{"id":4516,"date":"2024-01-30T10:05:37","date_gmt":"2024-01-30T15:05:37","guid":{"rendered":"https:\/\/magazine.alumni.ncsu.edu\/?p=4516"},"modified":"2024-03-15T13:56:25","modified_gmt":"2024-03-15T17:56:25","slug":"enough-is-enough","status":"publish","type":"post","link":"https:\/\/magazine.ncsu.edu\/2024\/enough-is-enough\/","title":{"rendered":"Enough is Enough"},"content":{"rendered":"\n\n\n\n\n<p class=\"is-style-lead\">CHARLESTON, S.C. \u2014 Dr. Ashley Hink \u201905 remembers the moment that everything changed for her as a trauma surgeon and public health researcher. Her experience had exposed her to numerous patients coming into the hospital violently injured, but this scenario was different.<\/p>\n\n\n\n<p class=\"is-style-default\">She found herself treating a four-year-old boy who had been shot. And after administering CPR to the boy, she was then treating his father, who was the shooter. Despite her care, the scenario ended up a murder-suicide. And as Hink sat at home later that night, watching the report on the news, she was struck by the missed indicators that the father would shoot his son. The father was a violent felon and had a history of being abusive. He had a history of mental illness. And a friend gave him a gun. Hink asked herself a chain of questions.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Treating More Than the Wound of Gun Violence | Ashley Hink | TEDxCharleston\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/pJBqk40TCVU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><figcaption class=\"wp-element-caption\">Treating More Than the Wound of Gun Violence | Ashley Hink | TEDxCharleston<\/figcaption><\/figure>\n\n\n\n<p class=\"is-style-default\">\u201cWhy don\u2019t we care that more children, teenagers and young adults are being injured and dying from this? Why are we treating them and sending them out without actually addressing their risk factors? And why are we not better addressing all of their needs after they experience this really violent injury?\u201d<\/p>\n\n\n\n<blockquote class=\"wp-block-ncst-pullquote has-orange-400-text-color\"><div class=\"pullquote-container\"><p class=\"pullquote-content\">  \u201cWhy don\u2019t we care that more children, teenagers and young adults are being injured and dying from this?\u201d<br>\u2014Dr. Ashley Hink \u201905<\/p><\/div><\/blockquote>\n\n\n\n<p class=\"is-style-default\">Hink, an associate professor of surgery and a burn and critical care surgeon at the Medical University of South Carolina (MUSC), in Charleston, S.C., decided she could answer those questions by addressing gun violence in a state that has the fifth highest firearm homicide rate in the country. And in North Charleston, from 2017\u200a\u2013\u200a2021, aggravated assaults involving guns almost doubled, according to <em>The [Charleston] Post and Courier<\/em>. So, in 2021, she started <a href=\"https:\/\/muschealth.org\/medical-services\/emergency\/trauma\/turning-the-tide\">Turning the Tide<\/a>, South Carolina\u2019s first and only hospital-based violence intervention program. Its aim is not to change gun laws or take away anyone\u2019s guns.<\/p>\n\n\n\n<section class=\"wp-block-ncst-image-grid\">\n<section class=\"wp-block-ncst-image-column\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1021\" height=\"844\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_bullets_rgb.jpg\" alt=\"\" class=\"wp-image-4524\" srcset=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_bullets_rgb.jpg 1021w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_bullets_rgb-300x248.jpg 300w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_bullets_rgb-768x635.jpg 768w\" sizes=\"auto, (max-width: 1021px) 100vw, 1021px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"576\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_InDoorway_rgb-1024x576.jpg\" alt=\"\" class=\"wp-image-4527\" srcset=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_InDoorway_rgb-1024x576.jpg 1024w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_InDoorway_rgb-300x169.jpg 300w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_InDoorway_rgb-768x432.jpg 768w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_InDoorway_rgb.jpg 1500w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\">Dr. Ashley Hink \u201905 keeps bullets in her office drawer and uses them in lectures she delivers as a trauma surgeon about gun violence. Turning the Tide, her hospital-based violence intervention program, at the Medical University of South Carolina is now touching firearm victims\u2019 lives outside of the trauma bay.<br><\/figcaption><\/figure>\n<\/section>\n<\/section>\n\n\n\n<p class=\"is-style-default\">Instead, Turning the Tide capitalizes on Hink\u2019s unique position as both a surgeon and public health researcher after years of seeing patients who\u2019ve been shot and coming to understand why they end up in her trauma bay. The program approaches gun violence as a public health crisis and looks to tackle the social factors that lead to the firearm injuries. It offers mentorship and other means of care\u2009\u2014\u2009from rides to school to assistance with food insecurity\u2009\u2014\u2009to gun violence victims between the ages of 12 and 30 and their families during their hospital stay and after they\u2019ve been discharged. In three years, Turning the Tide has helped some 360 patients with the goal that they not end up as a repeat victim.<\/p>\n\n\n\n<p class=\"is-style-default\">The program is Hink\u2019s way of combatting the perception that gun violence is a fait accompli. \u201cI know that a lot of it is preventable, and I think a lot of people across our country do not realize that, and they think this is inevitable,\u201d says Hink, pointing out that firearms are the leading killer of children and adolescents in America. \u201cThis is not normal. There are things that we are doing here that are propagating this problem that can be changed.\u201d<\/p>\n\n\n\n<h4 class=\"has-text-align-center wp-block-heading\">\u2018MY COMMUNITY\u2019<\/h4>\n\n\n\n<p class=\"is-style-default\">\u2018Hink, 40, says when she first started down the road to becoming a doctor, she thought she\u2019d end up a primary care provider or an OB-GYN. That was \u201cwhere I understood the intersection of public health and medicine to be.\u201d But something clicked with her experiences in college and soon after. While at NC&#160;State, Hink volunteered with the Alliance of AIDS Services, which focused on public-health-oriented outreach to AIDS patients, and she started to \u201creally understand and value how human behavior and policies influence health and access to care.\u201d She also volunteered at the Family Violence Center in Chapel Hill, N.C., helping victims of intimate-partner violence. It helped her reach what she calls an \u201caha moment\u201d of, \u201cWow, health care is really failing patients that experience violence.\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">Hink received degrees&nbsp; from NC&#160;State in microbiology and science, technology and society, and a master\u2019s in public health from Emory University. After graduating from East Carolina University\u2019s Brody School of Medicine, Hink landed in Charleston in 2013 as a general surgery intern and resident at MUSC.<\/p>\n\n\n\n<p class=\"is-style-default\">In July 2015, during her residency, Hink was on call when&nbsp; white supremacist Dylann Roof killed nine Black congregants&nbsp; at the Mother Emanuel African Methodist Episcopal Church.<\/p>\n\n\n\n<p class=\"is-style-default\">\u201cWe just jump into action to clear out the trauma bay, create an outdoor triage, mobilize other members of the hospital to come down. And we prepared to take care of all these people,\u201d she says, adding that the hardest thing about that night was that she never got a chance to take care of them because of the deadly violence in the church. Only one victim made it to the hospital but did not survive. \u201cTo know that it happened in my community, just down the road, to all of these really wonderful people was really awful and hurtful.\u201d<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Couch_rgb-1024x576.jpg\" alt=\"\" class=\"wp-image-4530\" \/><figcaption class=\"wp-element-caption\">Hink takes a moment of reflection and respite in her office at MUSC.<\/figcaption><\/figure>\n\n\n\n<p class=\"is-style-default\">Hink left MUSC in 2018 for a surgical critical care fellowship at Harborview Medical Center at the University of Washington in Seattle. She stayed in Seattle and worked on gun violence injury prevention and intervention with a center affiliated with the University of Washington funded by the Centers for Disease Control. There were more colleagues conducting the same type of research there, and state funds were more readily available in Washington for violence prevention work.<\/p>\n\n\n\n<p class=\"is-style-default\">But when the job opportunity at MUSC arose, Hink knew she wanted to return to the South, where there are few hospital-based violence intervention programs and even fewer state legislatures willing to commit money to them. In fact, Hink says, less than 10 percent of all trauma centers in the U.S. have such a program in place. She says that while the media tends to highlight gun violence in cities like Chicago, the highest firearm homicide rates are in Mississippi, Alabama, Louisiana and South Carolina, areas with some of the country\u2019s least restrictive gun regulations. \u201cIn the South, talking about gun violence, you know, she did not pick the easy path,\u201d says Christa Green, a public health researcher who\u2019s the program director for Turning the Tide. \u201cShe intentionally took the hard road because she knew that this community deserved it.