Tag: race

Skin & Bones

Skin & Bones is Renée Watson’s novel about the experiences of Lena, a 40-year-old African American woman in predominantly white Portland, Oregon. Health, body image, weight, diet, and beauty standards are prominent topics throughout the book and these are contextualized within larger themes about race, gender, gentrification, work, love, faith, and friendship. There are many passages in the book that show how beliefs about health are communicated through interactions with Lena’s friends, family, romantic partners, co-workers, and service providers. For example, the book opens with a chapter entitled, “the weight I carry,” that problematizes assumptions about health and weight in an interaction with a healthcare provider. Lena’s observations about the interaction (e.g., the too-small gown, unfounded assumptions and problematic statements from the health care provider) are woven with reflections on her lifeworld. Immediately following this chapter is a brief reflection on “morbid” as a word used in relation to weight; it concludes with the statements, “Comment on my appearance. But tell yourself it’s about my health.”

Health-related themes are prominent enough that one might assign the entire book and this would provide opportunities to see “big” or “fat” as an identity that intersects with race and gender and to discuss health themes in relation to sex, social support, family, and community. However, the book is also written in chapters (some only a paragraph long) that could be excerpted to explore specific topics. For example:

the aforementioned “the weight I carry” and “morbid” focus on a health care interaction
“Sunday supper” includes a reference to a mother who died from a failure to diagnose breast cancer because she was “a poor Black woman”
“shopping while fat” and “back to school shopping” address finding plus-sized clothing
“macro microaggressions” details lunch with younger white co-workers and concludes with the line, “…they sat there and basically admitted—in my presence—that of all the cares and worries to have in life, their greatest fear is having a body that looks like mine.”
“aunt Aretha” examines “soul food” and its complicated connections to health, family, race, and class
A sequence of chapters–“fat girl, dance,” “how whiteness killed the body positive movement” (an excerpt from Kelsey Miller), “debriefing,” “positivity,” “positive,” and “body positivy” address how fat acceptance intersects with race and this is taken up later in two chapters describing Lena and her friends’ experience at a “Fat Girl Wellness Conference”

One especially powerful recurring storyline involves messages about self-acceptance, health, and diet that Lena received from her own mother and what she communicates with her daughter. These are difficult chapters and include a near overdose on diet pills that is initially taken as a suicide attempt. A strong bond between Lena, her mother, and her daughter sustains them and the book addresses the complexities of communicating about health, race, gender, and beauty in our personal relationships.

Dying to be Competent

“Dying to be Competent” details Cottam’s experience with healthcare discrepancies in her experience giving birth attributed to the fact that she’s a woman of color. Cottom describes having her physical pain be completely dismissed by healthcare professionals and claims that this resulted in the tragic consequence of her daughter dying shortly after birth. Through her personal story, Cottom illustrates the inequalities within healthcare due to structural racism, and the grave lack of care women of color too often receive. This essay could be used in classes to further investigate the structural forces within our society and how they are subsequently intertwined with healthcare as well as how it creates marginalization and lack of care within the healthcare system. Additionally it could be used to discuss the role of unconscious biases and stereotypes within the medical field.

What Does It Mean to Die?

“What Does It Mean to Die?,” an article written by Rachel Aviv, chronicles the conflict between the Winkfield family and the medical staff who declared Jahi Winkfield deceased from brain-death. After a tonsil removal surgery, Jahi began coughing up blood and bleeding from her nose profusely. Her mother, Nalilah, the principal interview throughout the article, described how her daughter was not receiving proper care, which Nalilah attributes to racial discrimination. After continued neglect in the ICU, Jahi’s heart stopped, and two days later, she was declared brain-dead. She was put on a ventilator, but in California, there is a limited amount of time a hospital will allow a patient to remain in care. Due to the malpractice that had already occurred in her daughter’s care before “death,” and religious bases, Nalilah argued for her daughter’s right to remain on the ventilar and be cared for. The article offers contextual information regarding California law and insights from bioethics experts, as well as working physicians. After deciding to move to New Jersey due to their laws regarding religious-based continuation of care laws. Aviv details the controversy that emerged from this case, especially from the interest of the press and the pushback from medical professionals. Jahi continued to receive care from nurses and remained on a ventilator. Nalilah, her family, and some medical professionals believe that Jahi still is not “dead;” Jahi has physical responses, menstruates, and has a lowered heart rate at the sound of her mother’s voice. These facts prove, for some, as evidence for her right to care. However, some argue that this could be a shared delusion in the family. Regardless, the article presents many perspectives that ask the audience to understand the situation from different sides, while still staying grounded in Jahi’s story and Nalilah’s fight for care.

This story could be used in discussions of modern-day bioethics, especially in discussion of continued discrimination of BIPOC patients and families. Furthermore, it could lead to a discussion about the right to care and how we define “death” in different contexts.

Worlds Apart

Worlds Apart is a documentary split into four 10-15 minute sections that each focus on a different cross-cultural health experience. We delve into a Muslim man’s journey with stomach cancer when he turned down chemotherapy due to interference with daily prayer. We follow his daughter communicating with the doctor to see if there are any ways that both could be achieved. It also tells the story of a Lao woman with a hole in her heart who can receive surgery to fix it, but whose mother and grandmother are concerned that the scar will inhibit her Buddhist reincarnation. We then see a Black man waiting for a kidney transplant who searches for a nephrologist he can trust and speaks out on the disparity in waiting times for transplants between white and Black patients. Lastly, there is the story of when a Puerto Rican woman with diabetes, hypertension, asthma and depression turns to home remedies after her mother’s death, which she believes was caused by taking too much prescription medication.

