Annual health fair seeks to raise awareness of racial disparities in care

Adam Parker
The Post and Courier

Anthony Quattrone, S.C. executive director of the Partnership to Fight Chronic Disease, was among volunteers at U.S. Rep. Jim Clyburn's Aug. 8 Santee health fair, an annual event meant to assist residents along the Interstate 95 corridor and raise awareness of health disparities.

Adam Parker
The Post and Courier

LeRoy Hampton, 53, of Lone Star suffers from high blood pressure and diabetes. At the health fair, he had a volunteer nurse draw blood for testing. "At my age, I want to keep up with it as much as I can," he said.

Editor's note: This is one in an occasional series of articles exploring the ethical issues people face as they seek medical care over the course of their lives.

SANTEE — Looking ready for anything, LeRoy Hampton sat down at the screening table and extended his arm for the tourniquet.

A volunteer nurse prepped the syringe, tapped Hampton's inner elbow to get the vein to flare a little, then plunged the needle in. Hampton, a 53-year-old resident of Lone Star and a veteran of the Department of Social Services, looked on stoically. He said he had good reason to come here to the free health fair: He's a black man with diabetes and high blood pressure — statistically more likely to die before his white counterparts.

"At my age, I want to keep up with it as much as I can," Hampton said.

This is the fourth year of U.S. Rep. James E. Clyburn's health fair. It's held in conjunction with the Rudolph Canzater Memorial Golf Classic, a tournament hosted by Clyburn that brings 500-600 golfers to Santee each August. A few hours of free medical screening are badly needed along the Interstate 95 corridor, the poorest and least developed part of the state, Clyburn said.

"This corridor has the highest rate of prostate cancer among black males," he said. "Santee is the center of the stroke belt, the buckle of the stroke belt in the entire Southeast. The year before last, I was told it had the highest incident of amputation because of diabetes."

For years, health disparities between blacks and whites, and the troubling implications for society, have prompted him to take action, Clyburn said.

Personal experience has played a role, too: His wife, Emily, had bypass surgery, prompted by diabetes. His diabetic father-in-law was a double amputee. Being proactive about the disease is critical, Clyburn said. Aches and pains shouldn't be ignored.

"But others don't know. They think they're just getting old, they think it's arthritis," he said.

Medical racism

The difference in care quality and medical outcomes between whites and blacks has prompted a number of studies indicating that the main reasons include socioeconomic and environmental factors, barriers to accessing the health care system, lifestyle choices, institutional bias and a history of distrust.

By the time Congress outlawed segregation through passage of the 1964 Civil Rights Act, life expectancy among blacks born in 1960 was 63.6, seven years less than whites, and infant mortality rates were double those of whites. (In 1965, the Medicare bill was passed by Congress.)

It didn't help matters that the American Medical Association, the country's most important and influential medical trade group, whose mission was to protect the interests of doctors and patients, had been complicit in denying membership to black doctors and had systematically refused to assist blacks when they asked for help.

The organization amended its constitution and bylaws in 1968. But the impact of AMA policy, acknowledged by the group when it issued an apology July 10, has been profound, many say. The policy affected state medical associations, exacerbated disparities and delayed the health industry's ability to address the problem effectively, according to Dr. Thaddeus Bell, a Charleston physician and vocal advocate for black health.

Though blacks comprise 29 percent of the state's population, they constitute about only 5 percent of its medical doctors. To raise awareness, Bell joined the executive committee of the South Carolina Medical Association in 2005. His friend and colleague. Dr. Gerald Wilson, a highly respected black thoracic surgeon, was president.

"I wanted to help Wilson change the mentality of the organization," Bell said. "I knew that the S.C. Medical Association had less than 2 percent black membership. I became aware from the very outset that they were very satisfied with the status quo."

The group didn't seem determined to increase membership diversity or address the burning health issues of blacks, he said.

The AMA's 1847 Code of Medical Ethics included a statement requiring physicians to use "zealous and methodical efforts for the relief of the suffering and unfortunate, irrespective of rank or fortune, or of fortuitous elevation of any kind."

Yet, by the group's admission, "The AMA failed to take action against AMA-affiliated state and local medical associations that openly practiced racial exclusion in their memberships, practices that functionally excluded most African-American physicians from membership in the AMA."

Without membership in these associations, doctors were regularly denied hospital privileges and access to patients.

In 1962, Wilson's former medical partner, Dr. Everett L. Dargan, applied for membership in the Columbia Medical Society, an AMA affiliate, but was denied.

When he wrote to the AMA asking for help, the national group responded by explaining that it doesn't get involved in local disputes, Wilson said.

As a result, Dargan could not immediately gain privileges to practice at Columbia Hospital. (Later, he became the chief of the medical staff at Palmetto Richland Memorial Hospital, the first black to hold the post.)

Sowing distrust

If change comes slowly within medical institutions, it comes equally slowly within the black community.

Bell, the force behind the ongoing "Closing the Gap in Health Care" project, said black patients sometimes don't follow instructions well, or they fail to visit him before a problem becomes acute. Occasionally, he has sent patients away with an admonishment: Either do what I tell you or don't come back.

But doctors, too, need to improve the way they relate to patients, Bell added. Both black and white physicians need diversity training. They need to be sensitized to cultural practices. And they need to be aware of inherent suspicion among blacks who have not forgotten about institutional efforts to exploit them.

The Tuskegee Syphilis Experiment, conducted on 399 mostly illiterate black sharecroppers from Alabama between 1932 and 1972, was administered by the U.S. Public Health Service. The men were told they were being treated for "bad blood," but none were treated for late-stage syphilis, even though the deadly disease was curable. Officials were waiting to collect data from autopsies.

