Written by Linda J. McKibben, MD, DrPH, FAAP, FACPM
June 28, 2017
I imagine the relatively easy part for most doctors of my generation of baby-boomers is to accept racism as real and persistent. We were never exactly encouraged to share our personal experiences with racism in medical school. My class of 180 students at the Medical College of Georgia had about 30% women and enough African-Americans to count on one, maybe two hands. The metaphor for avoiding the topic was my naïve but sincere intake of breath upon catching a glint of the glowing but painted-over words on a hospital door room in Augusta, Georgia, “Colored Only.” By definition, I am a life-long learner relative to how racism against people of color works. I confess to being a feminist European-American with fair, freckled skin and two adult children who report (or rather, were disappointed to report) that their genomic ancestry is as European as is possible. They were born and raised in Boston where I trained, while our extended families live in Georgia, Texas, or North Carolina.
To gain perspective on this sensitive topic, I read Dr. Damon Tweedy’s book “Black Man in a White Coat.” An African American woman physician, who acted as a critical reader of this blog, recommended Dr. Tweedy’s book. She knows Dr. Tweedy and also trained at Emory, which is where they both experienced some of the worst racism from patients. She mentioned that white female medical students were often confused as nurses, while black female medical students were confused more commonly as social workers when seeing patients on the hospital wards. None of us, neither Dr. Tweedy, my friend, nor I, were trained in medical school to cope with racism or sexism. The excuse? There was simply no room in the medical education system at that time, which largely served the underinsured or uninsured, to give into the whims of patients’ demands for specific colors or sexes of doctors. So the “system” was “take it or leave it”. We doctors who may have felt oppressed or insulted were expected to serve all patients without judgment, even if we preferred to avoid the stress or pain. Dr. Tweedy highlighted a case in which both the patient and family ended up being grateful and apologetic when the N-word-doctor saved his life.
Dr. Tweedy describes specific ways in which he personally experienced not-so-subtle antagonism from other doctors, who assumed he was “there to fix the lights.” As a Duke-trained psychiatrist, he articulates the impact on himself extremely well. I was particularly impressed by his ability to consistently relate the emotional hurt of racist behavior to physical pain, unhealthy behaviors, and chronic, stress-related disease, such as hypertension or depression. To Dr. Tweedy, the statistics on racial health disparities became almost unbearable to hear, over and over and over again, as he did as a medical student.
My “ah, hah!” moment occurred in May at a women’s empowerment conference in D.C. during a panel about the current challenges for immigrant communities, including real incidents of public, verbal aggression against young women wearing hajib, or headscarves. A woman next to me seemed uncomfortable but asked how she could help, “other than by watching what I say or how I speak.” She directed her question to a young Muslim “Dreamer” who had talked about how she would give back to the community as a nurse. She was born in the U.S. to undocumented immigrant parents. We laughed together in appreciation for the young woman’s spontaneous and cheerful response to the tentative questioner, “It’s ok to say, ‘I’m white and I need help!’” This immigrant had brilliantly welcomed us to join the uncomfortable but critical conversation: how can we as Americans overcome our internalized racism?
The first time I remember talking about racism with anyone was during childhood in the late 1960’s. I was a 4th grader living in Jefferson City, Missouri. A black family with two teens moved next door to us in a formerly all white, middle class neighborhood. I was fairly oblivious to any differences until my Mom and Dad explained that some of our neighbors did not want a black family in our neighborhood. My Mom was completing her college degree in elementary school education. My father was a civil engineer and federal employee. My parents taught me in words and actions that hating is wrong. My parents were openly friendly, socialized with the new family, and asked the teenage daughter to be our babysitter. I admired this young woman who was college-bound. I felt safe enough to ask her if anyone had ever called her the N-word. She was visibly sad and patiently explained that such an incident happened once, when some children were told by their mother to say that terrible word to hurt her. That shocked and enraged me. For the first time I felt deeply the sadness of racism from another’s point of view, as if “seeing” an injured person whose wounds were previously invisible. I realized my parents were role models, standing up for what is right and unpopular. Raised in the South, they valued education and progressive ideas. In fact, we left Missouri to return to Austin, Texas where my father earned an MBA at the University of Texas, where my parents previously met as college students.
After my father graduated, my family was transferred to Jackson, Mississippi just two weeks after the public schools were desegregated by court order. My parents chose to keep us in public schools, which was difficult for them as each of us four children—I was the eldest—were assigned to different schools somehow. I was a racial minority in a formerly all black high school that now housed only eighth graders. I noticed the poorer quality of the facilities, the schoolbooks, and athletic equipment, compared to my previous mostly white school in Austin, Texas. I heard the stories of “white flight” to new white-only private schools, which were set up without much planning. At Powell Junior High (1970-71), I met many African-American kids who were good students and very friendly. I liked my African-American teachers. One girl objected to me being there, which made me feel bullied—but she didn’t use racial slurs. Some kids liked to touch my waist-length, straight hair, which I didn’t mind. While the school I attended was predominantly black, I felt oddly segregated from my classmates because I lived in a white neighborhood. Dad sometimes talked about how angry the local white people were about desegregation. His stories made an impression on me as a kid. Inconceivably to me, white people who refused to accept the legality of desegregation filled in a public swimming pool with concrete rather than integrate it! I think of that ruined swimming pool as a metaphor for the adverse effects of systemic racism on our healthcare system. Consider the debate we’re having about whether to take away healthcare from millions—targeting the most vulnerable citizens, such as women and children, rather than declaring that healthcare is a human right across America, regardless of local economic conditions.
