Preparing for Our ‘Next’ in the Times of COVID-19: Truth and Reparation As We Witness Health Injustice in Real Time
As reports continue to surface that Black, Latino, Indigenous, and LGBTQ+ communities are among the hardest hit by COVID-19, members of those communities, like me, affirm the statement that we’ve heard for many generations — that whatever is happening to the world at large, hits us much harder. In this case, as with so many others, it is deadly. As a Black Woman Doctor in Brooklyn, NY, I’ve seen and felt this with my colleagues, patients, and community. As a labor leader serving and fighting side by side with my essential worker colleagues while Chair of the 1.1 million member SEIU Healthcare from 2010–2016, including during the Ebola epidemic, I remember having conversations with union members and raising the alarm nationally and globally that we should listen to and value workers and invest in our public health infrastructure to value the lives of all communities experiencing inequities. As a wellness professional with generations of history of meditation and movement for self-care and health, I’ve seen how it’s not just COVID-19 that is affecting our health, it’s the news and trauma or neglect caused by hearing every day that you are more likely to die or suffer physically or economically from COVID-19 because of racism (not race).
It’s time for some truth and reparation regarding the US Healthcare System. The system is working exactly the way it was designed. This is not a new concept. While many have written for decades about the injustices that exist, and the last decade has seen additional prolific work to expose the racism that exists in the fabric of our society, we are still wrestling with this truth. And while many amazing souls called to honestly tend to the health of everyone deal with the aggressions and microaggressions of this injustice everyday and are at risk for increased levels of stress, burnout, and disease, the entire system abides by the core concepts woven into the fabric of our society since its beginning. The system generally ignores and exploits Black, Latino, Indigenous, and LGBTQ+ communities and prioritizes those that already have the most.
Truth in this moment requires us to acknowledge the 1. Exploitation and neglect of Black, Latino, and Indigenous Bodies, 2. Vilification and marginalization of community based, traditional, and natural practices and strategies that augment our mental, physical, and spiritual health, and 3. Erasure and ignorance of the innovation and strategies of those same communities. Reparation requires divestment from the above practices and brave and robust investment at all levels, from rural and urban communities to our entire society, that urgently address the damage that has been and is being accelerated by our current pandemic. It also requires transformational investment in changing our system for next steps and building a foundation for a just future. Without these urgent steps, we will surely repeat this deadly cycle.
In short, our current truth is that dominant systems tasked with health in the US and around the globe have deemed our communities not worthy of being seen, heard, or attended to in all the ways that are needed for us to be well. Legit reparation (reparation = the action of repairing) requires unapologetic and robust power to declare in policies, practice, and investment that we are deserving of being worthy and well.
Our Bodies
As a Black Woman growing up in the rural midwest, studying in the Washington, DC metropolitan area and in New York City, and having navigated and studied the US Healthcare system from many angles, I’ve always been painfully, professionally, and personally aware of the way it exploits and abuses Black, Latino, and Indigenous bodies. Prior to this pandemic, our society was shook (but not entirely surprised) by testimonies of Black people pleading for attention to their breath — whether it was the GOAT Serena Williams having to convince her health team that her concerns about her breath were real or Eric Garner having to plead 11 times, “I Can’t Breathe,” before his murder. In this Pandemic, I’ve personally worked with patients, friends, and colleagues who have seen or experienced being told that despite their self-report, they were not worthy of consideration, treatment, or a test even though changes to breath are considered a key indicator of the clinical syndrome associated with COVID-19.
Additionally, at the intersection of this injustice, are my colleagues designated as essential workers, many of whom get up everyday, commute, and work without protection they deserve — at times even risking retribution if they acknowledge this exploitation.
Acknowledging this truth and appropriate reparation requires more than a seminar on “cultural competency.” One must purposefully disrupt culture, systems, policies, and practices that foster and nourish this system and invest in and protect people and actions that boldly lift voices from the streets to the suites of our society.
Community based, traditional, and natural practices and strategies
While the sentence, “An ounce of prevention is worth a pound of cure,” is one many of us are familiar with, the US Healthcare system has long prioritized resources that focus on illness, medications, and procedures that may provide profit to some institutions long after diseases have progressed for an individual. Once again, this does not comprehensively serve marginalized populations who disproportionately take hits to health and wellbeing from birth to death. In the context of COVID-19, this is communicated as, “Only call us when you can barely breathe,” with little instruction on what may be useful in prevention besides avoiding the virus. (And YES! Wash your hands and physically distance yourselves to the extent you can.) But there are so many things that are traditional methods of care passed down for generations that assist in both providing the body with mental, physical, and spiritual ways of dealing with every single new illness that has arisen. As a family physician and geriatrician who has worked with so many populations who don’t have access to the newest/fanciest things, to ignore these practices is not only neglectful, it is unethical, because to ignore these strategies suggests that many people should sit at home in terror, furiously wash their hands, and do nothing other than wait for the COVID 19 to come to their door.