This documentary showcases narratives that illuminate the limits of Western medicine and expand our ideas of how the American medical system can grow to be more inclusive, equitable, and sensitive. From the intersection between medicine and religion to institutional racism to the clash between types of medicating, Worlds Apart is an excellent resource to learn about a variety of cross-cultural healthcare topics in a person-centered manner. It would fit into more sociological classes like cultural anthropology or a world medicine class, but it could also be useful in a training course for pre-med or med students to broaden their ideas of how to individualize healthcare. It could be shown in class to prompt a discussion or assigned as homework along with a written reflection or essay assignment. View the “Facilitator’s Guide” in the Teaching Materials tab to find more specific ways to integrate it into a course. This documentary is not open access, but it can be viewed on WorldCat, which many institutions have access to.

Worlds Apart Facilitator’s Guide

This is a thorough facilitator’s guide on how to facilitate class discussions on the cross-cultural healthcare documentary Worlds Apart (a detailed summary can be found in the Search for Stories tab). In brief, Worlds Apart is a documentary split into four 10-15 minute sections that each focus on a different cross-cultural health experience, including a Muslim man’s journey with stomach cancer, a Lao woman with a hole in her heart, a Black man waiting for a kidney transplant, and a Puerto Rican woman with diabetes, hypertension, asthma and depression. This documentary showcases narratives that illuminate the limits of Western medicine and expand our ideas of how the American medical system can grow to be more inclusive, equitable, and sensitive.

The facilitator’s guide provides background on the filmmakers and their intentions. It includes suggestions for facilitators such as setting ground rules for discussion and asking students to jot down notes during the documentary. The four-part narrative-driven documentary is summarized, and then each section is broken down in great detail, so even someone who did not watch the film could understand the exact circumstances of each family and individual being featured. After each synopsis we also receive medical background information and a variety of discussion questions specifically tailored to different issues discussed in the stories. Each section has a separate “focus” also outlined, ranging from language barriers to explanatory modules to informed consent to racial/ethnic healthcare disparities to non-adherence to medications. This guide was created “to give health care professionals an engaging experience through which to explore ideas about cross-cultural issues in health care and to learn from the actual experiences of both patients and clinicians,” but could also easily be adapted to a university classroom setting to guide student discussions. The guide does not include any assignments, but any of the issues headlining the discussion topics could work well as research essay prompts.

The Immortal Life of Henrietta Lacks

This book is a biography of Henrietta Lack, a black woman who died of cervical cancer in 1951. Before her death, Henrietta Lacks’ cells were harvested from her cervical tumor without her knowledge or consent. The HeLa cell line originates from these cancerous cervical cells, and it is the cell line most used for any study on human cells. Neither Henrietta nor her family were consulted nor informed about the mass distribution and use of her cells until decades later when her cells were already the cause of many medical discoveries and breakthroughs. This book was the first to paint the whole picture of the human behind the most famous cell line.

This book might be used in courses on research and medical ethics, on health (in)equities, or on narrative medicine. For example, it sheds light on all of the factors, both medical and societal, that led to a lack of adequate or ethical care. Her story shows the importance of health stories for humanizing medicine. It allows for reflection on the history of healthcare as it relates to women and people of color (specifically black people and black women).

Allyson Felix es campeona de la salud materna

Allyson Felix is an Olympic athlete who experienced complications with her pregnancy. She prepared for her pregnancy, exercising and trying to take every precaution. However, on a routine check-up, she was informed she had grave preeclampsia. Frightened and confused, Felix learned black women were at a higher risk for these complications. Felix received quality care and recovered from the disease, but wants all pregnant women to be aware of this risk. This is a quick read of about 10 minutes for intermediate level Spanish readers. The Q & A interview format help with comprehension. Readily usable in a medical Spanish class to expose students to health disparities (risk factors, access to care, outcomes) or in a mid-level composition, conversation or health narratives course.

Art + Medicine | Speaking of Race

This one hour PBS broadcast features voices of many physicians of color at the University of Minnesota. Each physician talks about instances of race impacting their practice as well as the care that patients of color receive. It begins discussion of why race is important to talk about in health care and ends on each provider’s favorite aspect of teaching and medicine.

Heart Sounds

In this 5 minute read, a first year medical student discusses treating a patient whose family had to overcome indifference in the ER in order for him to receive treatment. Additionally, the medical student illustrates managing the unknown when assisting a patient with an advanced and nuanced condition. The student decides that the best treatment they can provide is listening to the family’s complaints, fears, and happy moments in order to encourage them to keep believing in this patient’s future.

The story touches on cardiology as a specialty and would benefit pre-medical undergraduates as well as professional students recently starting their health profession. It highlights the importance, and difficulty, of active listening.

COVID-19 through the Eyes of a Black Medical Student

Shuaibu Ali is a medical student who reflects on how his experiences growing up in an urban environment increased his risk for various health conditions. He makes the case for the importance of personal stories from individuals from historically marginalized groups as a way of personalizing statistics on health disparities and exposing conditions that create them.

I have used this essay in an undergraduate narrative medicine practicum class to prompt discussion about the importance of hearing stories from marginalized groups and the power of story to mobilize social change.