Who has access to good healthcare? Who finds it difficult to go to the emergency department? Why? Who has found the lack of representation in a hospital a deterrent to pursuing treatment? These questions puzzled me for so long. Only this summer, through the volunteer program Project Healthcare (PHC) at Bellevue Hospital, did I finally have the opportunity to observe the treatment of a diverse patient population in a major city.
Let me begin this by saying that the previous year witnessed the death of many African-Americans at the hands of police in the States. However, this racial inequity extends beyond the streets. It cannot be denied that racism has driven health inequities amongst historically underserved and marginalized populations. According to the Harvard Public Health Review Editorial Board, it has done so through “inequities in environmental exposures, limitations in access to health care and other factors that affect optimal health and well-being.” I can attest to cultural differences becoming barriers to healthcare using several examples of doctor-patient interactions from my shifts in the Adult Emergency Service (AES) sector of Bellevue’s Emergency Department (ED).
On an evening AES shift in late July, I met an Indian man, Tariq (not his real name), who had come in with a stomachache. I wondered if he had a pancreatic problem or if he was suffering from constipation. I did not know much, except that he was a taxi driver who had come to the States a couple of months previously. When the resident, a white man, approached him to start the process of diagnosis, I noticed that the resident seemed worn-out and not ready to have long-winded questions from his patient. He wanted the patient to be concise and laconic. When we learned that the taxi driver had recently ate a lot of spices, the resident giggled a little and said, “You’ll get a big bill for this, you know that, right?” Tariq had feared for his life because he was unaware that he had only a stomachache. Back home, in Egypt, he would have been sent away with no bill to pay. He was poor and did not know the American health system, and not knowing how it works is exactly how he suffered discrimination. The community surrounding him did not help him understand the system.
Tariq had mistakenly thought that he would be treated, or seen, for a small fee. For that reason, there needs to be an outreach program by New York hospitals to reach the underserved communities to combat institutional racism. If each hospital does so, individuals of underprivileged backgrounds can feel more confident in pursuing treatment and not grow fearful of “big bill[s].” These outreach programs could illustrate the different types of insurances and provide a list of free health services offered by institutions or organizations as well as a list of common diseases and their symptoms.
Another trend I noticed was that some physicians treat patients differently because of their race or income. In other words, physicians can discriminate against other individuals. In a hospital, physicians have power, and thus, are actually in a position to oppress others when they don’t provide the best healthcare possible. I remember my first overnight shift distinctly because it was the first time I met an Arab in the AES. Her name was Hafiza (not her real name), and everyone pronounced her name incorrectly, as they do with my name. (I looked at all the boards to see if there were any Arabs in the ED. I had promised myself that I would help the underserved and knew the sense of shame Arabs were known for when it came to treatment.) It was 7 a.m., and she walked in wearing a hijab. As a white-passing Arab, like many of us, she did not recognize that the fellow in the red shirt could be from the same region as her. I asked her what her name was and if she knew what it meant. I heard the “H” pronounced like I pronounce it. I asked her if she spoke Arabic, and she smiled profusely. She was there because of an ear infection and a minor issue. She spoke very little English, and so I helped Dr. Jackson (not his real name), the resident, in his questions.
Translating was the purest form of bridging worlds, and a bridge is a position of power. I used this to help someone I formed instant rapport with because of my identity. She had had several surgeries to make her look better. I was actually shocked because in our culture, it is “eib” (shameful, roughly translated) to change the way you look, as God created you the way you are. She told me before I left that she would have been ashamed to tell the resident about those surgeries, lest he judged her. From this interaction, I learned emergency departments could improve doctor-patient interactions by bringing people from different cultures into the residency program. In other words, the internal structure of the emergency department must meet the external need of the community. This restricts racism and makes patients more willing to disclose information important for treatment.
In a New York Times article distributed among volunteers during our public health course with Dr. Erin Hultgren at Bellevue Hospital, I read that “earlier in the 20th century, trends in life spans were of declining disparities … because improvements [such as] sanitation benefited [the] rich and poor alike.” Moreover, Dr. Dana P. Goldman, the Director of the University of Southern California’s Leonard D. Schaeffer Cneter for Health Policy and Economics noted that the adoption of medication for high blood pressure in the 1950s led to a major improvement for black men, erasing a big part of the gap with whites. How can we revive these trends? How can we stop health inequities? Through the topics taught in the summer course, Dr. Hultgren ensured that volunteers understood the disadvantages of living in certain geographic regions or communities. I learned that racism comes in different forms, but debilitates the advance of the community as a whole. Now, I find that the most important issue to address is the institutional racism present in health institutions. It would be a step in the right direction to provide the best healthcare possible.