HV Triad 3: --

Inequity in Care- and how unconscious bias can influence patient outcomes

Years ago I did a home visit for a middle school student who cared for her grandmother. When I arrived, she was also caring for her cousin who was 2 years old. Her cousin was missing his hands and feet. At some point, the mother arrived and shared the story of how her son lost his limbs. She shared he was sick, and she went to several er’s and was turned away and accused of abusing her son as his limbs were black and blue. Eventually her son was received at a hospital, and was eventually diagnosed treated for an infection, eventually resulting in the loss of limbs. I always wondered if this mother was taken seriously at the 1st hospital, and her son received the appropriate treatment in a timely manor, would he still have his hands and feet. This experience demonstrated to me people may have a difference experience when seeking medical care based on unconscious biases people have.

Surprised by the Black Student Union

When I was in college, a friend and I were the co-organizers for a celebration to welcome our new college President. Me, my friend and the incoming President were White, and most of the coordinating committee were also White. The prior President was Black, and there was disappointment among some students that the new President was also not Black and hadn’t been overly supportive of racial and equity issues.. I thought I was relatively close to friends in the Black Student Union (BSU), as I had marched with them against Apartheid and other issues. But, on the day of the celebration, at the beginning of the event, about 20 BSU members entered the room with picket signs and loudly noted their disappointment with the new President. I was shocked and appalled, and felt betrayed by my “friends.” Years later, i came to understand that I had the advantage to host this celebration, and did not consider the needs of Black and other students. This event gave the BSU a space to have themselves heard, and they made the news the next day- not the positive story I had anticipated.

Stolen Dreams and Opportunities

When I was in college I wanted to study abroad. I completed my application and submitted all of the necessary papers. However, my advisor did not support my interest and he actually did not provide any information for me to review. My advisor told me that was not a good fit for me and that it was too much for me to handle with my course work. I had to do my own research for opportunities such as exchange student and scholarships. I did not know the process or where to begin, it was really discouraging at 18 years old. My roommate had the same advisor and not only did he encourage her, she was provided informational packets and then shared her excitement with me. Well, guess who announced that she was selected to study abroad the following semester with all expenses paid. My college roommate! The information that she received was not available for everyone and it was totally unfair. Inequity on so many levels. I had a higher GPA than she did, I expressed my interest and she did not but, was chosen! Information was not shared with everyone and the selection was bias! Application process was never shared!

Childhood dreams

While at a conference, that was primarily attended by while colleagues, I was often in spaces where I was the only black person. on one occasion the conversation drifted to childhood and upbringing and even how the majority of my white colleagues raised their children. It amazes me how much they had access to. how much more of the world they were exposed to and how race wasn’t a constant conversation in their home. It makes me jealous and joyful at the same time. but that access/equity will never sit well with me

Organizations Prescribing Solutions

I have sat on a few county wide conversations, some of them are focused on equity specifically and the idea of community led processes, but by no means is truly that. What has been really frustrating is to hear people prescribe solutions to the community. For example, the Barbershop talks are becoming a best practice, and organizations/system leaders want to force their messaging onto communities through this venue, rather than working with them to co-design what the barbershop would want. Additionally, yoga is promoted as such a huge mental health benefit to our community, everyone is talking about the benefits of it, but does our community feel comfortable in the current yoga spaces? Are they prescribing this solution without asking if the community wants it.

Lessons from the classroom

I would like to share an example that involves children to note that inequity often begins early on.

Many families in our own communities struggle everyday with virtual school, because they lack access to reliable internet connections, computer equipment, technical skills, adequate space or privacy in the home or simply having someone available to guide them through it. Other families do not have these limitations, and therefore their children are more likely to succeed. In some instances, children who are struggling may unfairly be labeled as difficult, disinterested or lazy. The playing field is simply not level.

At such a young age, these children are already experiencing the harsh reality of inequity.

WANTED: New Thinking and Leaders Willing to Lead

The storming of the Capitol Building is a story of the deep inequities, of racism and white supremacy. For some, this is blatant and obvious. For others, there is no comprehension of these connections. Is it based on the eye of the beholder? A group of white professionals were talking about being done with perfunctory diversity trainings and workshops. They were saying we (the US) need something stronger. Not driven by HR departments or 2-hours mandated in a school district setting. The entire framing of our systems needs to change in order to make real progress. I agree. Until people are pushed out of their comfort zones personally and accept a degree of personal reflection on these matters, our work will be surface level and meaningful, community and societal level change, won’t be realized.

No Cocktails For You

My son’s father passed away due to complications from COVID….he was exposed (on his job at the water utilities department) while working in very close quarters with a contractor who had tested positive for the disease. There is no hospital in the rural county where he lives, but he was transported by ambulance to the closest facility about 30 minutes away with obvious signs of apoxia, O2 levels well below the 94% that most acknowledge as a threshold for concern. He spent about 6 hours in the ER before he was moved into a room…on a regular floor (where the nurse to patient ratio is much lower). He was ultimately moved to ICU, intubated, and…there is actually no “and,” there’s a “BUT.” But, he died.

My son’s dad fought, my son fought for him….finally getting eyes on his case after a personal friend of his called the CEO of one of the largest health systems in the country. That gentleman reached out to the CEO of the hospital where his dad was a patient. Several specialists were consulted. All of this after 8p on August 25th. They all said they wish they’d consulted on the case sooner…it was too late. We know that because he passed away the next morning on August 26th.

Inequity treating addictions

In trying to combat the opioid epidemic in 2017, I was confronted by a black friend who expressed his anger at the way the healthcare system, legal system, and local governments were now rallying to this cause, which he attributed to the impact on the white community. He was right. This was and is a glaring example of inequity. I considered all the partners involved in the effort to combat the epidemic, and I realized that almost none were black or Latino. Our previous attempts to combat substance use disorders and addictions had been largely punitive and enforced along racial lines. These biases and practices continue today in how we treat addiction and its community effects.