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There But for the Grace of God, Go I

John Locke famously wrote, “The disease inflicts bureaucracy and what they usually die from is routine.” As a current advocate and caseworker at an NGO called Health Leads, which operates out of three New York City public hospitals: Harlem Hospital, Bellevue, and Woodhull, and as a former volunteer with Syrian refugees in Bulgaria, I think no truer words have been phrased. Entering the public health and social services spheres demands a modicum of patience with the proverbial red tape. It is crucial to set the expectations of your clients fairly low—in preparation for the detached, broken system that we are all forced to work within. Yet, what is ultimately both unconscionable and devastatingly avoidable are the poor outcomes this system forces, and then claims as compulsory collateral damage, when in fact they are inherently needless and arbitrary. These outcomes are a choice we make as a global society and a local body politic that have become simplified and dichotomized to the point of absurdity.

As a student of biology, I have become accustomed to view problems from an acutely specific perspective. The natural sciences are very much the world of chance encounters with inexorable consequences: too many days at the beach without sunscreen, and a cell is exposed to excessive UV radiation. The DNA base pairs form thymine dimers. Too many mutations without adequate repair mechanisms, and a cancer forms, slowly and steadily. Perhaps it’s caught in time for treatment, or maybe it goes unnoticed until the damage is irreparable. The patient sits before their doctor and hears the words, “I’m so sorry, there’s nothing we can do,” and so often that is the unbearable truth. Now take the positions my clients are in—through circumstance and systematic indifference or oppression, they have found themselves at the mercy of a city or state agency for subsidized childcare, SNAP (food stamps), an immigration attorney, job placement, utility reductions, affordable housing, tutoring for their children, health insurance, and the list goes on. It is my job to navigate the array of governmental and community based resources, determining my client’s eligibility based on income, family size, and citizenship status. I place phone call after phone call—as do all of my colleagues—to make their connection with the resource as seamless as possible but the majority of the time, the response on the other end of the phone is, “I’m sorry, there’s nothing we can do.” The biologist in me fumes as I thank the faceless voice and hang up.

The answer is absurd in its very essence. My client’s dilemma is not a malignancy. The solution is obvious by common sense standards, and the obstacles between its resolution and its protraction are often a set of arbitrary and thoughtless statues, applied without context. A family denied SNAP benefits because of a phone interview that the Human Resources Administration re-scheduled four times, a child forced to continue to live in a moldy subsidized housing apartment because the state senator’s office I called never sent the inspectors they promised, a Mali born mathematician and his family with their green cards errantly sent to Colorado instead of the Bronx who cannot call INS to see how to collect them because the phone menu is in English and the department of justice has no French interpreters. Again, the list goes on. Who do we begin to hold accountable if not the footmen we interact with routinely rather than the elusive masters of the universe who garner votes but furnish no deliverables to their constituencies? There seems to be so little incentive for sufficient execution and so little empathy in the face of penury, of course coupled with xenophobia and the myopic balance sheets. It is within each of our own spheres of power—each cog as it were to take on more responsibility and go the extra mile to find a loophole or an hour to strategize until a top down approach can be initiated. We are not speaking about driver’s licenses at the DMV, but rather lives, whose courses are too often cut short by indifference and ceremony. Everyone, at every level, must be held accountable for such a travesty. We have only one life and it must not be spent in interminable wait.

Lest the rant about biology seem extraneous, let me attempt to tie it back in. None of this is real. The laws we live by, the statues that dictate fate, and the arbiters of those outcomes—all of it is constructed. This is necessary of course. The social contract is essential to civilization, but we should not forget that all of this is manmade. These processes and loopholes, they’re language in the end, forged by men without a crystal ball. Yet they determine destiny and for some reason appear immutable. For the past two years, I have traveled to Bulgaria to teach and do research with Syrian refugees who existed then, as many of them still do, in a bureaucratic limbo. In the summer of 2015, an archaic statue in EU law called the Dublin Regulation, which required asylum seekers who had been documented to remain in their port of entry, was uplifted by certain German states. Smuggler buses flooded the camp that I formerly worked in, bringing almost all of its inhabitants to the Greek-Macedonian border where a razor wire fence had been erected. While Germany had repealed an arcane law, fearing potential permanent settlers, the governments of Macedonia and Greece prevented roughly 15,000 people from escaping toward northern Europe. The transit camp in Idomeni, Greece that was subsequently created, lasted for little over a year until the Greek army entered this past May, tear gassing at random to incite a riot. The camp was militarized, volunteers were arrested, and the refugees were distributed throughout Greece, some in locales previously deemed unfit for animals. The few that made it to Germany found themselves in areas that had not repealed the Dublin Regulation. Since people are documented willy-nilly in Bulgaria, families that made it as far as Germany, some documented previously and some not, found themselves the subject of police raids and were deported back to Sofia to await an appeal.

Hundreds of thousands, if not millions, of people’s lives are being dictated by an arbitrary collection of artificial edicts and clauses. The difference between continuing one’s life and remaining in the penumbra of society can be the difference of a word penned hundreds of years ago—not by fate, or nature, or God. We have irrationally submitted to imperfect laws as a global society, when the solutions to so many of these complex problems are indeed simple enough when we have a common end. There is no justification for forcing people to wade through legalese—often not in their own language—denying them an interpreter, refusing services like subsidized housing and education that should be treated as human rights. There is a concept in the field of public health, which requires that every law that is passed must stand up to a lens of public health, no matter how seemingly irrelevant or far fetched. Will it further the health and human dignity of the community in the long term? If not, what is the collective purpose? Why do we impose obstacles on each other, when our own biology and the universe itself do such an excellent job on their own?

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Nika Sabasteanski is from Brooklyn, New York, and is currently studying at Barnard College of Columbia University, majoring in biology with a minor in political science. She is focused on a career in public health, which combines policy with medicine on a global scale, and is interested in working with refugees. She can be reached at nds2133@barnard.edu.

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