The Physician, The Course Elective and Her Specialty –The Crista E. Johnson Story

By James Z. Daniels | Uploaded Aug 9, 2016 |

There was something about her,” Dr. Carol Johnson said, “that marked her out for a very successful career,” and Crista Johnson – Dr. Crista Johnson, her daughter, has not disappointed her parents, Drs. Edgar and Carol Johnson. Her story, some would say, is an improbable one. Brought up in a home with firm and focused immigrant parents, she and her two siblings were provided oversight and guidance mingled with persuasion that success comes by diligently seizing the opportunities that education brings. It is also the story of one of those daughters in particular who through discipline and determination committed to being the best she could be. Strongly influenced by her faith, she has scaled the heights of professional success as a practicing physician.

From her earliest memories, Crista Johnson sensed that her parents were determined to see to it that her education and that of her two sisters was the very best possible. They committed to this principle even where the quality of education delivered was at times less than they desired. All three daughters are products of the Bloomfield, Connecticut public school system, the town adjacent to the capital city, Hartford.

After receiving his Ph.D. from Andrews University in Berrien Springs, Michigan, a very small town  not far from Benton Harbor,  the home of the Whirlpool Corporation, Jamaicans Edgar Johnson with his wife, Carol,  along with four year old daughter Crista, relocated in 1979 to Bloomfield where Carol’s mother, a recently minted immigrant lived after arriving from Jamaica. They enrolled Crista in a private elementary school and she stayed there through third grade. Her parents expected to enroll her in 4th grade at Vincent Elementary School in Bloomfield but the principal insisted that she was too young for 4th grade and should be enrolled in 3rd grade. Knowing her preparation, her father demanded that Crista be tested. The results confirmed that she should be placed in 4th grade and she was. This event was a marker for high achievement and high expectations that often led the Johnsons in an independent minded direction regarding the education of their children.

 

The Bloomfield, Connecticut Experience

For most of their public school experience, all three girls, Crista, Joette and Gretchen, were held to a strict standard of using their time constructively. There was no idle TV time and there was measured playing time. Their time after school had to be spent in what their mother, Carol, referred to as “constructive guidance.”  This was a self imposed schedule of activities that the girls had to devise and chart each school day. It was reviewed by the parents at the end of the day to see how well they had followed their own self imposed schedule. Parental assessment would result in a grade for the quality of how they spent their time. It was a discipline that has forever shaped their lives.

Music, for the Johnsons, played a critical role in buttressing the requirement that all time must be productive. Crista enrolled in piano lessons at age six; Joette played the viola and the piano and Gretchen played violin and the piano. As they grew older more and more time was allocated to music. By high school they were practicing approximated up to 4 hours each day. To this was added homework and study time and, yes, they could watch the Bill Cosby show.

Dr. Crista Johnson and her program manager, Social Worker Jeanne Nizigiyimana

The Johnsons expected that their children receive the best education possible from the Bloomfield school system. Bloomfield in 1973 had been named an All American City. But in the 1980’s and beyond, the town began experiencing white flight as the demographic shift resulted in more minorities moving into the town and whites moving out. The school system reflected the transformation.

Crista Johnson believes that with white flight came a lowering of expectations by teachers of the African American students and recalls one of several encounters her father had while attending a parents’ night when she was in 9th grade. During the one-on-one with the math teacher, Ms Levy, he asked how Crista was doing in the class. Ms. Levy, Crista said, responded that she was doing quite well. “What is her overall grade?” Her father asked. “She has a C.” Her father’s responsive was instinctive. He made it emphatically clear, or as Crista described it, “he kicked up dust,” a Jamaican expression, that a “C” grade was not considered doing well and no child and certainly none of his should be settling for a “C” grade when they could be striving for an “A” grade if the teacher demanded this of them. Both Ms. Levy and Crista got the message. At the end of the year her grade had risen to an “A” and Ms. Levy was a better teacher.

Crista believes, however, that the teacher’s response was indicative of the decline in expectations of African American students as the school’s demographics transitioned from a white majority student population to a majority African American population. In the years between her start in the 4th grade until her graduation in 1992, the district went from an even split between white and minority students to a student body where 90 percent of the students were minorities.

On three separate occasions, Crista said, teachers and guidance counselors expressed shock that she dared to believe that she could get into the very best colleges in the US. She was known by many to be an outstanding student; a fact confirmed when she ranked third in her graduating class. On one occasion she was asked what her plans were for college. She responded that she was applying to Johns Hopkins University and expected to pursue a career in medicine. The counselor literally laughed and told her that there had not been a student from Bloomfield who had been admitted to Johns Hopkins in 11 years. “You should stick,” she was told, “to in-state schools because they are more likely to accept you.”

Former superintendent of Bloomfield schools, Paul Copes, also concurs that there was a period as the demographics of the student body changed and those changes were not reflected in the composition of the faculty and administration, “there was a lowering of expectations regarding the performance of the African American students most of whom had migrated from Hartford.” He commended the diligence of the Johnsons to insist that their daughters be held to a standard of high expectations. “They were model parents not only because of their concern for their own children but because they sought to encourage other parents to demand the very best of the system and their children.”

