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Navigating the Labyrinth of Healthcare Disparities –

A Personal Story by Erica Olivier

Allow me to introduce myself. My name is Erica. I am a 40-year-old Black woman from Milwaukee, Wisconsin, deeply entrenched in the realm of Public Health. My love for my city is unwavering, yet my journey within maternal and child health has exposed the stark realities of health inequities within the Black community.


My struggle with reproductive health dates back to my teenage years. I experienced prolonged, excruciating menstrual cycles, often accompanied by frequent bleed-outs and hemorrhaging, which led to multiple hospitalizations. As an adult, I experienced spontaneous miscarriages and was considered high-risk when it came to carrying a baby to full-term. I, like countless others, rely on the healthcare system to help me understand what is happening to my body; to assess, diagnose, and treat any underlying concerns. As a human being, I expect to receive comprehensive, sensitive, timely, equitable, and informed care. Unfortunately, that expectation often falls short.

erica-olivier-quoteI am sad to say I have many examples of discrimination while seeking care. One particularly impactful incident unfolded when I sought help for significant bleeding and pain. In an appointment with an OBGYN specialist, who was an older, white man, I felt dismissed and unheard. He never made eye contact, consistently talked over me while I explained my symptoms, and his tone was notably dismissive. He used complicated medical jargon and refused to acknowledge my concerns, suggesting I ‘wait and see’ until my cycle ‘leveled out’ on its own. It took relentless advocacy on my part to prompt further testing, eventually leading to the discovery of a large number of cysts on my ovaries, which required immediate surgery and cancer screening.

Leading up to surgery, I informed the nursing team, mostly young, white women, about my history of challenging blood draws due to weak veins. Despite this, they persisted in attempting to insert IVs into my arms, failing three times. Eventually, they conceded to trying another way to provide anesthesia. Expecting a mask or another approach, I was instead taken to the operating room, where I was restrained to the operating table. To my horror, my body and arms were strapped down. The staff continued their attempts eight more times. I remember tearfully asking them, repeatedly, to stop – confused as to why they weren’t listening. It took the intervention of a nurse, ironically a woman of color, to step in and halt the process. The team then resorted to a vein mapping machine, and finally located a viable vein.

The aftermath left me traumatized, infuriated, and in pain. I woke up to my arms covered in bruises. Why didn’t anyone listen to me? The cysts they removed revealed pre-cancerous signs, further emphasizing the significance of advocating for myself. It terrifies me to think about the potential consequences had I not insisted on being heard – a missed screening opportunity and the looming threat of untreated cancer.

As a strong, educated, and outspoken Black woman challenging the status quo, I recognize that not everyone shares the same capacity. Many women struggle to advocate for themselves in spaces where their rights are violated, yearning to trust in healthcare systems guided by Hippocratic oaths to ‘do no harm’ and ‘treat fairly.’ My story, though personal, echoes the experiences of thousands and further highlights the inexcusable situations and dire consequences of unchecked biases in healthcare. We bear a duty to the public, safeguarding their health and safety amidst the very real threats of racism, bias, prejudice, and oppression. Holding those accountable for our well-being is imperative for providing equitable, accessible, inclusive, and informed practices, treatments, and resources.


Unmasking Racism in Milwaukee's Health Landscape – By Bailey Murph

 

In 2019, the City of Milwaukee Health Department, in tandem with the city's Common Council, boldly declared racism a public health crisis. This proclamation signified a pivotal moment, recognizing the profound impact of racism on health outcomes, particularly for communities of color. Beyond individual behavior, this declaration solidified the department's commitment to dismantling laws, policies, and practices that reinforce racist power structures.

Milwaukee, often labeled one of the nation's most segregated cities, carries a legacy of systemic racism dating back to its inception. The history of discrimination against Black Milwaukeeans in housing, employment, education, and public services intertwines with the city's fabric. This systemic racism has sown seeds of segregation and ongoing disenfranchisement, leading to health inequities that persist to this day. 

Throughout history, communities of color have been excluded from each facet of society, through redlining1 and organizational practices. This exclusionary pattern, called systemic racism, has directly contributed to segregation and continued disenfranchisement of communities of color. As a result, many people of color lack access to essential components of good health, such as stable employment, affordable housing, nutritious foods, quality education, and fair healthcare. Studies also underscore alarming healthcare disparities for black patients, revealing lower likelihoods of receiving appropriate treatment, and preventive services and confronting biases that influence their overall care.

