Upper Valley health care workers attuned to racial inequities

  • Chad Lewis, who is a fourth-year student at the Geisel School of Medicine at Dartmouth, stands in the entranceway of the Outpatient Surgery Center at Dartmouth-Hitchcock Medical Center on Wednesday, June 17, 2020. Earlier this month at the medical center, Lewis took a knee for eight minutes and 46 seconds in honor of George Floyd. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Jennifer Hauck

  • Photographed on Wednesday, June 17, 2020, Chad Lewis, who is a fourth-year student at the Geisel School of Medicine at Dartmouth, grew up in a blue-collar family in San Francisco. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News — Jennifer Hauck

Valley News Staff Writer
Published: 6/17/2020 9:29:20 PM
Modified: 6/17/2020 9:29:12 PM

LEBANON — Twin State health care providers are among the growing number of people across the country who are examining their roles in perpetuating racism and calling for change in the wake of the killing of George Floyd and the surge of support for the Black Lives Matter movement.

Earlier this month, many of the nation’s health care workers took a knee for eight minutes and 46 seconds in honor of Floyd, who died in Minnesota last month as a white police officer kneeled on his neck for that length of time. The nationwide demonstrations, which included providers across the Dartmouth-Hitchcock Health system, were intended to show support for the Black Lives Matter movement and inspired by a student-led group, White Coats 4 Black Lives.

Among those who took a knee at Dartmouth-Hitchcock Medical Center in Lebanon on June 5 was Chad Lewis, a fourth-year student at the Geisel School of Medicine at Dartmouth who grew up in a blue-collar family in San Francisco and served a combat tour as a Marine in Iraq.

“It was great to see such a large group of physicians, nurses, and other healthcare providers stand in solidarity with their black colleagues and to honor the life of George Floyd,” said Lewis in an email.

In addition to acknowledging the moment through demonstrations earlier this month, many health care organizations in Vermont and New Hampshire have issued statements denouncing police brutality and acknowledging the role racism plays in creating disparities in health care. People of color often develop chronic diseases earlier in life than white people, which can increase their risk of dying at early ages. These disparities have been highlighted by the relatively high rates of disease and death due to COVID-19 for people of color.

These disparities are evident nationally, as well as in the Twin States. Despite making up just 1.4% of New Hampshire’s population, black people account for 6.3% of COVID-19 cases in the state; 5.5% of the hospitalizations; and 2.5% of the deaths. In Vermont, where black people also account for just 1.4% of the population, they account for more than 8% of reported COVID-19 cases.

While Lewis said he appreciates the widespread sympathy and support being shown to people of color in the wake of Floyd’s death, he also said that the deaths of black people at the hands of police aren’t new. He said he wonders why this degree of support hasn’t been there in the past, and he isn’t sure whether it will translate into concrete action for change now.

Lewis is a member of the Student National Medical Association chapter at Geisel, which supports minority medical students and underserved populations, and is an independent member of White Coats 4 Black Lives. There was previously a chapter of WC4BL at Geisel that had been dormant, but some students are working to bring it back, he said.

Lewis said that “even right here at Dartmouth-Hitchcock” there are signs of racism in the Upper Valley.

“I have had to operate on and care for patients with swastikas tattooed across their whole chest,” he said. “However, I still gave them the same level of care and attention I would have given anyone else, because it was the right thing to do.”

Other signs of racism in health care are perhaps less overt. Yasmin Kamal, who is in her third year of the medical program at Geisel and also has earned a doctorate in computational biology at Dartmouth, said it’s difficult to find cancer genomic data on people of non-European descent because they are understudied.

Despite the fact that most evidence for current cancer therapies was gathered by studying their effects on white people and not on people of other races and ethnicities, “everyone receives the same cancer treatment regimens,” Kamal wrote in an email.

“For example, as a person of South Asian descent, there are hardly any large-scale genomic studies on South Asians and their risks for various cancers,” she said.

In addition to needing to gather more information to inform treatment for people of color, medical school curricula also could be improved in the way they address social determinants of health, including race, Lewis said. While professors often mention race as a risk factor for disease, he said they don’t often delve into the social reasons behind that fact.

“Not only does this practice potentially help propagate implicit biases in future physicians, but it also reinforces the idea that doctors should attribute false biological characteristics to monolithic groups,” Lewis said.

In the example of COVID-19, risk factors for infection include living in crowded housing, said Xusana Davis, Vermont’s executive director of racial equity. People of color are more likely to live in crowded conditions because of a long legacy of housing discrimination, she said.

People of color also are more likely to have underlying health conditions that might make them more susceptible to serious symptoms due to COVID-19, such as heart disease or respiratory illnesses such as asthma, she said. This is in large part due to environmental effects, such as poor air quality, on the body over time, she said.

Davis, like Lewis, said she appreciates the gestures of support in recent weeks, but she would like to see concrete steps toward change.

“I think it’s great to show solidarity with justice movements,” she said. “It is so much more important to really live it out in your daily practice.”

For example, hospitals and health systems could examine their hiring practices and work to diversify their ranks.

“There are so many barriers of entry to the profession itself,” she said of the field of medicine. “Who are all the surgeons?”

And, she noted, people of color have good reasons to distrust the health system because they have been used as test subjects in unethical studies, such as in the case of the Tuskegee syphilis experiment in which researchers for the U.S. Public Health Service recruited hundreds of black men with syphilis in Alabama in the 1930s. The researchers told the men they were treating them for the disease, but actually denied the participants treatment for four decades even though penicillin became a widely accepted treatment for syphilis in the 1950s.

Kamal echoed Davis’ call for increasing diversity among physicians and academics.

“It is important to find ways to connect students of color with mentors and leaders in medicine that are also of color so that the institutions of medicine continue to be diversified and can therefore provide better health care tailored to the diverse ethnic populations they serve,” Kamal said, noting that Geisel is working on these issues.

Geisel Dean Duane Compton said via email that the school recognizes racism as a public health threat and he acknowledged “that racial prejudice and prejudice toward other non-majority groups unfortunately exist within our own educational community. We regret that we have not addressed inequities and bias at Geisel more effectively. We need to do better.”

Compton provided a list of 10 things Geisel is doing to address the problem, including diversifying the faculty at the medical school and working with D-H to diversify the staff at the medical center, as well as improving how the issues of diversity, inclusion and bias are addressed in the curriculum.

The school plans to increase training for staff and seminars for students on these topics. It also plans to host a town hall “for the purposes of remembering those who unjustly lost their lives, to reflect, and to begin an ongoing discussion on how to address the racial inequities within our school,” Compton said.

While the Vermont Medical Society approved a policy aimed at addressing bias in health care in 2018, Dr. Catherine Schneider, the society’s president, said Floyd’s death has brought the issue once again to the fore.

“We need to be more actively engaged in the change and making sure that all Americans have equal access to care and are treated fairly,” said Schneider, who is section chief of surgery at Mt. Ascutney Hospital in Windsor and participated in a June 5 demonstration at Mt. Ascutney in Floyd’s honor.

“It’s a wake-up call for all of us.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

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