Juliana Anyanwu has only ever wanted to be a doctor. As a child in Nigeria, Anyanwu spent a lot of time in hospitals for her allergies. One of the doctors listened to her in a way that made her feel seen and understood.
She was also a very smart student. “In Nigeria,” says Anyanwu with a laugh, “if you are smart you are either a doctor, engineer or lawyer.” She went to medical school at the University of Nigeria’s Enugu campus, graduated in 2003, and worked for three years as a doctor. In 2006, Anyanwu immigrated to the United States to join her husband.
Even though she had been practicing medicine in Nigeria, in order to receive her medical license in the United States, Anyanwu had to pass multiple licensing tests and then complete a residency program. Her studies were derailed when, in 2008, her husband lost his job during the recession. She began working full time, studying and raising the couple’s three small children.
In 2011, the family moved to Cedar Rapids for her husband’s job. Anyanwu shadowed local doctors and was accepted into the residency program at the Cedar Rapids Medical Education Foundation. Residency programs are hard to get into. An article published in the September 2017 issue of the Journal of Surgical Education noted that the increase of graduates from medical schools has not been met with a growth in residency programs. International medical school graduates have to compete with American medical school graduates for coveted spots. International medical graduates have only a 50 percent chance at being placed in a program, and Anyanwu had done that. She was so proud. She’d worked so hard. She’d moved to a new country, had children, worked full time, survived the recession, passed her tests and had gotten a residency.
It felt exactly like a miracle.
Her time in the residency, however, was brief and horrible. Anyanwu told me that she was required to work longer hours than allowed under the rules determined by the Accreditation Council for Graduate Medical Education. One doctor asked her who watched her children while she was away. Another, her mentor, said she looked like “she’d been pulled in off the streets” — a racist inference to the ghetto.
Three months in, she was allegedly fired for cause, and was not given information about mediation. (None of the doctors Anyanwu worked with returned multiple requests for comment.)
Robert Farinelli, the program director, confirmed Anyanwu had been a resident, but he denied her version of events. He stated he would be “surprised” if any doctor had said anything racist to her and denied any wrongdoing on the part of the program. He did say that mediation was a normal part of the termination process, but couldn’t speak to why it wasn’t offered to Anyanwu, noting he was not part of that process. “In my time at the program, I have never heard any complaints,” Farinelli told me in a phone interview.
“What about Catherine Hansen?” I asked.
“Well, no complaints that had merit,” Farinelli said.
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Catherine Hansen, was a resident who was fired in 2014. Hansen sued the program in 2016 for discrimination and unlawful termination. On Jan. 11, 2018, the lawsuit was dismissed and Hansen was reinstated at the program. Hansen entered the program in 2012 and was a colleague of Anyanwu’s. Hansen’s lawsuit mirrors Anyanwu’s complaints, claiming that she and other female residents were assigned more patients and worked more than 80 hours a week. Dr. Donal Kevin Gordon, who fired Anyanwu, also fired Hansen. He did not return multiple requests for comment.
Anyanwu said Hansen had asked her to join in on the lawsuit, but Anyanwu refused. She’s a Christian and said her faith doesn’t encourage lawsuits. Plus, they didn’t have money for a lawyer. Anyway, Anyanwu didn’t want to cause trouble; she just wanted to be a doctor, and believed she could get back into the program if she had more hands-on experience. So she enrolled in a master’s in health care administration program at the University of Iowa. Then, she did an two-year externship at St. Vincent’s Hospital in Erie, PA,, while her family stayed in Cedar Rapids, Anyanwu slept on couches, cooking food and cleaning in exchange for rent. When she came back, she contacted the program again.
The responses were dismissive and tense, asking her to stop contacting people in the program about possible externships.
“Juliana, you cannot do this. You simply cannot make your problem a problem for others in this community. And you cannot put me in the position of having to deal with those new problems,” Dr. Gordon emailed in August of 2013. Other emails are less direct and encourage her to find an externship and apply again. It’s easy to see why she didn’t want to sue. She didn’t want money — she just wanted to be a doctor. And she thought if she just did the right thing and worked hard, she could still do it. She didn’t realize it was a game designed to make her lose.
A 2019 study by the Economic Policy Institute found that the Midwest is one of the worst places for black Americans to live. Iowa was one of 10 Midwestern states with the worst ratios of black to white unemployment. Here black people are incarcerated at five times the rate of white people and black Midwesterners of all income levels are less likely to receive preventive health care.
Historical, economic, demographic and political forces have created a system of inequality, a system that was bearing its full weight on Anyanwu. Without money or resources, she had no recourse. She got a job at Mercy, where she cleaned hospital rooms. The very same hospital rooms used by her former colleagues — the residents who weren’t fired. She came home every night and wanted to die. She had a master’s, a medical degree, and she was earning $15 an hour cleaning the very hospital where she had wanted to practice medicine.
She spoke to Dr. Timothy Quinn at Mercy, he told her to work and apply for jobs as they opened, and she did, but she was never hired for them. (Dr. Quinn did not return requests for comment for this story.) Anyanwu quit Mercy after six months. She just couldn’t do it, not with all her former colleagues — now doctors — silently watching her mop floors. She took a job with another company where she manages care for dependent adults. It’s a job she doesn’t need a degree for, but it’s the only one she could find. When she heard about Hansen’s settlement in 2018, whatever hope remained vanished. Hansen had sued and gotten a chance, while Anyanwu was cleaning hospital rooms.
Anyanwu spent her life doing the right thing — she followed all the rules, she didn’t fuss, she did what she was told, and now here she was $70,000 in debt from her master’s with no job, or even the hope of one. “I am 43,” said Anyanwu, “I have nothing saved, so many bills.”
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To Anyanwu, the silence and stonewalling of the doctors and the program is telling: if they ignore her and pretend she isn’t there, act as if they had no role in what happened to her, she will just go away. The statute of limitations has expired and Anyanwu can no longer sue. But she still wants answers. She wants to know why she wasn’t offered mediation. She wants her dignity. She wants to work in a hospital and use her years of training and expertise to help people who are sick and hurting — a place she’s been too many times. But more than all of that, she wants a chance, a real chance.
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