My heart doctor, a man from Iran, is always very thorough and listens to me. But on one occasion he cut me off. It was when I mentioned to him that his intake form had nothing for my ethnicity. He replied that “we” pay no attention to that. I remonstrated a bit but realized I was in troubled waters because he no doubt learned that discussing “race” was controversial and he probably sounded good when he said he pays no attention to that.Of course I had the usual formulation for a widely recognized problem of less and poorer care given patients in marginalized groups. What I had prepared was that most doctors are not from marginalized groups unless you count immigrants like my doctor (and almost all my others). So they, like most White people, do not know the history of people like my wife, who did not see a doctor until she was married (to me) at 22, and she worked in the cotton fields in Arizona in the late 40s at age 6 or so where they were still spraying with DDT, a known carcinogen (about a decade ago she had a double mastectomy). For me, the link was the absence of knowledge of these patients on the part of physicians but that put us back into the usual panacea: more education.
Then I read, just today, an article by a Dr. Lullove. He treats diabetic patients, most of them coming from those marginalized groups. He delved into the mechanics of health care via the government and insurance companies. What it turns out is that everyone in the trade uses algorithms, algorithms which base their mechanics on a patient’s record, i.e. their past. Here’s what gets left out.
Many Black women do not get health care, let alone good health care. Why is that? In part, because they live in medical deserts just as they live in food deserts, i.e. business goes where there is money to be had and poor, Black communities do not have it. I remember traveling 20 minutes by car to a decent grocery store and it wasn’t all that great since inner city stores get the left-overs from sister stores in more affluent parts of the city. By bus it is now one and a quarter hour. Serving our area were two small grocery stores owned by Chinese. One had a good reputation for its treatment of its Black customers.
The same went for doctors and dentists. My wife went to the dentist only to have a tooth pulled, the typical just-in-time health care, but she didn’t get even that for other medical needs. The way the slaves treated illness was through practices handed down from practices in Africa and handed over by the Native Americans, along with what folk medicine the Whties shared. One major element in treatment was religion, religion in the form of prayer. When doctors operated on my wife for a hysterectomy they remarked on the shriveled appendix they found and asked her if she had ever been deathly ill and what care she had received, because it looked like none. She told them the ladies came from the church in shifts to pray for her. That was it. They are known as prayer warriors and I have seen them in church, serious ladies with tambourines circling about an ill person and chanting and singing while tapping out exotic rhythms. It is very powerful and no doubt has some psychosomatic effect, but it is not treatment, let alone surgery.
Such total lack of care in unusual now; even a school nurse provides some care. Overall though a serious lack of preventive prophylactic care, vaccination outside of that provided at school, and daily palliatives for irritations, allergies, minor wounds were absent in cases of deep poverty. My wife lived in a loving family and the church was supportive as were the teachers in her all-Black school.Those do not substitute for standard medical care. Broken arms might be put in a cast and I know my brother-in-law received extensive care when he got a bad case of polio. Again, however, overall the sort of care better-off people receive was and often still is lacking. The effects of this should be well-known and taken into account, but there are problems with that, to wit:
Many persons I’ve studies with and worked with take information about people they have little familiarity with and apply it in an indiscriminate fashion. For instance, they will assume that any Black person was raised in poverty or grew up speaking Black dialect; those things were true of my wife but not of her best friend, whose mother was a teacher and whose father had played pro-ball and worked in Latin-America. Jackie even got a trip to Ghana when she was in college. My wife always reached out into the broader world which her sister did not do. My wife worked with her mother in White homes any time she was not in school, and when not at work or in school she was in church, so no play time to speak of. But she watched closely the doctors’ wivves she worked for and she read magazines on fashion, decorating and etiquette and, crucially, she began imitating the way they talked. But the most crucial was that she began reading her older siblings’ school books before she herself went to school (the only other books in the house were the Bible and, thankfully, the Book of Knowledge encyclopedia).
So now my wife presents as a sophisticated, educated, fairly well-off person, but underneath that her health is still fragilie.