On Ferguson: A Call to Medicine

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There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest frustration and bitterness mire the work we do – trying to forget, but ever-reminded. So although there is nothing new to say, perhaps there is something new to do.

Here, I am looking squarely at you, my fellow physicians. We, who deal in health and disease must think critically and act effectively to address the issues raised by the death of Michael Brown and those who came before him. We are the trusted public servants charged with protecting the populations in our care, to promote health and prevent and treat disease. But are not health and disease simply the crude boundaries of life and death? Then, how will we move to protect the lives of black and brown youth that are threatened by violence? How will we confront the reality that the #1 cause of death for black males aged 10-24 is homicide? What are we doing about the death rate for young black males that is the highest among all adolescents in America? Black male teenagers are 37% more likely to die than any of their peers. And according to the CDC, because these deaths are secondary to external injury, they are by definition, preventable.

So I will ask again, what are we doing about it?

Because, despite the vaccines given to ward off the threat of disease, and the medications prescribed to prevent seizures, kill cancer, and treat infections, black males may not make it out of adolescence alive if we don’t address the violence.

In preventative medicine, we talk about risk factors to identify patients who may suffer from an illness in the future, and prevent it, before suffering and/or death could ever occur. In oncology, we talk about getting to the diagnosis and treatment early, so that in cases where it makes a difference, everything that can be done, will be done. And yet, as black youth die in the streets because of where they live, and how they dress, and the volume at which they listen to their music, we are silent. We, as a collective field, say nothing and we do nothing.

Black lives matter because all lives matter and no one gets that more than we do. So as young black bodies line our streets without reason or recourse, we must start asking what that means for all of us. We must start changing the way we teach and practice medicine. Because if we fail to protect these youth, because we don’t understand their music, or we don’t like the way they dress, or we don’t feel comfortable with the way they speak – whatever the because – then we fail ALL of our youth. We fail to do service to the highest honor of our profession, to protect the lives we care for.

Now, this issue is complicated and deeply rooted in the legacy of discrimination that defines American history and continues to inform America’s present. And you may even avoid talking about it in your personal life, let alone your clinical practice. But your, or my, discomfort does not make it any less our responsibility.

So let’s start dealing with it. I’m talking about poverty. I’m talking about racism. I’m talking about structural inequality. I’m talking about the gender wage gap, the academic achievement gap, and the housing equity gap so wide whole generations fell in and got lost. It is time to engage these topics as legitimate and enduring parts of medical education, public health messaging, and clinical prevention strategy.

No excuses.

If you don’t have the faculty to teach this material, call upon our colleagues in the social sciences to share their expertise. If you don’t know how to address community violence, reach out to non-profits who have made this struggle their life’s work. And if you shy away from the institutional failings that underlie the policies that contribute to the disparities, then call on your local, state, and federal policy makers to change the law.

There is literally no time to waste. Every faceless, nameless brown child who drops dead in the streets could have and should have been prevented. Let this issue not settle in the subconscious recess of our field while children suffer. Because in the end, it is not about Ferguson, it is not about Michael Brown, it is not about the countless others who met a similar fate, it is about what we are doing to ensure that all lives matter, regardless of the color of that life’s skin.

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The Final Word on Black History Month: My Manifesto

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Every February, some of you invariably ask, why do we have Black History Month? Predictably, some of you will pose this question to the black people you know. As a black person, I offer you my final word on the subject, my manifesto, if you will.

Why Black History Month? Consider these reasons.

#1. You don’t know black history and if you are an American, that means you don’t know part of your own story.

The struggle to teach African-American history in our children’s classrooms continues. Take Chicago Public Schools, for example. They represent the 3rd largest school district in the country and despite having a mandate to teach African-American history for more than 2 decades, it was not until December of 2013 that they officially announced plans to implement a formal, yearlong, integrated African-American Studies curriculum into their public schools.

Without normalizing and institutionalizing African-American history into our collective forums for public discourse, we segregate ourselves from the breadth of the American experience. In so doing, we fail to capture an essential truth about America, that we are a multi-cultural, multi-ethnic population that has benefited from the contributions of people of color from our founding.* Every time we resist that central truth, we deny the very thing that makes us American, our shared history.

#2. You need to say thank you.

As does everyone who has benefited from the contributions of African-Americans to American life. Whether it be for the traffic light that safely regulated your morning commute (thank you Garrett A Morgan!) or the blood transfusion that saved your loved one’s life (thank you Charles Richard Drew!) or the vaccine that prevented your child from dying from a preventable illness (thank you Henrietta Lacks!), we must acknowledge the ways in which our lives are enriched because black people consistently made, and continue to make, defining contributions to our society.

And here I’ve only listed a few examples of notable inventions.

What of the impact of African-Americans on the evolution of music in this country? It is almost unquantifiable. From the folk music, bluegrass, and jazz that drew from the tonality of negro spirituals to the rhythmic beats of rock-n-roll, doo wop, disco, funk, soul, rap, and hip hop that emanate from urban America, African-American culture has created or influenced virtually every aspect of American pop culture through music, including the trending fashion, dance, and American vernacular that grew out of these popular genres. Just ask Elvis Presley’s modern-day protegĂ© Miley Cyrus. Twerkin’ ain’t easy and that charismatic rump-shakin’ didn’t start at the VMAs.

