By Täu Moon
There are many factors that engender potentially dangerous, even lethal, nuance in healthcare systems. Many of these often stem from the myriad differences in the composition of identity, character, background and phenotype from healer to patient or even from the agent to the influenced. The primary factors serving as this work’s foci are environmental, linguistic, and ethnological dissimilarities and how, comparatively, they offer change in prognoses, for better or worse. Even something as simple as sharing some of the same physical features makes a significant difference in both treatment and prognosis. We see this illustrated quintessentially in the case of black women, as pointed out in a lecture by Dr. Weed; did you know that when concerning African American female patients in healthcare several times over? No biological differences created by race and still a huge gap in the quality of health services different races experience… In a perfect world there’d be no implicit biases or other factors contributing to the prevalence of medical inequity and lives wouldn’t claimed unnecessarily. It is because of our world, the medical world, is not free of constraint surrounding prejudice and inherent biases that create a preservative imperative. The Southern Oral History Project is something I believe to not only be a means of retaining an otherwise fragile history, but a beacon of acknowledgement and a call to action.
Differences in Environment
Geographical isolation is hailed by biologists to be a means of acting as a form of incompatibility between organisms, just as it is paralleled in institutions of catharsis and care. Furthermore, isolation in rural healthcare systems, especially that of rural southern locales introduces a threat as well. Changes and lack of similitude from one to another in such places is assigned a negative connotative value by default at onset and is comparable to a proverbial supply of oxygen to the flames of bias that consume the psyches of both healer and consumer. There is certainly a psychological, push factor that looms above marginalized identity groups and often contributes to fear and dread produced when needing to collaborate or form a relationship with a medical professional. This is best elucidated with the following metrics:
- Black women are more likely, anywhere from 300% to 400%, to experience pregnancy-related death than white women.
- Black women experience physical “weathering”, a condition making their bodies appear to age faster due to chronic stress linked to socioeconomic disadvantage and discrimination, which makes pregnancies at younger ages riskier.
- In a study funded by the Institute on Minority and Health Disparities, it was discovered that Native American death rates for heart disease, stroke, and diabetes are ten (10) for the first and second and seventy (70) percent higher for the latter than that of their non-Hispanic white counterparts.
These statistics just barely scratch the surface of the statistics on people of color (POCs). Native Americans, to their credit, try to maintain independence and self-sufficiency, having their own infrastructure and empirical medical knowledge. However, when medical ailments and conditions prove too challenging or difficult than their systems are able to handle, they are flushed out of their homes and into the cold, bright white, sterile halls that, more often than one would think, wind up becoming final destinations. We see that these corridors are secular and self-important, and more often than not wind up not collaborating with native medical tradition, the lack of empathy leading to a reluctance to participate because of this infantilization of sorts.
Observing the statistics gleaned, it’s obvious how inherent this unnecessary negativity, almost equivalent to that of a punishment there seems to exist for not being a non-Hispanic white male, whose metrics notably are considerably better superficially than POCs, especially the ones denoted in the facts above. But why does all this matter? It matters because there is no reasonable factor that provides evidence for the medical lack of positive egalitarianism in the healthcare system that could level these metrics for the good of everyone who must enter the system for supposed survival.
The language barriers presented by immigration or cultural differences are veritably detrimental to the provision of quality healthcare or cathartic services. As more and more people take up new identities, the obvious need for bilingual healers has been listed as an obvious threat to positive prognoses. A study by Medscape will serve as the example: when over four thousand United States healthcare providers we asked in a survey about how they meet multilingual needs, a reported 16 percent answered, ‘I don’t know’. Nearly one in every four have contracts with telemedicine services as interpreters. Around one in every three asked about the patient’s primary language at intake to prepare for tackling those differences. Given that the not only American, but International demographic is predicted to shift, such that multiracial people will be the ‘majority,’ meaning medicine will need to evolve with this change; hiring language-competent professionals. It will save money, decrease interdependency that slows operations, and allow institutions to consolidate. It was reported that only 60% of physicians, compared to nearly 80% of nurses, have a formal plan to meet language needs and while this number could be much lower; it could be worse, it is unacceptable. Like the canary in the coal shaft warning miners of impending danger, patients with limited English proficiency may be the harbinger of challenges that go beyond language differences.
