Power to the Patients: Teaching the History of Race and Medicine during COVID-19

Christopher D. E. Willoughby

Raphaelle Peale, “Portrait of Absalom Jones,” Delaware Museum of Art, 1810. Courtesy Wikimedia Commons.

This January, I began teaching my class Race and Medicine in U.S. History at Penn State. At the time, I had no idea a pandemic was imminent that would further unveil the racial and economic inequality undergirding our medical system. In this course, we discussed the history of medical professionals’ abuse of people of color from slavery to the present. However, we also examined how activists like the Black Panthers worked to put power in the hands of ordinary people through community clinics.[1]

The outbreak of COVID-19 made the lessons of this class especially clear. Specifically, considering COVID-19 in light of the history of medical racism and black healthcare activism draws attention to the need for a healthcare system in the United States that empowers and learns from patients. The history of medicine and public health is filled with politicians and physicians giving faulty and misleading advice to people of color. Yet, the history of healthcare activism reminds us that the best salve for these shortcomings is governmental and community medical programs that seek to create an empowered patient class, able to question physicians and politicians alike.

When reading Rana Hogarth’s Medicalizing Blackness, my students and I grappled with a case from the early republic, where racist authorities pressured African Americans to be frontline workers during a pandemic. In 1793, yellow fever wracked the Northeast. A virus more commonly found in and around the tropics, that year yellow fever was simply devastating in Philadelphia. Thousands died, and many fled the city, hoping to escape an illness that causes jaundice and vomiting dried blood.

Despite its dangers, Benjamin Rush, the U.S.’s most famous physician, requested that black Philadelphians nurse the sick. Rush, like many other white doctors, maintained the false belief that people of African descent were born immune to the virus. As Hogarth explains, some black Philadelphians might have acquired immunity after surviving a previous bout with the virus, but no genetic evidence exists to support inherited immunity.[2]

Likely feeling the pressure to perform citizenship and gain greater rights, many black Philadelphians stayed, and many died. In their account of the epidemic, two prominent black Philadelphians, Absalom Jones and Richard Allen, related the case of a poor man named Sampson. Sampson, like many others, answered the call for black people to nurse their white neighbors. According to Jones and Allen, Sampson “went constantly from house to house where distress was.” Quickly though, Sampson succumbed to the fever and died. Jones and Allen noted that “after his death his family were neglected by those he had served.”[3]

The case of black nurses during the yellow-fever epidemic of 1793 provides a number of valuable lessons for COVID-19. For people of color, personal safety and the pressure of modeling “good behavior” in a racist society are often in conflict, just as some African Americans fear for their safety when wearing a face covering today.[4] Due to racist oppression, black Philadelphians, like other disenfranchised Americans at the time, lacked the authority and power to seriously challenge the recommendations of public health officials, even as they worried about endangering their personal safety.

Winston Salem Black Panthers’ Ambulance, 1975. From It’s About Time: Black Panther Party Legacy & Alumni

The Black Panther Party established community clinics in the 1960s as a direct response to centuries of racist and unequal medicine practiced by U.S. doctors. As Alondra Nelson explains in her history of the Panthers’ healthcare activism, the Panthers saw clinics as an opportunity to provide free healthcare, educate people so they could participate in their own care, and create a more empathetic and community-oriented medical profession.[5]

The Panthers adapted their clinics to approaches pioneered by Mao Zedong in China and Ernesto “Che” Guevara in Cuba. Guevara and Mao intended to blur the line between expert and patient. Guevara explained this dynamic in his 1960 speech “On Revolutionary Medicine,” which I assign alongside Nelson’s monograph. As Guevara saw it, Cubans had to establish educational and medical programs that enabled citizens to practice their own preventative medicine. Rather than merely practice charity upon the poor, doctors needed to work with and learn from them.[6]

The Panthers adopted a similar model in their clinics in the late 1960s and 1970s. As Nelson relates, physicians brought preventative medicine into the clinics and educated people about how to monitor their own bodies. Simultaneously, the Panthers gave physicians a crash course in revolutionary ideology and the healthcare concerns facing impoverished black communities. The Panther clinics worked to empower patients to be their own first line of defense, when it came to health. They also sought to rebalance the medical encounter as between equals.[7]

