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Doctors Confront Generations of Fear of Medical Debt in Black Families

Dr. Kecia Gaither is a practitioner in one of New York's most at-risk middle- to low-income neighborhoods. As director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, Gaither is no stranger to the reality of women of color becoming statistics of disparity, bias, and racism.

“Racism is a public health threat,” says Gaither, a double board-certified OB-GYN and maternal-fetal medicine specialist.

Dr. Kecia Gaither

Black women are three times more likely to die of pregnancy-related causes. They are underrepresented in clinical trials, and have a greater likelihood of late-stage cancer diagnoses, and treatment delays.

It’s About Money

The medical community is finally catching up to the numbers. Gaither, for example, broadened her own education in healthcare-related finances, which helps her wrangle with some of the barriers facing low-income communities. These include food deserts, the lack of preventive health services, pollution exposure from local factories, stress-inducing institutional bias, and poor access to healthcare due to lack of insurance.


The onerous debt of healthcare has haunted some families for whole generations, training grandparents, parents and adult children to be terrified of medicine.

The U.S. is one of only a few developed nations with no universal health coverage. For most Americans, the quality of medical treatment comes down to income and insurance. The insurance industry cherry-picks who it covers, what procedures it pays for, and it gets to charge customers the very maximum a state’s insurance commissioner or equivalent state agency allows. With a profit-minded third-party deep in the gears, U.S. healthcare spending reached $4.5 trillion in 2022, averaging $13,500 per person. The average cost per person in other wealthy countries is less than half as much.

Board-certified OB-GYN Dr. Rixt Luikenaar knows care that is affordable and within reach is key. Her Rebirth Health Center in Salt Lake City offers every patient “reasonable self-pay prices,” as well as access to an insurance agent with experience helping patients obtain affordable health insurance.”


The onerous debt of healthcare has haunted some families for generations, however, training grandparents, parents and adult children to be terrified of medicine. Children see the dread of a new bill in their parents' eyes, and they hear it at the dinner table, and the lesson sticks. Dr. Garen Wolff, an allergist-immunologist and the chief physician of Wolff Allergy & Asthma of Detroit wants to reintroduce healthcare back into under-served households. She volunteers at health fairs for the Detroit Medical Society (DMS), which uses school- and church-sponsored health fairs and medical seminars to reach Black women. The organization also distributes medical info at community focal points, including beauty salons and public gatherings, and they buy magazine and social media ads.


Saturating a community with info can do only so much against whole generations of learned behavior, so Wolff encourages individuals to take the difficult first step of instigating honest health-related conversation with family. Knowing a family’s medical history can be a lifesaver because conditions such as Type 2 Diabetes and hypertension often target multiple members. But some women (particularly family matrons) are leery of upsetting relatives with news of an illness, or they consider certain intimate cancers a private matter. Black women are more likely to die from stroke, hypertension, and certain cancers because they schedule visits only at advanced stages of disease – when the pain is just too much – regardless of the family’s history of disease. This must end.


“If a family member is diagnosed with cancer at a young age (20-50 years old) or there are multiple cancers in a family, screening should take place at an early age,” Wolff says. Plus, routine visits give patients access to vaccinations and pap smears, mammograms, and colonoscopies, which yield early results.

Change the Dynamic: Attack First

Being proactive also means getting honest about your age. "Middle age" could mean nothing to a weightlifting, spinning dynamo like you, but tiny, hidden physiological changes are still an open door for some very bad things.


“The frequency of a physician’s visit (should be) dependent on a person’s age and medical conditions. At the minimum, you should see a primary care physician once a year for an annual physical,” Wolff says.


Make sure to order general lab tests at every visit. And if you’ve got a chronic condition like diabetes or hypertension it probably hasn’t gone anywhere, even if it’s gone silent. More frequent visits for you, friend.


Additionally, Wolff warns patients to not ignore their body’s warning signs, despite the strain a medical visit puts on your job and your bank account. However hard an MRI can hit the savings, a $16,000 monthly dose of cancer drug hits much harder. Certain red flags should drive you right out of your house and into a waiting room: Unintentional weight loss (more than 10 pounds in 1-2 months) could be dangerous, as well as difficulty swallowing, significant fatigue, headaches, inability to control bowels or urine (of course!), and blood in urine or stool, to name a few.


“Always listen to your gut,” Wolff said.


For Black and brown women, however, an early visit is more frequently inconclusive. A growing body of research indicates women are underrepresented in medical studies, and there are unconscious biases that contribute to gender inequality in medicine. For Black women, the results are even more discouraging.


Patients deserve respect but don’t always get it, according to Luikenaar. (We knew this, of course.) Some of her patients report negative experiences with healthcare providers who they claim failed to treat them as a “whole person.” Impatient doctors sometimes prescribe pills without explanation and don’t take the time to talk. If patients perceive their concerns are not heard or they don’t feel comfortable, they may delay diagnosis and treatment. 



More Color in Clinics

Luikenaar (Right) poses with actress Laverne Cox

Luikenaar says doctors should fully inform patients about their bodies, as well as what preventive care is available, the reason for certain tests, and ways to improve health. If they fail to deliver, do not hesitate to push.

It also helps if patients can hear people like themselves discuss health and wellness, which is why hiring Black indigenous people of color (BIPOC) and queer health employees generally save lives, as does increasing the number of providers in underserved communities. To that end, Gaither advises doctors to guide med students into resource-deprived communities at an early stage of their careers. Mentoring in Medicine is one such organization that fields low-income, underrepresented students committed to medically under-served communities.

Gaither’s own workplace encourages community involvement with training programs for doulas and midwives, who reduce incidences of poor perinatal outcomes. They also encourage healthcare adjuncts to visit mothers in their homes, as well as perinatal social workers attuned to issues impacting social determinants of health—nutrition, housing, transportation, clothing, and access to insurance. Gaither herself initiated a cardio-obstetrics program (A Mother’s Heart) in response to the high percentage of pregnant women in her demographic with cardiovascular disease.


A collaborative effort of healthcare providers are working to cut the disparity, but the gap remains. Clinicians say the focus needs to also shift at the university level, at schools and facilities that provide medical training. If more doctors are made aware of better methods earlier in their career the whole dynamic could change.

(This article originally listed the incorrect author. Terribly sorry for the snafu) --Ed


Edgary Rodríguez R. is a Latina journalist, writer and audiovisual producer. She likes to escape to imaginary worlds while reading and to explore new places in the real world.


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