Home Opinion If you don’t see race, you don’t see me: how colorblindness obstructs...

If you don’t see race, you don’t see me: how colorblindness obstructs health care.

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Social colorblindness seems to be a trending topic in my life.

I absolutely understand why people, especially White people, say things like “I don’t see color.” Almost 10 years ago I used similar language myself. It all started to unravel during a cultural competency training I completed. I took the training because it was a requirement for my research group to conduct a study that focused on Black men, but it kind of changed my life.

Honestly, I went into the course thinking that I would be support for my peers because I had it all figured out. I remember proudly declaring to our trainer that I did not see race – it was strictly a descriptive identifier, and I also remember feeling offended that she seemed to attribute some form of naïveté to my Caribbean background.

I explained that I treated everyone with the same amount of respect and I did not impose preconceived stereotypes on people based on race. She smiled and said what I was describing was not colorblindness, but she also challenged me to think about the comfort I got from being “colorblind.”

Colorblindness was an easy out. It was easy to say “I treat everyone the same,” but it was a little bit more difficult to embrace our differences and accommodate those differences. Colorblindness meant that I didn’t have to change. It also meant that I had no biases. It absolved me. The problem is that I became complicit in the fight against injustice. It was lazy and in some ways suggested that I didn’t have much to learn.

But the fact is, I do have much to learn.

As I have evolved in my identity as a Black woman, I have been more thoughtful in unpacking my experiences because I know that there is great discomfort that comes with the topic of equality… and equity.

Not too long ago I started having significant pain in my right side. I always suffered from terrible menstrual cramps and had pretty much accepted pain as part of my life (sidebar: there is great need to address how we talk about women’s reproductive health with young ladies, especially in communities of color), but the shooting pain I started to experience was beyond my usual threshold.

After multiple episodes, a doctor’s visit, and a trip to the ER, I finally landed at a women’s clinic with a huge clue as to what was going on with my body. I had large fibroids and a cyst on my right ovary.

I walked into my office visit with confidence and excitement to finally get solutions. The deflation was unreal when the provider said that she didn’t have any good solutions for me. She explained that cysts are common and typically don’t cause pain at that size. And the fibroids? Her patients who have fibroids usually don’t know that they have them because they really don’t cause too many issues. I was too young for her to recommend anything drastic like a hysterectomy and she didn’t think I should risk surgery for something that she didn’t believe to be a major concern. We discussed birth control options, but most of the visit was her pitying me that I was experiencing pain while telling me there just wasn’t anything she could really do.

I sat in my car for what seemed like forever… in tears. I convulsed in the driver’s seat wondering how I would find my way to work and make it through the day. I finally called my dad (who was a nurse at the time, now nurse practitioner) and he comforted me as he always does. My parents and I tried to figure out a solution. My mom questioned if we could have prevented this by taking my cramps more seriously when I was younger. My dad went on a whole rant about how society does not prioritize and fund women’s health; this planted the idea of a project he wants to work on that openly discusses dysmenorrhea, the impact on society, and why all (regardless of race or gender) should care. I spoke to a few friends that I knew had conditions and events related to reproductive health, and each one asked the same question. How many of her patients are Black?

Most Black women have family and friends that have had complications due to fibroids. My doctor was treating me the way she probably would treat any of her patients. Her patients did not present with complications due to fibroids, so she was treating me equally.

She was colorblind.

She didn’t see my race or ethnicity. In medicine, I imagine it is difficult to balance standardizing treatment while also individualizing care. Health protocols are developed based on research and are supposed to be designed to be effective while also reducing waste to keep costs down. This is why it is important that our health system is culturally competent – from research to delivery.

I have a 6-year- old nephew. For the most part, my sister was healthy when she was pregnant with him. One day, towards the end of my sister’s pregnancy, she was experiencing contractions and not feeling well. She went to the hospital and was told that she should wait until her contractions were more regular.

My sister knew something was wrong and insisted that she needed medical attention. When they took her vitals, her blood pressure was so high that they immediately admitted her. They found that she had developed preeclampsia and in a matter of minutes, my sister went from healthy pregnancy to high risk.

Stories from my sister (who has her PhD in Microbiology), Beyoncé, and Serena Williams let us know that the infant and maternal mortality disparities in America go beyond access and socioeconomic status (SES). My sister was knowledgeable enough to communicate with her medical team in a way that was urgent, but not aggressive; but too often Black women have to be their own advocates.

While my nephew and sister are now healthy, we think about that day often. What if she did go back home? I watched my sister in the hospital bed leading up to my nephew’s birth. I watched the doctors and nurses consult trying to figure out the best care plan, and in those moments I couldn’t help but wonder if the evidence they were using included Black women. I couldn’t help but wonder if she were White, if things would be different.

A lot of people I know would get frustrated with that thought process. They would want to know if my sister showed any signs of preeclampsia and told the nurses. They would also want to know if she told them that she wasn’t feeling well and provided all her symptoms. They would be interested in her age and history. “It’s because she’s Black” is an uncomfortable conclusion for people. But that’s reality.

The doctor from the women’s clinic scheduled a follow up visit with me four months from our initial meeting. At that time we would do an ultrasound and compare images to see if my fibroids were growing. However, within weeks of my initial appointment, my pain level reached a point where I couldn’t sleep or move comfortably. One afternoon while hunched over in pain at my desk at work (sitting was too painful), I scheduled an appointment with the same clinic and another doctor was available. The new doctor immediately attributed my pain to the fibroids and scheduled a CT scan. She explained to me that some of my fibroids had likely outgrown their blood supply and that would cause pain. She also reassured me that this was not uncommon for Black women and eventually I had a myomectomy, removing six fibroids.

It was amazing to me that two doctors from the same institution had such remarkably different outlooks on my presentation of fibroids. One said her patients don’t usually have pain or complications, the other recognized that as a Black woman, I was at greater risk.

Racial disparities exist. That’s not a theory. That’s also not an accusation. That’s a fact. So, my race and ethnicity should be considered when determining what kind of healthcare I need.

That’s the equity piece. We should treat everyone with respect and provide the same opportunities, but we must embrace our differences and acknowledge when those differences affect our outcomes.

I think sometimes we are so afraid of discriminating that we end up causing harm. Recognizing that you may need to implement a more appropriate model is not discrimination or preferential treatment. Discrimination and preferential treatment suggests that without those actions, equality would have existed; behaviors like withholding treatment or giving pertinent information. Those kinds of violations tend to be more obvious. Colorblindness fails because it is irresponsible. It overlooks the systemic barriers that prevent equality while giving the facade of equity.

Wisconsin has the worst birth outcomes for Black infants in the country. Nationally, the rates of infant mortality and maternal mortality in Black communities are significantly higher than in White populations. My sister and I had access to various healthcare options. It wasn’t that long ago that I was uninsured. It was simply too expensive and as a young adult with no history of health conditions at the time, I believed it was a low risk choice. In retrospect, I was not making a very informed decision. I didn’t really understand health risk and what having health insurance means. When I became insured, a whole new world opened up for me when I discovered that my coverage included preventative care incentives. Being rewarded for going to the doctor was a foreign concept, but it is such an obvious and simple way to protect against disease and increase the chances of early intervention should a condition develop.

But.

That access means nothing without cultural competency. If we continue to face discrimination, racism, and even color blindness, Black women will continue to be at high risk for poor health outcomes. We need culturally competent providers and a culturally competent healthcare system.