you, your message isn’t clear.” Instead the history was limited to the basics, “When did your breathing get so bad? Are you allergic to etomidate or rocuronium? Because we’re pushing them in your IV now.”
And yet, I know the reasons these patients were sicker. You, as a physician or a trainee know the reasons they are sicker. We, as a society, know the reasons that they are sicker. But are we willing to admit our failings as a supposed multi-racial and multi-cultural society built over generations of immigrants?
Medical racism existed long before COVID. The social determinants, or factors, affecting the health of each non-white American starts before conception. We live in a country where we do not guarantee access to nutrition, preventative health care, green recreational space under smog-less skies, medical treatments, equal education, economic opportunities and even access to a daily living where you do not feel an innate stress just for being You. Not only do we fail to guarantee these norms, norms that other countries have deemed are rights, we have systematically failed to provide these fundamentals of Maslow’s hierarchy to those of You who do not look like our Founding Fathers.
Compounding this are the inconsistent messages spread amongst the non-English speaking media and ultimately, their communities. How can you tell someone to stay home because this is dangerous to all Americans while simultaneously stating it is essential that You work? If all of your neighbors continue to leave the house every day, wouldn’t You eventually get the message that this must be dangerous to someone other than You?
The phone interpreter wasn’t the only one struggling to understand the message.
This left me wanting to scream above the rhetoric, “this affects everyone, this affects You!” Instead, as the outbreak started in Arizona, I began telling entire dark skinned families checking in for tests, often after a family member died, “thank you for coming to the ED, but we don’t have tests for You.” They sometimes seemed confused, hadn’t our sports teams started testing all of their asymptomatic members regularly? Hadn’t they been told America was indebted to them for their Essential service? But most were accepting; this wasn’t their first experience with a double standard. Instead of a test, I would provide a list of places reportedly offering them, though few ever seemed to provide patients with their results.
It became tempting to ask my non-Anglo family not “what brings you in today,” but instead: “who died?” While interviewing one family at the vending machines in our waiting area, the only physical space left for patient contact, the English speaking mother told me that they thought it was “Fake News,” that is, until Abuela died. I never expected I would be stuck attempting to disentangle which symptoms were COVID and which were grief. I asked them to honor her by sharing her story within their community to try to save others. To share the message with her neighbors and peers, “This affects Usted!”
But without the luxury to work from home, a way to get there without utilizing socially un-distanced public transport, a way to pay bills until they were asymptomatic, and access to appropriate medical care should those family members symptoms’ worsen, then I, we, have been dishonest. This doesn’t affect You. It affects Them. And until we make it a problem affecting all of You we will passively continue to support the discriminatory factors deeply embedded in American health care. Step outside your clinic, your hospital, your classroom and make this Your problem. <>
“ This doesn’t affect You. It affects
Them.