Photo courtesy of Martine Geary-Souza

School News

Alum Transforms Pain into Progress, Champions Trauma-Informed Care in Medical Education

During her recent practicum at The Fenway Institute, Martine Geary-Souza (SPH’25) authored a policy brief calling for universal trauma-informed care to better support LGBTQ+ patients.

Martine Geary-Souza (SPH’25) envisions a healthcare system that preserves the dignity and autonomy of its most vulnerable patients.

While completing her practicum as a research fellow at The Fenway Institute—one of the world’s preeminent LGBT health and HIV research, education, and policy organizations—Geary-Souza authored a brief advocating for the widespread adoption of trauma-informed care (TIC) in healthcare settings. Titled Equity in Action: Universal Trauma-Informed Care as a Lifeline for LGBTQ+ Patients, the brief underscores how disproportionately high rates of trauma exposure among LGBTQ+ people contribute to disparities in health outcomes. It also details how fear of discrimination—particularly among transgender and gender-diverse patients—often leads LGBTQ+ individuals to avoid care, worsening outcomes and reinforcing cycles of trauma.

In the brief, Geary-Souza calls for national adoption of TIC. She makes her argument amid a shifting political landscape punctuated by the rollout of federal policies that restrict recognition of LGBTQ+ identities and access to HIV treatment and gender affirming care. Geary-Souza urges reforms to medical education and accreditation standards to ensure medical professionals are trained in the neurobiological effects of trauma and equipped to meet the complex needs of patients navigating today’s sociopolitical challenges.

“[S]ince we cannot consistently determine who has experienced trauma, establishing TIC as the standard of care ensures universal implementation and maximizes its impact,” reads the brief.

As a survivor of childhood sexual abuse (SA), Geary-Souza has experienced glimpses of what a safer, more supportive clinical environment could look like, but her experiences seeking care since a diagnosis of complex post-traumatic stress disorder (C-PTSD) in high school mostly left her feeling dismissed and invalidated.

For years, Geary-Souza suffered a litany of symptoms from debilitating pain to unexplained seizures. At times bed bound and unable to attend classes, she sought the help of numerous doctors to little avail. In 2019, a week-long stay at Brigham and Women’s Hospital resulted in dozens of normal test results and a diagnosis of functional neurologic disorder (FND).

Her doctors told her that the best way to explain the condition was to think of the brain as a computer. Multiple sclerosis and epilepsy are issues in the hardware of the computer, which is why they show up on tests—FND on the other hand, is a software issue and thus effectively invisible. The disorder appeared to be more common in people with PTSD, they told her.

In 2022, researchers would gather enough evidence to suggest a clinically significant trauma subtype of FND, linking PTSD and childhood abuse to neurologic symptoms.

“For me, that was hugely validating. They used my C-PTSD not to say, ‘You need to go to therapy,’ but [rather], ‘There’s something that was dramatically altered in the way that your brain functions because of this,” recalls Geary-Souza. She began to think about what it would look like if all providers used a patient’s history of trauma to inform their care rather than to dismiss their need for it. Determined to help other survivors navigate the system, she went on to earn her bachelor’s in social work from Salem State University.

As a social work student, Geary-Souza gained experience at both the micro and macro levels—providing one-on-one support as a therapeutic mentor to children and families at the Justice Resource Institute, an outpatient mental health serve provider to the southern New England region, and advocating for system-wide improvements at Boston Children’s Hospital to help the Department of Gynecology better serve vulnerable populations. The two placements helped Geary-Souza realize that her strength and passion lie in driving change at the population-level. In other words, she says, “I really just wanted to do public health.”

As an MPH student at SPH, Geary-Souza’s drive to help other survivors avoid hardship evolved into a broader goal: to transform how medicine is practiced. She developed a preliminary curriculum to train providers in TIC and pitched it to Boston Medical Center. Although funding to pilot the curriculum fell through, she remained undeterred.

Geary-Souza turned to SPH’s Activist Lab for guidance, sharing her vision of launching a national organization to consult with medical schools and healthcare systems on implementing TIC. When she described her dream to Craig Andrade, associate dean for practice, he responded: “You can’t give this to anybody else […] We need to figure a way for you to do this—so that it’s yours.”

