June 5, 2015
A hotel parking lot somewhere outside Chicago
It is 1:30AM when we finally roll up to the parking lot of the hotel where we pick up the final member of our bird-dog crew. Our final destination is Des Moines, Iowa, the site of our first event of the weekend, a meet and greet with Senator Lindsey Graham (R-SC). Senator Graham is chair of the Senate Foreign Operations and Related Programs subcommittee–and a key player in the future of global AIDS funding.
At this point we’ve been driving for thirteen and a half hours straight–all the way from AMSA’s headquarters in Sterling, Virginia. But the schlep is worth it for a chance at one-on-one access to a key policymaker.
This is bird-dogging.
The chance to use your voice to get answers from policy makers directly. At a public event, you ask a pointed question (with an implied answer) forcing the person in question to take a stand on a particular issue.
Bird-dogging at a Senator Rubio town hall meeting asking for his support for global AIDS funding
And the issue in question today is the dire state of global AIDS funding. Just this past week the House submitted their version of the 2016 budget. It fails to restore the devastating cuts made since 2010 to vital HIV/AIDS treatment and prevention programming, the President’s Emergency Plan for AIDS Relief (PEPFAR). These cuts are beginning to manifest in a big way–this year we saw the number of persons enrolled for treatment through PEPFAR plummet. If PEPFAR funding is not restored we will continue to see drops in enrollment–which means less people on treatment, more deaths, and a real step backwards on the path to end AIDS.
There are many steps to a successful bird-dogging (in fact AMSA has a 101 sheet here). We start off on the right foot by arriving early–you’ve gotta get good seats! When the opportunity comes for a question you want to be front and center with the speediest hand-raise possible.
While we are waiting for the room to open, myself, Matt, fellow AMSA leader, and Paul, our colleague from our partner organization, HealthGAP, get together with our fellow bird-doggers Julie and Nicole–Student Global AIDS Campaign (SGAC) leaders at Iowa State. We work on formulating the key ingredient–an air-tight question that will force a real answer. In this case we want Senator Graham to commit to $300 million restoration of funding to PEPFAR in his budget bill this July. Our question is:
“Senator Graham, thank you for being a champion of global AIDS funding. We know you’ve supported this program, a legacy of President Bush, for a long time. As you know President Obama has made cuts to PEPFAR every year since 2010. We are starting to see real effects of this–this year we saw a precipitous decline in the number of people enrolling for treatment with PEPFAR. Will you continue to support global AIDS and commit to restoring $300 million for PEPFAR this July in your budget, with or without sequestration?”
After the Senator’s speech, when the time comes for question and answer, I am seated front and center and fling my hand up high and fast.
It pays off. I get the first question.
The senator’s answer is pretty close to what we want. He explains what PEPFAR is to the crowded room, and even elicits an applause of support for the successes of the program. But his answer isn’t quite complete. He says he will try to support PEPFAR but does not repeat back to us the 300 million dollar figure. He says that sequestration makes promises like this difficult. This is quite a common tactic–he has somewhat evaded my question in order to bring up a point he would rather discuss–in this case the national debt and the importance of reforming social security–one of his main campaign platforms.
Luckily, there is time left for more questions and we are many in number!
A few questions later, Paul, our partner from HealthGAP, is called upon. He follows up the prepared question with a second that attempts to directly address sequestration before again asking the senator to commit to $300 million restoration.
He is interrupted and the senator again derails to a different topic.
But luckily we get one more chance. Nicole, Iowa state student and SGAC leader, is called on for the final question. She rises and begins to address the number of lives lost if the funding is not restored before she is interrupted–”You’re preaching to the choir,” says the senator. He begins a rather long digression into the troubles of budgets in general–if you fund one thing you must cut another, etc. But importantly he ends by mentioning the exact dollar amount that we requested for PEPFAR–$300 million. He’s committed to our specific ask publicly, on video–exactly as we had hoped.
(See the whole process from our first question to last here)
After the event we make sure to finish up with some other key bird-dogging tactics–gumming up the handshake line and talking to media.
Eventually, we head out and meet to debrief over some celebratory pie. We’ll want to send out an update to our fellow bird-doggers across the country so they can use today’s success in their encounters with the Senator: “My friends talked with you in Iowa and you promised them there that you would commit to $300 million restoration for PEPFAR…”
In addition, we can follow up in meetings with senator Graham’s staff and remind them of what we were promised in Iowa.
This is a huge win.
We begin our trip back exhausted but exhilarated. There is palpable excitement in the air. And it’s not just the promise of a glimpse of the World’s Largest Truck Stop on the way home (though this is admittedly a plus).
This is what it feels like to reach the people in power.
This is what it feels like to make change.
As physicians we are going to find ourselves hitting consistent barriers–maybe our patients won’t be able to afford medicine, or make it to their appointments, or follow through on our recommendations for diet, exercise, etc. At those times, when we realize that all of our knowledge and experience won’t fix the structural problems our patients face, it is important for us not to step back and admit defeat. It is important for us to remember that we can access those in power and in doing so that we can make change.
Alison Case is this year’s Education and Advocacy Fellow with AMSA. You can reach her at email@example.com. She would love to help you get involved with AMSA advocacy and to hear your ideas for how we can make change!
Matt Moy is AMSA’s Healthcare for All Campaign’s Co-director. You can reach him at firstname.lastname@example.org. He would love to answer any and all questions you have in getting involved with activism with AMSA as a future health provider!
And look out for our advocacy workshops–coming to your chapters this fall!