BY Perla Mora
From an early age, I learned that the medical system wasn’t built for people like my mother. Her inherent distrust of it meant we rarely saw a doctor growing up. Admittedly, I did not know what a primary care provider was until I went to college and had never seen a doctor outside of an emergency room. As a child of undocumented immigrants, my disconnection from the healthcare system was inherited and persisted well into my early adulthood. My mother was a single parent on a low income and had little to no understanding of the American medical system, much less the financial resources to afford health insurance or care. Her linguistic and cultural barriers added a greater layer of complexity which meant she often sought out alternative forms of medical treatment for our family. I observed how my mother and other members of our immigrant community were apprehensive of the medical system and instead entrusted curanderos, or traditional Mexican healers with their serious health concerns. These curanderos offered natural remedies for our ailments, and it was only when the natural remedies didn’t work, that we resorted to the emergency room for treatment.
During my freshman year in college, my younger brother called me complaining of severe stomach pains and asked for advice on whether he should go to the emergency room. At the time, my family and I told him to wait it out because we were used to bearing with our medical ailments for prolonged periods of time and were afraid of the prospect of expensive medical bills. Thankfully, his girlfriend at the time convinced him otherwise and my brother underwent life-saving emergency surgery to treat his appendicitis. Experiences like these highlight the degree to which disenfranchised communities of color are collectively traumatized by their experiences navigating our medical system. Constantly living in a protracted state of distress and fear. Fear of not being able to afford medical treatment or being turned away, fear of not being able to articulate our symptoms due to linguistic or cultural barriers, fear of medical misdiagnosis, fear of unscrupulous doctors, and fear of having our families torn apart by immigration authorities for simply seeking care.
Sadly, for many as part of our immigrant communities, death is the only recourse when confronted with a medical emergency. Recently, a close family friend went to the hospital complaining of stomach pains and was sent home reassured that her symptoms were nothing to worry about. As her symptoms persisted, she went to the hospital an additional three times, and time and time again was sent back home. In an act of desperation, she eventually left the country to seek medical treatment in Tijuana, Mexico where she was finally diagnosed with an aggressive form of stomach cancer and given only a couple weeks to live. Stories like these make up the harsh medical realities for countless immigrants and disenfranchised communities of color who live on the edge of our healthcare system and fall victim to its inequities.
Similarly, systemic racism impacts reproductive health factors such as abortion. In 2019, I underwent an abortion after being victimized by a stranger who took advantage of me in a moment of vulnerability. This traumatic experience resulted in an unwanted pregnancy and abortion which I navigated on my own due to shame and social stigma. I experienced barriers to treatment access such as unnecessary wait times, procedural rules, and regulations as well as expensive out-of-pocket copays which amounted to nearly $600. At the time, I had just moved to DC and finished an unpaid internship, so I had to ask my employer for a personal loan because I couldn’t afford the procedure. After going through all these hurdles, I was made to listen to the fetus’s heartbeat on the day of my appointment and repeatedly questioned about my choice to follow through with my decision. It was an incredibly distressing experience because I assumed it would be different considering I lived in a liberal part of the country; however, I realize now that my reproductive healthcare choices were always conditional upon various other factors outside of myself.
In the context of the Dobbs 2022 supreme court ruling which revoked the right to abortion, an even greater number of women of color will experience reproductive oppression which will have fatal consequences. It is estimated that the total abortion ban will increase overall maternal mortality by 21% and by 33% for Black Americans[1]. According to the White House’s 2022 report on the Maternal Health Crisis, Black and Native women are already two to three times more likely than White women to die from pregnancy complications. Further, the report confirms that women of color in the United States die at a higher rate from preventable pregnancy-related causes than any other developed nation on Earth[2]. As such, the Dobbs ruling has worsened the cause for racial equity in healthcare by making it even harder for women of color to possess bodily autonomy and freedom over their own reproductive healthcare choices.