Concerned about so-called "crack babies," the Medical University maintained a policy from 1989 to 1993 that allowed drug testing of pregnant women seeking prenatal care, especially when the women were suspected of abusing cocaine. Because a live fetus is considered a "person" under South Carolina law, expectant mothers who used cocaine after the 24th week of pregnancy could be accused of a crime.

The Medical University shared test results with police, facilitating the arrest of 30 low-income and indigent women. All but one were black. They were charged with drug possession, child neglect and distributing drugs to a minor. Some served time in jail. When in 1994 the federal government investigated the hospital for ethics violations and discrimination, the policy was suspended.

In 2001, the U.S. Supreme Court found the hospital's drug screening to be illegal search and seizure, a violation of the Fourth Amendment.

Bell said these episodes have caused many in the black community to question the practices of medical professionals, and that they still reverberate in the black community, sowing distrust of the health care system.

Behind disparities

The contention that poverty and unequal access to care played an active role in health disparities was strengthened by a 1992 study published by J.S. Rawlings and M.R. Weir that showed infant mortality rates among children of blacks in the military to be much lower than the rates of civilian blacks.

"We investigated race- and rank-specific infant mortality rates among dependents of military officers and soldiers at Madigan Army Medical Center, Tacoma, Wash., between 1985 and 1990," Rawlings and Weir wrote.

"The overall infant mortality rate was 9.3 deaths per 1,000 live births compared with 10.1 deaths per 1,000 live births in the United States in 1987. Mortality rates for infants born to families of junior enlisted soldiers were similar to those for infants born to families of noncommissioned and commissioned officers. The mortality rate among black infants was 11.1 deaths per 1,000 live births compared with 17.9 deaths per 1,000 live births among all black Americans in 1987.

"These lower rates of mortality among black infants may be due to guaranteed access to health care and higher levels of family education and income in the multiracial subpopulation served by our medical center compared with the nation as a whole."

Wilson said the causes of health disparities include bias among medical professionals. For example, doctors are taught that Crohn's disease affects mostly whites and European Jews, so they are less likely to consider it when assessing Crohn's-like symptoms in others, even though experts now know that there are environmental factors. Obstetricians tend to administer less pain medication to black and Hispanic women, he said. White veterans with cardiovascular disease are referred for surgery more often than black veterans with the disease, even though access to health care is the same, he said.

A 2007 study by Massachusetts General Hospital found that certain physicians were less likely to prescribe an aggressive clot-preventing treatment for black heart attack patients than for whites.

Attitudes and assumptions, then, are likely to influence how doctors treat their patients, Wilson said. "White and black doctors both show bias. The reason is they're trained by the same people."

Dr. Charles Bratton, a transplant surgeon at the Medical University, said he sees the effects of health disparities in patients all the time. Blacks suffer disproportionately from hypertension, diabetes and other problems that contribute to kidney disease, and because of these persistent health issues, blacks are less likely to qualify as living donors.

"Without early intervention and systemic changes, the problems will only be magnified," Bratton said.

The solution, he said, is obvious but complicated and costly. It requires a huge public investment in radical change, beginning with improvements to public education, changes in what and how we eat, better employment opportunities and easy access to comprehensive health care.

"The answers are easy, we know how to do it, we just don't have the will to do it," he said.

An opportunity

At the Santee health fair, Anthony Quattrone stood behind a folding table, handing out literature. Quattrone, S.C. executive director of the Partnership to Fight Chronic Disease, said his organization works hard with few resources to educate the public and policymakers. He said it's important to promote good preventive care.

"It's not just a health care crisis, it's a health crisis," he said.

Another table featured US TOO, a support group for prostate cancer patients. Volunteer Lee Moultrie said a Charleston group meets at 7 p.m. on the first Tuesday of each month at Old Bethel United Methodist Church on Calhoun Street in Charleston.

"Besides offering support, we want them to remain up-to-date on information and science," he said.

Jim Fivecoat of the Obesity Action Coalition stood ready to explain that obesity is more than a condition, it's a disease for which a number of treatments are available. Medical University nurses were on hand to recruit people for a cardiovascular study.

Rosalie Carbon, 60, of Santee came to have her blood sugar and cholesterol measured. Diabetes runs in the family, she said. A notice about the health fair appeared in the local paper. "My sister-in-law called me and said, 'Do you want to go?' I said, 'What the heck.' "

It's no coincidence that the rural counties along I-95 are considered both the state's stroke belt and the "corridor of shame," a label that refers to the dismal conditions of many public schools, Clyburn said. Nor is it an accident that unemployment rates are higher among residents of these counties. Infrastructure improvements must be made if the region is to see any economic development gains, he said.

At a January 2005 groundbreaking ceremony for the Lake Marion Water System, Clyburn had : "This is an exemplary step towards embracing the regional cooperation needed to improve the plight of residents and communities along the I-95 corridor; residents who are suffering from poor health indices and reeling from high unemployment, and communities that are being ravaged by the lack of infrastructure and stifled by underfunded schools. For some residents, this is the first step toward quality drinking water and for some communities, it is the first step toward attracting much needed economic investments."

Physical and economic well-being go hand in hand, Clyburn said. "You can't eat well without a good job; you can't get a job without employers; you can't have employers without clean water," he said.

In 2004, the AMA, its black counterpart, the National Medical Association, and the National Hispanic Medical Association formed the Commission to End Health Care Disparities. Together they are developing strategies to address the racial factors contributing to unequal medical care.