E7: Medical Misogynoir Pt. 2

Marlene Harris-Taylor:

In January of 2020, Bloomberg CityLab published an article about a new study from Pittsburgh researchers, naming the best and worst cities for black women. Among cities with at least 100,000 black women, Cleveland came in dead last in terms of livability. In this city with a nearly 50% black population, this news drops like a bomb, and reactions were mixed.

[Music Playing]

Do you think Cleveland is really the worst for black women? And what do you say?

Female:

“I say …

Female:

“It depends on the person they ask.”

Female:

“When I dropped it in one of my black girl group chats, the emojis were just eye rolls.”

Female:

“I'm not surprised. Not even a little.”

“Female:

“It’s heartbreaking and also embarrassing.”

Female:

“Is it like this everywhere? Is it me?”

Female:

“This city will make or break you.”

Female:

“City of black women that are looking around at their outcomes, their future, their past, and saying, this city makes me anxious.”

Female:

“If anybody's out there listening in Cleveland, please get out.”

Marlene Harris-Taylor:

On Living For We, we talk to Cleveland's black women from all walks of life, from the CEO of one of our major healthcare systems to self-starting entrepreneurs, judges, lawyers, doctors, artists, students, and mothers who've experienced loss.

We share stories from these women as change makers and architects of their own futures celebrating their victories, challenges, and personal growth along the way.

So, is it really true what they say? Is Cleveland deserving of the least livable title? And what can we do to make lasting improvements for black women in our city?

I'm Marlene Harris-Taylor, and this is Living For We, a project of Connecting the Dots between Race and Health, from Ideastream Public Media.

Cleveland is a healthcare Mecca, or at least that's what people say. With world renowned hospitals, there should be an abundance of quality care right here. But are you surprised to hear it doesn't always work out that way for black women in this city?

As we heard in episode six, part one of Medical Misogynoir, some nasty stuff has gone down for black women in hospitals and doctors' offices. One guest in that episode, Dameyonna Willis, shared how her beautiful spunky eight-year-old daughter was very sick when she was just five-months-old. And doctor after doctor ignored Dameyonna when she told them the asthma treatments weren't working.

Dameyonna Willis:

“Six different doctors told me it was asthma. I would go and they would send me home and then I would come back the same day because I'm like, something is wrong with this baby. Like she's panting. You can see her chest moving up and down.

And so, I'll come back, and they'll probably be like, she's back. And they will ask me, are you using the things we're giving you? Are you doing the steps that we're telling you to take? And I'm like, I am. Something is wrong with my baby.”

Marlene Harris-Taylor:

We talked about how if her daughter Kylie had not finally gotten the correct care, she could have been another tragic loss, adding to Cleveland's dismal infant mortality rate. It's a perplexing problem.

This episode we hear from two black women doctors who were born and raised in the city. Dr. Carla Harwell is now Medical Director of University Hospitals’ Otis Moss Jr Health Center, in the Fairfax neighborhood. But she grew up just a few miles away in the Union Kinsman area.

Carla Harwell:

I'm celebrating 25 years this year at UH Otis Moss Jr Health Center.

Marlene Harris-Taylor:

Dr. Harwell has been taking care of black women for years. So, I asked her why so many black and brown babies are not making it to their first birthday.

Carla Harwell:

A lot of times when I'm traveling around the country, I get that question a lot. How in the world can Cleveland have the highest infant mortality rate or one of the highest in the country? I just shake my head and kind of bow my head down and say, “I don't know. We don't know.”

Marlene Harris-Taylor:

Many researchers are starting to say it's just racism. It's the stress, the added layer-

Carla Harwell:

Mm-Hmm (affirmative).

Marlene Harris-Taylor:

Of stress.

Carla Harwell:

Yeah, I would agree with that. I mean, the systemic racism, I think that exists still in this country is going to always be to me that sort of overlying cloud until we can break that up.

Marlene Harris-Taylor:

Dr. Harwell is one of a small number of black doctors in town, and so is Dr. Linda Bradley, an Ob/Gyn at Cleveland Clinic. She grew up in the Hough neighborhood.

Linda Bradley:

I grew up around Cleveland Clinic and went to elementary school until first grade. And at the time there was overcrowding and I could only go to school half a day, kindergarten and first grade. So, for a better education, moved to the Lee-Harvard community and it's there that I grew up for junior high, remaining of elementary junior high and graduated high school from John F. Kennedy High School.

