"Imagine we’re talking just like we are right now, and I have a heart attack.”
Don’t worry. Dr. Denrick Kimathi Cooper, Director of International Emergency Medicine at Ochsner Health, is in no real danger. As he assures me, this is just an example—one that, if I follow along, will not just illustrate the components of a functioning emergency medicine system, but will also help me understand health equity from a global perspective.
“If that happened in New Orleans, you’d call 911 for me,” he goes on, “and an ambulance would come pick me up. I’d go to the ER. I’d be evaluated. Pretty soon, I’d be seen by a cardiologist.”
Barring some major complication, Cooper would probably be alright. He would go back to his normal life with a new understanding of his health and a memorable story about a magazine interview that took a remarkable left turn.
“But if that happened somewhere like Liberia, there is no 911, and there’s no EMS system,” Cooper said. “You might have a good Samaritan bringing you to the emergency room. Or if an ambulance does pick you up, it might be staffed by responders who aren’t really trained. Then you get to the ER, and maybe there’s just a dermatologist who doesn’t know how to diagnose a heart attack.”
The New Orleans scenario, Cooper explains, indicates some degree of health equity. Not only did the dominos fall in a perfect line, but the dominos existed to be lined up in the first place. In the other scenario, there would be no promise of such a chain reaction. Too many dominos—proximity to someone who can help, access to a phone, that phone’s ability to connect you with prompt and specific medical care—could be missing, leaving crucial gaps that would make the outcome unpredictable.
What this metaphorical comparison reveals, Cooper said, is a difference in resources, the allocation of which is a key determinant of equity. But even that example might be too extreme. Such radical differences in health-affecting resources need not occur among continental lines. They can occur between neighboring cities. Between neighboring streets. Or even between neighboring houses.
Because, when it comes to health equity, it’s not just about the body you inhabit. Moreso, it’s about who you are, where you are, and the sociological intersection of the two that dictate how you live and how you die.
Cooper puts it most succinctly when he said: “Your zip code is just as important to your health as your genetic code.”
It might sound pessimistic, but it’s a reality—one that, if Cooper has his way, he will help to change for people everywhere, from New Orleans to Liberia and beyond.
The way he sees it, Dr. Cooper’s path in life always came down to one of two options: he could work in medicine, or he could put his long limbs to use as a professional basketball player.
“Unfortunately, I can’t shoot,” Cooper said, “so that decision was made for me.”
Cooper was born to Jamaican immigrants in (rather aptly) Jamaica, Queens in New York City. His father had had much better luck with his own long frame and was recruited by NYU for his exceptional talent in track and field. After arriving in New York, Cooper’s parents gradually flew out other relatives until they’d established their own home away from home, albeit one still intimately connected to Jamaican culture. Their primary tethers to that culture were Cooper’s grandmothers, who remained in Jamaica and served as role models for their grandson.
“I grew up going back and forth to Jamaica for holidays and winters…or if I was being bad in the summer,” Cooper said. “Both of my grandmothers were nurses there, and just being exposed to medicine, and seeing someone who looks like me being involved, played a huge part in me becoming a physician.”
Cooper was diligent in watering the seed his grandmothers planted. While in high school, he volunteered at Mercy Medical Center in Long Island, where he cleaned stretchers in the emergency room. Then, while earning his undergraduate degree in molecular biology from Princeton University, he enrolled in a pipeline program meant to expose minority students to medicine.
“That’s when I said, ‘I’m actually going to do this,’” Cooper said.
He took some time off after college—to “grow out my dreadlocks, play with my band, and live that life”—but Cooper said there was never any doubt he would continue to pursue medicine. He held true to that promise. After a year off, Cooper went to medical school at Case Western Reserve University in Cleveland, Ohio and matched into emergency medicine.
Cooper was back in the ER. But this was no longer high school, and this time, he was doing more than just cleaning gurneys. He was elated.
“I loved the pace. I loved being around patients,” Cooper said. “In the ER, you’re the doorman to the health system. You’re seeing all walks of life. I felt very proud to serve that, even to this day.”
Cooper next completed his residency at Mount Sinai St. Luke’s in western Manhattan. From day one of the three-year program, Cooper had his sights set on a path forward. Several facets of his life and identity had crystallized into a clear goal: his reverence for his grandmothers and their selfless dedication to others, his instilled virtues of living in service to one’s community, his passion for emergency medicine, his love of travel and culture.
“I knew I wanted to pursue global health,” Cooper said. “So, I did a two-year fellowship working at St. Luke’s and going abroad. I went to Liberia, Uganda, Indonesia, and Thailand. Medical school gives you a good foundation in taking care of patients, but at the level of being a real health advocate, that’s where I got my chops.”
