[Lace Watkins]

https://laceonrace.com/2021/05/24/vaccines-and-medical-racism/

 

Vaccines and Medical Racism

Discussion

[Rebecca McClinton]

I spend 40+ hours of my week working in the healthcare industry. The inequities are vast. Again and again I see Medicaid clients struggle to receive equitable care, to be taken seriously, stigmatized and gaslighted. I advocate for them, but often feel at a loss for how vast the deficits are. I also notice how easy it is to “blame the system” rather than investigate my part in it…times when I’ve been “too tired” and shortened a phone call to check in or advocate, times when I’ve stood back for my own self preservation from fighting louder, harder because I valued being liked by a colleague over a needed call-out. I’ve gotten better and those I work with know where I stand now more than they did before, but I have to continue pushing and always be looking inward for those internalized stigmas that can hurt others the worst.

[Emily Holzknecht]

I have a relative who has the CA version of Medicaid, and it doesn’t pay for a large amount of the medical care that he needs just for basic function, not even enough functionality to hold any sort of job. Other family members pay those extra costs. Because we are white we have generational wealth that can make up for the shortcomings of California-care and for the gaslighting he received when he tried to apply for disability. His situation is much better off than if he were Black or brown both from the generational wealth perspective and also from the gaslighting perspective and the quality of care that he receives when he does go to the doctor. I am reminded of the arguments made by white people that racism isn’t real because my life is hard too. His life is hard, but it would be so much harder if he was Black or brown.

[Shara Cody]

When crisis happens, racism in the public health and medical systems makes sure that the focus is on the collective as a single unit and on where things are already working/in place (aka white people in places with existing options) instead of looking for gaps (beyond the topical level related to the specific crisis). For both HIV/AIDS and COVID-19, if you have enough money you can buy the best treatments to improve your outcome because capitalism and racism drive healthcare instead of health being considered a basic human right. To personalize, similar to when changes were made only when Ryan White was diagnosed with HIV/AIDS, I’m thinking of the way I often only believe in the impacts of things when it happens to someone I know or identify with (other white people who live and work similar to me). It’s easy for white people, including me, to think that systemic racism in the medical system isn’t a big deal when you haven’t dealt with it or to victim blame (judge). Listening and believing BIPOC as well as looking at all the underlying factors instead of the surface of situations is an absolute must for reducing and stopping harm from the medical system to BIPOC. A big take away from this post are the ways to address access issues: ensuring medical facilities are located in all areas, improving public transport including cost and scheduling, and guaranteeing the right to quality healthcare for all which must include addressing racism that is perpetuated in medical training. I’m going to ask my family doctor what they are doing to address racism in the medical system and their practice and ask local politicians what they’re doing to ensure access and equality.

[Julia Tayler]

I agree that we need to be proactive in our communities. I’m thinking that I need to reach out to our hospitals. One problem Is the lack of trust – deserved – that black and brown people have with mainstream healthcare. Thank you for bringing up ideas that I can follow up with too.

[Shara Cody]

Hi Julia, the lack of trust in the medical system is as you said, deserved, because of racism. I’m curious why you specified “mainstream healthcare”? I not familiar enough with the American medical system to be sure what that means, but I would think that racism in the medical field exists in all healthcare.

Also I wanted to mention that suggestions for action were included in the post and I re-stated them. Here is the excerpt from near the end of the post:

“What can we do? We can ask our own healthcare providers what they are doing, not just for us and for our immediate families, but for the community as a whole. Look at where your clinics and hospitals are located. Ask for mortality rates by demographic. Ask your local and state lawmakers what they are doing to make healthcare as a whole more accessible and equitable, and what they are doing in particular for COVID to insure equity and just treatment for all of their residents.”

[Julia Tayler]

Hi Shara,

The reason I said mainstream healthcare was I was under the impression (and I could be very wrong) that some overworked neighborhood clinics provide better healthcare. Again, I could be wrong about this.

I must have missed the end of the post. Thank you for pointing it out to me.