The performance demanded of Crista was clear. At all cost she was to achieve the highest grade scores possible. She was not to be fazed by the deficiencies of the school system. She and her sisters were expected to bolster whatever was not supplied by the schools. Grades that fell short of an “A” resulted in parental conversations.

In high school, Crista was inspired by books written by Dr. Ben Carson. At the time he was the director of pediatric neurosurgery at Johns Hopkins University, and an African American. He had led the team of doctors who performed the first successful separation of conjoined twins joined at the back of the head. But his life’s story in no way approximated Crista’s. He was raised by a mother with a third grade education and he struggled to get his life in order as a teenager. Raised by parents who are devout Christians, Crista admired the openness with which Dr. Carson spoke about his faith.

At Bloomfield High School, as the demographics shifted, the school system that once offered Advance Placement (AP) courses every year changed to every other year, and as a reflection of a different expectation of the students, began to introduce courses in wood working and mechanics. Crista wanted to take AP courses in calculus, physics, chemistry, and English and had the grades to prove it. She was only able to take AP biology on the off year only because her parents fought the system, she said.

While in high school, she spent every summer in enrichment activities and programs.  Many of them were recommended by her biology teacher Mrs. Valerie Gange. These programs exposed her to the varying aspects of the sciences as Mrs. Gagne, who is profuse in her praise of Crista --“If I only had more students like Crista,” nurtured her interest in the sciences. She facilitated opportunities for Crista to be mentored in research at the University of Connecticut Medical Center and various science workshops at the University of Hartford. It came as on surprise when in 1992 she was accepted with early admission to Johns Hopkins University. She had met and completed her high school requirements within 3 years.

Clinic Staff

Off to Johns Hopkins

John Hopkins University was an unknown world to Crista when she arrived as a freshman. “I was enrolled in courses with students from the top private schools in the country and the competition was, to say the least, fierce.” She had frequent spells of self-doubt and questioned what she was doing there. She believed she had made a mistake. Some of the students had already taken college level courses at their high schools. She cried often and told her parents that she wanted to withdraw. She describes those crying episodes as, “bawling her eyes out.” During those pleading sessions with her parents, her father’s standard mantra was, “you are no longer running with the foot soldiers you are running with the horses, so step it up.” 

Another was, “You are not a chicken. Do you want to soar with eagles?” She, did, however, know she could count on their support and it bolstered her determination to rise to the challenge one she faced head-on.

Eighteen hour study-days became the norm. The physics course taught by a Nobel Prize winner became her watershed for success. Her diligence paid off as she received a grade of “A.” Her life was fully consumed with studying and as a classically trained pianist she continued her mastery of an expanded musical repertoire playing more and more challenging pieces while also serving as the pianist for the church she attended in Baltimore.  But as she moved towards completing her undergraduate degree, there were a combination of events, totally unplanned, that sealed her commitment to a career in medicine.

Crista Johnson completed her undergraduate degree in biology at Johns Hopkins University and immediately began her medical school training at Weil Medical College at Cornell University in 1996. She graduated in 2000 with a medical degree and a specialty in Obstetrics and Gynecology. Her awards for superlative academic performance include recipient of the Gustav Seeligmann Prize for Obsterics; recipient of the Gustav

Noback Memorial Prize in Anatomy, and First Place Prize National Senior Residents Conference of the American Society of Plastic and Reconstructive Surgeons, among others. Upon graduation she began her residency at George Washington University Medical Center. It was during her residency that she began to delve into the relationship of culture to the successful practice of medical care. What accounts for this interest in a field that up until then was somewhat obscure among medical practitioners? It began during her time at Hopkins.

Having completed all required courses, she decided to take an elective in pre colonial Africa and was required to read Alice Walker’s novel, Possessing the Secret of Joy that deals with Female Genital Circumcision (FGC).  Prior to this, Walker’s fame was attached to her novel the Color of Purple.

Crista had never heard of this cultural practice before so in her senior year to meet the requirements of the course, she wrote a final research paper and made a presentation to her classmates. This was a thesis-length document on the topic of Female Genital Circumcision in Africa, Asia and the Middle East. It was an eye popping presentation to her fellow students who were clearly shocked having had no knowledge of this outrageous procedure in countries where it is regarded as a celebration, a rite of passage, even a protection against promiscuity inflicted on young girls.

FGC is recognized as a human rights violation around the world affecting 140 million women, is a federal crime in the United States. For Crista the thesis was her watershed and set her mind turning on the relationship and connection between culture and medicine, a topic I had written about and was published in the Hartford Courant in 1995. It shaped the course of her medical career.