1Redlining is a term that describes the discriminatory practices of denying minority populations access to equal loan and housing opportunities (Foltman, L. & Jones, M. How Redlining Continues to Shape Racial Segregation in Milwaukee: 1930s Lending Map Reveals the Policy Roots of Housing Discrimination. (February 28, 2019). Accessed on February 8, 2024. URL: https://apl.wisc.edu/shared/tad/redlining-milwaukee

In particular, Black women have endured health discrimination dating back to slavery. When the field of gynecology was still being developed, Black women were subjected to nonconsensual experiments for the purpose of advancing research. This disturbing history echoes through time, contributing to the ongoing disenfranchisement, lack of bodily autonomy, racial disparities, and health inequities faced by Black women.2 Alarming statistics reveal Black women suffer higher maternal mortality rates, increased likelihood of late or no prenatal care, preterm births, and low birth weight babies compared to White women3. These stark health outcomes directly result from racial discrimination in healthcare. Studies expose implicit biases.4 ingrained in medical treatment toward Black women, perpetuating beliefs that they experience pain differently, and possess thicker skin, and stronger bones5. Addressing these biases is crucial for dismantling the persistent disparities in Black women's healthcare.

2Chinn JJ, Martin IK, Redmond N. Health Equity Among Black Women in the United States. J Womens Health (Larchmt). 2021 Feb;30(2):212-219. doi: 10.1089/jwh.2020.8868. Epub 2020 Nov 25. PMID: 33237831; PMCID: PMC8020496. 
3Hill L, Artiga S, and Ranji U. Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. KKF. 2022 Feb. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/
4Implicit bias is the attitude or internalized stereotypes that unconsciously affect our perceptions, actions, and decisions. These unconscious biases often affect behavior that leads to unequal treatment of people based on race, ethnicity, gender identity, sexual orientation, age, disability, health status, and other characteristics. (https://www.ncbi.nlm.nih.gov/books/NBK589697/)
5Jones SCT, Anderson RE, Gaskin-Wasson AL, Sawyer BA, Applewhite K, Metzger IW. From “crib to coffin”: Navigating coping from racism-related stress throughout the lifespan of black Americans. Am J Orthopsychiatry 2020;90:267–282. Crossref, Medline, Google Scholar

Milwaukee's declaration against racism as a public health crisis signifies a transformative commitment to dismantling entrenched disparities. The city's history, woven with systemic racism, demands comprehensive reform. From redlining to biased healthcare practices, the impact persists, underscoring the urgent need for equitable, accessible, and inclusive systems. This narrative is not just Milwaukee's; it resonates nationwide, reinforcing the importance of addressing and rectifying the deep-seated roots of racial health disparities.
 

Initiatives for Change: Birth Outcomes Made Better (BOMB) Doula Program
 

In 2019, the City of Milwaukee Health Department launched the Birth Outcomes Made Better (BOMB) Doula Program. BOMB Doula is dedicated to supporting healthy pregnancies and nurturing healthy babies, with a particular focus on improving birth outcomes and maternal health, especially for Black pregnant and birthing individuals facing infant mortality rates three times higher than their White counterparts.

The BOMB Doula Program extends vital support and education to Milwaukee families, guiding them through the journey from prenatal care to 12 weeks postpartum. By addressing disparities head-on, this initiative strives to reshape the narrative, fostering a future where all individuals, regardless of race, can experience childbirth with dignity and equal access to quality healthcare. For those interested in signing up or seeking more information, please contact the Milwaukee Health Department at 414-286-8620. Let's embark together on the path to healthier pregnancies and equitable access to quality healthcare, starting right here. 


 

The Authors:

Erica Olivier

Deputy Commissioner, Community Health

Bailey Murph

Deputy Commissioner, Policy, Innovation & Equity

Both Murph and Olivier are integral figures within MHD, driving the department toward success and ensuring equitable health practices in Milwaukee.

This blog post marks the beginning of a recurring series within The Beat, aiming to spotlight the profound impacts of racism on public health. Stay tuned for more enlightening discussions on this critical issue.

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