Generations of Americans are being raised in a culture that has deep and expansive roots in the African-American experience, but one that is equally devoid of public and enduring recognition of the contributions of African-Americans. Assuming the cultural expression of a group of people, without acknowledging said group, undermines their importance and in some ways, denies their humanity as it assumes they do not have the right to own their own expression. This is called misappropriation and it is the result of an amnestic historical memory, that is so short, it fails to encompass the areas in which our stories are linked and our lives find common ground. But fear not, the cure for misappropriation is simply a proper thank you.

And what of the countless unknown African-Americans who have given of their lives to protect the honor and safety of our country? Next month, President Obama will celebrate some of those men for their distinguished military service and award them the nation’s highest commendation given for combat valor, the Medal of Honor.** If the President’s actions here may serve as an example, when people give of their time, service, and sometimes their lives, for the betterment of our free republic, we must, even if belatedly so, say thank you.

Finally, I think it generally true, that when you honestly appreciate another person’s culture and life and consider their past and their future indelibly connected to your own, you are less likely to instantly think them a criminal, and “stand your ground.” Perhaps what we should “stand our ground” for is the recognition of the humanity in each other. Because when you appreciate people, you don’t shoot them and if Black History Month offers nothing else, perhaps it can serve as a moment for you to embrace African-Americans and in so doing, help bring our sons home safely at night.

#3. You don’t know black people.

If you keep a running tally of how many black people you know or feverishly defend the fact that you “have black friends,” you may not have had the intimate interactions that allow you to disconnect individuals from the stereotyped characteristics you associate with their race. In other words, if Joe is your “black friend,” he’s not really your friend and you don’t really know Joe.

But that’s okay. Perhaps you live in one of the few ethnically monolithic enclaves in our country, or somehow your only exposure to black people has been through The Cosby Show, or The Chappelle Show, or when Kanye upstaged Taylor. If this sounds like you, maybe it is time to branch out, meet new people, new BLACK people, and see what all the hype is about. The African-American experience is as varied as it is rich and our limited representation in the media doesn’t nearly approximate what it might be like to actually know us, dine with us, laugh with us, grow with us.

On a deeper level, if, as a society, we continue to live segregated lives in which we form ethically homogenous social circles, we will never have a basis from which to collectively digest, interpret, and process the complicated transactions that take place between the disparate cultures represented in our communities. Furthermore, challenges that require understanding another culture’s experience and the historical impacts of institutionalized discrimination, like for example, health disparities, or the educational achievement gap, or the disproportionately low rates of African-American women in the health professions, or the disproportionately high incarceration rates of African-American males, will remain insurmountable.

#4. You don’t like black people.

And frankly, black people may not like you either. And yet here we are, continuing to co-exist. So what should we do about it?

Get over it!

There is a reconciliation that needs to occur around issues of race in America and I’m not talking about tolerance. Tolerance is complacency in the face of continued unrest. It is offering separate but equal, instead of demanding that equal be the standard for equal. To heal the massive division in this country around racial injustice, we have to actively confront our bias to move on, even when that bias is unconsciously harbored.*** Black History Month offers us the first step to do this. As the great American poet, Maya Angelou said, “History, despite its wrenching pain, cannot be unlived, but if faced with courage, need not be lived again.”

Today, we face continued affronts to equality in this country as some Americans seek to marginalize groups they just don’t like. Look what is happening in North Carolina and Ohio to undermine voter’s rights, or in Arizona, where a bill to refuse service to gay Americans made it all the way to the Governor’s desk before being vetoed! Here, our broken history repeats itself and if we aren’t careful, we may all eventually find ourselves less free to pursue liberty and happiness. As Dr. King said, “Injustice anywhere is a threat to justice everywhere” and we must take a lesson from black history to see the trend repeating itself and threatening all of our freedoms. The solution is to challenge prejudice at every point it rears its ugly head, starting with ourselves.

#5. You are black and yet you feel disconnected from the African-American experience and the Africana Diaspora.

When historian Carter G. Woodson started Negro History Week in 1926, it was a part of a larger effort to cultivate ethnic pride. As the trans-Atlantic slave trade scattered Africans across the western continents, it violently divorced black people from the rich ancestry that informed who they were. The absence of that foundation created a dangerous space for black people to be defined outside themselves, by their new roles and their new lives.

One dynamic of racism that is as inconspicuous as it is pernicious, is the effect of internalized racism on the African-American psyche. It is the wilted acquiescence to the accusers taunts, that you are as they say you are, be that ignorant, useless, dirty, ghetto, lascivious, pugnacious, unworthy, or unlovable. Internalized racism breeds a self-hatred that dissolves the bonds between people who share the detested characteristic.

In short, racism shames blackness.

And internalized racism is the insidious acceptance of inferiority. It acts to separates people from their value and their ethnic community.

