To effectively defeat the pandemic, we have to tackle white supremacy in healthcare
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- One of the biggest threat sto the health of patients of color during the COVID-19 pandemic is the plague of white supremacy.
- We need to come together and focus our power on a response to the pandemic that addresses white supremacy.
- Governments and institutions need to listen to Black and Latinx communities and invest resources in solutions.
- Ana Delgado, CNM, MS, is the Assistant Director of Inpatient Obstetrics at San Francisco General Hospital and a Clinical Professor at the University of California, San Francisco School of Medicine.
- This is an opinion column. The thoughts expressed are those of the author.
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My patient had just been told that she had a serious complication in her pregnancy. We needed to take action to prevent her from losing her pregnancy or giving birth prematurely. The words barely registered because, at the same time, she found out that she tested positive for COVID-19.
She was overwhelmed with stress at the idea that she would lose her job in food preparation. The complication that felt like the top priority to her care team barely registered - the COVID diagnosis suddenly put her basic survival and ability to provide for her family at risk.
Her story is not unusual among the low-income Black and Latinx patients I see at San Francisco General, our county's safety net hospital, which is charged with caring for San Francisco's uninsured, publicly insured, and otherwise marginalized communities. Many of these patients are either losing their jobs as the service industry collapses or putting themselves and their families at risk as essential workers. They're at the nexus of violence and oppression from the state, whether through a cruel deportation machine or rampant police violence. And for Black people who identify as Latinx and/or immigrants the oppression is increased.
My patients want to be able to build their families and support them so they can thrive. The barrier in their way is the plague of white supremacy that has sickened this nation for hundreds of years and has manifested anew during the COVID-19 pandemic. When the poison root is the same, whatever grows from it is linked. Our communities shouldn't be fighting over scraps while our government fails to meet this moment, handing down inadequate and racist responses.
A worsening pandemic
COVID cases are surging again. We cannot call for unity in facing this crisis without a reckoning with the racism that pervades it. While we may feel relieved to have an incoming administration that believes in science, we can't rest until we have a comprehensive response that addresses the white supremacy that is sickening my patients and people like them. Communities of color need to build power together to fight the persistent white supremacy that denies us that justice.
Over the last several months, we've seen how overrepresentation of Black and Latinx workers in the service industries made them uniquely vulnerable to the health and financial impacts of COVID.
I sat with a Latinx couple, recent immigrants expecting a baby, in the exam room as they both got notifications on their phones that they had been laid off from their food service jobs. They stared into space, processing the blow as they were trying to deal with planning for parenthood. Many families couldn't even get the meager $1,200 payment from the federal government because the Trump administration disqualified any households where a member didn't have legal immigration status.
Those lucky enough to keep their jobs often do so without adequate access to personal protective equipment. If those essential workers are exposed to COVID-19, they don't have paid sick leave and it can be nearly impossible for them to distance from their families.
If a new parent or their family member tests positive for COVID-19, they are sent home with instructions like keeping the infant 6 feet away as much as possible, which isn't practical in situations where multiple families live together. Or they might be intimidated or coerced into having their newborn separated from them and not breastfeeding because they weren't given the option or were told by hospital administration that it was policy to separate all newborns from people with COVID.
The spread of the pandemic has prompted healthcare policies that disproportionately impact patients of color. Giving birth without a family member or support person to advocate for you can be a matter of life or death in a discriminatory system that is killing Black, Indigenous and people of color at an unacceptable rate.
Read more: Tell people the truth: The vaccines are great
A system that is failing people of color
I was recently evaluating a Black woman in labor, alone due to restrictions on visiting in our triage unit. I imagined what it must be like to enter into a space where statistics show you have a two to three times higher chance of death, and to make things worse, you are alone. A white woman in that same situation would likely not be carrying the weight of that fear and would be more likely to be cared for by a care that more closely reflects their values and their community.
Then there are the patients that never make it in the door due to fear of law enforcement. Patients approaching our hospital might see one of the 29 San Francisco Sheriff's deputies who are assigned to campus. A few sheriff's vehicles that might not even merit a glance from a white patient could tip the balance away from seeking care for a Black patient watching the relentless pattern of summary executions of Black people by the police. An undocumented patient told me her family members didn't want to get tested for fear that they would get deported for having COVID.
My patients deserve reproductive justice (a human rights framework coined by Black women), the ability to have bodily autonomy and to parent their children in safe, sustainable communities. Governments and institutions need to listen to these communities and provide the resources and access to power to support community-based solutions. And equity demands that the communities most impacted receive the most support, meaning that leaders need to build comfort with explaining why resources should be preferentially distributed to Black and Latinx people. For example, what would it look like for the promising COVID-19 vaccines to be distributed equitably, first to these communities that have been so impacted?
We need to come together with courage and focus our combined, unrelenting power at the enemy of white supremacy to manifest the true embodiment of reproductive justice.
Ana Delgado, CNM, MS, is the Assistant Director of Inpatient Obstetrics at San Francisco General Hospital and a Clinical Professor at the University of California, San Francisco School of Medicine.
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