STUDENT VOICES | ETHICS AND SOCIAL JUSTICE ESSAY PRIZE SECOND-PLACE WINNER

By Denayia Miniex, Fordham University at Lincoln Center

Unheard or Ignored: The Medical Complaints of Black Women

Actress Issa Rae once said, “Black women aren’t bitter, they’re just tired of being expected to settle for less.” In the healthcare system, that is exactly what we are expected to do. Black women are forced to face issues such as matricide, racist medical history, stereotypes surrounding drug abuse, and the mistreatment of their children at the hands of doctors. The history of abusive experimentation on slaves continues to perpetuate the mistreatment of black people in the healthcare system. Therefore, it is the responsibility of medical institutions to properly educate their doctors and hire people of color.

Pregnancy is one of the most life changing experiences for a woman. An expectant mother should be ecstatic to choose her unborn child’s name, find who they resemble most in appearance, and watch them grow up into full adults. However, in America these expecting mothers are dying at an alarming rate, before even getting a chance to embrace motherhood. We are failing mothers, and the number of deaths per year is only on the rise. From 1987 to 2014, the amount of pregnancy related deaths has suffered a twenty-six percent increase, according to The Center for Disease Control and Prevention. The CDC also entails that the United States ranks the lowest out of all developed countries.

Unfortunately, what is being ignored about these statistics, is that us black women make up the greater part of those deaths. For the majority, these deaths are not associated with education, income, or health insurance status. In a study conducted by the Department of Health, a black woman with an advanced college degree is still more than twice as likely to experience severe childbirth complications than a white woman who has not completed high school. Leaving medical racism to blame, as these complications are not coincidental nor circumstantial. With this dark gynecological history dating back to slavery, the advancement of the study rests on the pain and suffering of black women (Holland). Unconscious bias grew out of this history and is still killing us to this day. This bias spreads beyond the delivery room, as the pain of many black patients is also being denied by doctors in the emergency room and in everyday practice. Emory University conducted a study in the 2000s in an emergency room in Atlanta that showed that seventy-four percent of white patients received painkillers for their bone fractures, while only fifty percent of black patients did (Somashekhar). The experimentation on black people during the time of American slavery has created these stereotypes; and whether or not doctors are aware that they use them, they are harmful to the well-being of their patients.

The recorded experimentation of black women began in the 1830s. Surgeons were performing experimental ovariectomies and c-sections on enslaved women. The scientist known as the “Father of Gynecology,” James Marion Sims, is still praised for his discoveries concerning the female reproductive system. His work using the vaginal speculum and innovative surgical procedures has proven valuable in the world of gynecology. That said, the accomplishments accredited to Sims are not his own. All of his work was able to be done by the dark slave trading taking place in Montgomery. From 1845 to 1849, performed over thirty of his inhumane human experiments on a seventeen year old girl named Anarcha and even more additional surgeries on eleven other enslaved women (Holland). He performed surgery on a woman named Lucy, who was made to bend over on all fours with her head in her elbows for over an hour while she yelled in what Sims admitted to be extreme “agony” (Holland). Lucy afterwards contracted blood poisoning, and took months to recover from the operation. She was expected to die. When conducting these experiments, Sims chose not to use anesthesia, as he believed and taught that black people were incapable of feeling pain or anxiety. In Sims autobiography, The Story of My Life, he writes, “There was never a time that I could not, at any day, have had a subject for operation,” and thinks about these days as the most “memorable time” of his life. There are many people who try to justify Sims practices, saying that women with fistulas — inflamed tissue that grows between sexual organs — would have agreed to take part in his experiments in hope for treatment. Though, there is not recorded proof of their consenting to these excruciating surgeries. The only legal form of consent that Sims needed to practice on these women were from their owners. These women’s owners would be financially invested in her health as his servant or fieldhand. Furthermore, a slave woman who could not reproduce more children was seen as a waste of resources due to her position as nothing more than a reproductive agent. Sims believed that black people were less intelligent than white people, as he thought that their skulls grew too quickly around their brain (Holland). Sims even blamed black people for their deaths on his operating table, as he believed that there was nothing wrong with his methods. He felt comfort in believing that the death was in the hands of, “the sloth and ignorance of their mothers and the black midwives who attended them” (Holland). As a result of his racist beliefs, Sims always used anesthesia on his white female patients. As the “Father of Gynecology” most OB-GYNs and surgeons continue to follow his practices and believe in his teachings. Thus, Sims’ medical ethics still have an influence on black women’s treatment today.

A modern day example of this can be seen in the case of Serena Williams, a well-educated black woman who is the number one ranked female tennis player in the world. Serena almost lost her life due to childbirth complications, and her story exemplifies the plight of black women during pregnancy. After going through phases where she experienced difficulty in breathing, Williams told her nurse, “that she needed a CT scan with contrast and IV heparin (a blood thinner) right away” (Williams). However, the nurse refused to acknowledge her complaints as a legitimate problem and later defended her actions by claiming that Serena was confused by medication. The doctor gave Williams an ultrasound which revealed nothing. When they finally listened to Williams and gave her a CT scan, the scan revealed that she had several blood clots that settled in her lungs. Serena had been right all along.

Williams makes over eighteen million dollars a year, is an athlete, and is college educated, yet she is a black female. Her race and gender almost caused her to be another statistic, an example of racist medical matricide. Serena Williams is a prime example of how black women, a minority social group, are often disregarded and disbelieved as they are seen as the inferior social group. When commenting on the issue after the fact, Serena said: that we must start “empowering adolescent girls to demand quality care” (Williams). Many black women are complaining in the medical room, and their voices are just not being taken seriously.

