“Yes, Yolanda,” I respond, pulling a chair and sitting next to her so I’m at eye-level. Yolanda holds her son skin-to-skin, his tiny body curled on her chest, a soft blanket covering him. She’s sitting in a chair beside his incubator, rocking him softly, quietly, the same way she does every day during her visits. “It can happen to your son. Anything can happen. But it will not happen today. Not today. Not on my watch.”
I reassure Yolanda, an African American mother whose son, Anthony, was born prematurely and is fighting for his life in the neonatal ICU. This mother is tearful. She is scared. She knows about the disparities in health outcomes of African American patients in our health systems. She wants to know, and rightfully so, if this will affect her son.
As her gaze searches for mine, questioning and uncertain, my response is one of calm reassurance. This is what I’ve been trained to do as a neonatal ICU doctor—give truth, however unpleasant, wrapped in care, assurance and kindness. But even as I present a self-assured front to Yolanda, inside, I do question if this assurance is true. Can I really deliver on this promise that her son’s treatment will be free of implicit bias? Will it be free from other components of institutional racism leading to health disparities? Just because I’ve decided to be conscious and intentional about identifying and avoiding implicit bias in my practice, does it make a difference in Anthony’s life if we do not all decide to make a change, together, as a healthcare system?
This month, we remember Juneteenth, (short for “June Nineteenth”), our country’s second independence day. It marks the moment in history when the last of enslaved African Americans in Texas learned they were free. President Lincoln signed the Emancipation Proclamation two and half years earlier, but it wasn't until June 19, 1865, that the news finally reached Texas. On this day Americans, together, honor the sacrifices of our ancestors and celebrate the progress that has been made in our fight for equality.
Juneteenth represents freedom. Freedom we achieved, together, as a nation. And freedom does not exist without overcoming bondage. Even though we mark this moment in our history as the day representing the end of slavery and the beginning of a new era of freedom and opportunity, our healthcare system remains in bondage to structural and institutionalized racism and implicit biases, leading to pervasive healthcare disparities that cripple the health of not just racial and ethnic minorities, but our entire nation.
While I’m grateful for the strides we’re making to address this, healthcare teams still have a long way to go. We can do better. We need to do better. We pride ourselves on always doing what is right for the patient. Doctors vow to Primum non nocere: “First, do no harm” when we take the Hippocratic oath at the start of our medical career. This oath should extend beyond our bedside practice and into our care delivery systems, our healthcare policies and our entire culture. We should treat health disparities like any other medical morbidity. We should dedicate time (from daily rounds to strategic hospital-wide initiatives) and resources (from grant proposals to large budgetary inclusions) to improving diversity, equity and inclusion strategies.
We, together, should engage with our community partners and hold our politicians and executive leaders accountable to support justice initiatives that play key roles in breaking down the structures of institutionalized racism within our healthcare systems. Health disparities are complex problems. They require a collaborative, multitiered and interdisciplinary approach to solving them. This means we all must work together—Americans from all races, ethnicities and socio-economic backgrounds. We must all do our part, together.
An old Nigerian proverb professes, “A gentle stream washes away the face of the hardest rock.” When we each commit to actively addressing health disparities, in whatever role we play in the healthcare space, we become, together, the gentle, persistent stream that washes away the hard, rugged, stubborn rock of institutional racism. And we can do it. Together. We can only do it together—each one of us doing our part to create change.
So, even though I’m uncertain now in my response to Yolanda, I have faith. We will get there. I know we will reach the day when I can confidently shift my words from “Not on my watch” to “Not on our watch.” This is true freedom. Juneteenth reminds us that we achieved freedom before. And we will do it again. Together.
Nwando Eze, MD, FACHE, serves as regional medical director, Neonatology, The Permanente Medical Group.