By Rosemarie Miller
For more than a century now, there has been a broad disparity in the quality of care that blacks and whites receive. Nowhere is this disconnect more clearly seen than in the state of Mississippi, which almost proudly proclaims that it“ranks last, or close to last, in almost every leading health outcome.”
This disconnect, rooted in historical disparities between black and white institutions, as well as the prevailing racism of the time, has resulted in wildly different health outcomes between black/brown people and whites at a comparable socioeconomic level. The disconnect dates back for years, originating in the Antebellum era when slaves were denied basic medical care, and continuing into the present. Doctors and historians have experienced it first-hand.
Dr. Hurlie Sullivan, a lifelong Mississippian and physician, was in her early twenties when she noticed a strange discrepancy in the way patients and doctors interacted. This discrepancy, coupled with her own life experiences, drove Dr. Sullivan to begin her residency at the University of Mississippi.
“When I first began my residency over thirty years ago, I noticed how hesitant my patients were with me. At first, I thought maybe they can tell I’m extremely new to this,” said Dr. Sullivan, now a full-time clinician at the University of Mississippi.
“That’s when I became very observant of the doctor-patient interactions surrounding me and even asked around to hear what other doctors had to say,” continued Dr. Sullivan. Even post-slavery, black people experienced extreme segregation and unjust treatment while attempting to receive medical help of any kind. Despite major legislative and social change meant to address these iniquities, a large disparity still remains in the quality of care between black and white patients.
The Mississippi State Department of Health acknowledges these disparities, noting in a 2017 reportthat there is a “disproportionate burden of disease and illness […] borne by racial and ethnic minority populations.”
Despite this acknowledgement, the problem appears to be getting worse. An article by Linda Villarosa of the New York Times, published this April, illuminates how this disparate treatment affects infant mortality rates, with black women being more likely to have their concerns dismissed and discounted.
“Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850, 15 years before the end of slavery, when most black women were considered chattel,” Villarosa said.
Awareness, however, is as much a product of training as it is of bias. A number of studies, including a 2016 NIH study on pain assessment,note that racial bias plays an outsized role in how doctors, primarily white doctors, assess and treat the pain of black/brown patients. Among white doctors, there is an unspoken assumption that black/brown people are biologically different from whites, somehow more averse to or inured to pain. The 2016 study is of particular note because it studied the attitudes of both white laypeople and white medical professionals, and found similar levels of bias among the populations. White medical professionals who held biased beliefs about black physiology were more likely to assume that black patients’ pain threshold was higher, and that black patients were more likely to heal without professional medical attention.
Dr. Sullivan experienced these biases firsthand. Between the ages of 15-19, she had an eye condition where she had to seek medical condition. In Greenwood, Mississippi, seeking help was not the easiest.
“We had to be there at 8 a.m. because he (the doctor) would schedule 25 to 30 black people at 8a.m. The bad thing about it, if you were not there even five minutes after 8am, you couldn’t be seen that day. Another crazy thing was we wouldn’t be seen until about 3pm. We all had to sit outside under the tree, go eat Kentucky Fried Chicken and wait until the white patients were done being seen. This was so they wouldn’t encounter us throughout the day,” she said.
“I saw this doctor for four or five years until he finally told me, ‘I just don’t know why you can’t see’ and sent me to someone else. That was just normal, another thing is if the nurse called your name at ten o’clock just to see if you were still there and by some chance you had left to go to the store, you got kicked off of the list and couldn’t be seen that day,” she continued.
Dr. Donald Williams, a tenured historian from Alcorn State University specializing in African-American history, said that Sullivan’s experience is not dissimilar to others. He himself even experienced it.
“Growing up in Port Gibson, Mississippi, it was understood that the doctor’s office and dental offices were segregated. We would have to go either early in the morning or late at night, if you tried to just walk in throughout the day you most likely wouldn’t get waited on. And the doctors wouldn’t touch you, meaning the doctor would never put his hand on you, they would just touch you through your clothes,” said Dr. Williams.
Not only were doctors making it a chore to visit them, but they would also perform procedures without consent.
“I know of two cases of sterilization, one in Humphrey’s County where I was a nurse at the time. There was a lady who only had one child and couldn’t understand why she couldn’t have another child. She found out years later that her tubes were tied by this local doctor at the time of her first child. Which, in my mind is a way of keeping educated blacks from reproducing,” said Dr. Casandra Thomas, a black woman and practitioner at Baptist Medical Center in Jackson, Mississippi who has been studying the ways that different social contexts affect quality of care among black/brown patients.
“Well initially I think they were skeptical because of past experiences. But I feel 99 percent of my patients trusted me personally. But that was mostly because they felt a closeness because they were being treated by someone who looks like them,” said Dr. Thomas.
“I think this was because they had gone to white doctors all their lives and didn’t receive any hands-on care, they would simply put a stethoscope up to their chest and write a prescription,” said Dr. Thomas.
A 2004 University of Maryland studynotes the benefits of having racially/culturally diverse physicians available. “Racial/ethnic minority patients […] are more likely to feel that their physicians [are] involved […] in decisions about their care when the physician [is] of the same sex and race.”
“Whereas it was much easier learning to trust a black doctor not afraid to touch you, to examine you, not afraid to tell you about your condition…which wasn’t the norm. After events like the Tuskegee case and what happened to Henrietta Lacks, I think we all as doctors have to be more aware of our actions,” continued Dr. Thomas.