 

Refugee Women

The Newly Minted MD

Crista began her residency at George Washington University where this aspect of medical practice took on a larger proportion of her practice. While completing the rounds each morning – the practice of physicians visiting their patients to check on their condition and prescribe procedures, medication, therapy, etc., she saw how other physicians reacted with shock and disbelief when dealing with certain patients. These patients had been victims of cultural practices typically associated with foreigners and there were many, many such women in the District of Columbia. “What these physicians saw,” said Dr. Johnson, “included but were not limited to body branding, embedded tattoos, and facial scarring.” She was particularly concerned that the practice by doctors of bringing medical students to look at these patients and have extended conversations in their presence was very humiliating. They openly expressed how barbaric and primitive the markings on the bodies and faces of the patients were unaware that it would affect the quality of their care.

Patients saw the expressions on the faces and in the eyes of the medical students. They experienced shame and embarrassment. Dr. Johnson believes that she began to observe over time a reduction in the number of women from countries where these practices were common showing up for regular doctors’ visits. They were, however, being admitted to the Emergency Department to receive treatment for illnesses that could have been prevented with early intervention. Many of these African and Moslem women were waiting until the last minute to seek medical care. From her point of view, “trust had been shattered and the Emergency Department became the place where contact with these patients became the point of admission for medical care.”

Dr. Johnson realized that there was no formal training to prepare doctors to deal with these patients. As far as she knew, it was not a topic included in the typical medical school curricula. To her, and in a phrase, what she observed at GWU was ‘culturally ignorant behavior’ and it began to prescribe her OBGYN practice. After she completed her residency, she enrolled at the University of Michigan Graduate School and completed the Master of Science degree in Health and Healthcare Research. She simultaneously received the Robert Wood Johnson Foundation Clinical Scholar Fellowship where she remained for two years. It was no coincidence that she sought to attend the University of Michigan Medical School. This was where Dr. Benjamin Carson received his medical training after graduating from Yale University.

However, between the completion of her residency and the start of her work at the University of Michigan Medical School, she sought to attach herself to a practice in the Washington, D.C. area but had no success. No medical practice wanted to hire her for just one year. She received rejection after rejection so she applied to and accepted a fellowship as the Female Sexual Medicine Clinical Fellow in the Department of Urology at the David Geffen School of Medicine at UCLA and served as a clinical instructor. This medical facility provides several services for the medical evaluation and treatment of female sexual function complaints. It was here that she honed her surgical skills and mastered the procedure known as vulvar plastic reconstructive surgery and today is counted among a very small number of surgeons skilled in this procedure.

 

Recruited to Lead

Dr. Johnson said that after accepting the fellowship from UCLA she received an offer from Maricopa Integrated Health System (MIHS) at the Arizona State University in Phoenix to establish and lead the Refugee Women’s Health Clinic (RWHC).

In January 2009, the MIHS staged the grand opening of the (RWHC) with Dr. Crista Johnson as the medical director of the clinic. It is believed to be the second clinic in the U.S. that specializes in obstetrics and gynecology for refugee women from Africa, Asia and the Middle East. The first is at Brigham and Women's Hospital, a teaching affiliate of Harvard Medical School.

When queried regarding why Arizona’s interest in women refugees, and why Dr. Johnson was selected, Dr. Dean Coonrod of the MIHS said Arizona is 7th highest state for refugee resettlement by the federal government, primarily because of the state's relatively low cost of living and job opportunities. Between 1990 and 2009, the African-born population in Arizona soared 577 percent to over 20,000 from 2,917, according to figures from the Migration Policy Institute in Washington, D.C. Refugees and immigrants from countries where FGC is practiced include Somalia, Sudan, Liberia, Mali, Burundi, Ivory Coast and even Egypt are arriving in the Phoenix area. Other countries represented include Iran, Iraq, and Cambodia as well. Many come to escape civil strife in their homelands. According to reports, Somali is the second-most-requested language for interpretation services behind Spanish.

"What was striking was the language barriers and the stress of the women when they would come to the hospital," Johnson said. "The clinic will be an oasis to the community because there will be people who understand them better."

Nine languages - from Swahili to Somali are spoken by the clinic's program manager, the medical assistant and volunteers. Brochures are translated into several languages and staff spend time in neighborhoods and with organizations educating women and families about the clinic. This effort is led by its program manager Jeanne Nizigiyimana, a Tutsi, who fled civil war in Burundi a decade ago and the pressure from family and tribal leaders. She came to Arizona and completed the Master’s degree in Social Work.

In May 2010, the Arizona Business Magazine, the state’s leading business publication in presented to Dr. Johnson its Third Annual Health Care Leadership Award during a reception at the Ritz-Carlton in Phoenix.  This annual event honors outstanding work in all facets of the medical industry from top hospital executives to doctors, researchers and nurses on the frontline of care.  Dr. Johnson continues to lead the international advocacy for the sanctioning of this cruel procedure in appearances before the United Nations High Commission on Refugees  

In June of 2011, the Refugee Woman's Health Clinic was featured in a photo exhibit on Capitol Hill in Washington, DC in celebration of World Refugee Day.  Dr. Johnson was on hand at the opening ceremony to speak on the work of the clinic and its impact on the lives of refugees.

As a product of the Bloomfield School System, this graduate and child of immigrant parents has distinguished herself beyond anything that her peers or teachers could have imagined. Many may still find her accomplishments improbable.