\u201d<\/p>\n\n\n\n<blockquote class=\"wp-block-ncst-pullquote has-orange-400-text-color\"><div class=\"pullquote-container\"><p class=\"pullquote-content\">  \u201cIn the South, talking about gun violence, you know, she did not pick the easy path. She intentionally took the hard road because she knew that this community deserved it.\u201d<br>\u2014Christa Green<\/p><\/div><\/blockquote>\n\n\n\n<p class=\"is-style-default\">Hink was able to get financial buy-in at MUSC from the provost\u2019s office and the department of surgery, which gave her enough money to start Turning the Tide. (Today, the program is fully funded by 16 external grants.) Using a successful hospital-based violence intervention program in San Francisco as a model, she created Turning the Tide in June 2021. The program now has three client advocates, a program director, an adult trauma injury prevention coordinator and Hink as its medical director.<\/p>\n\n\n\n<section class=\"wp-block-ncst-image-grid\">\n<section class=\"wp-block-ncst-image-column\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"750\" height=\"844\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Christa_rgb.jpg\" alt=\"\" class=\"wp-image-4553\" srcset=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Christa_rgb.jpg 750w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Christa_rgb-267x300.jpg 267w\" sizes=\"auto, (max-width: 750px) 100vw, 750px\" \/><figcaption class=\"wp-element-caption\">Christa Green, program director<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"750\" height=\"844\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Keith_rgb.jpg\" alt=\"\" class=\"wp-image-4554\" srcset=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Keith_rgb.jpg 750w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Keith_rgb-267x300.jpg 267w\" sizes=\"auto, (max-width: 750px) 100vw, 750px\" \/><figcaption class=\"wp-element-caption\">Keith Smalls, client advocate<\/figcaption><\/figure>\n<\/section>\n<\/section>\n\n\n\n<section class=\"wp-block-ncst-image-grid\">\n<section class=\"wp-block-ncst-image-column\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"750\" height=\"844\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Cat_rgb.jpg\" alt=\"\" class=\"wp-image-4555\" srcset=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Cat_rgb.jpg 750w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Cat_rgb-267x300.jpg 267w\" sizes=\"auto, (max-width: 750px) 100vw, 750px\" \/><figcaption class=\"wp-element-caption\">Cat Yetman, client advocate<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Adrianna_rgb.jpg\" alt=\"\" class=\"wp-image-4556\" \/><figcaption class=\"wp-element-caption\">Adrianna Bellamy, adult trauma injury prevention coordinator<\/figcaption><\/figure>\n<\/section>\n<\/section>\n\n\n\n<p class=\"is-style-default\">It\u2019s come full circle for Hink, who\u2019s applying that public-health focus she first encountered years ago in Raleigh and Chapel Hill. Categorizing gun violence as a public health crisis allows Hink and her team to unpack multiple layers as to why it occurs. They can consider how poverty, unemployment, a prevalence of run-down or abandoned buildings, and a lack of green space may impact communities with high rates of violence. \u201cThis bears out in the literature,\u201d says Hink, who publishes journal articles on risk factors associated with gun violence. \u201cThose communities, both urban and rural, that have high rates of disparity are significantly more likely to experience higher rates of firearm violence.\u201d<\/p>\n\n\n\n<h4 class=\"has-text-align-center wp-block-heading\">SHOWING UP<\/h4>\n\n\n\n<p class=\"is-style-default\">Hink says what stands out to her about Turning the Tide\u2019s first three years is how its clients feel seen and heard by the program\u2019s team. Katrina Kiora, 32, who was shot three times by her ex-partner in North Charleston, is one of those. She credits Hink with saving her life and the program with helping her believe in herself, from cheering her on at her job as a manager at McDonald\u2019s to helping retrieve her dog King, an American Bully who ran away the day she was shot. \u201cShe basically still has me here,\u201d she says of Hink.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_KatKing_rgb.jpg\" alt=\"\" class=\"wp-image-4558\" \/><figcaption class=\"wp-element-caption\">Katrina Kiora shows off her best friend, King, an American Bully that Turning the Tide helped get back to her after she was shot three times in April 2023.<\/figcaption><\/figure>\n\n\n\n<p class=\"is-style-default\">Hink admits sometimes the work is hard and drains her, especially on top of her long hours of surgeries and research. But when she speaks of Kiora or other patients, all of whom she remembers by first name like they\u2019re neighbors, she recalibrates, almost coming back to life. \u201cIt comes through,\u201d Hink says. \u201cThey\u2019re like, \u2018This person actually showed up for me.\u2019\u201d<\/p>\n\n\n\n<blockquote class=\"wp-block-ncst-pullquote has-orange-400-text-color\"><div class=\"pullquote-container\"><p class=\"pullquote-content\">  \u201cIt comes through. They\u2019re like, \u2018This person actually showed up for me.\u2019 \u201d<br>\u2014Dr. Ashley Hink \u201905<\/p><\/div><\/blockquote>\n\n\n\n<p class=\"is-style-default\">Turning the Tide\u2019s client advocates jump into action and immediately go to work when they get the \u201cGSW\u201d alert\u2009\u2014\u2009short for \u201cgunshot wound\u201d\u2014\u2009coming in on their cell phones. It\u2019s all about those three letters for the client advocates against the backdrop of national victim recidivism trends. The data reveals a blunt reality for victims.&nbsp; Once someone is a victim of a violent injury, they face a higher risk of being victimized by another violent injury as compared to those who\u2019ve never faced being a victim before. \u201cThat\u2019s where it sinks in,\u201d says client advocate Keith Smalls of the alerts. \u201cThere\u2019s a possibility that it\u2019s somebody that we served before.\u201d<\/p>\n\n\n\n<section class=\"wp-block-ncst-image-grid\">\n<section class=\"wp-block-ncst-image-column\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_OnCall_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4537\" \/><figcaption class=\"wp-element-caption\">Once a trauma call comes in on Hink\u2019s pager, above, and, right, on a client advocate\u2019s phone featuring the letters \u201cGSW\u201d (\u201cgunshot wound\u201d), they head to the trauma bay. Below, client advocates Keith Smalls and Cat Yetman stand behind a line in the trauma bay, waiting for an opening to approach gunshot victims to introduce themselves.<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_GSW_rgb-1.jpg\" alt=\"\" class=\"wp-image-4538\" \/><\/figure>\n<\/section>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_ERLine_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4536\" \/><\/figure>\n<\/section>\n\n\n\n<p class=\"is-style-default\">Once the alert comes in, the client advocate heads to the trauma bay. As nurses and doctors clean wounds or put in chest tubes, the advocates wait for an opening to make their introduction. They approach the patient\u2019s bedside to talk, treating the patient with dignity and avoiding language or tone blaming them for ending up a gunshot victim.<\/p>\n\n\n\n<p class=\"is-style-default\">The approach is known as trauma-informed care, and it\u2019s one of the program\u2019s tenets. The goal is to consider the patients\u2019 life experiences, make them feel more comfortable and let them know that they have an ally. \u201cA lot come from homes where they don\u2019t have a lot of family support, and poverty,\u201d says Hink. \u201cThey might be living in communities with high rates of violence and the presence of crime and gangs.&nbsp; Some of them have never, literally, left their community, and they don\u2019t know what else is out there, and they have been made to feel like this is as good as it gets, and that they can\u2019t be more, and are used to people letting them down, or telling them that they will never amount to anything else.\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">Smalls introduces himself and asks about the victim\u2019s family and how he can contact them. \u201cEverything that comes out of our mouth, it\u2019s a sense of encouragement, inspiration, motivation\u200a\u200a. . .\u200a\u200alove,\u201d says Smalls. \u201c\u2018You belong to me now, and I belong to you. We belong to each other now.\u2019\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">The client advocate\u2019s work can shift to sitting with friends and families and making trips back and forth to the ER relaying messages. Sometimes, they encounter family members who want to seek revenge for the victim, but Turning the Tide\u2019s client advocates work to quell those situations, as retaliation suppression is one of the program\u2019s main goals. It\u2019s not uncommon to deal with multiple patients at once.<\/p>\n\n\n\n<p class=\"is-style-default\">Client advocate Cat Yetman remembers a night where she had five patients, three at MUSC and two at neighboring MUSC Shawn Jenkins Children\u2019s Hospital, which takes patients 15 years old and younger.