And, as it turns out, it’s also where Cooper realized health equity was to become an inextricable aspect of his career.
Go Where the Need Goes
It would be inaccurate, Dr. Cooper explained, to conflate health equity and equality.
“It’s not about giving everyone the same amount,” he said, “because not everyone starts with the same amount.”
Think of it this way: equality would be serving everyone at a dinner party the same amount of food, even though some guests began the evening with already-heaping plates. Equity would be serving more to the guests who began with empty plates until everyone has a similar portion.
“Health equity is about thinking of where the most tremendous need is, and figuring out how we can allocate resources to fit that need in the best way possible,” Cooper said.
How are those needs measured? He said it comes down to a term that, while previously used only by those working in medical professions, became more commonly known during the COVID-19 pandemic: social determinants of health.
“Literacy, finances, access to healthcare, education, housing stability, food security, and so on—these are all social determinants of health,” Cooper explains. “And they’re affected by things like racism and discrimination.”
Therefore, health disparities—negative consequences that emerge in the absence of health equity—typically affect populations that are already vulnerable, such as “minorities in race, ethnicity, culture, sexual orientation, and gender.” For example, consider how Black people are more likely than any other race to die from heart disease, or how LGBTQ+ people suffer poorer mental health outcomes than cisgender heterosexual people.
Even before his medical training, Cooper had witnessed the realities of inequity and health disparities. His father’s family came from a rural part of Jamaica where “poor access to healthcare ran rampant, and it would take hours for someone to get to a doctor.” And, growing up in Queens to immigrant parents, Cooper knew that it was difficult—for some people, impossible—to start acquiring resources and changing one’s social determinants of health.
“My family climbed the socioeconomic ladder through my childhood,” Cooper said. “We moved from a friend’s basement, to an apartment, to a house. But the entire time, my parents let me know that we were fortunate to have the resources we did have. It changed my approach to life and being a physician.”
Cooper came to appreciate that lesson even more when he began practicing international emergency medicine during his fellowship. In Liberia, he observed a stunning lack of resources. There was no national health insurance system, and poverty was widespread, meaning most people either paid for healthcare out of pocket or simply did not receive care. On top of that, as Cooper made clear in his 911 example, there were no emergency medical services—a deficiency his presence was meant to address.
Building emergency medicine capacity in such vulnerable communities was rewarding, Cooper said, but it wasn’t easy.
“One of the nurses I worked with went into cardiac arrest,” Cooper recalls. “In America, we might give them an IV, shock them with a defibrillator…but none of those things were around. It came to a point where I thought, ‘I’m an emergency medicine doctor, and I’m powerless to help this patient.’ It was disheartening, especially when you know you could do more if you were somewhere else, in another country or state, with different resources.”
Coop and the Stoop
After his fellowship, Cooper returned to New York, a temporary stopover while he searched for the right medical institution to further his work.
Soon, a former director from his residency program recruited him to Ochsner Health, where emergency medicine specialists were needed to help launch a new Emergency Medicine Residency Program.
“I interviewed with a lot of institutions,” Cooper recalls, “but this one was unique. This one was starting a residency, and it was New Orleans.”
According to Ochsner, the new residency features “a thoughtfully designed and innovative didactic curriculum” and “top-notch clinical training.” For Cooper, it was a perfect match. He accepted a position and moved to New Orleans with his wife in 2019.
Along came COVID.
The city that Cooper had been so eager to experience quickly shut down. Doors were closed. Tickets were refunded. Fear and uncertainty dominated every conversation. It would have been easy to feel frustrated, helpless, or defeated. However, Cooper soon discovered there was little time for all that. Friends, family, and acquaintances had questions about the unfolding pandemic, which was by all means revealing itself to be an emergency—and they knew who to go to for emergencies.
“People would ask what I think about this, or how I feel about that,” Cooper said. “I had questions coming from all directions, and I had answers because I was very much in it. I could read the research and put it out in understandable terms.”
The pandemic was not just throwing health disparities, particularly among Black Americans, into harsh relief: it was exacerbating them, and Cooper recognized that sharing sound medical information was itself an act of health equity. Once again, a need had made itself known, and he began looking for a way to meet it. Luckily, the perfect forum already existed.
“STOOP55 was originally born out of mine and my friends’ interests,” Cooper said. “Two of my best friends, Stephen and Gavin, are in the media sphere, so before the pandemic, STOOP55 was a way of building community among musicians and artists in Brooklyn.”
