\u201d<\/p>\n

As someone who demonstrated fearlessness when going up against authoritarian institutions in her native Iran, we wonder if Sepideh sees herself playing any kind of advocacy role as a healthcare practitioner in the United States.<\/p>\n

\u201cI would like to,\u201d she responds.<\/p>\n

Earlier, she had submitted a proposal to PAEA for presentation, but it wasn\u2019t accepted. \u201cI really lack in writing skills,\u201d she says with some sense of disappointment. The paper was critical of how PAs are currently being contracted in rural settings with low pay and no job security. She also feels strongly about PAs students playing a greater role at UW Medicine. \u201cThis is an academic environment, and a wonderful place to have more PAs involved. But you actually see a lot less than elsewhere.\u201d<\/p>\n

For Sepideh and her Seattle Class 49 cohorts, graduation is coming soon. We inquire as to what kind of job she might take after her training at MEDEX concludes. Is she drawn to family medicine, or some specialty practice?<\/p>\n

\u201cAt this point, whatever comes first,\u201d she says. \u201cI need to care for my family.\u201d<\/p>\n

With two children and elderly parents to support, practical considerations come foremost.<\/p>\n","protected":false},"excerpt":{"rendered":"

Jailed in her native Iran for opposition to government policies regarding women, Sepideh Makouei is on her way to becoming a physician assistant in the US. While in the MEDEX program Sepideh is making use of all her life experience to claim her place as a future practitioner with skill, empathy and cultural competence.<\/p>\n","protected":false},"author":1,"featured_media":10345,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[],"class_list":["post-10335","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-experience"],"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts\/10335","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/comments?post=10335"}],"version-history":[{"count":0,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts\/10335\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/media?parent=10335"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/categories?post=10335"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/tags?post=10335"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}