Many black people are being undertreated for pain in America. This has to do with harmful unconscious stereotypes and the inability for physicians to empathize with their patients if their appearance does not match theirs — which is conventionally white and male. This is a phenomenon known as the racial empathy gap. A study conducted by the University of Milano-Bicocca illustrated the racial empathy gap showed that when Caucasian people were shown a video of black and white people being hurt, their empathetic reaction was significantly higher for white people (Bolognini). The struggle to identify with the pain of another race is deeply-rooted in the history of this country’s relationship between blacks and whites. Only four percent of America’s doctors are black, so the racial empathy gap is bound to primarily affect black patients.

Racial disparities in pain medication has recently affected myself personally. When I was diagnosed with Mononucleosis (“mono”) and Strep throat here in New York city, I was denied pain medication until after my third visit of complaining of intense pain. I thought to keep fighting to get pain medication after a conversation with a friend who went to the same hospital for treatment of Mononucleosis. He is a white male who is the same age as me. My friend informed me that they had given him pain medication and a throat-numbing spray immediately upon diagnosis. This had come as a huge shock to me, as I was in even more pain than him due to the double diagnosis. This unfair treatment that I received is apparently not rare in America’s healthcare system.

So why are black people seen as more prone to abusing prescriptions when actually they struggle to receive medication in the first place? Of course, there are still some black people who are getting prescribed pain medications, a percentage of which actually become addicted. However, prescription drug abuse affects people of all races, therefore making the addicted-black-person stereotype obsolete. According to the CDC, in 2014 seventy one of every
million white Americans died of drug overdoses involving prescription opioids. Conversely, the overdose-death rate of black Americans is thirty-three out of every million (CDC). Clearly, the CDC’s evidence statistically proves that this stereotype is false.

Black patients often seek care elsewhere when denied proper service by a doctor. However, many of these patients think are under the impression that their undertreatment is a result of their insurance status or because they were poor — not for their identity as black. This unfair treatment is not exclusive for black adults, but children are being affected as well. A study conducted in an emergency room revealed that black children who were diagnosed with appendicitis were less likely to receive any pain treatment with moderate pain and less likely to receive opioids with severe pain than their white counterparts. Black children are still suffering from inhumane medical practices (Noonan). Unfortunately, experimentation on black children was another aspect of James Marion Sims’ atrocities. Sims made an effort to try and treat trismus nascentium with a shoemaker’s tool; the goal of the surgery was to loosen the child’s skull (Holland). Using a shoemaker tool like the children are objects equal to a shoe, is a cold act. The blame for the suffering of blacks lies on the non-evidence based practices and unconscious implementation of stereotypes.

If the statistics on black people’s undertreatment is to be lowered, Americans must take a critical look at the medical field itself. Firstly, physicians must be educated on the topic of false “biological sciences” that affect the treatment of different races. In medical textbooks, Sims’ work should be criticized for its racist roots whenever it is mentioned. Moreover, black people need more representation in the medical field. Black male and female doctors will help fight against the racial empathy gap, thus providing adequate and fair treatment to patients. For example, designating places for people of color during the hiring process — a form of affirmative action — will ensure that black Americans are properly represented in the medical field. Serena Williams wrote regarding this mistreatment, “ You can demand governments, businesses and health care providers do more to save these precious lives” (Williams).

To this day, people still believe that black people are somehow physically inferior and immune to pain. As a result, the black community is suffering unfair medical treatment, which I have experienced firsthand as a black woman. How much longer will it take for us to be able to receive the same care that we deserve? The mainstream news presents unjustified killings and treatment of black people, and yet the issue of unfair medical treatment remains unspoken about. Behind the scenes, we are facing racial oppression in the healthcare system. A life without a mother, a life spent in physical pain, or our life being taken away, is not one that we should be in fear of on the basis of our skin tone. Especially when such cases are preventable, we need our physicians to dig deeper and listen harder.

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Works Cited

Bastién, Angelica Jade, and Issa Rae. “’Insecure’ Series Premiere: Single Black Woman.” The New York Times , The New York Times, 20 Jan. 2018, http://www.nytimes.com/2016/10/09/arts/television/insecure-series-premiere-episode-1recap.html.

Forgiarini, Matteo et al. “Racism and the empathy for pain on our skin” Frontiers in psychology vol. 2 108. 23 May. 2011, doi:10.3389/fpsyg.2011.00108

Holland, Brynn. “The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Slaves.” History.com, A&E Television Networks, http://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experimnts-on-slaves

New York City Department of Health and Mental Hygiene (2016). Severe Maternal Morbidity in New York City, 2008–2012. New York, NY.

Noonan, Jessica. “Black Children Less Likely to Get Pain Meds in ER.” ABC News, ABC News Network, 30 Apr. 2012, abcnews.go.com/Health/Wellness/black-children-pain-meds-er/story?id=16231146.

“Reproductive Health.” Centers for Disease Control and Prevention , Centers for Disease Control and Prevention, 7 Aug. 2018, http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillancesystem.htm.

Somashekhar, Sandhya. “The Disturbing Reason Some African American Patients May Be Undertreated for Pain.” The Washington Post, WP Company, 4 Apr. 2016, http://www.washingtonpost.com/news/to-your-health/wp/2016/04/04/do-blacks-feel-less-pain-than-whites-their-doctors-may-think-so/?utm_term=.5e196f854d37.

Williams, Serena. “Serena Williams: What My Life-Threatening Experience Taught Me About Giving Birth.” CNN, Cable News Network, 20 Feb. 2018, http://www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index

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Denayia Miniex is the second-place winner of the Fordham University Center for Ethics Education Ethics and Social Justice Essay Prize. She is currently a student at Fordham University, Lincoln Center.