We had some good times in Mississippi—my surprise 13th birthday party, for example. But because of the mostly unremitting oppressive atmosphere, we were relieved when my father was transferred a year and a half later so we could attend DeKalb County schools in Atlanta, Georgia. Interestingly, I recently met a woman born and raised and currently living in Mississippi who detests the persistence of racist attitudes there. “Really, y’all?” she quipped.
In 1978, I graduated from the University of Georgia and entered the Medical College of Georgia (MCG). One summer, I worked as a community organizer for the Georgia Student Health Association (GSHA), a student-run group of dental, nursing and medical students from MCG and Emory University. With support from the state public health department and academic centers, we set up free health screening clinics in rural communities for a few weeks each summer. I felt it important to persuade the community and students that local families should house us regardless of race. As a result, African Americans hosted some of us. My hostess once commented after reading a local newspaper article about the GSHA Health Fair I had written. She complained about seeing her name as the only one without a title, such as Ms., Miss, Mrs. or Dr. I owned up to being the one who made that disrespectful mistake and apologized. Another lesson learned, made possible by trusting in and choosing diversity!
After that, the lessons about internalized racism were more nuanced and ambiguous; which is probably a sign of progress. While a pediatric resident at Boston City Hospital, an African-American intern whom I supervised perceived me as racist towards her. Fortunately, she confided in the Chief Resident, for whom I had enormous respect, who talked to me about it. Both were African-Americans. The Chief Resident reassured me he did not perceive me to be racist. Nevertheless, I was confused and a bit scared. Exploring the situation with him, I offered that I had thought perhaps she (the pediatric intern) might have been suffering from depression; often her energy and mood had seemed “low.” He thought about that and seemed satisfied. For all purposes, the issue ended and was not further escalated. Regretfully, I’m left wondering if she was right. For example, did I distance myself inappropriately from her, maybe fearing being perceived as racist toward her? Today, I would like to understand better what hurtful words or actions had led to her complaints. Importantly for my own benefit, the incident heightened my awareness of the possibility of subtle racism against people of color in professional settings, where differences in power and authority add yet another layer of complexity.
By participating in community affairs, many of us doctors may gain new insights into why racism persists across party lines and how this undermines the healthcare system. That epiphany occurred while I accompanied experienced canvassers from Virginia, knocking on doors to encourage registered Democrats to vote. At one home, we discussed a Latina candidate running for a state delegate office. To our surprise, the voter interpreted the politician’s website as accusing Virginians of being racists! She was passionate. “We’re not racists. We adopted a son from southeast Asia!” She added, “My daughter was upset because another child at her school was crying for fear of losing a grandparent to deportation.” The mother had told her concerned daughter (who might have feared such a fate for her adopted brother) that deportation is an expected consequence of disobeying the laws on immigration. We did our best to assure her the candidate’s position was not represented by such sentiments. As we departed, I worried about her children, all our children. Are we (white Americans) teaching that it’s ok to subvert the civil-rights of people of color (e.g., pouring concrete into a public pool to undermine legal desegregation), while it is unforgivable for people of color to seek jobs or healthcare or education for families when legal immigration is out of reach or unaffordable—perhaps in part due to racism? I recall a white British woman at the women’s empowerment conference protesting the poor treatment of immigrants of color. “No one ever complained about my accent when I was an immigrant for many years. This is plainly about skin color and religion!” These perspectives from the community may help inform doctors who want to heal both sick patients and bad health care policies.
The Southern Poverty Law Center (SPLC) has documented an explosive rise in the number of hate groups since the turn of the century, driven in part by anger over Latino immigration and demographic projections showing that whites will no longer hold majority status in the country by around 2040. As shown on the graph below, the rise accelerated in 2009, the year President Obama took office, but declined after that, in part because large numbers of extremists were moving to the web and away from on-the-ground activities. In the last two years, in part due to a presidential campaign that flirted heavily with extremist ideas, the hate group count has risen again.”
Keeping our eyes and ears open, we doctors may see that American history is neither white nor black, as described by Dr. Michael Eric Dyson, a professor at Georgetown University. His book, “Tears We Cannot Stop: a Sermon to White America,” is full of interesting information and new ideas. Artists continue to create fascinating movies about historical American-style racism, including: “The Lovings,” about an interracial and “illegal” marriage in Virginia; “I Am Not Your Negro,” about the articulate and passionate author, James Baldwin; and of course, “Hidden Figures,” about NASA and the brilliance of African-American women scientists.
I am so grateful to my parents, who to this day demonstrate respect for civic engagement, journalism and government. My parents were street-level bureaucrats or public servants, not activists per se. Of course, the open and massive demonstrations of violence against civil rights activists scared average people away. They and I were mortally embarrassed once after I “walked out” in protest after my high school soccer team got into trouble for pouring champagne at a celebration; I was nearly suspended myself. After that, I kept my head down until I met a key mentor, a Jimmy Carter appointee and physician in the Georgia Department of Public Health, the late Dr. James Alley, who introduced me to the Georgia Student Health Association and the possibilities for a career in public health and preventive medicine.
Although we may not talk about it enough, many of us Southerners (all Americans) are benefitting from childhood exposure to progress brought about by laws enacted during the era of Civil Rights. Even so, I sometimes wish for a wearable device or app that could accurately track internalized racism and send me timely and helpful alerts. For now, I choose to internalize this: “I’m white and I need help!” Many more of us doctors should follow Dr. Tweedy’s example and openly examine our innate biases and the way upbringing and social context may have helped or hurt our professional development; or indeed, the way our country makes health policy. The right time to talk about internalized racism is now, while we decide whether essential healthcare is a woman’s right and a human right in America, regardless of local economic conditions! Really, y’all?
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