[Christina Sonas]

The healthcare system has changed, as white capitalist supremacy systems do, only as minimally as necessary to keep the system safe from revolution. Which inevitably means handling each circumstance as it occurs, and only when it starts to bother white people, rather than making any broader shifts that would help non-white people, and impact HIV-AIDS, cancer, lead poisoning in children, COVID, heart disease, and all the other things, all at once. So there are initiatives to make sure everyone has broadband access, and Wal-Mart is making sure everyone has access to one of their stores, but the USA still does not live up to the ideal of the Declaration, almost 250 years later, that government exists to secure the inalienable right of Life.

I drive farther away from the city, deeper into the suburbs, in order to access much of our healthcare at lovely new facilities built in towns that don’t really have a middle class, much less a working class. The assisting nurse drives in 50 miles from the Central Valley every day. What would I find if I turned my search toward the city instead? There is an 8-mile desert through south and east Oakland: no hospitals, no urgent care clinics. Only the Roots Community Health Center, serving the primary care needs of an area with hundreds of thousands of people.

One thing I know I can do is start paying attention to my local health district, which runs a nonprofit hospital in my town. There is a substantial Latinx working class in the service area, but to me, it looks like all the other high-income facilities. That almost certainly means it’s not meeting their needs.

[Emily Holzknecht]

I am thinking about where you say the assisting nurse drives in 50 miles every day. I have family in the Bay Area and I used to live there as well, and I know well of the long distances people travel to their workplaces that are located in areas where many who work there cannot afford to live. Healthcare centers of all sorts have janitorial staff, entry level technicians, receptionists and many other important workers who have to be brought in to the well-off areas where healthcare centers decide to locate. Then they go back home and there are no services nearby when their own family members are in need.

[Rebecca McClinton]

I like how you remind us that all systems are only “minimally as necessary”. So true. I’ve grown skeptical of grant funded programs at my work that are here for a minute, then gone. It’s traumatizing really, to be told there will be some help/services, only to have it taken away. Then there are the barriers to accessing this minimally necessary programming (sign these documents, agree to this and that, don’t do this/that). It doesn’t even make it worth it a lot of the time.

[Kelsi Watters]

I can relate to the iisue of transportation access as it relates to oppression around access to healthcare. I am familiar with the challenges of public transportation, having to rely on it myself. I live about 2 miles from the hospital where I work; however, it can sometimes take an hour or more for me to get to or from work, in between wait time and riding time. However, I do have the privilege of living in a city where there is much greater location access to healthcare, drug stores, grocery stores, etc., as well as transportation (although Charlotte is pretty large so I am not certain if the entire city has equitable access to these resources). I am also privileged in that, from time to time, I can afford to take an Uber to work if my transit falls through.

[Julia Tayler]

I hadn’t thought about the employees who don’t live nearby and have family who need healthcare. My community is at most 45 minutes away from the hospitals but in the Bay Area I know that 45 minutes is a minimum one way. I’ve also noticed that the administrative part of healthcare has gotten a lot more cumbersome. I take care of my mom and fill out the forms for her but think about others that don’t have someone to help with the 27 pages of medical history that you have to fill out every time you go to the doctor’s office – the same one you were at 4 months ago. We need a drastic overall of the health system in this country.

[Emily Holzknecht]

Here and in previous discussions we’ve been talking about access to medical care. On a previous post I looked at CVS locations in my city and state because white people were talking about vaccines are available at CVS in a way that made them seem accessible. It turned out that most of the state does not have reasonable access to a CVS. Today I looked beyond CVS to see access to medical care in my city. Looking at hospitals, it seemed like people of different incomes were all pretty far from hospitals though of course some people do live around hospitals. They weren’t located in the upscale areas. Switching to medical clinics, however and then medical centers and adding Walgreens and even trying out doctors, it is clear that the majority of these types of facilities are all spread out in the same quadrant of the city with the same people having access to them as to the CVSs and with other parts of the city needing to travel to get to medical care.

I am thinking about the programs where doctors get their med school tuition paid off if they spend a certain amount of time working in an under-served area. I am thinking that doctors graduating from school are still mostly white people. They get their debt forgiven if they work in Black or brown communities and then can move their business out of those communities and make a ton of money without debt working and living in white communities while also feeling like good saviors for their time working in the Black and brown communities (which they were actually benefiting from because it contributed to their generational wealth). If our country was to make degree programs and med school free, then the white doctors wouldn’t have an incentive to go work in Black and brown communities because they wouldn’t have debt to be forgiven. BUT medical degrees would be more in reach for Black and brown people who may be more likely to set up their practices in Black and brown communities and stay there. Free college education could help to make access to medical care more equitable.