The situation worsens. A study performed on the impact language barriers has on mortality from a diverse and immigrated population, in which eight regions of the world were considered, was conducted in Canada. It reports that acute complications and cardiovascular event (ailment) was significantly high enough not to be able to attribute the results to chance. The most popular languages in the United States are English and Spanish and given that multiracial identities are to be the majority as populations begin to shift, it is imperative that there be at least be some forethought to battling perhaps the strongest intangible barrier among providers and consumers of healthcare. Even AAVE, black-exclusive language gained via being raised, assessing stigma attached to it, poses a language barrier in and of itself.
Comparison of Healthcare Systems / Ethnological Roles
A comparison of healthcare and reasons for these differences may help illuminate the issue at hand, the social determinants of healthcare. In the case of Lata Chatterjee, an overworked Chinese American professor, she developed mononucleosis and presented with lethargy, eventually unable to work and at physicians’ mercies. They poked and prodded, testing for tropical and African diseases under an incorrect assumption of her racial identity, while taking a toxically paternal role in her healing. Chatterjee had the fear that being ignored because of sexism would kill her. It speaks volumes about needing not just better care for underrepresented groups, but the vitality of a standard of healthcare that would increase unilaterality and thus equity. Later in her verbal testimony she speaks to the vitality of adaptation for immigrants’ survival. Survival wasn’t just a test for one person or group of people; Angela Salamanca, restauranteur, activist, artists, innovator, and mother details her experience with American Insurance as parasitic. For just two days’ mandated stay, she had a $3,000 bill, which encouraged her switch to alternative medicine like acupuncture and methods passed orally and intergenerationally. Colombian healthcare differs much from how it is in the States. For example, instead of going to big hospitals, in most cases, Colombians saw family doctors, one person in the family with esoteric medical knowledge and experience capable of taking care of the whole family. That, barring the large building this would likely take place in and its sterility, would certainly have legal ramifications in the US due to the Hippocratic Oath. It places contingency on the section prohibiting the use of extraordinary measures to save a patient, which undoubtedly would occur given the familial bias. “I never had a good experience [with insurance]… it’s expensive because it’s so complicated with copays and deductibles. I wish I could opt-out. I don’t see any value in it,” says Salamanca.
American and Colombian healthcare do share this in common: in a class-based system like this one, whoever has the most money and connections got the best care, which automatically puts the financially unstable, whose limitations and lifestyle choices available already pose a threat to their health at a built-in disadvantage. In what was referred to as a patchwork non-system of intertwined ideas for healthcare that all eventually come to negatively impact the people who depend on it, it is much easier to use the outside-looking-in perspective Salamanca has to understand the need for a change in ideology. Ideological heterology in healthcare systems allows readers and consumers of these works to draw their own conclusions as to the quite mortal threat that is imposed by participation in institutions composing the United States’ medical infrastructure.
Healthcare is an institution that, in America, is nowhere near perfect. Unnecessary deaths, inequitable complications, skewed morbidity, and poor judgement plague its operation and those who fall into the hands of workers as well. Intangible barriers like the ones discussed pose an enormous threat to getting the best care possible, which should be the goal of each and every worker in the healing profession, but they so frequently fall short because of the inability to subordinate these challenges with competence. It is because of the dangers that lie in the labyrinth many feel they must traverse to advocate for themselves, they ensure that their stories, their culture, important segments in lives are shared, so that things like improving staff and cleaning up the more gruesome numbers that these healers carry with them, and action because of things being brought to the right people’s attention don’t stop; that trials and hoops these storytellers and researchers had to jump through aren’t for naught. That perhaps someday another generation can use a primary source to understand their background, their heritage, and all it took was an interested student, digital passerby, or future professional to take the time to listen.
 Caldwell, David. “U-0518”. Southern Oral History Project, 2011. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/6871/rec/1.
 “Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities.” National Partnership. National Partnership, 2018. https://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html.
 Kimes, Caroline, et. al. “Lessons Learned in Community Research Through the Native Proverbs 31 Health Project.” NCBI, 2014, doi: 10.5888/pcd11.130256.
 How Healthcare Providers Meet Patient Language Needs. Baltimore, MD: Centers for Medicare and Medicaid Services, 2017. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Issue-Brief-How-Healthcare-Providers-Meet-Patient-Language-Needs.pdf.
 Partida, Yolanda. “Language Barriers and the Patient Encounter.” AMA Journal of Ethics, Aug. 2017, https://journalofethics.ama-ass.org/artical/language-barriers-and-patient-encounter/2007-08.
 Chatterjee, Lata. “Y-0084”. Southern Oral History Project, 2016. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28325/rec/1.
 Salamanca, Angela. R-0820. Southern Oral History Project, 2015. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/26860/rec/1.