In discussing this history, I asked my students if a system guided by the Panthers’ ideals would prevent abuses of those like Sampson who died due to faulty public health advice or the men from Tuskegee, Alabama, who were deceived and denied treatment for syphilis by the U.S. Public Health Service. One answered simply, yes. A better public health apparatus would reflect the ideals of the Black Panthers and the volunteerism of black Philadelphians in 1793. It would educate and enlist every American to understand and take responsibility for the public’s health.

On the last day of class, I asked my students to get into groups to discuss, diagnose, and cure what ails our healthcare system today. They described a system where patients were treated unequally and lacked the power to collaborate with experts for their own care. My students also noted the failure of our social state to provide sick leave to all employees and an effective safety net for the unemployed. These circumstances, we agreed, could make worse a second, ongoing public health crisis. Before the pandemic, our for-profit, technocratic healthcare system provided few tools for patients to interrogate, comprehend, and, when necessary, challenge public health and medical experts. Now, it has become untenable.

Gail Reed, “Claudia Lopez, an intern, with outpatients at 5 de Septiembre Polyclinic, Havana,” from the World Health Organization’s Bulletin

Despite this bleak diagnosis, my students also harbored some hope for the future. They took seriously the lessons of the Panthers and other black healthcare activists like the NAACP and the Black Hospital Movement.[8] Across their presentations, they concluded that structural changes were necessary that would make healthcare universally available. Like the Panthers though, they also argued that implementing socially just healthcare required empowering patients to be an active part of the healthcare system.

When I reflect about teaching during COVID-19, I will consider the despair of the moment and the frustration of teaching remotely. However, I also will recall how my students and this moment rekindled my own commitment to imagining and advocating for a just healthcare system. As my students argued, this system would empower patients to narrate and protect their own health. It would guarantee universal access to all patients, devoid of their citizenship status, gender, race, sexual orientation, or wealth. Moreover, a just national healthcare system would include and empower every American as both patient and participant.


Endnotes

[1] I owe thanks to William Horne and Will Mackintosh for giving valuable feedback on this essay.

[2] Rana Hogarth, Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780–1840 (Chapel Hill, NC, 2017), 17–47. Deirdre Cooper Owens, “COVID-19 Reveals a Long History of Health Inequities Affecting African Americans,” Houston Chronicle, Apr. 22, 2020. https://www.houstonchronicle.com/opinion/outlook/article/COVID-19-reveals-a-long-history-of-health-15218565.php

[3] Absalom Jones and Richard Allen, A Narrative of the Proceedings of the Black People, During the Late Awful Calamity in Philadelphia, in the Year 1793: And a Refutation of Some Censures, Thrown Upon Them in Some Late Publications (Philadelphia, 1794), 11.

[4] Alejandro De La Garza, “’It Conjures Up Every Racial Stereotype.’ For Black Men, Homemade Masks May Be a Risk All Their Own,” Time, Apr. 16, 2020, https://time.com/5821250/homemask-masks-racial-stereotypes/.

[5] Alondra Nelson, Body and Soul: The Black Panther Party and the Fight against Medical Discrimination (Minneapolis, 2011), 76–89.

[6] Nelson, Body and Soul, 64–74. Ernesto “Che” Guevara, “On Revolutionary Medicine,” Che Guevara Internet Archive, trans. Beth Kurti, Marxist.org, accessed Mar. 29,2018. Or Obra Revolucionaria, no. 24, (1960), [missing page numbers?]

[7] Nelson, Body and Soul, 75–90.

[8] For a complete list of the readings, you can find my syllabus here: https://www.academia.edu/41613946/Syllabus-Race_and_Medicine_in_U.S._History_PSU_Spring_2020_

26 May 2020

About the Author

Christopher D. E. Willoughby is Junior Visiting Fellow at the Center for Humanities & Information at the Pennsylvania State University.

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