In March 2021, I landed on my deathbed with a bilateral pulmonary embolism (PE) diagnosis and a weakened heart. I survived this health crisis because of my own family’s history navigating the broken healthcare system which taught me to advocate for myself at an early age. At that time, I didn’t fully understand my diagnosis but learned blood clots were masses of blood that do not break properly resulting in the potentially fatal coagulation of blood in the blood vessels, limbs, lungs, brain, heart, or kidneys[3]. A staggering one in four people will die from blood clots worldwide and it is known as one of the leading causes of death among pregnant women.[[4]] According to my Hematologist, my PE resulted from the combination of asymptomatic Covid and my NuvaRing birth control. This diagnosis was made even scarier because my only discernible symptoms were a stiff neck and a numb left arm. Thankfully, on the day of my diagnosis, I had an empathetic physical therapist who took my symptoms seriously and advised me to go to the emergency room immediately. At the ER, my doctors expressed how lucky I was to have made it in time and told me to “buy a lotto ticket” which is a reaction that caught me by surprise because I could’ve easily ignored my symptoms. My Hematologist also nonchalantly noted how I would’ve likely died in my sleep in two weeks’ time if my PE was left untreated. These comments did not provide me with a sense of relief but rather reminded me of the extent of disconnect that exists between patients and their providers; the same disconnect from the medical system that I had been accustomed to my entire life.
Throughout the course of my PE recovery, I discovered blood clots are very common and are one of the leading causes of Covid deaths worldwide. According to the Heart Association, people who have had Covid are at a greater risk of developing life-threatening blood clots for up to a year after their diagnosis[5]. This same study found that Black and Asian people are at an even higher risk of developing potentially fatal blood clots compared to the rest of the population. Consequently, the Covid pandemic exposed racial healthcare disparities which disproportionately impacted communities of color.
As a resident of Washington, DC during the pandemic, I witnessed significant differences in the Covid emergency response, quality of care, and overall community outreach. As of 3/5/21, DC’s Black population made up 75% of Covid related deaths in the city even though they comprise 45% of the overall population. This statistic represents the largest disparity gap in the nation between the Black population and the percentage of overall Covid deaths.[6] Further, people of color disproportionately endured barriers to vaccine access with only 26% and 8% of Black and Brown populations, respectively, being vaccinated against Covid as of the date of the study. Comparatively, 33% of the White population had been vaccinated by the same timeframe and made up only 10% of overall Covid fatalities in the city. These appalling racial disparities in healthcare are not a coincidence and can in part be explained by inherent racial biases and structural inequities inherited from our nation’s legacy of segregation. Racial biases resulting in medical providers not taking pain assessment or treatment recommendations for Black women as seriously as their White counterparts because of false beliefs regarding biological differences between them.[7] These biases have real-world life-or-death implications which are made worse by compounding intersectional factors such as gender, socioeconomics, religion, sexual orientation, and cultural background.
People of color in this country are collectively traumatized by our medical system because they are disproportionately impacted by health crises and oftentimes die from preventable causes such as blood clots, pregnancy, or abortion access. Their pain is not taken seriously due to racial biases, and/or they lack access to quality healthcare. Their stories demonstrate the extent to which the U.S. healthcare system is fractured and does not serve everyone’s healthcare needs equally. If we are to advance as a society, we must prioritize a more universal, integrated approach to healthcare that is more patient centered. This can be achieved by prioritizing cultural competency as part of the medical school curriculum and recognizing it as a significant factor in improving the quality of care across our healthcare system. Additionally, the government should mandate medical institutions that receive federal funds to meet annual targets and reporting requirements demonstrating enhancements to quality of care, cultural competency, and diversity promotion initiatives. Advocating for more culturally informed providers will lead to more people of diverse backgrounds pursuing careers in medicine as well as a higher caliber of overall care and an increased level of trust among patients. Improving our healthcare system for all regardless of race is imperative because healthcare is a human right, and we cannot expect to progress if the basic needs of our citizenry are falling behind. In the meantime, it is up to us as individuals to be our own best advocates and never assume that the American medical system was designed to address our collective healthcare needs.