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.

Racism in the Ranks: Discrimination in the Armed Forces

Toni Morrison in her novel Home, tells the story of Frank Money, an African-American Korean War veteran who returns home and is forced to battle racism.  Frank, like so many other veterans, suffers from Post Traumatic Stress Disorder.  The men who fought in the Korean War witnessed countless acts of violence and returned home severely emotionally damaged. Frank as an African American was not only forced to endure battle and the loss of his best friends in Korea but racism as well. 

According to the Korean War Legacy Foundation, racism towards African Americans servicemen remained a concern during the Korean War. Just two years before the United States became involved in the conflict in Korea, President Harry Truman signed Executive Order 9981 officially ending segregation in the armed forces. Truman believed that African-American troops were honorably risking their lives and deserved to be treated with the upmost respect. Unfortunately, many high-ranking military leaders simply ignored the President’s new legislation, as many units remained segregated.

Although this was a major step for African-American civil rights, acts of racism towards black soldiers did not cease.  In an article titled Black and White in Vietnam, Gerald F. Goodwin of the New York Times wrote of time he spent with soldiers during the Vietnam War, which took place years after the conflict in Korea. Goodwin explains that African-American soldiers were frequently denied promotions and were more severely punished than their white counterparts. For only making up 11 percent of the total servicemen in Vietnam, African-Americans accounted for 34.3 percent of court-martial punishments.  Not only were black soldiers unfairly punished, but also assigned to more dangerous posts. This inequality resulted in African-American deaths representing 25 percent of all of the American deaths in Vietnam. In light of the discrimination that took place in Vietnam, one can estimate the magnitude of inequality that took place during the Korean War.

Soldiers willing to lay down their lives in service of their country should be hailed as heroes, regardless of their ethnicity.  The acts of courage displayed of African-American servicemen often went unnoticed and unrewarded.  However, African American soldiers returning home from World War II were treated with far less hospitality than they truly deserved.  Isaac Woodard Jr. fought bravely in the United States Army in World War II and was honorably discharged and returned home to the United States. Only hours after being discharged, Woodard was pulled off of a bus by police and was beaten, resulting in the loss of his eyesight (Korean War Legacy Foundation).  Woodard’s story was not the only heartbreaking atrocity that took place. However, his story is noted as a major reason that Truman signed Executive Order 9981 into law. 

Frank’s PTSD in Home is attributed to the loss of his fellow soldiers in battle and the killing of a defenseless Korean girl. It is without question that Frank is an imperfect man. He committed an unforgivable act of violence that clearly haunts him and is a main cause for his alcohol abuse. However, Frank is also a victim. He witnessed the deaths of some of his best friends and was forced to deal with the added stress of being an African-American in the armed forces. I possess a great deal of sympathy for Frank. I believe him to be a good person who was unfortunately jaded by racist beliefs of the time.  He protected his sister since he was just a boy and felt a great deal of guilt for leaving Lotus and enlisting in the military. A man who feels guilt by engaging in a selfless and honorable act cannot be bad person by nature. His environment and experiences twisted him into a man capable of killing an innocent girl. I believe that Frank is a complicated character who was coerced by racist institutions into becoming a man of sin.

After all Frank Money is a fictional character, but he represents a generation of African-American veterans. He is an analogue for veterans who chose to fight for their country even though their country treated them as less than human. I consider this act of the highest honor. As a descendent of veterans, I understand the sacrifice and selflessness of fighting for a country. Racism and discrimination is unacceptable, especially when it occurs to brave men that are willing to leave their lives and families to protect their nation. The military owes these men immense gratitude and reform. President Harry Truman realized the sacrifice of black servicemen and began to repair a broken system with the signing of Executive Order 9981.  In modern times, discrimination remains present in the armed forces, as Carla Herreria reports that black soldiers are currently two and a half more times as likely to be punished through a court-martial or nonjudicial means than their white counterparts. Even though discrimination remains prevalent in the military today, efforts should continue in order to make sure that African American heroes are being treated as they rightfully deserve.

Knowledge and the Ability to Notice

Dionne Brand once said, “My job is to notice… and to notice that you can notice.” The ability to notice involves observation and understanding.  “To notice” seems like a simple task but is a difficult skill that can be strengthened. For example, one day it was pointed out to me that one of my best friends used the word “like” very often. Even though I had never noticed this trait before, everyday thereafter I noticed and was frustrated by the overuse of that conversation filler.  I believe that this same approach can be used to help eliminate racism. If everyone could be educated on atrocities that have occurred in the past they are far more likely to realize similar situations and avoid them in the future.  Everyone is responsible to educate him or herself and notice acts of racism so that they can begin to combat it.

I believe that the skill of noticing is paramount in changing societal views on race. If we as students, and ambassadors of change, can understand the formation and origins of race, we can begin to affect positive change.  Geraldine Heng wrote in her book The Invention of Race in the European Middle Ages, “…race is a structural relationship for the articulation and management of human differences, rather than substantive content”.  Human differences are evident, but the foundations of race as we know it were set in place to elevate some and reduce others. Now that race has been defined as a structural relationship, observers can begin to identify acts of racism. Once acts are identified as racist to the general public, actual informed action can take place to prevent it. As a member of a group of people that experiences little discrimination, not all acts of racism were obvious to me. By learning more about racist acts in the past, I have gained a new ability to notice the numerous acts of racism that occur everyday without being noticed by ignorant bystanders.  Knowledge is a tool that is paramount in importance in terms of combating bigotry.

My prior belief of medical professionals is that they are some of the most knowledgeable, caring and selfless people in today’s society.  Harriet A. Washington has shaken my assumption in her book Medical Apartheid. It was a shock to me that doctors, in our not so distant past, treated African-American patients with such negligence. Washington tells of a story where a doctor “decided to amputate the leg of a fifteen-year-old slave girl without making any other attempts to treat the relatively minor injury”.  Previous to embarking on this journey I would have taken a doctors decision to be irreproachable. However, this act was willingly malicious to a poor girl who happened to be born with a darker shade of skin and it opened my eyes to the racism present among people devoted to healing.  This education has allowed me to be more cautious of those I believed to be antiracist, and notice racism in the future.

I fear that without proper knowledge of past atrocities in the medical field, new medical professionals are unequipped to notice discriminatory acts. Dr. Lisa Cooper of John Hopkins University School of Medicine conducted a study that showed that nearly two thirds of doctors exhibited unconscious racial bias. These doctors lack the ability to notice their own discriminatory acts against certain races. I do not believe that the majority of doctors see themselves as racist but are subjected to the effects of racist professionals in the past. I believe that is should be every physician’s own responsibility to educate himself or herself in order to notice that they are providing preferential care. The racism demonstrated by the doctors in the study may be unconscious but through education they can begin to “…notice that you can notice” as Dionne Brand has put it.

I enrolled in Literature, Medicine and Racism because it was a topic that was previously foreign to me. As a student applying into the medical field, I have not been informed on the racist past.  I have been educated to think about physicians as scientists who pursue knowledge in order to better aid humanity. Of course, this has not always been true. In order to become a physician who combats racism instead of perpetuates the system of racist traditions I must become educated on the immoral history of the field. A philosopher named George Santayana, has explained that “Those who do not learn history are doomed to repeat it”. This quote inspires me to learn as much as I possibly can about the shortcomings of the profession that I am soon to enter, so I gain the ability to notice every act of racism and do everything in power to correct those actions. I vow to become more informed to strengthen my ability to notice and enlighten others that they to have the ability to notice.