Nature Reviews Neurology is interviewing individuals who are driving efforts to address disparities in neurology through a broad spectrum of diversity, equity and inclusion initiatives. We spoke with neurosurgeon Sonia Mejía Pérez from Mexico about her work to address gaps in hospital care for individuals from minority groups, such as LGBT+ people.
What is your current position and what diversity, equity and inclusion (DEI) activities are you involved in?
I am a Neurosurgeon and Professor of Epilepsy Surgery at the National Institute of Neurology and Neurosurgery in Mexico City, the largest neuroscience centre in Latin America. In the 60 years of history of the institute, I am the only female attending neurosurgeon. I also recently served as the Chairwoman of the Educational Department of the institute.
My work with the Educational Department aims to identify gaps in hospital care that can result from a lack of knowledge of the specific needs of individuals from minority groups, such as those from sexual and gender minorities (LGBT+).
My overall mission is to be a role model for future generations; offering mentorship and sharing knowledge, life experience and academic advice are my main goals as a neurosurgeon professor. I also work with pre-med students in mentoring programmes to help individuals to reach their potential and eliminate possible barriers related to DEI issues.
How does your work address disparities in neurology?
Disparities in neurology can arise from a lack of education in caring for individuals from minority groups. Furthermore, stigmas and biases embedded in society can impair healthcare experiences for certain individuals, affecting their ability to seek timely care and interact honestly with physicians. In turn, these factors can lead to the individual obtaining treatment that might not be the best or the most appropriate for them.
With my team in the Educational Department, we developed a questionnaire to conduct situational analysis of DEI matters at the institute. The questionnaire is completed by residents and administrative personnel, and aims to identify issues or gaps in knowledge related to the care of individuals from minority groups. On the basis of the results, we establish a strategic plan to educate our personnel on DEI-related topics. This analysis was first conducted in 2019 and is now done on an annual basis, and helps us to readjust our annual work plan to address these matters.
One of our latest contributions was the publication of a protocol for neurosurgical care for the LGBT+ community (J. A. Álvarez-Castro et al. Cureus 16, e52005; 2024). The idea was supported by a previous case report we published about a multifocal glioblastoma and hormone replacement therapy in a transgender female individual. We realized that training in how to treat this specific population is lacking; things like how to use pronouns correctly and what specific needs LGBT+ people might have are information that we felt compelled to write down and share with the neurosurgical community in order to improve the quality of our practice and tackle health disparities.
“We realized that training in how to treat this specific population is lacking”
The protocol focused on the medical, psychological and sociocultural aspects that might influence quality of care and treatment outcomes for LGBT+ people in the setting of neurosurgery. We also aimed to identify gaps in current knowledge and practice, as well as offering insight into areas in which adjustments and personalized procedures are required to guarantee fair, inclusive and sensitive healthcare for this group.
What support do these DEI initiatives need?
So far, I have been very fortunate to garner support from the local authorities. However, there is still a lot of work to be done.
Comprehensive situational analysis in each institution should be a first step in addressing and acknowledging the problem. The analysis can aid the development of action plans and specific public policies, which can be applied according to the different sociocultural backgrounds in the local population. Mexico, like other countries, has severe disparities regarding sociocultural status; the strategies applied to reduce the healthcare attention gap must be adapted to each specific population.
Forums for open discussion are imperative to support these activities and to address varying needs and opinions effectively. I believe that the leaders of every institution should be involved in these discussions, given that they are the ones who can help to establish public health policies. Experts on the specific subjects being addressed and, of course, general public representatives should also be included.
How could your work be applied or relevant to global neurological health?
I strongly believe in the value of situational analyses and the review of both public and academic local policies on an annual basis to provide a diagnostic on where we stand, and also to identify specific issues that require attention. Such analysis can be done with minimal financial resources, making this method accessible to any institute.
Sharing the results of such an analysis can help to inform and inspire other departments, institutes or countries to develop diverse strategies, ideas and topics for discussion. For example, following our analysis, we organized an informative session for all hospital staff, held in the hospital auditorium, where we shared the results and discussed some DEI topics.
Publications that address the identified gaps, such as our protocol for LGBT+ care, are also important to drive progress in these areas. This exchange of information can foster collaboration and innovation on a global scale, ultimately contributing to the advancement of public health initiatives and the improvement of health outcomes worldwide.
In what ways can other people in the neurology field support efforts to address neurological health disparities?
Given the importance and complexity of the issue, efforts to understand the root causes of disparities in neurological health should be a priority for research in every country. Academic journals can encourage this effort by publishing research focused on this topic.
Education, training and mentorship opportunities for early-career professionals to promote career development in DEI-related topics, such as LGBT+ health, are important. Lack of awareness of, and sensitivity towards, the needs and experiences of LGBT+ people, for example, can have a substantial influence on the quality of care, where decision-making is crucial and the physician–patient relationship is paramount. Thus, incorporation of LGBT+ health into the career development of medical personnel can help to mitigate health disparities in this population.
Advocacy and diffusion of information to the public have crucial roles in amplifying the discourse surrounding these matters, increasing awareness of the issues and gathering support for solutions. Educational workshops, community health screening and outreach programmes should form part of the community engagement agenda.
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Kiani, L. Addressing disparities in neurology by identifying gaps in hospital care. Nat Rev Neurol 20, 253–254 (2024). https://doi.org/10.1038/s41582-024-00960-0
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DOI: https://doi.org/10.1038/s41582-024-00960-0