<\/p>\n\n\n\n<p class=\"is-style-default\">At first, the doctors and nurses in the ER were protective of their environment and were curious about the advocates, who are not medical personnel. Eric Schott, a trauma performance improvement coordinator at MUSC, first encountered Turning the Tide\u2019s client advocates as a nurse in the ER two years ago. He says it took about three months or so, but eventually the advocates were a welcome sight. He knew he could focus on medical care while they could be there for the patient in a wholly different way.<\/p>\n\n\n\n<p class=\"is-style-default\">\u201cI was always so happy to see them,\u201d Schott says. \u201cI know the patient I\u2019m caring for is going to get something a little bit extra that they may not see anywhere else.\u201d<\/p>\n\n\n\n<aside class=\"wp-block-ncst-sandwich-narrative with-image\"><div class=\"ncst-sandwich-narrative\"><div class=\"sandwich-narrative__image-container\"><img loading=\"lazy\" decoding=\"async\" width=\"1500\" height=\"844\" class=\"sandwich-narrative__image wp-image-4550\" alt=\"\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Katrina_rgb.jpg\" srcset=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Katrina_rgb.jpg 1500w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Katrina_rgb-300x169.jpg 300w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Katrina_rgb-1024x576.jpg 1024w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Katrina_rgb-768x432.jpg 768w\" sizes=\"auto, (max-width: 1500px) 100vw, 1500px\" \/><\/div><div class=\"sandwich-narrative__text-container\"><h2 class=\"sandwich-narrative__heading\">Rising Tide<\/h2>\n\n<p><em>Three gunshot injuries halted Katrina Kiora\u2019s life in Charleston, S.C. Turning the Tide is helping her get back on her feet and feel whole again.<\/em><\/p>\n\n\n\n\n<div class=\"wp-block-ncst-collapsible-more ncst-collapsible-more\"><div class=\"collapsible-more__collapsed-content-container collapse panel-collapse \" id=\"collapsible-more-0\" aria-labelledby=\"collapsible-more-heading-0\">\n<p>Katrina Kiora was at her friend\u2019s house in North Charleston, S.C., in late April 2023. She had been trying to end a relationship with a partner, but he showed up and kicked in the door. \u201cHe shot me three times,\u201d she says, \u201conce in my chest, one in my stomach and once in my face.\u201d<\/p>\n\n\n\n<p>Kiora, 32, is one of the 360-plus victims of firearm violence in the Charleston area helped by Turning the Tide, a violence intervention program at the Medical University of South Carolina. She credits Dr. Ashley Hink \u201905 and program client advocate Cat Yetman with saving her life. \u201cThey both were there. They checked on me,\u201d Kiora says. \u201cThey made sure I was there.\u201d<\/p>\n\n\n\n<p>Her injuries caused Kiora to spend several weeks in and out of the hospital with surgeries. She had a tube in her stomach and one in her ribs. Her pancreas was particularly damaged, and she credits Hink with removing half of it in a difficult surgery. And Kiora, a transgender woman, says Hink always acknowledged her identity, adding that a challenge at hospitals is that health care professionals often call her by the name she no longer acknowledges. \u201cNot with Dr. Hink or any other nurse at the hospital,\u201d Kiora says. \u201cThey call me by Katrina.\u201d<\/p>\n\n\n\n<p>Kiora speaks with quick sentences with a gentle voice, and sometimes, she has to pause to talk to herself, still trying to process the violence that befell her last spring. \u201cNo more tubes,\u201d she says. \u201cNo more surgeries. &nbsp;. . .No more bullets inside of me.\u201d<\/p>\n\n\n\n<p>As a client advocate, Yetman has been in lockstep with Kiora through her recovery, both physical and emotional. On the day Kiora was shot, King, her American Bully and best friend, ran out of the door and went missing, ending up at the Charleston Animal Society. When Kiora located him, she had trouble getting him back because the dog had blood\u2009\u2014\u2009Kiora\u2019s\u2009\u2014\u2009all over his coat, and there were fees attached to his care. So Kiora called Yetman, who interceded. Yetman says Charleston Animal Society came to an agreement about the fees once they knew the whole story, and soon after, King was back with Kiora.<\/p>\n\n\n\n<p>Sitting on a picnic table in Hampton Park on Charleston\u2019s upper peninsula, Kiora\u2019s and Yetman\u2019s bond is evident. Kiora says she first trusted Yetman because she\u2019s tall like her. They easily make each other smile. And Yetman beams when Kiora talks about her current job as manager of a McDonald\u2019s. It\u2019s clear Kiora feels she has someone in her corner, someone who has helped her once again become whole.<\/p>\n\n\n\n<p>\u201cI\u2019m back to being who I am,\u201d she says, \u201cwhich is Katrina.\u201d<\/p>\n\n\n\n<p><em>&#8211;CHRIS SAUNDERS<\/em><\/p>\n<\/div><a class=\"collapsible-more__interaction-cta collapsed\" href=\"#collapsible-more-0\" id=\"collapsible-more-heading-0\" data-toggle=\"collapse\" data-target=\"#collapsible-more-0\" aria-controls=\"collapsible-more-0\"><span class=\"collapsible-more__expansion-indicator\"><span class=\"ncst-plus-minus-toggle\"><\/span><\/span><span class=\"collapsible-more__text\">Expand to read more<\/span><span class=\"collapsible-more__text-collapse\">Collapse<\/span><\/a><\/div>\n<\/div><\/div><\/aside>\n\n\n\n<h4 class=\"has-text-align-center wp-block-heading\">THE STUFF YOU DON\u2019T THINK ABOUT<\/h4>\n\n\n\n<p class=\"is-style-default\">Client advocates point out that so many victims of firearm assaults encounter obstacles most couldn\u2019t conceive. It\u2019s the stuff most of us have the luxury of not considering. For instance, Yetman says they had a patient, a mother, who was in the operating room. And her child needed to breastfeed. They were able to ensure the baby received formula and diapers.<\/p>\n\n\n\n<p class=\"is-style-default\">It\u2019s just one example of that \u201clittle bit extra.\u201d A great deal of that extra occurs when a patient is ready to be discharged. Many times, when a gunshot patient comes in, their clothes must be cut away so doctors and nurses can triage or operate. Turning the Tide\u2019s office is stocked with a cabinet full of shirts, shorts, sweatpants, socks and undergarments so that the patients can leave with new, clean clothes.<\/p>\n\n\n\n<section class=\"wp-block-ncst-image-grid\">\n<section class=\"wp-block-ncst-image-column\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Clothes_rgb-1024x768.jpg\" alt=\"\" class=\"wp-image-4545\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_InMeeting_rgb-1024x761.jpg\" alt=\"\" class=\"wp-image-4546\" \/><\/figure>\n<\/section>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_CatNeighbor_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4544\" \/><figcaption class=\"wp-element-caption\">Top left, Turning the Tide has a cabinet stocked with clothes for victims who\u2019ve been shot and had their clothes cut away in surgery; Hink, top right, in a meeting with her team. Above, much of the work for client advocates like Yetman takes place out in Charleston\u2019s communities.<br>&nbsp;<\/figcaption><\/figure>\n<\/section>\n\n\n\n<p class=\"is-style-default\">Once discharged, they encounter a new list of concerns: food insecurity at home, cell phone service ending if&nbsp;they missed the due date on a bill while in the hospital, and simply feeling safe back in their community. \u201cWe do want to see a reduction in what we call recidivism, right? People being reinjured again,\u201d says Yetman. \u201cBut what really matters to me is, does my patient go home? Are they safe? Are their families safe?\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">Most of the patients who accept after-discharge services and stay on as clients aren\u2019t heading back to the Charleston that was named the top U.S. city to visit in July 2022 by <em>Travel + Leisure<\/em> magazine readers, welcoming some 7 million visitors per year. In 2022, tourism brought $12.8 billion to the city in hospitality dollars, according to <em>The [Charleston] Post and Courier<\/em>. Turning the Tide\u2019s clients are heading back into communities like North Charleston, West Ashley and the West Side. Those neighborhoods are home to vulnerable populations, with high poverty and low education rates when compared to the rest of the region.<\/p>\n\n\n\n<section class=\"wp-block-ncst-image-grid\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_CharlestonAerial_rgb-1024x576.jpg\" alt=\"\" class=\"wp-image-4532\" \/><figcaption class=\"wp-element-caption\">Above, Charleston\u2019s economic disparity can be seen here. Gadsden Green Homes, public housing in the West Side neighborhood, sits directly across President Street from stunning homes. Below left, designer high rises tower over another housing complex, and, below right, laundry hangs on the lines of Gadsden Green.<\/figcaption><\/figure>\n\n\n\n<section class=\"wp-block-ncst-image-column\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Highrise_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4533\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Clothesline_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4534\" \/><\/figure>\n<\/section>\n<\/section>\n\n\n\n<p class=\"is-style-default\">Gentrification is pushing out residents, most of whom are Black and brown. Some clients are returning to public housing, where renovations and updates are few and there\u2019s pest infestations and dilapidated playground equipment. Corner memorials, with teddy bears and remembrance letters, pay respects to the communities\u2019 most recent murder victims.