END RACISM IN THE HEALTH CARE SYSTEM )
(A bold critique of the pervasive racism present in America's medical-industrial complex of the 1970's. Undated and uncredited.)
1. The Racism of Professional Medicine:
The character of the AMA is only a reflection of the whole of professional medicine and the barriers to entry into any of the health fields. Less than 2% of American physicians are black even though blacks constitute more than 11% of the nations population. No change is to be expected in the future, as most medical schools have less than 2% black enrollment. The AMA has consistently refused to take any position encouraging minority group entry into medicine nor has it done anything to censure those local and county societies which still refuse admission to members of minority groups. Much of the barrier can be attributed to the elitist admission standards to which most medical schools hold, but again, the AMA has refused to intervene to remove the white stereotypes from medicine.
The oppressive hierarchy of health workers is much more evident in the field of nursing. It is the common hospital where all RNs are white, L.P.N.s and nurses aides black and brown. The nurse is the victim of the doctors abuse and conveys it to those beneath her. Those subjected to the most oppression are those at the bottom; the sides, orderlies and maintenance workers. They have no protection under national or state labor relations boards, and as the many recent hospital strikes have shown,the right to unionize is one accepted eagerly by few hospital administrators. Earning pittance wages with no dignity or job security, hospital workers have been faulted at every turn in their attempts to organize themselves.
A major cause of worker dissatisfaction is the lack of upward mobility, in the health fields. LPNs cannot become RNs, RNs cannot become MDs, orderlies see little hope of entering medical school. The current calls for paramedical personnel may be necessary to alleviate the manpower shortage in some specialized areas, but any such program is racist if it continues to perpetuate the dead-end nature of hospital jobs. What we need are more workers to take care of patients, with a leveling of the hierarchy and more equitable distribution of responsibility for patient care. We need a new definition of roles, whereby access to any field is available to all who want to enter, not designated by social class or racial background. No longer can we tolerate a system which capitalizes on the oppression of others for personal advancement.
In the past dissatisfactions about working conditions and subjugation of workers have been cited as causes of inferior patient care. But as the contradictions of the heath care system grow glaringly obvious, hospital workers are finding common cause with poor patients, often serving as their advocates for grievances. Workers know well the attitudes expressed by many professionals towards poor people and the low quality or inadequate care which results.
II. The Duality of the Health Care System:
The privatism of the fee-for-service system allows the doctor to treat whom he pleases. As a top administrator at one Chicago hospital admitted publicly, "Doctors are people. Who wants to spend their time in Siberia(away from a medical center) with people who stink, cant speak your language and dont care about their health, much less about the things a doctor is interested in?
This attitude of contempt, characteristic of many private physicians results in the dearth of doctors to treat poor people, as in Chicago where less than 185 doctors practice south of Roosevelt Road, i.e., in the entire southern half of the city). This means that for many the emergency room may be the only available source of health care. Yet Illinois is the only state which requires hospitals to treat emergent patients seen in the Emergency Room. If the poor patient is seen upon presentation at the hospital, he most probably will only be given care necessary for life and then"dumped"on the large municipal hospitals. Such dumping of "undesirables" leads to situations where an average black in Chicago travels 16 miles to and from Cook County Hospital while living within one mile of the"white" hospital. Yet 50% of Chicagos black people can find hospitalization only at Cook County Hospital, due to color bars and quotas which exist throughout the city.
The poor or minority group patient may have fortunate access to two other sources of health care: the outpatient clinic or welfare doctor. The outpatient clinic may be run by a government agency or medical center, but in either case, the result is the same low quality medical service. They are treated by medical and nursing staff with undisguised condescension and punitive behavior, while they are expected to be grateful, for being given care. No personal responsibility for patients is assumed by the doctor, as patients see a new one each time. Patients are stripped of their rights to informed consent, confidentiality privacy and dignity; deprived of the protection of a private physician and in the case of the medical center, reduced to teaching material for the house staff. Feelings of dehumanization and experimentation pervade the clinic, as the patients are not educated about procedures to be performed nor warned of harmful effects. Revelations of practice such as the guinea pig testing contraceptives on Puerto Rican women prior to marketing further justify growing distrust of the professional.
The reasons for these attitudes on the part of physicians are apparent. They are taught on poor people, how to treat rich people. Little emphasis is placed on the special problems of poverty, the ecology of the ghetto. No respect is paid to the value of health as a community resource, although it not only affects demographic change and composition, but also affects the ability of individuals to function productively within the community. It is no coincidence that the high rates of deaths for blacks are in the area of communicable diseases and nonmotor vehicle accidents. Blacks are more than twice as likely to die from pneumonia and influenza and four times so in the case of syphilis.
The welfare doctor is the alternative curse of the ghetto ill. No policing has been undertaken by the AMA against such bankrolling, despite loud proclamations of such intentions (for instance, last year by the Chicago Medical Society). $7.50 payments for patient visits and $3.00 per shot (Illinois figures). Thus every patient gets a shot on every visit, whether medically warranted, or not.