Andrade connected her with Sean Cahill, director of health policy research at the Fenway Institute, who invited her onboard to research realistic avenues for universal TCI implementation to benefit the LGBTQ+ community. Geary-Souza spoke with SPH about the collaboration and her ongoing advocacy work.

How did you become familiar with the concept of trauma-informed care and when did you realize the importance of educating medical care providers in its tenets?

I think I knew what it was without having the name for it from the time that I was in high school because what had gone on with me for so long with doctors was this dismissal. When I was in high school, I disclosed my abuse, and shortly thereafter, alongside my mental health, my physical health just fell apart […] And throughout all of this, I would wager about 90 percent of the doctors that I saw in that four-year period looked at me and went, “This is in your head. Go to therapy.”

There were two instances in high school that I [can] point to clearly and say, “Oh, my goodness. This doctor saw me, heard me, validated me, and did something about it.” That’s my primary care physician who, thank God, he […] always had my back. Then, there was a surgeon that I connected with […] he saw me and within 10 minutes said, “I am pretty confident that you have endometriosis. I’d like to schedule a surgery.”

This is where the trauma-informed piece started to really click with me. At that point, my history as an abuse survivor was in my medical history because I disclosed and because I’d been formally diagnosed with C-PTSD. [The surgeon] saw that and immediately said, “I see that you have PTSD. Can you talk with me a little bit about what would be helpful for you during surgery, so you don’t get triggered?” He said, “Usually, there’s a gas mask that we put over you to try to help you go to sleep, but we have something else that we can use because I know that a lot of [SA] survivors don’t want something over their mouth, that this makes them panic, so we have another device that wouldn’t go completely over your mouth and if you want to use that, we can.”

I’d been to a million different specialists for so many different things, and nobody had taken the time to really sit down with me and ask, “What parts of this could be changed to be more comfortable for you?” That started the wheels turning in my head. Imagine if, instead of having to fight to be heard in a medical office, you’re having this incredible collaborative partnership where you genuinely feel like the provider understands your pain, wants to help you, understands the impact that trauma has had, not just on your mental health but on your body, and [they’re] educated in ways to help you find a way to manage that. That should be what we have. And in the research that I’ve done, the providers that I’ve talked to, almost all of them want that too, but they don’t have the training or the education to prepare them.

Congratulations on your recent graduation! Now that you have completed your degree, what are you looking forward to doing with your public health education?

So much! I am working on registering an LLC. I have a logo that was designed by a good friend of mine from high school who is an advocate in the LGBTQ+ space. Then, I’m fielding a couple partnership and collaboration offers with a couple different medical institutions across the country to see what a good pilot site could be to carry out the implementation plan that’s outlined in the brief. Also, I will still be working with Danielle [Haley] on the Centers for AIDS Research pilot study that we presented at the [Center for Trauma and Mental Health fellowship showcase]. I’m really excited to keep doing qualitative analysis with her on that. She’s also offered me the opportunity to author that paper with her.

[I’m] just excited to finally focus on doing what I have wanted to do since, you could say 2021, but honestly for so much longer than that, and [that’s] change the way we approach trauma, how we support survivors of trauma, and how we go about healthcare. Because the reality is that if trauma-informed care is implemented on a universal level, it doesn’t just improve care for survivors of trauma. It improves care for everybody. I’m really excited to dive full-on into that and try to make that a reality.

Your recently published brief details how trauma-informed care could improve health outcomes for the LGBTQ+ community. As someone who identifies as part of the community yourself, what does Pride Month mean to you?

Not many people know this, but Pride Month also coincides with PTSD Awareness Month, which I think is very fitting, especially because there are such disparate rates of trauma for the LGBTQ community. I think the brief [came] out at a really good time because right now so much of the LGBTQ community, especially the transgender and gender-diverse communities, are at such a high risk and exposed to so much discrimination and so much violence. The rates of trauma are unfortunately only going to go up over the next few years. This year [during] Pride Month, I am excited to have this out there and to be [positioning] myself very clearly as an advocate saying, “No, we’re going to do better. We need to do better.”