Sick with Sickle-Cell

Harriet Washington, in Medical Apartheid, recounts the story of Walter Clement Noel. In 1904, Noel was a first-year dental student from a wealthy black family. He was admitted to a hospital for pain, bruising, and sores along with other symptoms. Noel was diagnosed with Herrick’s anemia, which is known today as sickle-cell anemia. At the time of the diagnosis, James B. Herrick the attending physician published the findings and also claimed “…Noel’s was a disease that struck only blacks” (Medical Apartheid, 155).  Unfortunately, this inaccurate idea was soon widely accepted in the medical community and set the stage for sickle-cell to be a facet of systematic racism in the medical field.

During my undergraduate education as a student majoring in biochemistry, I have had the opportunity to study sickle-cell anemia. I have become familiar with the molecular and evolutionary basis of sickle-cell. Sickle-cell anemia affects the hemoglobin of red blood cells and causes them to have an altered form. According to Meredith Wadman, of Nature, the sickle-cell gene is a mutant “S” gene that replaces the normal “C” gene. People that have two copies if the mutant “S” gene, exhibit red blood cells that have a “half-moon shape” and altered function.  Wadman also explains that people who carry one of the “S” genes do not typically exhibit symptoms of sickle-cell but are less susceptible to effects caused by the malaria parasite due to a slightly altered formation of hemoglobin.

Sickle-cell anemia in the early 1900s was wrongly used as evidence for the inferiority of black people as a race. Washington explains, “the erroneous belief that sickle-cell anemia strikes only blacks became fully entrenched, thus reinforcing belief in the inherent inferiority of African-Americans”(Medical Apartheid, 156).  Although sickle-cell anemia is characterized as a disease that disproportionally affects people of African descent, the high rates of disease are not due to any racial differences. The theory of evolution says that traits that are advantageous to the survival of an organism will have an increased frequency. The gene for sickle-cell is no different. People who resided in Africa, where the malaria carrying mosquitos are native, were more likely to survive if they carried one of the mutant genes for sickle-cell. Medical practitioners of the Noel’s time saw this condition as a disadvantage of the black race when really it is only present because it was advantageous. In addition, the sickle-cell gene does not exclusively reside in people of African descent but in all races. Washington describes it best by explaining, “…the common denominator of sickle-cell disease is not race, but living in proximity to the malaria bearing Anopheles mosquito”(Medical Apartheid, 155). Sickle-cell anemia is not based in racial differences but in ancestral location.

The idea that this disease was a physiological downfall of black people is not only incorrect but set up systematic racism in the medical community for years to come. In an article authored by Jennifer Adaeze Okwerekwu, the unfortunate truth about lasting systematic racism towards sickle-cell patients today is brought to light. As a third year medical student, Okwerekwu came across a sickle-cell patient in immense pain that had a fever and a cough that required treatments including fluids, pain medication and oxygen. She planned to ask her resident, her superior, to order these treatments. However, Okwerekwu then explains that she “… came to realize that she needed more than that: She had symptoms of acute chest syndrome, a leading cause of death for patients with sickle cell disease.” This may not seem that significant, but it shows the lack of urgency that medical professionals take with sickle-cell patients. Emergency room systems are supposed to match the most serious cases with the most experienced and competent physicians. Okwerekwu, who at the time was not a licensed doctor, raises the question “As sick as she was, why was I, a medical student, the first one to evaluate her?” The patient required urgent care by an experienced physician. The mistake of making the sickle-cell patient a low priority could have cost their life if Okerekwu was less capable and did not recognize the symptoms.

The medical care of the patient that Okwereku treated was simply not a priority for the medical staff. The racial history of sickle-cell anemia has caused a lack of priority in research and patient care.  In Okwereku’s article she comments on how research for sickle-cell is disappointing as well. “More people suffer from sickle cell than cystic fibrosis, but cystic fibrosis research gets 3.5 times the funding that sickle cell does.” Okwereku, as a doctor of color, states in her article that she is recommitting herself to treat patients equally and notice when her “attitudes have been wrongly shaped by racism, whether subtle or overt…” This lamentable story demonstrates one of the many ways racism remains present in our society.  Washington, throughout Medical Apartheid illustrates many ways in which racism plaques the medical community.  Hopefully, in the near future, more doctors will follow in Okwereku’s footsteps to continuing to notice and combat discriminatory practices.

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