It is rare to have extended conversations with elders about health justice. Just recently, I sat down with three elders who are physicians in Cincinnati and who happen to be African American. As director of an organization committed to changing healthcare in Cincinnati for those in greatest need, I wanted to listen to the experience of physicians that had to survive a long history of segregated education, and a community that was highly suspicious of health justice for neighborhoods marked by extensive mortality. I had seen the statistics that revealed that there was a 35 year gap in life expectancy for neighborhoods with large numbers of poor and Black. I had seen the modest improvement in infant mortality for this same population even though the nation’s highest ranked hospital for children resides across the street from these communities. After doing vaccinations for flu and COVID in these neighborhoods amongst a reluctant population, I listened to stories about poor and non-existent treatment that discouraged participation in health care. I had also seen the withdrawal of providing vaccinations on the part of health departments and the willingness of drug stores to step in and provide “healthcare.” With partners in churches, synagogues, and the mosque, a new organization was formed to address the persistence of this pattern of mortality for adults and children. I wanted to know where the hope for the future resided as we worked to provide vaccinations, trips to and from cancer diagnosis and treatments, support for people to get second opinions when necessary, and how experienced physicians from the community saw the possibilities of change.
We met in an old community center in the College Hill neighborhood. Each of the physicians were eager to share their stories about coming through medical education and starting a practice. They were each in their 70s, and two were fully retired while one physician continued to work part-time. A common theme was exclusion: no one on graduating from medical school were welcomed into the medical profession. Instead, rejection was common. Such statements as “We don’t want a black/white team,” or “No, there is no room for a Black neuro-surgeon,” or “No hospital will hire us,” was the way each story began. The stories of setting up a practice, or finally landing a position in an emergency room, or a white doctor risking that white mothers might come and see a black doctor, were related without anger. Instead, there was a pride: “I doubled the number of babies born in one year,” a doctor said. Another told the story of starting a two person practice that was successful. Beneath the surface, these memories touched on points of anger that were kept under wraps, but from time to time surfaced in comments about the rigidity of the Jim Crow medical profession. The quietest of the three began his comments in the following way: “Race matters. The mere appearance of a Black sets up racial tones in whites.” When the discussion turned to the present and future facing Black medical students a sense of righteous anger surfaced: “All hospitals have a duty to work with poor, homeless, and the refugee populations. Every hospital and medical school is on welfare from the federal government. They all receive Medicare and Medicaid funds. Don’t let them get off their responsibility. They are using our tax dollars.” I heard recommendations about patient steering: “You tell patients to stay away from those hospitals that discriminate against the poor. The loss of patients will change their minds. And go to the press: tell this story of rejection!” The physicians believed that once the public was aware of the patterns of both rejection and mortality, there might be a change on the part of the hospitals. They strongly urged me to “Find the real change agents in the hospitals that can make a change. Don’t rely on the CEOs.”
This discussion was a wonderful opening for stories of justice, caring, kindness, and survival. Each of these physicians had come through more than they were prepared to fully disclose. I was reminded of the words of a great Holocaust scholar, Lawrence Langer, who believed that the full stories of the horror that people faced were needing to be told even though the words would be so painful. I felt that these elder physicians were revealing stories that might have been kept secret until this point or that they were stories that were only whispered in secret. Having the chance to listen, to absorb the details, and to applaud their courage, their resilience, and their anger was a great privilege. Now, Cancer Justice Network/Coaltion for Health Justice, could learn from their experiences and, with their help, plan for a different future. In the room with us were two Black medical students, perhaps hearing the stories in great detail for the first time. I am sure they were wondering about if there were real changes in the medical profession that would allow for their full development. The discussion went on for two hours. We had a hard time leaving each other. A sacred space for their words have been created. Now, we needed to take action.