[Rebecca McClinton]

Those programs that ‘pay tuition off’ mean the staff are only present as long as they have to be to get their student loans paid off, then they’re often so burnt out by high case loads, low pay (high school janitor at the local school district gets paid more than those entry level master degree positions), and unbearable bureaucracy and paperwork demands they leave. Average at my work is a staff will stick around about 1.5 years, maybe two, then they’re off. This leaves the true victims, those receiving care, experiencing constant churn in their treaters. Just when you’re starting to finally trust one person (because availability is only 1-2X monthly to be seen), then you have to start all over again wondering if the the next person will treat you justly, what their biases are, how long they’ll be around. How is a person supposed to heal under those conditions? At that point it often just becomes re-traumatizing or the person gives up and decides that suffering is less painful than trying to seek out the help to address it.

[Emily Holzknecht]

I have experienced that churn of primary care providers. I get established with a provider and then the next time I need to make an appointment, that person is no longer at that practice though I think the churn is related to tuition being paid off. I am trying to think when the last time I saw the same primary care physician (not a specialist) twice. It might have been almost 20 years ago. However, as you point out, for Black and brown people, who have personal and generational experience of medical providers not being trustworthy, trusting a brand new provider is a whole other ballgame than it is for me. Additionally many Black and brown people have far more reasons to see a doctor than I do as I and the generations before me have been able to access fresh and healthy food, live in areas with low pollution, buy health related products and services, live with lower stress levels, have better medical care even when it’s not always with the same provider, and so on. The churn that I experience does not negatively affect me as much as medical provider churn affects Black and brown people.

[Julia Tayler]

The sad state of our healthcare system is something I’ve really learned from Lace and this past year. COVID and all the “never befores” that have happened have shown a light on a lot of inequities and failures in our communities. I work with a non-profit that has a healthcare mission and we are focusing on the inequities in care for black and brown moms. As someone mentioned above I need to ask questions in my community and work to help with solutions. Starting now.

[Kelsi Watters]

Today I listened to a video created by the Director of the Spiritual Care Department at the hospital where I work, in which he discussed the spiritual principles of our healthcare system. He made a comment that all hospitals in our health system offer equal access to health care regardless of one’s ability to pay. Thus, patients do not get turned away from our Emergency Department because of an inability to pay. However, he called this “charitable care” and generosity. Not one mention of systemic racism, no acknowledgment of racial disparities in healthcare. Without systemic racism, the racial disparities in healthcare would not exist. Systemic racism creates socioeconomic barriers to health care for Black and brown people, it is why some people do not seek medical treatment when it is needed, and/or come to the hospital unable to pay. It is true that not all patients who are unable to pay are Black and brown, but most of the time BIPOC are disproportionately dealing with socioeconomic barriers that make it difficult or impossible to afford health care. So while it is a start that our hospitals offer access to healthcare regardless of socioeconomic status, the fact that systemic racism was not even acknowledged is deeply problematic. Besides, what happens for patients who cannot afford to pay for medical care, who need to be transitioned into a rehab or nursing facility? They once again end up in the same situation. Without acknowledging systemic racism, anything else the healthcare system does to expand healthcare access, is only putting a Band-Aid on the problem.

[Shara Cody]

@kels Hi Kelsi, I’m identifying with the “touching” on the fix or thing I believe makes me good without naming and fully addressing the actual issue. As you said, not addressing the actual issue only bandaids the situation, and I think when I do this, the bandaid is more for me than for anyone affected so it’s more like a cookie or sticker.

You mentioned that people aren’t turned away from the emergency department even if they can’t pay but does that mean they won’t be admitted or be able to have certain treatments that aren’t considered “emergencies”?

[Rhonda Freeman]

I want to be transparent that this discussion hits at my ‘giving up’ nerve. My primary care physician is a black woman and I have followed her to different locations because she is an excellent physician. I have put little thought into how hard it is for people to get to her in the suburbs. Everything I think about this subject, it hurts my head. I have the story that the US Healthcare system is the caste system at its best. It is easier for me to figure out ways to work on voting right and be relational. Health care? I can speak up, but the rest feels like complaining with nothing to do about it.

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