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"778\" height=\"844\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_TeddyBear_rgb.jpg\" alt=\"\" class=\"wp-image-4529\" srcset=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_TeddyBear_rgb.jpg 778w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_TeddyBear_rgb-277x300.jpg 277w, https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_TeddyBear_rgb-768x833.jpg 768w\" sizes=\"auto, (max-width: 778px) 100vw, 778px\" \/><figcaption class=\"wp-element-caption\">A memorial\u00a0for a 32-year-old man who died at this spot in downtown Charleston after being shot nearby.<\/figcaption><\/figure>\n\n\n\n<p class=\"is-style-default\">Mass shootings prey on our national conscience when they happen. Uvalde. Parkland. Newtown. Naturally, they make us imagine the worst\u2009\u2014\u2009an active shooter coming into a school and killing our children. But Hink&nbsp;notes that those shootings comprise a tiny fraction of firearm injuries and deaths.<\/p>\n\n\n\n<p class=\"is-style-default\">\u201cI think I definitely experienced the shock of mass shootings, but I realized what we all now know,\u201d she says. \u201cMost people that are being shot are being shot all around us every day in our communities,\u201d she says, \u201cand their stories don\u2019t make the headlines. But it\u2019s happening all the time.\u201d<\/p>\n\n\n\n<blockquote class=\"wp-block-ncst-pullquote has-orange-400-text-color\"><div class=\"pullquote-container\"><p class=\"pullquote-content\">  \u201cMost people that are being shot are being shot all around us every day in our communities, and their stories<br>don\u2019t make the headlines. But it\u2019s happening all the time.\u201d<br>\u2014Dr. Ashley Hink \u201905<\/p><\/div><\/blockquote>\n\n\n\n<p class=\"is-style-default\">Ninety-three percent of patients the program serves are Black, and 84 percent are male. And Green, whose research focuses on violence prevention, says that disparity is underscored even further when it comes to children. In a national study she conducted with colleagues, they found that the rate of firearm homicide deaths for Black children is nine times greater than that of white children. \u201cYou can\u2019t really talk about gun violence without talking about racial disparity,\u201d she says, \u201cbecause a Black person and a white person living in Charleston are living two very different lives most likely on average.\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">Community members view gun violence as an existential threat to the health of their communities\u2019 future. Chantelle Mitchell is a community activist, mentor and motivational speaker in Charleston who works with Turning the Tide as a community partner with Youth Advocate Program, a nonprofit focusing on foster care and community-based services. And when asked to articulate how prevalent gun violence is in the community, she doesn\u2019t need statistics. She has firsthand experience. She lost one of the youths she was working with to gun violence back in June. And her daughter lost her best friend two years ago. He was 15. \u201cThese kids are out there playing football, double dutching,\u201d she says, \u201cbut when you see these kids coming in with gunshot wounds, you have to figure out why.\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">And Mitchell says that Turning the Tide has remedied what was a major problem for gunshot victims. \u201cWhat they realized when they created the program was once [victims] are discharged, no one was following up with them. These are 12-, 13-year-old kids,\u201d she says.<\/p>\n\n\n\n<p class=\"is-style-default\">Hink says that three years ago, firearms victims who\u2019d come to MUSC were getting shot, receiving medical care and then being sent back out to those communities with no connection or resources. Now, Turning the Tide helps victims and their families establish lines of credit, stocks their fridges and pantries with food, and encourages them to complete their GEDs and get driver\u2019s licenses. Smalls serves as a father figure to many of his clients, even helping some get staff jobs at MUSC. Talking about those successes makes Smalls smile his gentle grin. There\u2019s also something distinct about his mentorship and satisfaction. He\u2019s personally known the toll of gun violence in Charleston, as his 17-year-old son was shot and killed in North Charleston in 2016.<\/p>\n\n\n\n<p class=\"is-style-default\">\u201cI think one of the most serious statements that I\u2019ve ever heard a parent say, that \u2018I\u2019d rather go visit my child in jail than visit him at the grave,\u2019\u201d Smalls says. \u201cI understand that point. A gravesite is hard.\u201d<\/p>\n\n\n\n<h4 class=\"has-text-align-center wp-block-heading\">NEXT LEVEL<\/h4>\n\n\n\n<p class=\"is-style-default\">Hink admits she\u2019s most at home in the trauma bay. It\u2019s there and in environments like the ICU she says she can do what she does best, \u201ccreating organization out of chaos,\u201d as she cares for injured and critically ill patients. Hink\u2019s office in MUSC\u2019s Clinical Sciences Building holds a couple of keepsakes that signify her connections to those patients. There\u2019s the painting of a crane by a former patient, and a glass pyramid a former patient\u2019s family gave her. Etched in it is the word, \u201cINSPIRE.\u201d<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Inspire_rgb.jpg\" alt=\"\" class=\"wp-image-4541\" \/><\/figure>\n\n\n\n<p class=\"is-style-default\">\u201cThere\u2019s a huge difference in the way that Dr. Hink interacts with patients versus maybe other attending physicians or other health care providers,\u201d Yetman says. \u201cShe wants to know how patients are doing after she is done caring for them. She thinks about them. She remembers them. She focuses on the humanity of the individual.\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">That same level of compassion extends to the fiber of her team\u2019s members. Words colleagues use to describe Hink apply to the program. Sturdy. Strong. Unflinching. Refusing to accept the status quo. \u201cShe\u2019s a beast,\u201d another doctor says of her in passing. \u201cShe\u2019s next level.\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">Hink meets with the Turning the Tide team on Monday afternoons, celebrating their wins with a satisfactory nod. Empathy, too, as she worries about her team. \u201cThey come in, and they\u2019re helping patients and families when they are in their darkest moments and they\u2019re terrified,\u201d she says. \u201cThere\u2019s a lot of vicarious trauma that those of us experience in doing this work, and they have a really hard job.\u201d<\/p>\n\n\n\n<p class=\"is-style-default\">She continues working to ensure that Turning the Tide is sustainable. She would like to hire more client advocates to decrease caseloads. She\u2019s still poring over data from Turning the Tide\u2019s first three years, but says the numbers anecdotally suggest reductions in repeat injuries, an increase in the number of patients returning to MUSC for clinical follow-up appointments and a reduction in unplanned emergency room visits.<\/p>\n\n\n\n<p class=\"is-style-default\">Hink also meets with city leaders and politicians, both Democrats and Republicans, who voice support for her work. She looks for more community partners, like schools, criminal justice victim advocates, family counselors, food and housing nonprofits, and law enforcement. She lectures on topics ranging from firearm violence epidemiology to violence intervention strategies. (And she\u2019s a new mom. She and her partner just welcomed a baby girl in December.)<\/p>\n\n\n\n<p class=\"is-style-default\">And Hink does it all in her next-levelness to address the essential question that drives her. \u201cAt the end of the day, in our country, firearms are the leading cause of death for kids,\u201d she says. \u201cHow is it that we are okay with that and we\u2019re not doing more to prevent it?\u201d&nbsp;<\/p>\n","protected":false,"raw":"<!-- wp:ncst\/dynamic-header {\"block\":\"ncst\/default-immersive-post-header\"} -->\n<!-- wp:ncst\/default-immersive-post-header {\"backgroundColor\":\"orange_400\",\"displayCategoryID\":5,\"subtitle\":\"Dr. Ashley Hink \u201905 takes on gun violence in Charleston, S.C., by treating it as a public health crisis. Photography by Joshua Steadman.\"} \/-->\n<!-- \/wp:ncst\/dynamic-header -->\n\n<!-- wp:paragraph {\"className\":\"is-style-lead\"} -->\n<p class=\"is-style-lead\">CHARLESTON, S.C. \u2014 Dr. Ashley Hink \u201905 remembers the moment that everything changed for her as a trauma surgeon and public health researcher. Her experience had exposed her to numerous patients coming into the hospital violently injured, but this scenario was different.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">She found herself treating a four-year-old boy who had been shot. And after administering CPR to the boy, she was then treating his father, who was the shooter. Despite her care, the scenario ended up a murder-suicide. And as Hink sat at home later that night, watching the report on the news, she was struck by the missed indicators that the father would shoot his son. The father was a violent felon and had a history of being abusive. He had a history of mental illness. And a friend gave him a gun. Hink asked herself a chain of questions.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:embed {\"url\":\"https:\/\/www.youtube.com\/watch?v=pJBqk40TCVU\",\"type\":\"video\",\"providerNameSlug\":\"youtube\",\"responsive\":true,\"className\":\"wp-embed-aspect-16-9 wp-has-aspect-ratio\"} -->\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\nhttps:\/\/www.youtube.com\/watch?v=pJBqk40TCVU\n<\/div><figcaption class=\"wp-element-caption\">Treating More Than the Wound of Gun Violence | Ashley Hink | TEDxCharleston<\/figcaption><\/figure>\n<!