With a history of abuse in American medicine, Black patients struggle for equal access

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• Judy Woodruff:

  Inequities around the world clearly also exist here.

  Black Americans have faced discrimination and even abuse by medical professionals throughout our country's history. And in the midst of the coronavirus pandemic, these problems have only been magnified.

  First, we hear from Americans who have directly experienced medical discrimination. And then Yamiche Alcindor speaks with a doctor who has studied this painful legacy.

• Alie Streeter:

  So, about 10 years ago, when I was in college, I just started fainting pretty regularly.

  And the very first doctor I saw kind of ignored everything that I said, because she wanted to focus on an STD panel, because she was convinced that I had tertiary syphilis at the age of 22.

  I said: "Don't you have to have that for like 10 years before that would happen?"

  And she said, "Yes."

• I was like:

  "Well, I wasn't having sex when I was 12."

  She refused to believe me. She refused to believe that, at that point in my life, I'd only had one partner. And she just was adamant, would not look at any other options. And then, at some point in time, I just stopped going to the doctor and I dealt with not knowing what was wrong with me.

  Two years ago, I was at work. I couldn't make sentences. I couldn't read. I got rushed to the hospital. They thought I was having a stroke. And it was only then that they determined that I have complex migraines, which mimic other things.

• Nea Justice:

  I had my gallbladder removed. I noticed after I left the hospital I was in a lot more pain than I thought I should be in.

  By the fifth day, I was not able to keep any food down. I had a fever. It was about 103. I reached out to the surgery team. He was just so dismissive. He wouldn't run any tests. I came home and e-mailed my doctor. She made an appointment at a hospital. So they did the proper blood work and everything and determined that I was septic.

  The doctor told me once I made it to the hospital, like, you couldn't have survived another night like that.

• Brittney Gray:

  I had to get a laparoscopic procedure.

  I remember sitting in the bathroom and feeling like something — like my — something was falling out. What I saw, like, protruding, I was, like, terrified, so went to the E.R. The supervising doctor was able to remove it. It was like a curved metal thing.

  And the resident comes down, and it's a young white girl. She was just, as matter of fact, like: "Oh, don't worry, it was sterile when we put it in."

  There was no like regard for, hey, that was put in on Thursday, and it's not meant to stay there. A couple of days later, I'm still feeling pain. And I called the doctor's office. The doctor calls back and she goes: "Well, I don't want to give you any more opioids, because I don't want you to develop a habit."

  Huh? Like, I don't know. I just felt like it was disrespectful. It was dismissive.

• Nea Justice:

  I felt that it had a lot to do with me being a Black woman. And I just wasn't in a position to really advocate for myself at that time. I was sick. I was barely standing up.

• Alie Streeter:

  I know 100 percent that the treatment that I would have gotten, the dismissiveness of my symptoms and my health history and not believing me would not have happened had I not been a woman of color.

• Brittney Gray:

  I think race sometimes is a roadblock for some people, where they're not able to feel empathy.

  I would have felt better if she had a reaction to it and asked me how I was doing.

• Alie Streeter:

  I have a 7-year-old who I have taken him — he had a very severe medical issue. And we were repeatedly ignored over and over and over and over again. And it took me bringing his white father to repeat what I have been saying for the three previous appointments for them to take it seriously.

• Nea Justice:

  I have been so terrified of getting sick because I don't want to end up needing a doctor, needing to go into a hospital. Like, the thought of it gives me so much anxiety, and if I end up there again, there's no way that I'm going to survive. Like, I got lucky this time.

• Brittney Gray:

  My dad got really, really sick from COVID. And he was in the ICU for 10 days. And, for me, there was a fear, because, at this point, nobody was able to go in.

  And I can't advocate for my dad. I don't know what his experience is. So, it is a fear of like, how are they going to treat him? You don't want to have to — if you're ever that sick, to put your life in the hands of somebody who might not even care about your life.

• Yamiche Alcindor:

  As we just heard, there is a deep distrust for the medical community among many African Americans.

  For more on this, I'm joined by Dr. Vanessa Northington Gamble. She's a professor at George Washington University and historian of American medicine.

  Thank you so much for being here, Dr. Gamble.

  What is the danger in focusing too much on the distrust of Black people for the medical health care system, than rather focusing on the untrustworthiness of the system?

• Dr. Vanessa Northington Gamble:

  I think the problem is, with this focus on the distrust of African Americans, it becomes like this inherent trait of African Americans, that these distrustful Black people, as opposed to focusing on a health care system that does not have trustworthiness.

