Living in a Medical Apartheid
TSCBC Book 8 - Legacy: A Black Physician Reckons with Racism in Medicine, by Dr. Uché Blackstock
I’ve been following Dr. Blackstock on social media for a while, reading her thought-provoking posts about systemic issues in healthcare. The second I learned about her book, I knew I had to buy it.
Of course, at the time it came out I was super unemployed and stressed out so here I am a year later, finally reading her book. And what a time to read it with everything this current administration is throwing at us.
I can only imagine how the numerous cuts to federal programs are going to impact and compound the systemic issues we already have. With that said, let’s get into the book.
Welcome to The Socially Conscious Book Club. This week’s pick is Legacy: A Black Physician Reckons with Racism in Medicine, by Dr. Uché Blackstock.
In this book, Dr. Blackstock talks about her upbringing, how she and her twin sister, Oni, followed in their mother's footsteps, the original Dr. Blackstock, her time in med school, her medical career, and the things she has learned along the way.
It was from her mother that she saw what it was like to be a doctor who cared, listened to patients, and understood the need to take care of yourself so you can take care of others.
“I believe our mother practiced what is now known as structurally competent and culturally responsive care, which means that the entire complex nature of the patient's background and the social context in which they live, work, love, and pray is considered during evaluation.” Pg 2
There is a long history of mistreatment of Black bodies and it’s no different in the healthcare system [Pg. 71]. It may be even worse. So much “scientific” study was done at the cost of Black pain from purposefully injecting slaves with diseases [1], cutting slave women to study gynecology without anesthesia, keeping and profiting off our cells (Henrietta Lacks), or purposefully watching us die in the Tuskegee Syphilis experiment.
Much of this history is left out of textbooks and lectures as their benefits are taught to medical students.
Then there’s the stigmas. Saying that Black people are inferior, that we lack the necessary intellect, that we have a magical high pain tolerance, and that our complaints are just us seeking attention.
“…we know from multiple studies that clinicians have repeatedly caused harm to Black patients by dismissing their concerns and undertreating their pain.” Pg 5
Similar to how The Message by Ta-Nahisi Coates mentions white historians finding justifications to fit their preconceived notions, the same happens in this book with the Flexner Report.
Dr. Blackstock talks about how when white medical schools wouldn’t admit Black students, Black people created their own schools, but then Flexner’s report derailed that.
“He wrote that Black medical schools were "wasting small sums annually and sending out undisciplined men, whose lack of real training is covered up by the imposing MD degree." After the Flexner Report, five of the seven Black medical schools in America were forced to close down…” pg 27
Image what could’ve been if they had remained open.
Dr. Blackstock talks about how with systemic issues, you don’t just deal with one issue at a time, they compound. One issue filters into another, breaking down and slowly killing Black and Brown people at a faster rate than our counterparts. We internalize these everyday racial stressors. She calls this the weathering.
“It's hard to be healthy when you have no place to be outside in nature, when you can't access nutritious food, and when you are subject to pollution and other harmful environmental factors beyond your control. Today, studies show that your zip code is a much bigger determinant of health outcomes than your DNA.” Pg 47
The part that particularly struck me was Dr. Blackstock’s experience on the other side of practicing medicine, being the patient. In watching what her mother had gone through and her own misdiagnosis that could’ve killed her. It became more important than ever for her to be a better doctor who took the time to listen to her patients. But it also made her never want to be a patient again, something she had to grapple with when she became pregnant.
It's much easier to explain blatant acts like burning crosses and racial slurs than it is to explain unconscious bias in medical settings. Pg 89
As someone who wants children and at this point would be considered a “geriatric pregnancy” I think about the high mortality rate for pregnant Black women a lot. Already it’s so hard for our concerns to be heard.
I once gave a doctor a list of concerns I had, concerns that had piled up after years of inaccessible healthcare due to lack of coverage and money. It took a lot for me to even write these concerns down and bring them to her attention and yet my list was all but ignored.
I don’t why but sometimes the way a doctor responds makes me feel like it’s all in my head. They made me question if my issue was real just because I wasn’t feeling the pain just then. I thought “Maybe it’s not as bad as I think.” So I didn’t do a follow-up. A few months later the issue cropped up again, but by this time I no longer had insurance.