-- \/wp:embed -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">\u201cWhy don\u2019t we care that more children, teenagers and young adults are being injured and dying from this? Why are we treating them and sending them out without actually addressing their risk factors? And why are we not better addressing all of their needs after they experience this really violent injury?\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/pullquote {\"value\":\"  \u201cWhy don\u2019t we care that more children, teenagers and young adults are being injured and dying from this?\u201d\\u003cbr\\u003e\u2014Dr. Ashley Hink \u201905\",\"textColor\":\"orange_400\"} -->\n<blockquote class=\"wp-block-ncst-pullquote has-orange-400-text-color\"><div class=\"pullquote-container\"><p class=\"pullquote-content\">  \u201cWhy don\u2019t we care that more children, teenagers and young adults are being injured and dying from this?\u201d<br>\u2014Dr. Ashley Hink \u201905<\/p><\/div><\/blockquote>\n<!-- \/wp:ncst\/pullquote -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink, an associate professor of surgery and a burn and critical care surgeon at the Medical University of South Carolina (MUSC), in Charleston, S.C., decided she could answer those questions by addressing gun violence in a state that has the fifth highest firearm homicide rate in the country. And in North Charleston, from 2017\u200a\u2013\u200a2021, aggravated assaults involving guns almost doubled, according to <em>The [Charleston] Post and Courier<\/em>. So, in 2021, she started <a href=\"https:\/\/muschealth.org\/medical-services\/emergency\/trauma\/turning-the-tide\">Turning the Tide<\/a>, South Carolina\u2019s first and only hospital-based violence intervention program. Its aim is not to change gun laws or take away anyone\u2019s guns.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/image-grid -->\n<section class=\"wp-block-ncst-image-grid\"><!-- wp:ncst\/image-column -->\n<section class=\"wp-block-ncst-image-column\"><!-- wp:image {\"id\":4524,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_bullets_rgb.jpg\" alt=\"\" class=\"wp-image-4524\" \/><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:image {\"id\":4527,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_InDoorway_rgb-1024x576.jpg\" alt=\"\" class=\"wp-image-4527\" \/><figcaption class=\"wp-element-caption\">Dr. Ashley Hink \u201905 keeps bullets in her office drawer and uses them in lectures she delivers as a trauma surgeon about gun violence. Turning the Tide, her hospital-based violence intervention program, at the Medical University of South Carolina is now touching firearm victims\u2019 lives outside of the trauma bay.<br><\/figcaption><\/figure>\n<!-- \/wp:image --><\/section>\n<!-- \/wp:ncst\/image-column --><\/section>\n<!-- \/wp:ncst\/image-grid -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Instead, Turning the Tide capitalizes on Hink\u2019s unique position as both a surgeon and public health researcher after years of seeing patients who\u2019ve been shot and coming to understand why they end up in her trauma bay. The program approaches gun violence as a public health crisis and looks to tackle the social factors that lead to the firearm injuries. It offers mentorship and other means of care\u2009\u2014\u2009from rides to school to assistance with food insecurity\u2009\u2014\u2009to gun violence victims between the ages of 12 and 30 and their families during their hospital stay and after they\u2019ve been discharged. In three years, Turning the Tide has helped some 360 patients with the goal that they not end up as a repeat victim.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">The program is Hink\u2019s way of combatting the perception that gun violence is a fait accompli. \u201cI know that a lot of it is preventable, and I think a lot of people across our country do not realize that, and they think this is inevitable,\u201d says Hink, pointing out that firearms are the leading killer of children and adolescents in America. \u201cThis is not normal. There are things that we are doing here that are propagating this problem that can be changed.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"textAlign\":\"center\",\"level\":4} -->\n<h4 class=\"has-text-align-center\">\u2018MY COMMUNITY\u2019<\/h4>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">\u2018Hink, 40, says when she first started down the road to becoming a doctor, she thought she\u2019d end up a primary care provider or an OB-GYN. That was \u201cwhere I understood the intersection of public health and medicine to be.\u201d But something clicked with her experiences in college and soon after. While at NC State, Hink volunteered with the Alliance of AIDS Services, which focused on public-health-oriented outreach to AIDS patients, and she started to \u201creally understand and value how human behavior and policies influence health and access to care.\u201d She also volunteered at the Family Violence Center in Chapel Hill, N.C., helping victims of intimate-partner violence. It helped her reach what she calls an \u201caha moment\u201d of, \u201cWow, health care is really failing patients that experience violence.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink received degrees&nbsp; from NC State in microbiology and science, technology and society, and a master\u2019s in public health from Emory University. After graduating from East Carolina University\u2019s Brody School of Medicine, Hink landed in Charleston in 2013 as a general surgery intern and resident at MUSC.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">In July 2015, during her residency, Hink was on call when&nbsp; white supremacist Dylann Roof killed nine Black congregants&nbsp; at the Mother Emanuel African Methodist Episcopal Church.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">\u201cWe just jump into action to clear out the trauma bay, create an outdoor triage, mobilize other members of the hospital to come down. And we prepared to take care of all these people,\u201d she says, adding that the hardest thing about that night was that she never got a chance to take care of them because of the deadly violence in the church. Only one victim made it to the hospital but did not survive. \u201cTo know that it happened in my community, just down the road, to all of these really wonderful people was really awful and hurtful.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:image {\"id\":4530,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Couch_rgb-1024x576.jpg\" alt=\"\" class=\"wp-image-4530\" \/><figcaption class=\"wp-element-caption\">Hink takes a moment of reflection and respite in her office at MUSC.<\/figcaption><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink left MUSC in 2018 for a surgical critical care fellowship at Harborview Medical Center at the University of Washington in Seattle. She stayed in Seattle and worked on gun violence injury prevention and intervention with a center affiliated with the University of Washington funded by the Centers for Disease Control. There were more colleagues conducting the same type of research there, and state funds were more readily available in Washington for violence prevention work.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">But when the job opportunity at MUSC arose, Hink knew she wanted to return to the South, where there are few hospital-based violence intervention programs and even fewer state legislatures willing to commit money to them. In fact, Hink says, less than 10 percent of all trauma centers in the U.S. have such a program in place. She says that while the media tends to highlight gun violence in cities like Chicago, the highest firearm homicide rates are in Mississippi, Alabama, Louisiana and South Carolina, areas with some of the country\u2019s least restrictive gun regulations. \u201cIn the South, talking about gun violence, you know, she did not pick the easy path,\u201d says Christa Green, a public health researcher who\u2019s the program director for Turning the Tide. \u201cShe intentionally took the hard road because she knew that this community deserved it.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/pullquote {\"value\":\"  \u201cIn the South, talking about gun violence, you know, she did not pick the easy path. She intentionally took the hard road because she knew that this community deserved it.\u201d\\u003cbr\\u003e\u2014Christa Green\",\"textColor\":\"orange_400\"} -->\n<blockquote class=\"wp-block-ncst-pullquote has-orange-400-text-color\"><div class=\"pullquote-container\"><p class=\"pullquote-content\">  \u201cIn the South, talking about gun violence, you know, she did not pick the easy path. She intentionally took the hard road because she knew that this community deserved it.\u201d<br>\u2014Christa Green<\/p><\/div><\/blockquote>\n<!-- \/wp:ncst\/pullquote -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink was able to get financial buy-in at MUSC from the provost\u2019s office and the department of surgery, which gave her enough money to start Turning the Tide. (Today, the program is fully funded by 16 external grants.) Using a successful hospital-based violence intervention program in San Francisco as a model, she created Turning the Tide in June 2021. The program now has three client advocates, a program director, an adult trauma injury prevention coordinator and Hink as its medical director.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/image-grid -->\n<section class=\"wp-block-ncst-image-grid\"><!