The outstanding role that medical institutions have played in the oppression of poor, black and brown people is exemplified in the mental health field. Psychiatrist-as-cop is encountered frequently in jails, police stations, and the army. The definition of mental health is of its nature, racist. Medical staff have little perception of the stresses imposed by the environment, as distinguished from true psychological disorders. It has been shown that blacks tend to be categorized most frequently as paranoid schizophrenic regardless of their problems. This is of little consequence, for in most public mental health agencies: the psychiatrist serves only a cop-role of diagnosis for police purposes, with little thought of treatment. Frequently citizens arrested due to political motivation are quietly declared unfit to stand trial shipped off to serve indefinite sentences in mental institutions. Consider the state institution at Menard, Illinois, discovered to be holding hundreds of teenage boys, many former street leaders, due to their so-called maladaptive behavior .
Collaboration of medical institutions with police is infamous during riots and demonstrations. Records are perused without regard to rights of the patient to privacy and confidentiality. During the 1968 Democratic Convention, hospitals turned over lists of those seen for injuries in emergency rooms. In the recent murder of Black Panther leader Fred Hampton, the coroners office gladly cooperated with police in testifying that the body contained no drugs, whereas a private autopsy had previously showed over 2.5% Seconal present enough to have prevented his awakening. The hospital may also be the site of informal torture, as was done to Huey P. Newton when he was arrested in Oakland, California in 1967. Strapped by police to the table on both legs and arms, he lay in agony, as his wounded abdomen was brutally stretched and torn apart.
III. The Need for Racism:
Since the Kerner Commissions official declaration in 1968 that American society is racist, the American people have anxiously sought to come to grips with this statement, to assimilate it, to pervert it and to find more socially amenable alternatives to fulfill their racist needs.
No longer is the myth of the inferiority of the black man acceptable. Long nurtured by the scientific and medical communities, researchers in many quarters labored to prove the necessary premise that the black was indeed subhuman. As late as 1954, Dr. A. Carothers, an expert from World Health Organizations, stated: The African makes very little use of his frontal lobes. All the particularities of African psychiatry can be put down to frontal laziness. His notion that the normal African was a lobotomized European, followed closely from those of previous workers, such as Dr. A. Porot, who in 1939 claimed that the life of the African native was dominated by diencephalic urges. The collaboration of behavioral experts in the perpetuation of this myth has its most recent expression in the jensonist proposition of the possible existence of genetic racial differences as a basis for differences in IQ scores. For the most part, however, research of this type is no longer as easily funded, as a new, more egalitarian theory is sought.
Hence the argument of cultural opportunities becomes the new mode of expressing societys racist needs. The black is not subhuman; he only lacks the proper cultural background. On the government scene enters the new wave of liberal thought of 1960 and the host of government programs to repair the ladder of American success appear OEO, Job Corps, Teacher Corps, Headstart. They have all since failed and disappeared; for the basic fallacy of the argument was not exposed: the notion of opportunity implies from the beginning, an asymmetry of station the benefactor giving the seeker an opportunity. Such a stance denies the basic right of all men and women to fulfillment of their selves, to life itself.
And so the argument given in medicine anyone can enter medical school, regardless of color, provided HE IS PROPERLY QUALIFIED" No thought is given to the right of all people to health, health care and knowledge of their own bodies.
Clearly the theory of opportunity allows and encourages the perpetuation of our racist system, through both the racism of contempt by the ruling class as they assume the role of benefactor, and the racism of fear among the black and brown bourgeoisie, by promoting divisive competition instead of cooperation among all oppressed peoples.
The emphasis is placed upon the individual black man. It is his problem if he cannot get ahead. Such denial of basic class nature of his oppression and the group effort necessary to break it leads to fulfillment of his individual expectation failure. He must be satisfied with his low paying job, poor health care and dilapidated housing, for it is his own fault. It doesnt matter that he is denied entry into many unions and training programs, that there are few doctors who will deign to treat him, or that there is no "better" housing available in the ghetto in which he must stay. It is only through recognition of the collective struggle involved that he and his brothers will be able to join forces to effect change.
IV. An Approach to the Present System:
It is evident that our present health care system demands that a small group (the physicians) retain its authority as extollers of opportunities, while allowing a few to join its ranks in the interest of the myth. Within this system general betterment of . People ’s lives can only proceed under their discretion to decide which doors will open and which will slam shut.
To reorder our health care system, the myth of opportunity must be smashed. In its place must come the recognition of the right of all people to adequate health care and health training. To this end we call for:
1. Solidarity of health and hospital workers with patients to assume
control over those institutions with which they are associated.
Given all these expressions of racism in the health care system, what has been the response of the AMA and professional medicine? Opposition to all efforts towards change. They have refused to support those free community controlled clinics which do exist, while local. Health ”authorities” continue their harassment. In Chicago the clinics operated by the Black Panther Party and Young Lords Organization have been summoned to court by the Board of Health for non-licensure, while a survey revealed that over 60% of other clinics in Chicago have been running for years without Board of Health licenses. Only because these new clinics are operated for the people, without regard for the profit motive, they are being subjected to such harassment.
After great public relations from the Chicago Medical Society about its commitment to medicine for the poor communities, the Chicago Medical Society refused to grant any money to the Peoples Health Coalition, the coalition of free clinics in Chicago. Despite endorsement by Comprehensive Health Planning, a federal agency, of the high quality medical service provided by these clinics, CMS chose to decide that those clinics do not serve the community.
It is increasingly obvious that the AMA and its local affiliates are less than willing to keep their promises to poor people. Many groups have accepted responsibility for the health care of their own people, both those on welfare and those poor who cannot qualify for aid. They are growing more and more aware that professional medicine is the enemy .