And Lack of insurance… that is a whole other issue.
“Black patients were significantly more likely than other groups to visit emergency rooms because they were more likely to be uninsured and therefore more likely to use the ER to seek primary care. “Pg 105
I’ve had health insurance off and on over the years in my adult life. I’ve probably had more years without insurance than I’ve had with it. Even with the option to have employee-funded healthcare, a lot of the time the cost was still too high even pre-tax so I often opted to go without. Saving those few extra dollars for rent and groceries.
Even when the Affordable Care Act came along, I made too much to qualify for extra deductions but not enough pay for what they said I could afford, so again I went without. Often in working in the film industry, unless you're union, you usually don’t qualify for company insurance because by the time you qualify, the gig is over and you have to start counting days again at a new place.
When I did have insurance, it would feel nearly impossible to find a place that took my insurance. Insurance websites weren’t helpful because they weren’t updated. I would call and set up an appointment at a recommended place, only to find out that they no longer take my insurance. I relied heavily on urgent care and minute clinics to get by.
Knowing everything I know about health care and the way we are treated as Black people, I had come to the conclusion that I simply couldn't get sick. It was just too dangerous for me to be anything apart from healthy. Pg 150
Dr. Blackstock talks about one particular patient, Jordan, that she sees over time that has sickle cell, a disease that causes abnormal red blood cells.
I had heard of sickle cell but didn’t know much about it. It wasn’t until I saw the TV show Supacell that it really came to my attention. I didn’t know that this was a disease that disproportionally affected Black people and because of systemic racism in medicine, it is underfunded and lacking in research. Without research, it creates a lack of understanding of the pain sickle cell patients go through and therefore a lack of empathy from doctors.
Dr. Blackstock talks about the disparity in treatment Jordan receives from senior residents, assuming he was just seeking drugs instead of help. His death was one of many moments that radicalized her.
“Would we be making the same assumption if it were a disease that affected a predominantly white population? Most likely not.” pg 115
I read a great article the other day from another Substack author about the weight that Black women carry, the demands laid on us to be the best, and constant the demand for us to fix problems we didn’t create.
I think about this article when I read of Dr. Blackstock’s struggles, the weight of working in an underfunded BIPOC-heavy hospital, often being the only one who looks like her in the room, being questioned by white patients on her schooling, and often being the only one who sees the disparity around her.
This was twenty-first-century New York City. No one hung signs over the doors of Tisch and Bellevue saying COLOREDS and WHITES, but even so, these white patients sensed that somehow I must have walked in through the wrong door.
Pg 142
The “pet to threat” phenomenon she mentions, which was coined by Dr. Kecia Thomas, is all too familiar to me. Black women in predominately white spaces are first considered a “pet”. But the second they gain too much confidence or start speaking out they are turned into a “threat”. Which is what eventually forced Dr. Blackstock out of NYU.
It is a constant struggle against racism and systemic issues to get any sort of progress to move forward. It often feels that we take one step forward only to move two steps back. As Dr. Blackstock mentions at the end of her book when she talks about solutions towards a better future, “racism is not the problem of Black people to solve.” pg 263.
But so often white people hold back change out of fear of what they are going to lose that they can’t even fathom what they could gain.
A better path forward is on a path together.
Happy reading.
What were some of the social issues highlighted in the book?
Whew… how much time we got?
Healthcare: the constant disparity in treatment and access to care. The racist history of Black bodies being used for science and research. The apartheid-like state of public vs private healthcare.
Race: stereotypes that impede quality care and accurate diagnosis. DEI initiatives that breakdown and put more stress on those directly affected with little change by the administration.
Inequality: redlining and zip codes. Where you live factors into the length and health of your life. Black and Brown cities often have food deserts, less green spaces, and more pollution.
Further Reading:
Never forget that early vaccines came from testing on enslaved people
Structural Racism In Historical And Modern US Health Care Policy
Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington
When Covid hit Black Americans hard, too many white Americans shrugged by Dr. Uché Blackstock, M.D