Marlene Harris-Taylor:

Dr. Bradley made history. She was the first black woman doctor hired by the Cleveland Clinic in 1991. That's right, in 1991. Where were you in 1991? It really wasn't that long ago. And some of you listening were probably still in diapers. And Dr. Bradley shared with me that she had to interview over 30 times before she got the job.

Linda Bradley:

I'm the first black woman on the entire staff at the clinic when I started. And there are more now. I'm the first.

Marlene Harris-Taylor:

Wow.

Linda Bradley:

And I always said I didn't want to be the last.

Marlene Harris-Taylor:

Dr. Bradley is passionate about caring for black women and she's been delivering babies for a long time. So, I wanted her thoughts on why the medical system here seems stacked against black women and why Cleveland's black infant death rate is so high.

Linda Bradley:

I wish I could just have a magic wand and say, “We do this, we waive this, it's going to go away.” We don't know.

And one of the best studies that was just done within the last two years was with families that were in the armed forces, black, white, everybody gets the same care and the same thing. They saw worse outcomes.

Marlene Harris-Taylor:

All things being equal on that base.

Linda Bradley:

That’s right. Because that's-

Marlene Harris-Taylor:

Black women still had lost more babies.

Linda Bradley:

It's not just the babies, but the other significant morbidities with being pregnant and delivery.

Marlene Harris-Taylor:

Some people have told me that they believe that hidden factor is racism.

Linda Bradley:

But that goes along with everything we've been talking about, this whole issue of social determinants, those are systemic issues that lead to lots of stressors.

And then again, we do know that stress, whatever, however we define stress, causes potential changes in our sort of, people often use the word epigenetics. When things have happened from generations ago and what's carried on.

Marlene Harris-Taylor:

Do you believe that?

Linda Bradley:

I do, because I think certain things are subtly passed on. It may not be spoken, but medicine is education, it’s banking, it’s finance, it’s jobs, it’s policing. I mean, everything from A to Z.

[Music Playing]

Marlene Harris-Taylor:

All of those things that Dr. Bradley just listed are often called the social determinants of health. It's a phrase that people like to use to describe how systemic racism creates barriers that keep people sick, especially black people.

For example, if you live in an old rental property and your child is eating lead paint chips off the carpet, your baby might get sick. But if you can't get a good job because quality education is out of reach, you might not be able to afford a car to take your child to the doctor, let alone afford any prescriptions your child may need.

But of course, there's no one size fits all example of how discrimination leads directly to lesser health outcomes. So, people in health and academia often fall back on this term, social determinants to neatly wrap it all up. It works as kind of a shorthand, but is it too nice? Maybe we need another phrase that's more raw and real.

One person who doesn't have a problem being real about what's happening in Cleveland and why our infant mortality rate is one of the highest in the country is Jazmin Long, the CEO of Birthing Beautiful Communities.

As we heard in the last episode, this group is doing incredible work. The doulas help and advocate for black moms before, during, and after the birth of their babies.

And that's the number one question that people ask when they hear these terrible numbers of black babies dying in Cleveland. The first question is, why?

Jazmin Long:

Toxic stress and medical racism. Regardless of a woman's socioeconomic status, infant mortality is more likely to impact African American mothers. And we see this with people such as Serena Williams, who is a high power, high figure woman who was advocating for herself and still was not being heard by healthcare professionals.

And it's because when we go into some of these systems, we're not treated with respect. You might not outwardly express your anger, but inside that's going to make you very upset. And so, those are the kind of toxic stressors that lead to just women internalizing those feelings and moving forward and not necessarily having a safe space to process.

Marlene Harris-Taylor:

Birthing Beautiful doulas are getting the job done for black mothers in Cleveland, despite the fact that they aren't necessarily being financially supported the way they need to be.

So, you are proving, or have proved really to this point that it works.

Jazmin Long:

I really think that every birthing person who wants a doula should be able to receive a doula. I think there needs to be more money put behind doula services as we know that this is something that makes a really huge and critical impact. We're seeing the positive outcomes.

Marlene Harris-Taylor:

So, what’s the problem? Why isn't there the money?