For these people, for us, Black History Month is a moment to affirm and accept our value; to remember who we are and where we come from. Despite the positions of poverty and war in which many of our peers struggle today, both here in urban America and abroad in Latin America, Haiti, and Africa, we are not how and where we live. Our worth is not defined by our struggle but rather by the fervor with which we reclaim what has always been our gift, our blackness.

Now, I am not as presumptuous as to conclude that a month is sufficient time to heal a pain that stretches centuries into our past and finds new meaning in the systematic marginalization of black people across the globe. But I will say this, we have to start somewhere and we need to start together. Perhaps, at its very best, this month can cultivate the ethnic pride needed to combat racism, whensoever, and howsoever, we may face it. Because when you don’t feel worthy, you don’t act worthy and racism has become a self-fulfilling, self-injurious prophecy in the African-American community, and I would argue across the African diaspora. It is time to mend the broken fences in our community, to let people in and heal together. Let this be our chance.

Here’s my final word.

As the thread of African-American culture weaves throughout the American experience, it informs who we are as a nation. While a month is hardly sufficient time to truly appreciate the weight of the African American influence on American culture, perhaps it can serve as both a reminder and an invitation:

A reminder to engage in the self-exploration required to overcome the distraction of modern racial discourse that dichotomizes and compartmentalizes our history in a way that disconnects the culture we consume from the historical process by which it was created;

And an invitation to collectively share in the creative brilliance, ingenuity, and public service that defines the contributions of Black artists, musicians, writers, activists, playwrights, poets, scientists, philosophers, physicians, engineers, civil servants, lawyers, filmmakers, educators, servicemen and women, entrepreneurs, athletes, and entertainers.

These contributions enrich our experience as Americans. So on this, the last day of Black History Month 2014, let this be the start of celebrating our shared America history. Because, we, too, sing America.

* Although I must clarify here, that sovereign nations existed on this soil prior to the arrival of Europeans or Africans and the true founding of this land must always be credited to the Native, indigenous people of this continent.

** This award was also given to Jewish and Hispanic soldiers who were previously overlooked for recognition because of discrimination.

*** If you are ready to confront your unconscious bias, take the Harvard Implicit Association Test here!

Trayvon

Though much has been said, I feel a need to publicly recognize what has happened. Publicly. For when time has pacified our resolve and memory fails to do justice to the pain we felt, and new problems have filled our consciousness, so in that space, in that unformed future, even there, there is some record, some institutional recognition of what happened to Trayvon and why it mattered. Even if that institution is just the internet. And the memory is just my blog.

It was like the taste of blood in your mouth when you cut your gums with floss. It tastes strange, but familiar. It is less a wound, than a numb reminder of your sensitivity. You know it shouldn’t be there and yet it has always been there, pulsing under the surface.

I am of a generation that had forgotten. A generation whose survival did not depend on the stories of my grandparents or great grandparents or great, great grandparents, ushering me to safety with the shield of their experience. No one had to teach me how to live in a world where black men who upset white sensibilities were killed without reason or retribution or where black women existed as both the object of white men’s desire and their disgust. We were beyond that. I was a classmate, a peer, a colleague, and a friend. Race informed my life. It defined many of my experiences. But it is not my life. I do not wake to escape the burden of my race every day and succeed in spite of it. I am of a generation that with the right dose of education and opportunity have been enriched by my experience of race, emboldened by the history of my people, and empowered to define my own path.

And then there was Trayvon. Well, there was Rodney King and Amadou Diallo and Sean Bell and Oscar Grant…and then there was Trayvon. And those are only the ones who come to the top of my head as I write this and the ones who have been named in the news. What of the others? What of the nameless, young brown lives lost every year in Detroit, Saint Louis, Oakland, Baltimore, and Chicago? What of the more than 50% of African American males aged 10-24 who will die of homicide in the US?

And what of those who live? What of that time Henry Louis Gates Jr. was arrested outside of his own home in Cambridge and when Academy Award-winning actor Forest Whitaker was falsely accused of shoplifting and frisked in a NYC deli? And those are only recent examples of the most famous and prestigious among us. I mean, President Obama even admitted to being the undeserving target of fear and suspicion.

What of my own father who was asked to get out of the car for an impromptu frisking after being stopped by the police, despite our entire family being in the car, being in our own neighborhood, and never being issued a ticket or citation for any wrongdoing. I was only 8. When he returned to the car, I learned a different kind of silence – the silence of shared understanding, fear, confusion, and sadness.

Those are the small slights, the micro-humiliations you suffer when what you want to be melts in front of what you are. They are what Maya Angelou has called the “unnecessary insult.” What Jelani Cobb referred to as “an extended paraphrase” of history, where the unwelcome past lives all too comfortably in our present. The words disappointment or disillusionment don’t nearly explain the feeling. How do you explain realizing you live in a world where you have to remember and you have to teach your children and children’s children to remember for fear of the consequence…Where the struggles of yesterday can instantly be made your struggle of today, if you are wearing the wrong hoodie on the wrong skin tone, in the neighborhood where that threatens your life?

Don’t wonder what the fuss was about. It was about Trayvon and it is about those who have gone before him – carrying the burden of our reminders.