-- wp:ncst\/image-column -->\n<section class=\"wp-block-ncst-image-column\"><!-- wp:image {\"id\":4553,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Christa_rgb.jpg\" alt=\"\" class=\"wp-image-4553\" \/><figcaption class=\"wp-element-caption\">Christa Green, program director<\/figcaption><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:image {\"id\":4554,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Keith_rgb.jpg\" alt=\"\" class=\"wp-image-4554\" \/><figcaption class=\"wp-element-caption\">Keith Smalls, client advocate<\/figcaption><\/figure>\n<!-- \/wp:image --><\/section>\n<!-- \/wp:ncst\/image-column --><\/section>\n<!-- \/wp:ncst\/image-grid -->\n\n<!-- wp:ncst\/image-grid -->\n<section class=\"wp-block-ncst-image-grid\"><!-- wp:ncst\/image-column -->\n<section class=\"wp-block-ncst-image-column\"><!-- wp:image {\"id\":4555,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Cat_rgb.jpg\" alt=\"\" class=\"wp-image-4555\" \/><figcaption class=\"wp-element-caption\">Cat Yetman, client advocate<\/figcaption><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:image {\"id\":4556,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Adrianna_rgb.jpg\" alt=\"\" class=\"wp-image-4556\" \/><figcaption class=\"wp-element-caption\">Adrianna Bellamy, adult trauma injury prevention coordinator<\/figcaption><\/figure>\n<!-- \/wp:image --><\/section>\n<!-- \/wp:ncst\/image-column --><\/section>\n<!-- \/wp:ncst\/image-grid -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">It\u2019s come full circle for Hink, who\u2019s applying that public-health focus she first encountered years ago in Raleigh and Chapel Hill. Categorizing gun violence as a public health crisis allows Hink and her team to unpack multiple layers as to why it occurs. They can consider how poverty, unemployment, a prevalence of run-down or abandoned buildings, and a lack of green space may impact communities with high rates of violence. \u201cThis bears out in the literature,\u201d says Hink, who publishes journal articles on risk factors associated with gun violence. \u201cThose communities, both urban and rural, that have high rates of disparity are significantly more likely to experience higher rates of firearm violence.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"textAlign\":\"center\",\"level\":4} -->\n<h4 class=\"has-text-align-center\">SHOWING UP<\/h4>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink says what stands out to her about Turning the Tide\u2019s first three years is how its clients feel seen and heard by the program\u2019s team. Katrina Kiora, 32, who was shot three times by her ex-partner in North Charleston, is one of those. She credits Hink with saving her life and the program with helping her believe in herself, from cheering her on at her job as a manager at McDonald\u2019s to helping retrieve her dog King, an American Bully who ran away the day she was shot. \u201cShe basically still has me here,\u201d she says of Hink.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:image {\"id\":4558,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_KatKing_rgb.jpg\" alt=\"\" class=\"wp-image-4558\" \/><figcaption class=\"wp-element-caption\">Katrina Kiora shows off her best friend, King, an American Bully that Turning the Tide helped get back to her after she was shot three times in April 2023.<\/figcaption><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink admits sometimes the work is hard and drains her, especially on top of her long hours of surgeries and research. But when she speaks of Kiora or other patients, all of whom she remembers by first name like they\u2019re neighbors, she recalibrates, almost coming back to life. \u201cIt comes through,\u201d Hink says. \u201cThey\u2019re like, \u2018This person actually showed up for me.\u2019\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/pullquote {\"value\":\"  \u201cIt comes through. They\u2019re like, \u2018This person actually showed up for me.\u2019 \u201d\\u003cbr\\u003e\u2014Dr. Ashley Hink \u201905\",\"textColor\":\"orange_400\"} -->\n<blockquote class=\"wp-block-ncst-pullquote has-orange-400-text-color\"><div class=\"pullquote-container\"><p class=\"pullquote-content\">  \u201cIt comes through. They\u2019re like, \u2018This person actually showed up for me.\u2019 \u201d<br>\u2014Dr. Ashley Hink \u201905<\/p><\/div><\/blockquote>\n<!-- \/wp:ncst\/pullquote -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Turning the Tide\u2019s client advocates jump into action and immediately go to work when they get the \u201cGSW\u201d alert\u2009\u2014\u2009short for \u201cgunshot wound\u201d\u2014\u2009coming in on their cell phones. It\u2019s all about those three letters for the client advocates against the backdrop of national victim recidivism trends. The data reveals a blunt reality for victims.&nbsp; Once someone is a victim of a violent injury, they face a higher risk of being victimized by another violent injury as compared to those who\u2019ve never faced being a victim before. \u201cThat\u2019s where it sinks in,\u201d says client advocate Keith Smalls of the alerts. \u201cThere\u2019s a possibility that it\u2019s somebody that we served before.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/image-grid -->\n<section class=\"wp-block-ncst-image-grid\"><!-- wp:ncst\/image-column -->\n<section class=\"wp-block-ncst-image-column\"><!-- wp:image {\"id\":4537,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_OnCall_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4537\" \/><figcaption class=\"wp-element-caption\">Once a trauma call comes in on Hink\u2019s pager, above, and, right, on a client advocate\u2019s phone featuring the letters \u201cGSW\u201d (\u201cgunshot wound\u201d), they head to the trauma bay. Below, client advocates Keith Smalls and Cat Yetman stand behind a line in the trauma bay, waiting for an opening to approach gunshot victims to introduce themselves.<\/figcaption><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:image {\"id\":4538,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_GSW_rgb-1.jpg\" alt=\"\" class=\"wp-image-4538\" \/><\/figure>\n<!-- \/wp:image --><\/section>\n<!-- \/wp:ncst\/image-column -->\n\n<!-- wp:image {\"id\":4536,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_ERLine_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4536\" \/><\/figure>\n<!-- \/wp:image --><\/section>\n<!-- \/wp:ncst\/image-grid -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Once the alert comes in, the client advocate heads to the trauma bay. As nurses and doctors clean wounds or put in chest tubes, the advocates wait for an opening to make their introduction. They approach the patient\u2019s bedside to talk, treating the patient with dignity and avoiding language or tone blaming them for ending up a gunshot victim.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">The approach is known as trauma-informed care, and it\u2019s one of the program\u2019s tenets. The goal is to consider the patients\u2019 life experiences, make them feel more comfortable and let them know that they have an ally. \u201cA lot come from homes where they don\u2019t have a lot of family support, and poverty,\u201d says Hink. \u201cThey might be living in communities with high rates of violence and the presence of crime and gangs.&nbsp; Some of them have never, literally, left their community, and they don\u2019t know what else is out there, and they have been made to feel like this is as good as it gets, and that they can\u2019t be more, and are used to people letting them down, or telling them that they will never amount to anything else.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Smalls introduces himself and asks about the victim\u2019s family and how he can contact them. \u201cEverything that comes out of our mouth, it\u2019s a sense of encouragement, inspiration, motivation\u200a\u200a. . .\u200a\u200alove,\u201d says Smalls. \u201c\u2018You belong to me now, and I belong to you. We belong to each other now.\u2019\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">The client advocate\u2019s work can shift to sitting with friends and families and making trips back and forth to the ER relaying messages. Sometimes, they encounter family members who want to seek revenge for the victim, but Turning the Tide\u2019s client advocates work to quell those situations, as retaliation suppression is one of the program\u2019s main goals. It\u2019s not uncommon to deal with multiple patients at once.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Client advocate Cat Yetman remembers a night where she had five patients, three at MUSC and two at neighboring MUSC Shawn Jenkins Children\u2019s Hospital, which takes patients 15 years old and younger.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">At first, the doctors and nurses in the ER were protective of their environment and were curious about the advocates, who are not medical personnel. Eric Schott, a trauma performance improvement coordinator at MUSC, first encountered Turning the Tide\u2019s client advocates as a nurse in the ER two years ago. He says it took about three months or so, but eventually the advocates were a welcome sight. He knew he could focus on medical care while they could be there for the patient in a wholly different way.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">\u201cI was always so happy to see them,\u201d Schott says. \u201cI know the patient I\u2019m caring for is going to get something a little bit extra that they may not see anywhere else.