Jazmin Long:

Here's what I will say. When I started this organization in December 2018, we had about a $1.1 million operating budget. We are on the precipice of a $5 million operating budget and we're also building a birthing center, but we'll be the only free-standing birth center in the state of Ohio. Slowly but surely, people are coming along and recognizing that we are the solution.

So, for the very first time ever, we actually are in contract with Cleveland Clinic to refer patients to us. We're in contract with CareSource to refer clients to us. We're in the process of doing the same thing with MetroHealth and we hope to bring UH along with them as well.

So, for the first time we're getting the hospitals to not only buy in with sending clients to us, but also to pay for the services as well.

Marlene Harris-Taylor:

Why have they been so slow?

Jazmin Long:

I think to your point, one, I don't think people really believe we were going to be able to pull off what we pull off. I don't think folks thought our outcomes would just continue to be as incredible as they are.

“Oh, you guys do your little 50 women pilot. That's cute.” Now when we can show that we're serving hundreds of women, we've served thousands and our outcomes remain the same, you can't look past that.

And then when you have somebody like me who is willing to say the hard things, have the hard conversations and push, I think that's what's starting to move the needle. And again, I just think-

Marlene Harris-Taylor:

Tell me a little bit about that. You don't have to name names, but what are the kind of things you have to say to (and I'm not picking on any particular person), the powerful and the power structure. What are the kind of things you have to say to them in these closed-door meetings?

Jazmin Long:

The kind of conversation I'm having in these closed-door meetings is that you want Birthing Beautiful Communities and our doulas to save every black woman in this community. But you think it's appropriate to give us a $50,000 donation. You think that's enough money to actually help us move the needle forward. We know that advocacy has to be involved in this. So, how am I going to pay a lobbyist if you think that's appropriate? Those are the kind of conversations.

You're calling us when clients are high strung. If there's a patient that they can't deal with, you're calling us so that we can step in and be a buffer. But you don't want to pay for those services?

Marlene Harris-Taylor:

Here's the good news, the new birthing center could be a real game changer for black moms and babies. After all, Cleveland's infant mortality rate was one of the factors in the Pittsburgh study that landed Cleveland at the bottom of the list for black women.

As born and bred Clevelanders, both doctors Harwell and Bradley had strong reactions to the study and the ranking.

Linda Bradley:

Sadness, disappointment, anger. There are just certain things about race that's very hard to put your finger on. Sometimes it's what people say, how they look at you, how they talk to you, how they ignore you.

Marlene Harris-Taylor:

Did it resonate with you as a black woman who's from here and who's lived here?

Linda Bradley:

Absolutely. It resonated for me. We are the product of parents and grandparents and aunties and cousins and each of us has our own story. I think now this awareness, it's just bringing and allowing us to open Pandora's box. Let's look at this differently.

So, for instance, we have a once a month or twice a month, a conference called M&M Rounds, morbidity and mortality.

I got on about five minutes late, it was a Zoom call, we started seven. And I'm listening to the story of whatever happened to this patient. And at the end of the story that's told I just said, “Is this patient black?” And then I said, “What is her insurance? Where does she live?” And it turns out she was an African American patient.

The other thing is somebody will speak with me and says, “Well, she can't tell her story. She doesn't know her history.” As physicians, our job is to listen and to detangle the message. We have to help them make little building blocks.

And the other thing, we interrupt patients, we give them 6 seconds to 11 seconds to talk to us. If you let the patient talk to you and stop interrupting them, they will tell you the story. And then do what we call the ask back. Did I hear you correctly? Is this what you meant? Are there any questions that you still had that I didn't answer? Do you need something explained differently? Should we make a follow up?

And now it's beautiful. And now everybody has it, but we have virtual visits, we have My Chat.

Marlene Harris-Taylor:

Is that helping?

Linda Bradley:

Yeah.

Marlene Harris-Taylor:

With health disparities having the different ways to see patients?

Linda Bradley:

It can and it can't, because not everybody has the phones that you can do a virtual visit. I'm not cynical, but I'm saying let's be in contact with our patients. And I say, well, what's wrong with the telephone call instead of a televisit? My mother is 92, yesterday, she's an educated woman, but at 92 does not use cell phone. Why can't her doctor just telephone her?

Marlene Harris-Taylor:

Is the answer tied to insurance?