However, even Dr. Thomas’ own practice has not been immune to the effects of racism.
“I have another experience which occurred when I became a doctor, I had a patient who’s probably sixty-five years old who had a child when she was sixteen. At sixty-five, I examined her and she had no surgical history that she’d known anything about, just never had any surgeries.”
Thomas, however, soon realized that something about the records was wrong, and decided to investigate further.
“In my examination I found that she did not have a uterus,” Thomas explained.
“Keep in mind, she had no prior history of having surgery…all she ever knew is that she had a child at the age of sixteen. She never had another menstrual cycle and never was able to have another child. She could not believe it when I told her she didn’t have uterus…she was a very small lady so there was no doubt in my mind. I sent her to get an ultrasound just to make sure, it came back that she had had a hysterectomy unbeknownst to her at the University of Mississippi medical center. She had been given a hysterectomy at the time of delivery and did not know it and no one ever told her.”
Annette Hill, a nurse at Baptist Hospital located in Jackson, Mississippi, recalled the horror of a doctor working an emergency room in the late 1970’s.
“There was a Dr. Hall, a general doctor in Belzoni, Mississippi he believed in keeping most black people half sleep everyone I know was on valium, which means that you were not giving your best to every situation. I guess he thought black people were hyper or a little on edge. Another crazy thing about this Dr. Hall, back in the late seventies, when I was a nurse there; there was no shooting like they do now, but most people were getting cut or stabbed when they were in a fight. And many nights as I worked at the emergency room, Dr. Hall would be on call and would come over. But before he would sew anybody up, or treat you, or touch you or anything. If anyone in your family ever owed him a dollar, someone had to cover it that night before he would treat you,” said Hill.
The dental care black people received was in fact no better. Both Dr. Sullivan and Dr. Williams share memories of going to the dentist.
“Black people typically don’t go to the dentist and it’s because…even me as a child…I guess I was a teenager before I went to the dentist, again going through the back door waiting for several hours to be seen. The dental experience was excruciating pain, they were going to pull your teeth and it was going to be very painful. As if there were no anesthesia to give you, which there was. I think that blacks really suffered and with that type of stigma and pain, we just didn’t go. Unlike a white kid who goes to the dentist and actually get anesthetic medicine. They got fillings in their cavities, but not if you were black,” said Sullivan. Villarosa’s article expounds on this point, noting that black women are often “less likely to be given appropriate medications” for a number of life-threatening conditions, which “resulted in higher death rates.”
“Almost all the people I know my age had poor dental, most of them now don’t have any teeth, they have dentures. We would never get fillings, they would pull our cavities, most of the white people I know my age have pretty good teeth,” said Williams.
To help the problem of the black community not trusting doctors and medicine in general, Dr. Thomas believes it begins with black people treating black people, which currently seems to slowly be alleviating the mistrust.
“The biggest thing I see is that there are more black doctors now…they are allowing more black doctors to enter and actually graduate from medical school. This is enabling more blacks to take care of black patients and give them overall better care.” Recent studies show a marked increase in the number of black students pursuing the medical field, as well as a steep rise in the number of black women achieving Ph.Ds and other terminal degrees in medical and STEM fields.
However, Dr. Williams challenges this statement by pointing out that black doctors were involved and aware of the spreading of syphilis during the Tuskegee Experiment.
“The Tuskegee Experiment was very traumatic, once we learned about it. Most black people didn’t know about it, I didn’t learn about it until I was in graduate school at Michigan. The worst thing about it to me was the complicity of the black doctors in Tuskegee who participated in the experiment who knew what was going on but didn’t inform any of the black men and women who were given that syphilis virus. They had this virus in their system for decades simply to see what it would do to people. I could understand the racism of the white doctors but why would the black doctors go along with it? None of those black people were ever compensated and many died, had deformities, developed cancer, and went insane because syphilis destroys brain tissue,” said Dr. Williams.
Despite these challenges, the abundance of new research and reporting on the subject is having an effect. Villarosa’s Times story and other studies struck a chord, prompting other news outlets to disseminate the story and provide platforms for more black women to come forward about their treatment. Famous black women like Serena Williams and Michelle Obama detailed the struggles they’d had in having children and began to more forcefully advocate for black women’s care.
“Every mother, everywhere, regardless of race or background deserves to have a healthy pregnancy and birth,” Serena Williams wrote in an op-ed published by CNN.
Additionally, some comparatively large changes have taken place in Mississippi to combat these age-old disparities. In 2017, the Mississippi Department of Health announced a new state partnership initiative with the U.S. Department of Health and Human Servicesaimed at combatting racial health disparities, hoping to reduce hepatitis B diagnoses dramatically by 2020.
On the political front, Democratic Senate candidate Mike Espy, a black man, has made addressing these health disparities the centerpiece of his campaign, noting that he himself had a pre-existing health condition that he struggled to get cared for. His calls to expand Medicaid and increase the number of medical facilities available to black/brown communities has drawn plaudits from both sides, including his opponent Republican Cindy Hyde-Smith, who had gone on to adopt his rhetoric.
Whether these changes will make a material impact on the quality of care in communities like Dr. Sullivan and Dr. Thomas’ is yet to be seen.
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