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/sandwich-narrative {\"heading\":\"Rising Tide\",\"imageID\":4550,\"imageURL\":\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Katrina_rgb.jpg\",\"imageAlt\":\"\"} -->\n<aside class=\"wp-block-ncst-sandwich-narrative with-image\"><div class=\"ncst-sandwich-narrative\"><div class=\"sandwich-narrative__image-container\"><img class=\"sandwich-narrative__image wp-image-4550\" alt=\"\" src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Katrina_rgb.jpg\" \/><\/div><div class=\"sandwich-narrative__text-container\"><h2 class=\"sandwich-narrative__heading\">Rising Tide<\/h2><!-- wp:ncst\/text-heading-section -->\n<!-- wp:paragraph -->\n<p><em>Three gunshot injuries halted Katrina Kiora\u2019s life in Charleston, S.C. Turning the Tide is helping her get back on her feet and feel whole again.<\/em><\/p>\n<!-- \/wp:paragraph -->\n<!-- \/wp:ncst\/text-heading-section -->\n\n<!-- wp:ncst\/collapsible-more {\"instanceID\":0} -->\n<div class=\"wp-block-ncst-collapsible-more ncst-collapsible-more\"><div class=\"collapsible-more__collapsed-content-container collapse panel-collapse \" id=\"collapsible-more-0\" aria-labelledby=\"collapsible-more-heading-0\"><!-- wp:paragraph -->\n<p>Katrina Kiora was at her friend\u2019s house in North Charleston, S.C., in late April 2023. She had been trying to end a relationship with a partner, but he showed up and kicked in the door. \u201cHe shot me three times,\u201d she says, \u201conce in my chest, one in my stomach and once in my face.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Kiora, 32, is one of the 360-plus victims of firearm violence in the Charleston area helped by Turning the Tide, a violence intervention program at the Medical University of South Carolina. She credits Dr. Ashley Hink \u201905 and program client advocate Cat Yetman with saving her life. \u201cThey both were there. They checked on me,\u201d Kiora says. \u201cThey made sure I was there.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Her injuries caused Kiora to spend several weeks in and out of the hospital with surgeries. She had a tube in her stomach and one in her ribs. Her pancreas was particularly damaged, and she credits Hink with removing half of it in a difficult surgery. And Kiora, a transgender woman, says Hink always acknowledged her identity, adding that a challenge at hospitals is that health care professionals often call her by the name she no longer acknowledges. \u201cNot with Dr. Hink or any other nurse at the hospital,\u201d Kiora says. \u201cThey call me by Katrina.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Kiora speaks with quick sentences with a gentle voice, and sometimes, she has to pause to talk to herself, still trying to process the violence that befell her last spring. \u201cNo more tubes,\u201d she says. \u201cNo more surgeries. &nbsp;. . .No more bullets inside of me.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>As a client advocate, Yetman has been in lockstep with Kiora through her recovery, both physical and emotional. On the day Kiora was shot, King, her American Bully and best friend, ran out of the door and went missing, ending up at the Charleston Animal Society. When Kiora located him, she had trouble getting him back because the dog had blood\u2009\u2014\u2009Kiora\u2019s\u2009\u2014\u2009all over his coat, and there were fees attached to his care. So Kiora called Yetman, who interceded. Yetman says Charleston Animal Society came to an agreement about the fees once they knew the whole story, and soon after, King was back with Kiora.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Sitting on a picnic table in Hampton Park on Charleston\u2019s upper peninsula, Kiora\u2019s and Yetman\u2019s bond is evident. Kiora says she first trusted Yetman because she\u2019s tall like her. They easily make each other smile. And Yetman beams when Kiora talks about her current job as manager of a McDonald\u2019s. It\u2019s clear Kiora feels she has someone in her corner, someone who has helped her once again become whole.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>\u201cI\u2019m back to being who I am,\u201d she says, \u201cwhich is Katrina.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><em>--CHRIS SAUNDERS<\/em><\/p>\n<!-- \/wp:paragraph --><\/div><a class=\"collapsible-more__interaction-cta collapsed\" href=\"#collapsible-more-0\" id=\"collapsible-more-heading-0\" data-toggle=\"collapse\" data-target=\"#collapsible-more-0\" aria-controls=\"collapsible-more-0\"><span class=\"collapsible-more__expansion-indicator\"><span class=\"ncst-plus-minus-toggle\"><\/span><\/span><span class=\"collapsible-more__text\">Expand to read more<\/span><span class=\"collapsible-more__text-collapse\">Collapse<\/span><\/a><\/div>\n<!-- \/wp:ncst\/collapsible-more --><\/div><\/div><\/aside>\n<!-- \/wp:ncst\/sandwich-narrative -->\n\n<!-- wp:heading {\"textAlign\":\"center\",\"level\":4} -->\n<h4 class=\"has-text-align-center\">THE STUFF YOU DON\u2019T THINK ABOUT<\/h4>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Client advocates point out that so many victims of firearm assaults encounter obstacles most couldn\u2019t conceive. It\u2019s the stuff most of us have the luxury of not considering. For instance, Yetman says they had a patient, a mother, who was in the operating room. And her child needed to breastfeed. They were able to ensure the baby received formula and diapers.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">It\u2019s just one example of that \u201clittle bit extra.\u201d A great deal of that extra occurs when a patient is ready to be discharged. Many times, when a gunshot patient comes in, their clothes must be cut away so doctors and nurses can triage or operate. Turning the Tide\u2019s office is stocked with a cabinet full of shirts, shorts, sweatpants, socks and undergarments so that the patients can leave with new, clean clothes.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/image-grid -->\n<section class=\"wp-block-ncst-image-grid\"><!-- wp:ncst\/image-column -->\n<section class=\"wp-block-ncst-image-column\"><!-- wp:image {\"id\":4545,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Clothes_rgb-1024x768.jpg\" alt=\"\" class=\"wp-image-4545\" \/><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:image {\"id\":4546,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_InMeeting_rgb-1024x761.jpg\" alt=\"\" class=\"wp-image-4546\" \/><\/figure>\n<!-- \/wp:image --><\/section>\n<!-- \/wp:ncst\/image-column -->\n\n<!-- wp:image {\"id\":4544,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_CatNeighbor_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4544\" \/><figcaption class=\"wp-element-caption\">Top left, Turning the Tide has a cabinet stocked with clothes for victims who\u2019ve been shot and had their clothes cut away in surgery; Hink, top right, in a meeting with her team. Above, much of the work for client advocates like Yetman takes place out in Charleston\u2019s communities.<br>&nbsp;<\/figcaption><\/figure>\n<!-- \/wp:image --><\/section>\n<!-- \/wp:ncst\/image-grid -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Once discharged, they encounter a new list of concerns: food insecurity at home, cell phone service ending if&nbsp;they missed the due date on a bill while in the hospital, and simply feeling safe back in their community. \u201cWe do want to see a reduction in what we call recidivism, right? People being reinjured again,\u201d says Yetman. \u201cBut what really matters to me is, does my patient go home? Are they safe? Are their families safe?\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Most of the patients who accept after-discharge services and stay on as clients aren\u2019t heading back to the Charleston that was named the top U.S. city to visit in July 2022 by <em>Travel + Leisure<\/em> magazine readers, welcoming some 7 million visitors per year. In 2022, tourism brought $12.8 billion to the city in hospitality dollars, according to <em>The [Charleston] Post and Courier<\/em>. Turning the Tide\u2019s clients are heading back into communities like North Charleston, West Ashley and the West Side. Those neighborhoods are home to vulnerable populations, with high poverty and low education rates when compared to the rest of the region.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/image-grid -->\n<section class=\"wp-block-ncst-image-grid\"><!-- wp:image {\"id\":4532,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_CharlestonAerial_rgb-1024x576.jpg\" alt=\"\" class=\"wp-image-4532\" \/><figcaption class=\"wp-element-caption\">Above, Charleston\u2019s economic disparity can be seen here. Gadsden Green Homes, public housing in the West Side neighborhood, sits directly across President Street from stunning homes. Below left, designer high rises tower over another housing complex, and, below right, laundry hangs on the lines of Gadsden Green.<\/figcaption><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:ncst\/image-column -->\n<section class=\"wp-block-ncst-image-column\"><!-- wp:image {\"id\":4533,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Highrise_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4533\" \/><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:image {\"id\":4534,\"sizeSlug\":\"large\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-large\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Clothesline_rgb-1-1024x576.jpg\" alt=\"\" class=\"wp-image-4534\" \/><\/figure>\n<!-- \/wp:image --><\/section>\n<!-- \/wp:ncst\/image-column --><\/section>\n<!