The STOOP55 project, Cooper explained, brought out multidisciplinary creators from across Brooklyn for documentary-style interviews and performances on Stephen’s stoop. At the end of the season, all the featured artists would return for a block party. COVID-19 temporarily disrupted that vision, but with its existing audience on social media, Cooper saw another way that STOOP55 could serve the community.
“At the time, I talked to Stephen and Gavin about going live on the STOOP55 Instagram and just fielding questions,” Cooper said. “I was in contact with an ER in Brooklyn that didn’t have PPE, and we thought we’d do this as a way to raise money for masks at Brooklyn Hospital. We were all for it.”
Cooper said that a few hundred people tuned in for the first live Q&A. That number kept growing on subsequent streams. Cooper answered many of the viewers’ questions himself, but was regularly joined by other medical professionals who would share their own experiences and insight.
“We had more money flowing in, so we said, ‘Let’s keep going,’” Cooper said. “One week turned into five, then 10, then 20. It expanded from just information about COVID to hearing people’s experiences with being at home, being away from family, losing family. It was a way to get everyone’s perspectives. It was nice to answer people’s questions and bring some humanity to the experience.”
When vaccines began to roll out, Cooper talked his audience through their hesitations, offering evidence-based perspective on vaccine safety and efficacy. He even live-streamed getting his own first dose to encourage other vulnerable populations to do the same. Cooper felt called to lead by example—an appropriate instinct for someone who would soon be guiding Ochsner’s next generation of emergency medicine specialists.
Forging a Path Forward
This year, Dr. Cooper and the rest of the emergency medicine residency faculty graduated their first class of residents. The program was—and is—everything Cooper hoped it would be: efficient, highly collaborative, supportive, rewarding.
“Seeing the residents that we’re training grow from students to novice experts to colleagues has been one of my greatest successes,” Cooper said. “I’m very adamant in investing in the greatness of people and representing people who don’t see themselves in medicine. It’s important for me to help them realize their dreams because I’ve been lucky enough to realize mine.”
Still, Cooper said there is work to be done toward achieving health equity in New Orleans, where stark contrasts in health and resources are ever apparent between neighboring communities.
“We have a saying that global health is local health,” Cooper said. “In New Orleans, I find it interesting that when you think of life expectancy, there’s a discrepancy of 10 or more years depending on where you live. I work at Ochsner’s main campus, as well as in Kenner and LaPlace, and the way I have to think of treating a patient changes depending on the resources I know I have available. And even though we treat people in the ER, we discharge them into the same environment that contributed to the disease in the first place.”
So, whose job is it to repair such systemic fractures? Yes, medical professionals, but beyond that, Cooper said it’s important to think more broadly. Real change requires ideological evolution. Societal shifts. Behavioral adjustments. And, most important in Cooper’s view, policy change.
“Any time you’re thinking about social justice and equity, that’s the pattern we have to choose—to create policy that creates change for the better,” Cooper said. “As a community, we have to cherish and understand how important health equity is. A doctor can be a big part of that change, but so can anyone who isn’t in health care at all. We all have a stake in this. On a population level, we need to be advocates for changing policies that may have caused disparities. We have to invest in the community.”
From an institutional standpoint, such an investment might look like the Healthy State initiative, a program launched in partnership between Ochsner, the state of Louisiana, and Governor John Bel Edwards to improve Louisiana’s health rankings by 2030. From an individual standpoint, that investment can be something as involved as community outreach and volunteering at food banks—or something as simple as casting a vote.
For his part, Cooper just wants to live up to his name: “Kimathi,” he explained, “is the Kenyan word for ‘earnest provider.’” He wants to provide hope and compassion for vulnerable populations worldwide. He wants to provide love and support for his wife and their newly welcomed first child. He wants to provide education and clarity for his emergency medicine residents and his community.
Cooper is poised to do just that. Soon, he and his STOOP55 collaborators will release “Agandi,” a documentary they filmed when he worked in a resource-limited emergency medical center in western Uganda. He’s also part of a joint effort between Ochsner and Vanderbilt to develop emergency medicine programs at Georgetown Public Hospital in Guyana.
Such lofty goals are not easy, but they are not impossible, Cooper said, thanks to those who have walked with him along the way. He makes a point to express gratitude for everyone who has provided for him so that he, in turn, can provide for others: his family, his friends, and all the social advocates in New Orleans “both recognized and unrecognized who are building the foundation from which I have been able to operate.”
“We have to be optimistic about what we can do and what can happen in the future,” Dr. Cooper said. “As long as there are other people working toward that same goal, you don’t have to feel alone in your journey. Anyone can be a social advocate, and the more changemakers we have towards rectifying health disparities, the further we will go together.”
