Black Maternal Health Week: We must see people where they are and listen to them

A little kindness goes all the way. Ironically, this has very little, and everything, to do with color.

I’m always happy and willing to talk about racial issues and disparity, but I’m also keenly aware that I’m completely the wrong person for it. As a professional white male pushing sixty-five, there’s a bit of hypocrisy calling out the appalling way our culture has approached equity.

Women of color are dying at an alarming rate in our country. Much higher than the death rate of white women. Poor women of color fare even worse. Though the reasons for this are complex, they aren’t confusing. All people of color in our culture have a different historical, societal, economic, and institutional imprint that is woven into their fabric. Further, the stress of daily life beats down upon their physiology, increasing cortisol and catecholamine (stress hormones) production and effectively “weathering” good health right out of them (Dr. Arline Geronimus research).

Any thinking person who has lived through a few derechos and a pandemic can attest to the impact of stress on our lives. We all have PTSD right now. It is problematic though that those of us who survived the storms well, and actually did live through the pandemic, came from different neighborhoods than those who did not. Most of us want to be seen. People in my neighborhood saw each other right away. Apartment residents in Cedar Rapids’ poor neighborhoods really weren’t seen in the same way.

That affects health. Weathering in a figurative, and in this case literal, sense.

In context of these historical differences, and real time weathering, to assert that systemic racism, regardless of one’s definition of this red-hot term, does not exist or affect us, is absurd. We may not feel racist, but we all have bias and many of us have privilege.

Label the contrast or characterize the genesis of disparity as you will, but the facts are that women of color in our state and others in the U.S. are dying at a much higher rate than white women. This is because what they arrive at the table with is different, and not in a good way. This isn’t a biologic difference between women of color and women with white skin, it is the way our culture is living with treating one another. It isn’t enough to deal, or get by, survive, or adapt.

After all these years, I finally see that it is the other experiences that have happened to us and are happening now that inform behavior. I’ve also learned the hard way that I can’t, and shouldn’t try, to solve my patient’s problems, let alone dictate care.

When we see and listen to each other we learn. We learn about homes and neighborhoods. Is a home safe, warm, dry, and free from mold? If we listen, patients will tell us about food insecurity and access to the nutrition they need or cherish. It’s cold in Iowa during winter; do our families have warm coats, boots and gloves? Do they have a car, does it run, and can they afford gas for it? Or are they using their gas money to buy food for their children? In my neighborhood, and I’ll venture a guess in yours, we don’t much stress Maslow’s foundational needs (food, water, clothing, sleep and shelter). What experiences have affected our Cedar Rapids families? Unstable childhood homes, violence, and sexual assault also influence our behavior later in life. Generally, these aren’t choices we’ve made. Trauma happens to us, not because of us.

The point here is that if we don’t see people where they are and listen to them, we can’t learn from them. More than any place our family has lived, Cedar Rapids is a resource rich community.

Our community is family. In our clinic connecting our family to the local resources they dearly need is basic human kindness and responsibility. Only then can we contend with hypertension, or diabetes, or perhaps simply genuinely connect and congratulate them on their healthy pregnancy.

Then we can save lives.

Stephen Pedron, MD, MBA, is medical director of perinatal medicine at UnityPoint Clinic.