-- \/wp:ncst\/image-grid -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Gentrification is pushing out residents, most of whom are Black and brown. Some clients are returning to public housing, where renovations and updates are few and there\u2019s pest infestations and dilapidated playground equipment. Corner memorials, with teddy bears and remembrance letters, pay respects to the communities\u2019 most recent murder victims.&nbsp;<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:image {\"id\":4529,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_TeddyBear_rgb.jpg\" alt=\"\" class=\"wp-image-4529\" \/><figcaption class=\"wp-element-caption\">A memorial\u00a0for a 32-year-old man who died at this spot in downtown Charleston after being shot nearby.<\/figcaption><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Mass shootings prey on our national conscience when they happen. Uvalde. Parkland. Newtown. Naturally, they make us imagine the worst\u2009\u2014\u2009an active shooter coming into a school and killing our children. But Hink&nbsp;notes that those shootings comprise a tiny fraction of firearm injuries and deaths.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">\u201cI think I definitely experienced the shock of mass shootings, but I realized what we all now know,\u201d she says. \u201cMost people that are being shot are being shot all around us every day in our communities,\u201d she says, \u201cand their stories don\u2019t make the headlines. But it\u2019s happening all the time.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:ncst\/pullquote {\"value\":\"  \u201cMost people that are being shot are being shot all around us every day in our communities, and their stories\\u003cbr\\u003edon\u2019t make the headlines. But it\u2019s happening all the time.\u201d\\u003cbr\\u003e\u2014Dr. Ashley Hink \u201905\",\"textColor\":\"orange_400\"} -->\n<blockquote class=\"wp-block-ncst-pullquote has-orange-400-text-color\"><div class=\"pullquote-container\"><p class=\"pullquote-content\">  \u201cMost people that are being shot are being shot all around us every day in our communities, and their stories<br>don\u2019t make the headlines. But it\u2019s happening all the time.\u201d<br>\u2014Dr. Ashley Hink \u201905<\/p><\/div><\/blockquote>\n<!-- \/wp:ncst\/pullquote -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Ninety-three percent of patients the program serves are Black, and 84 percent are male. And Green, whose research focuses on violence prevention, says that disparity is underscored even further when it comes to children. In a national study she conducted with colleagues, they found that the rate of firearm homicide deaths for Black children is nine times greater than that of white children. \u201cYou can\u2019t really talk about gun violence without talking about racial disparity,\u201d she says, \u201cbecause a Black person and a white person living in Charleston are living two very different lives most likely on average.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Community members view gun violence as an existential threat to the health of their communities\u2019 future. Chantelle Mitchell is a community activist, mentor and motivational speaker in Charleston who works with Turning the Tide as a community partner with Youth Advocate Program, a nonprofit focusing on foster care and community-based services. And when asked to articulate how prevalent gun violence is in the community, she doesn\u2019t need statistics. She has firsthand experience. She lost one of the youths she was working with to gun violence back in June. And her daughter lost her best friend two years ago. He was 15. \u201cThese kids are out there playing football, double dutching,\u201d she says, \u201cbut when you see these kids coming in with gunshot wounds, you have to figure out why.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">And Mitchell says that Turning the Tide has remedied what was a major problem for gunshot victims. \u201cWhat they realized when they created the program was once [victims] are discharged, no one was following up with them. These are 12-, 13-year-old kids,\u201d she says.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink says that three years ago, firearms victims who\u2019d come to MUSC were getting shot, receiving medical care and then being sent back out to those communities with no connection or resources. Now, Turning the Tide helps victims and their families establish lines of credit, stocks their fridges and pantries with food, and encourages them to complete their GEDs and get driver\u2019s licenses. Smalls serves as a father figure to many of his clients, even helping some get staff jobs at MUSC. Talking about those successes makes Smalls smile his gentle grin. There\u2019s also something distinct about his mentorship and satisfaction. He\u2019s personally known the toll of gun violence in Charleston, as his 17-year-old son was shot and killed in North Charleston in 2016.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">\u201cI think one of the most serious statements that I\u2019ve ever heard a parent say, that \u2018I\u2019d rather go visit my child in jail than visit him at the grave,\u2019\u201d Smalls says. \u201cI understand that point. A gravesite is hard.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"textAlign\":\"center\",\"level\":4} -->\n<h4 class=\"has-text-align-center\">NEXT LEVEL<\/h4>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink admits she\u2019s most at home in the trauma bay. It\u2019s there and in environments like the ICU she says she can do what she does best, \u201ccreating organization out of chaos,\u201d as she cares for injured and critically ill patients. Hink\u2019s office in MUSC\u2019s Clinical Sciences Building holds a couple of keepsakes that signify her connections to those patients. There\u2019s the painting of a crane by a former patient, and a glass pyramid a former patient\u2019s family gave her. Etched in it is the word, \u201cINSPIRE.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:image {\"id\":4541,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/magazine.ncsu.edu\/wp-content\/uploads\/2024\/01\/Hink_Inspire_rgb.jpg\" alt=\"\" class=\"wp-image-4541\" \/><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">\u201cThere\u2019s a huge difference in the way that Dr. Hink interacts with patients versus maybe other attending physicians or other health care providers,\u201d Yetman says. \u201cShe wants to know how patients are doing after she is done caring for them. She thinks about them. She remembers them. She focuses on the humanity of the individual.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">That same level of compassion extends to the fiber of her team\u2019s members. Words colleagues use to describe Hink apply to the program. Sturdy. Strong. Unflinching. Refusing to accept the status quo. \u201cShe\u2019s a beast,\u201d another doctor says of her in passing. \u201cShe\u2019s next level.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink meets with the Turning the Tide team on Monday afternoons, celebrating their wins with a satisfactory nod. Empathy, too, as she worries about her team. \u201cThey come in, and they\u2019re helping patients and families when they are in their darkest moments and they\u2019re terrified,\u201d she says. \u201cThere\u2019s a lot of vicarious trauma that those of us experience in doing this work, and they have a really hard job.\u201d<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">She continues working to ensure that Turning the Tide is sustainable. She would like to hire more client advocates to decrease caseloads. She\u2019s still poring over data from Turning the Tide\u2019s first three years, but says the numbers anecdotally suggest reductions in repeat injuries, an increase in the number of patients returning to MUSC for clinical follow-up appointments and a reduction in unplanned emergency room visits.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Hink also meets with city leaders and politicians, both Democrats and Republicans, who voice support for her work. She looks for more community partners, like schools, criminal justice victim advocates, family counselors, food and housing nonprofits, and law enforcement. She lectures on topics ranging from firearm violence epidemiology to violence intervention strategies. (And she\u2019s a new mom. She and her partner just welcomed a baby girl in December.)<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">And Hink does it all in her next-levelness to address the essential question that drives her. \u201cAt the end of the day, in our country, firearms are the leading cause of death for kids,\u201d she says. \u201cHow is it that we are okay with that and we\u2019re not doing more to prevent it?\u201d&nbsp;<\/p>\n<!-- \/wp:paragraph -->"},"excerpt":{"rendered":"<p>Dr. Ashley Hink \u201905 takes on gun violence in Charleston, S.C., by treating it as a public health crisis.<\/p>\n","protected":false},"author":35,"featured_media":4525,"comment_status":"open","ping_status":"open","sticky":false,"template":"views\/single-immersive.blade.php","format":"standard","meta":{"_acf_changed":false,"source":"","ncst_custom_author":"","ncst_show_custom_author":false,"ncst_dynamicHeaderBlockName":"ncst\/default-immersive-post-header","ncst_dynamicHeaderData":"{\"backgroundColor\":\"orange_400\",\"displayCategoryID\":5,\"showAuthor\":true,\"showDate\":true,\"showFeaturedVideo\":false,\"subtitle\":\"Dr. Ashley Hink \u201905 takes on gun violence in Charleston, S.C., by treating it as a public health crisis. 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