Thread by @Lachelle_Dawn

I try to be thoughtful about what I write/say because words matter. I don’t always get it right, but this is a hill I am willing to die on.

*clears throat*

🗣 We don’t need to fix Black people’s mistrust. We need to fix medicine’s lack of trustworthiness.
#COVID19 #CovidVaccine

It isn’t enough to “remember Tuskegee.” The Tuskegee Syphilis Study ran from 1932- 1972. There’s segregation and disregard for humanity happening in the here and now.

40+ years after Tuskegee ended & 50+ years after “whites only” signs came down and hospitals are still segregated spaces! There are hospitals where it is rare to find a Black patient or provider.

The Black people who live across the street from these institutions know this segregation exists because they either choose to go elsewhere or are compelled to because of access issues. The providers working within are also aware that they work in a predominantly white space.

Many have heard rumors rooted in a modicum of truth about certain fancy pants hospitals stabilizing patients of certain demographics (poor, Black, undomiciled) in the ED and sending them to the county hospital for care. These aren’t tales of yore - they are tales of last night.

De-segregation isn’t a puzzle - it involves changing insurance practices, community engagement & providing resources that meet the needs of the population-like interpreters/advocates-so people feel welcome/cared for. We don’t lack the means or know-how for this, we lack the will.

Right now, Black Americans have the highest death rate for most cancers.

And Black women announce pregnancy & take their congratulations w/ a barrage of warnings to be vigilant-b/c if Serena & Beyoncé could’ve died from birthing complications surely none of us are safe.

Patients with sickle cell anemia, a disease that characterized by bone pain, have pain plans ignored & face stigma for requesting opiates. Clinicians roll their eyes at them. When calm, they’re told they are lying about how bad they hurt. When hysterical they’re called difficult.

And while Black pain is under-treated, cancer diagnoses are delayed and access to premier institutions is de facto limited by practices that enforce racial segregation - you know what is done for Black folks at higher rates? Amputations and castrations.

Then, for an evidence-based field, medicine has a hard time letting go of race-biology. We’re just starting to get around to accepting that it’s bonkers to universally correct GFR for race -a harmful miscalculation rooted in the brand of scientific racism that gave us phrenology

So yea - Tuskegee, Guatemala, Henrietta Lacks - Our memories are long. But we also hold the present sterilization of women in ICE facilities, and the Black woman who’s chest pain was just ignored in the ED

& the patient who has “non-compliant” written in the chart because they don’t take the ticagrelor that no one bothered to check if they could afford it.

What are we doing about the inequities / social determinants that compounded to yield covid19 mortality?

Black folks aren’t dying from #Covid-19 because we lack vaccines but b/c racism renders our communities overburdened with comorbidities and strapped to jobs & housing situations that prohibit people from being able to follow distancing guidelines/work from home.

So while we’re thinking about how to get a covid vax into Black folk. Black folk are thinking, why do these people who haven’t shown they care about my health before suddenly care about me & my community?

https://twitter.com/Lachelle_Dawn/status/1334411103389052928

So persuasion can’t be the goal. If someone doesn’t trust you & you walk in trying to persuade them to do something rather than to build & mend relationship, all you do is widen your trust gap.

This is how humans work. And in case it needs to be said: Black people are humans.

Persuading is also based in a racist assumption -namely that you need special tactics to convince Black people to save our lives.

You don’t.

Black people want to live.

If we trust that you have a safe way to ensure that we’ll live through the pandemic, we’ll take it.

Healthcare institutions need to work towards becoming trustworthy & actually showing care for & interest in Black communities. Don’t just swoop in to save the day during this catastrophe but also work prevent the next catastrophe by improving overall health & living situations

Back in July while musing about diversity in vaccine participation I wrote:

“If our desire to restore Black patients faith in medical professionals and institutions is sincere, we must target the racism that has long rotted our healthcare system.”

medium.com/@lachelle.week…

To summarize:
It’s not Tuskegee. It’s the racism.

It’s not distrusting patients. It’s the racism.

It’s not lack of health literacy or hedonism or antivaxxer tendencies. It’s the racism.

We must address the racism!