  So, what has the health care system done to engender the trust of African Americans? And by talking about trustworthiness, it puts the onus on the medical care system to change.

• Yamiche Alcindor:

  And there's been a history of the medical system not treating African Americans equally. How has that trauma been passed down by generations of African Americans in this country?

• Vanessa Northington Gamble:

  I think the trauma has been passed down by family stories and family histories.

  One of the major historical events that people talk about is the United States Public Health Service syphilis study at Tuskegee. But it's not the only history.

  And so I think families passed down the stories maybe of the syphilis study, but it might be how their grandmother was treated in the hospital, how their aunt was treated by a physician.

  The relationship of the African American community with the medical and public health communities did not begin or end with the syphilis study. There has been hundreds of years of mistreatment of African Americans within the health care system.

• Yamiche Alcindor:

  Both the COVID-19 pandemic that we're living through now, as well as the 1918 flu pandemic, they both exposed how we treat African Americans in this health care system.

  Tell me a little bit about how those two events relate.

• Vanessa Northington Gamble:

  In 1918, when the flu epidemic hit the United States, first of all, it was the nadir of race relations in the United States, as historians have said.

  This is the time of legal segregation. This is the time of the rise of the Klan. This is the time of disenfranchisement of Black people. And so in comes this epidemic in 1918. It laid bare the racial inequities in health care.

  So, African Americans could not get care in predominantly white hospitals. In Washington, they either had to go to a Black hospital, such as Freedmen's Hospital, or the Public Health Service paid to have separate hospitals, say, in a school here in Washington.

• Yamiche Alcindor:

  And what echoes do we see from the 1918 flu pandemic today, as we live through the COVID-19 pandemic?

• Vanessa Northington Gamble:

  It has laid bare inequities in terms of access to health care. It has laid bare inequities in terms of employment. Who are the first-line workers?

  It has led to inequities in terms of, like, vaccine allocation. The other thing that the 1918 influenza epidemic did, it showed how the Black community took care of itself. So, you had Black doctors and nurses and laypeople taking care of the sick.

  And you're finding that now with COVID-19, where you have Black organizations either taking care of Black people or advocating for Black people.

• Yamiche Alcindor:

  There's also this idea that Black bodies are viewed differently, that they're also treated differently by the health care system.

  Talk a bit about that and what that means when you look at present day, how people are dealing with things.

• Vanessa Northington Gamble:

  There is a long history of Black bodies being seen as different within the medical sphere, that Black bodies are inferior, that Black people are susceptible to particular disease because of their bodies.

  You see it at the end of the Civil War, where there was a high incidence of tuberculosis in Black people. The medical and public health community said, well, that's because their bodies are inferior.

  People say, well, African Americans have more COVID-19 because of their preexisting conditions. But what's causing those preexisting conditions? So people say, well, Black people have more hypertension, but there's no discussion about health care.

  Some people want to focus on, there's something about the Black body, as opposed to, where do people work, where the people live and where do people get their health care?

• Yamiche Alcindor:

  People are also being told, especially African Americans are told, trust the system, get this vaccine. There are some African Americans who feel like this is being rushed, that they don't worry about this.

  How do you think officials can thread the line between not talking down to people, but also trying to get them to trust the system that historically has not been kind to African Americans?

• Vanessa Northington Gamble:

  First of all, I tell people, don't get the vaccine if your questions have not been answered. I urge people to take it, but, at the same time, people have to feel comfortable taking it.

  You know, one of my concerns is that there has been such a focus on vaccine hesitancy, that we don't see the images as much as what happened in Philadelphia this weekend. An organization called the Black Doctors COVID-19 Consortium had a 24-hour walk-up vaccine distribution clinic.

  It was jam-packed. People sometimes for 10 hours to get the vaccine.

• Yamiche Alcindor:

  As you noted, the system that has treated African Americans unfairly at times, it was not built overnight.

  That being said, in the middle of a pandemic, what can the health care system do to better treat African Americans in this country?

• Vanessa Northington Gamble:

  One, I think that the health care system, when they think about things such as vaccine allocation, they have to go to where the people are.

  You cannot have a vaccine distributions clinic in a place where people need to take two buses to get to. The health care system also has to be more vocal to recognize that this is a longstanding issue and that racism exists in American medicine.

  But there also needs to be a discussion that this is just not about COVID-19, that we also have to talk about inequities in other parts of the American health care system.

• Yamiche Alcindor:

  Dr. Northington Gamble, thank you so much for this robust conversation about inequality in the health care system.

• Vanessa Northington Gamble:

  Thank you very much for having me.