Medical trauma is often defined as a traumatic event that has occurred from direct contact within a medical setting, and develops through a complex interaction between the patient, medical staff, medical environment, and the diagnostic (or testing) experience that can have powerful psychological impacts due to the patient’s unique interpretation of the event (Flaum & Scott, 2016). In the United States, medical trauma has many layered, complexing factors that also create a very unique, and deeply rooted historical disposition among Black Americans. “Every day, Black Americans have their pain denied, their conditions misdiagnosed, and necessary treatment withheld by physicians (Bajaj & Stanford, 2021).” How much of this pain is often denied by physicians?
To place this issue into a brief series of historical contexts, in the early 19th century (1820-1827), prominent white physicians toured the American South to distinctly establish “physical peculiarities” between the “difference of color” in people among those of African ancestry (who were enslaved at the time) in comparison to those of European ancestry (Tidyman, 1826). These physicians noted that those of darker skin complexions possessed thicker skin, making them less susceptible to pain, and arduous labor even in the “unhealthiness of hot climates (Tidyman, 1826).” In World War II, enlisted Black, Puerto Rican, and Japanese U.S. Army soldiers were singled-out for a secret chemical experience using mustard gas, in order to see the effects of exposure to the chemical agent in comparison to unexposed White soldiers (Dickerson, 2015). In one part of the experiment, military officers locked these soldiers in a wooden gas chamber that piped in both mustard gas and a similar chemical agent called lewisite (Dickerson, 2015). The experiment resulted in permanent damage to many of the soldier’s skin, nerves, lungs, and even DNA that inhibited their body’s cells to effectively repair themselves. In total, there were 3 types of mustard gas experiments: gas chamber, skin tests (mustard gas was applied directly to the skin), and field tests (soldiers were exposed to mustard gas in a simulated combat setting). Mustard gas is a known carcinogen (a substance capable of causing cancer in living tissues), and exposure to this chemical agent can cause various cancers, such as those that occur in the throat, lungs, skin, and bones. None of the soldiers involved in the experiment were given follow-up medical care and were sworn to secrecy under the threat of being dishonorably discharged. In the years that followed, some men went on to tell about the inhumane experiments to the public and medical community, many were disbelieved.
In more recent times, history has repeated itself, such as in the case of world-renowned tennis star, Serena Williams. After giving birth to her daughter, Alexis Olympia in 2011, Williams required emergency surgery to remove a pulmonary embolism that was blocking her air flow. However, attending medical staff did not believe Williams, when she told them that she was laboring to breathe. In particular, her nurse believed Williams was experiencing psychological issues related to her pain medication. Following Williams’ persistence to conduct a CT scan and receive a heparin drip, she was given the proper medical treatment that she needed. Although Williams is a high-profile Black celebrity, her initial concerns were ignored. If it had not been for her persistence and prior self-education about possible birthing complications, Williams may have not survived the ordeal.
Institutional Action and Creating a Culture of Accountability
Racism is the major root cause of medical trauma among Black and other minority patients. It has been (and continues) to be strategically and systematically placed in society, as well as throughout a host of American healthcare institutions, which were designed to support, protect, and provide treatment for all individuals regardless of their racial and ethnic backgrounds. If racism were a virus, it would be responsible for the next pandemic, creating a crisis that even the best healthcare systems could not manage. Nonetheless, its systemic insidiousness could be considered a “social virus,” one that infects the body not by traditional pathogenesis (the process by which an infection leads to disease), but through a voluntary, intergenerational transmission of prejudice, fear, and hate stemming from the mind. For its victims, it can lead to a lifetime of mistrust of the medical community, causing a trickle-down effect of self-neglect (for fear of seeking out proper medical attention), undertreatment of health problems, and an overall shorter life expectancy. Since the American healthcare system often mirrors the racist practices, ideologies, and policies that occur in society, it is not until healthcare institutions explicitly implement anti-racist interventions with a shared language of anti-biased language in their governing policies will health outcomes significantly improve for Blacks and other minorities. In addition, healthcare institutions must support appropriate, professional repercussions, holding physicians and other medical staff directly accountable for failure to provide equitable services to their patients and families.
ABOUT THE AUTHOR: Glahnnia “Renee” Rates, MSHS, CCHW II
Renee is the Founder & President of the Black Community Health & Wellness Association of Nevada (BCHWA), a non-profit, public health organization. Renee founded the BCHWA, after a traumatic experience in the Southern Nevada healthcare system, as she saw a further need to provide the community with health education, support, and resources needed to improve health outcomes among black and other minority communities. She works as an epidemiologist, focusing on chronic and infectious disease prevention, and implements health equity-based interventions to reduce health disparities across the state.