Linda Bradley:

Yes. Because you get paid more for televisits versus telephone.

Marlene Harris-Taylor:

Dr. Bradley's talking about the business of healthcare. Even though Cleveland's hospitals are technically non-profit, they still make some decisions based on the bottom line.

We all remember a time when doctors ran offices independently like mom-and-pop stores. Well, that time has passed, and the vast majority now work for large hospital systems with doctors now having to deal with insurance companies telling them what they can and cannot do for their patients.

So, now we turn to our other physician, Dr. Harwell, who says she was surprised to learn that Cleveland was named the worst place for black women.

Carla Harwell:

I was surprised that we were ranked so low. We are a city with three major hospital systems. We have University Hospitals, we have the Cleveland Clinic, we have Metro Health, and then all of the satellite offices that spring from those places.

And unfortunately, when black women walk into a healthcare provider's office, they're not walking in there with dollar signs across their forehead. They don't know, oh, that this person has a PhD, or this person is the CEO of this financial institution.

They're a black female walking in a door and are still faced with all of those roadblocks that could be placed in front of them. Whether they're unconscious biases that they're being met with or unfortunately in a lot of instances, conscious bias.

In defense, you got to listen to that word, unconscious biases. I mean, unfortunately a lot of these healthcare providers, I kind of believe don't really know that this is what they're doing.

Marlene Harris-Taylor:

I believe that.

Carla Harwell:

But there's a whole bunch of other ones out there that I think know exactly what they're doing. I think what those particular individuals are doing is stereotyping.

And so, here's a perfect example. This is a true story. I have a young African American male who has had to go on hemodialysis. And for those who don't know what that is, that's that the kidneys have stopped functioning for whatever reason. And he has to go three times a week, gets stuck with two needles hooked up to a machine that draws his blood out, goes into a machine, cleans his blood, and then is returned back into his body.

So, he has to be on this machine for three and a half hours, three days a week, for the rest of his life. He's 32.

Marlene Harris-Taylor:

Wow.

Carla Harwell:

For the rest of his life, unless he gets a kidney, which requires getting on the transplant list. I said, “So, how are things going with you on the transplant list?” He said, “What do you mean the transplant list?” I said, “You're not on the transplant list?” He said, “No one's ever talked to me about being on the transplant list.”

Marlene Harris-Taylor:

Wow.

Carla Harwell:

And so, I was like, “Hmm, now is there some other reasons why he's not a candidate?” So, he has a criminal past. He has been in and out of jail.

Marlene Harris-Taylor:

Okay.

Carla Harwell:

And so, maybe (it's just me saying this), being offered the opportunity to get on the transplant list, maybe you're not the best candidate for that based on your social history.

Marlene Harris-Taylor:

So, you say that's some of the thinking that perhaps-

Carla Harwell:

Perhaps.

Marlene Harris-Taylor:

Perhaps.

Carla Harwell:

I don’t know.

Marlene Harris-Taylor:

You don’t know for sure.

Carla Harwell:

I don’t know.

Marlene Harris-Taylor:

But perhaps it's like … well, what you're saying is a judgment is made that you're not a good person.

Carla Harwell:

Maybe you're not a good person and maybe you might luck out and be the one to get the call for a kidney versus this other good person.

Marlene Harris-Taylor:

Air quotes, good person.

Carla Harwell:

Air quotes, that will be better off with this kidney. So, I mean, I don't know. All I know is there's a disparity. There's a disparity and there is documentation of this in the transplant world of people of color being on the transplant list and/or even being told about getting on the transplant list.

Marlene Harris-Taylor:

Dr. Bradley called out another significant healthcare disparity concerning black women and hysterectomies.

Okay, if you're a black woman listening to this podcast, raise your hand if you or another black woman you're close to has had a hysterectomy. Yeah, my hand is up. Black women are notoriously plagued by fibroids. And Dr. Bradley says too often doctors recommend hysterectomies as the only remedy.

Linda Bradley:

That should be your last choice, not your first choice. And there are many, many medicines and new minimally invasive surgical procedures. When you have a headache and go to a neurologist or your internist, they're not cutting your head off. They're not decapitating you.

You have a bad tooth; you should not leave a dentist's office with all your teeth pulled. What our grandmothers and mothers had done years ago should not be what you get.