Holding Our Institutions Accountable: Lessons from the Medical Student Campaign to Divest from Trump's Mar-a-Lago

Over the course of the past year, several healthcare-related organizations have decided to stop holding fundraisers at Trump's Mar-a-Lago resort. Some of them had held annual events at Mar-a-Lago for decades, but given the president's consistent escalation of racist, sexist, and transphobic comments and policies, these organizations felt that they could no longer financially support him. In addition to outcry from local and national communities, tenacious pressure from healthcare professionals was a key factor in this exodus from Mar-a-Lago, demonstrating the impact that our sustained engagement can have in successfully holding our institutions accountable. We write to highlight some successful elements of our campaign and to encourage our peers to speak up when their home institutions are not living up to their stated principles.

As some of the students involved in this broad campaign, we hope to expand on this engagement and encourage our peers to continue advocating for health justice. As medical students, we are at the bottom of a steep hierarchy and often feel like our voices do not matter. We are under tremendous pressure to succeed on board exams and rotations, and we are keenly aware of the power that our medical schools and affiliated hospitals have over our careers. Despite this, students at Harvard Medical School and Case Western Reserve School of Medicine were able to influence our affiliated organizations - two of the top hospitals in the country - to take a moral stand and relocate their annual fundraisers. We held our organizations accountable and asked them to behave in a manner consistent with their mission statements, and eventually they listened.

Mar-a-Lago was not a fluke, but rather one event in a proud and successful tradition of medical student activists pressuring their institutions to do the right thing. In order to see more meaningful changes at our academic institutions, trainees must do more to build on this legacy of principled, patient-oriented activism by vigilantly looking for opportunities to act. They must see themselves as empowered. Trainees at Yale University historically fought to lower the price of a university-developed, life-saving HIV medicine in South Africa. More recently, students at Johns Hopkins have worked to ensure the affordability of a new tuberculosis drug. At Harvard, students led a campaign that resulted in affordable health insurance for low-income workers at their institution. As trainees, we are uniquely equipped with the right amount of idealism, drive, and future-facing vision to successfully fight for positive change.

Highlighting some key factors in the success of this campaign: First, we maintained open lines of communication with our institutions throughout the campaign. We identified allies in positions of power within the medical hierarchy, asked them to support our cause, and worked with them to establish meetings and direct communication with the leaders of Dana Farber and the Cleveland Clinic Foundation. Early on, students at Harvard and Case Western identified that we were independently making the same ask of our respective organizations and decided to join forces, which was an essential component of the campaign's eventual success. Despite these institutions' attempts to cloud or redirect our goals, we continuously restated our simple ask - that as medical and educational organizations, we must refuse to financially and socially support an openly racist, sexist, bigoted person. We stated this argument clearly and professionally, supported it with evidence, and were transparent about any next steps we planned to take.

Throughout the course of this several-months-long campaign, we allied with individuals and groups from outside the immediate medical professional community, including patients, artists, and groups representing issues including racial justice, single payer healthcare, and fair wage policies. When one of our organizations - the Cleveland Clinic - reneged on their promise to no longer hold fundraisers at Mar-a-Lago this summer, we restarted our campaign against this and made it very clear that we would not stop until they did the right thing. Through our initial open letters' sign-on format, we had built a several-thousand-deep community of supporters who were ready to jump in again when needed. When Trump's bigoted statements escalated to blatant refusal to condemn white supremacists after the Charlottesville attacks, the additional pressure hit a tipping point, and the Cleveland Clinic joined Dana Farber and dozens of other organizations in pulling out from Mar-a-Lago.

Medical student activists are simultaneously part of a wider movement, but we campaign in one place, against actors with which we have special influence and entanglement. This is critically important to re-establishing our profession's credibility as a calling that puts patients before profits and politics. Educational institutions that recognize and value the role of social determinants of health should actively encourage medical student activism. Medical students should be exposed to the principles and experience of social justice organizing, including strategic planning, power-mapping, and relationship building. We believe there are more potential medical student activists out there, ready to engage, and we hope to encourage them to pursue social justice organizing training and involvement.

As medical students, we were one part of a much larger, intersectional campaign pushing organizations to divest from Trump's businesses. As trainees in a field whose overarching goal is "to do no harm" and who see the human impact of Trump's policies on our patients, we were also in a unique position to hold our institutions accountable in standing up for those patients. Our open letters, national press coverage, demonstrations, and broad collaboration significantly contributed to the pressure that ultimately led to broad divestment from Trump's businesses. We hope that by sharing the successful aspects of our campaign, we can encourage our peers to become more involved in advocacy and to take responsibility for holding their home institutions to high ethical standards. Continued development of sustainable coalitions of healthcare student activism will further facilitate our ability to support the fight for health justice in our communities and beyond.