But isn’t that dangerous? What about science? There are two main points to consider here. 1. Why do many in society in the US consider all natural medicines and methods by default “dangerous,” and 2. Are these methods ethical to employ?
For the first point, it’s important to consider that historically speaking, attitudes in the US Healthcare system around natural and traditional medicine is more about power than about people’s health. Abraham Flexner, considered by many to be the father of Modern America’s medical education curriculum, narrowed our medical education’s focus to biomedical science and institutions. While many argue that Flexner’s recommendations elevated the innovation of the field of medicine, the vilification of natural remedies and other opinions such as the marginalization of Black people and Women in medicine, left huge voids that continue to hinder the care of all people at times when we need it most. During the pandemic, these structural barriers placed in the US Healthcare system serve to maintain inequity — which at times looks and feels to members of the Black, Latino, and Indigeous communities that we should wait patiently for any type of protection or care. While we wait, millions around the US and globe suffer and die.
A more equitable and just approach should be rooted in the principles of medical ethics: Respect for autonomy. Non-maleficence. Beneficence. Justice.
Respect for autonomy. Appreciating the respect for the individual’s ability to make informed decisions about personal matters (also see the “harm principle”)
Non-maleficence. One should avoid causing harm. This means that one should engage in traditional medicine — including techniques such as meditation and herbal remedies — not only in the context of individual and societal risk, but also in the context of the current situation. Non-maleficence with traditional medicine in our current pandemic context means to employ tradition AND wash hands, avoid exposure, and engage the system (where available) when needed.
Beneficence. We should take positive steps to help others. Culturally-grounded, healing-centered engagement has positive mental, physical and spiritual benefits. This engagement includes the intentional use of art for mental and spiritual health.
Justice. Within the lens of health equity, justice means that everyone has the ability to achieve their full potential of health. Given the inequities that exist in US Healthcare and the lack of resources that exist and are unequally distributed, it is only just that Black, Latino, indigenous, and LGBTQ+ communities have access to all available strategies to attain holistic health, including traditional medicine.
Our communities have been using techniques before and within this pandemic such as 1. Deep breathing, meditation, prayer, movement, art, music, dance and rest to support and monitor mental, physical, and spiritual health daily and understand any shifts in one’s health and 2. Deploying herbal and natural supplements such as oregano oil, ginger, and fire cider as first lines of support for the body, mind and spirit, and especially to support the body in mounting a response and healing if mild and moderate (and more than moderate when access to systems is not available) symptoms arise.
Innovation
We are clearly in need of a new path, including innovations in how we recognize and invest in care at the community level and how we discover and deploy the latest developments to address this and coming health crises. To be clear, community based-strategies have existed long before these same communities were marginalized. Our truth is that the expertise exists in Black, Latino, Indigenous, and LGBTQ+ communities and is often marginalized, vilified, appropriated, or ignored. Whether it’s recognizing the expertise of essential workers to detail the challenges and potential solutions of navigating all political and social determinants of this healthcare in the US AND this pandemic, the voices of wellness practitioners and community organizers who are understanding how the tragedies and successes are showing up on their block, the role of music, dance, and all forms of art as health strategies, or the public health experts, physicians, nurses and others who have worked in health equity for DECADES understanding and not surprised by this moment, too much talent has been sidelined by being ignored, shut down, or exiled because they dared to challenge the status quo. Reparation requires not only creating space for all of these voices and ideas to flourish and meet this moment, it requires a robust space that unapologetically lifts and defends the ideas and invests in the physical, emotional, and intellectual labor that comes with fighting a system that has been in place for 100s of years.
A Word on the Politics of this Moment:
As we move into this next phase of the pandemic, the concept that “this is not political” is attempting to emerge as a “unifying theme.” Truth: To ignore the fact that the political determinants of health including the necropolitical culture have led to this moment ignores a significant root cause of how we got here. To not address this directly sentences many Black, Latino, Indigenous, and LGBTQ+ communities in the US and around the globe to the worst of this pandemic including certain suffering and death.
Faith without works, intentions without action and investment, and innovation without truth are all incomplete strategies. We are able to choose a different path by fully acknowledging our truth and courageously moving forward boldly with reparation. Let’s decide that path.
