Health insurance means very little to a person without available and affordable transportation because he still does not have the ability to go see a doctor.”

A couple years ago, I traveled to Rwanda. Winding through the hilly countryside on a bus with my classmates, I would stare out the window and watch the passing towns. I would take inventory of the homes and storefronts. I would study the people. I would ask questions and dream up responses.

What were they thinking? How were they feeling? What were they doing? In other words, how was their head? How was their heart? How were their hands?

At the time, I thought I wanted to be a doctor. I had volunteered for three years at a world-renowned hospital, and I had seen how impactful a single doctor could be on a person’s life. So as we drove, I also wondered what their healthcare system looked like. Were any of these people I observed doctors? Were any of those storefronts medical clinics? What did access to healthcare look like here?

This experience sparked something within me, and over time, my questions have evolved. Now, I not only wonder who has access to healthcare, but question who has access in other areas of life as well. For example, who has access to education? Who has access to travel? Who has access to citizenship? To democracy? To owning property? To freedom of expression? Who has access to solidarity—who is impacted by issues we are willing to stand up and speak out against, and who is impacted by issues we tend to ignore?

As I use this broadened framework to revisit my initial question about access to healthcare, I find myself integrating more nuance and complexity into the discussion. In the United States, for example, when we look at healthcare, we often start talking about insurance coverage. Although universal coverage treats a symptom, it does not cure the disease. Health insurance means very little to a person without available and affordable transportation because he still does not have the ability to go see a doctor. It also means very little to a person working a minimum wage job because s/he still cannot afford to take time off from work to go see a doctor. Even if these barriers are not applicable to a particular individual, s/he still needs the health literacy skills to find a provider and ensure any appointments or procedures will be covered under that insurance. Despite efforts to provide coverage for every individual, access to healthcare is still a system hindered by all the institutionalized barriers and inequalities present in our communities. Those are the same barriers and inequalities that limit access to education, travel, solidarity and the rest.

Increasing access throughout the world requires us to diminish these systems of racism, sexism, poverty, violence, and discrimination. This is a tremendous undertaking, and it often seems one step forward prompts a backlash that leaves us ten steps backwards. In this last year, mixed messages, uncertainty surrounding healthcare, and fear resulting from the federal administration’s stricter immigration policies has magnified the challenges many communities face when trying to obtain health coverage. Recipients of Covered California and MediCal, which in most cases requires you to be a legal resident, are asking to be un-enrolled because they fear the government will punish them for accepting benefits from a federal program, and they would rather go without insurance, risking medical and financial hardships, than risk inviting any unwanted attention into their communities.

I have learned to …”

With each of these un-enrollment requests, my heart sinks; with every effort to repeal or sabotage the Affordable Care Act, my head fills with trepidation. I constantly face the reality that the United States, as an institution, considers healthcare to be a privilege not everyone deserves. For the most part, I remain hopeful we can eventually live in a nation where medicine is not considered a luxury. Through involvement and advocacy, I truly believe every individual has the agency to impact the health and wellbeing of communities throughout the United States.

But remaining hopeful is challenging, and I also experience waves of anger, frustration, cynicism and heartbreak. To move through the obstacles, I have learned to recognize the headway leaders before me have already made. To push for progress in the face of regression, I have learned to adapt in how I approach and address these issues. To promote meaningful change, I have learned to evaluate how I frame the work. This past year has required me to respond with patience, persistence, creativity and passion.

In doing so, I find myself circling back to the questions that brought me here in the first place. Who has access? Who does not have access?

I find myself back on that hilly countryside in Rwanda trying to connect with each individual. What are they thinking? How are they feeling? What are they doing?

I have found human connection to be my source of rejuvenation in this work, and I have found hope in the heads, hearts and hands of those around me.