Medical Care and Race as a Social Construct
I've been doing a little writing about race-based medicine. If the VBAC calculator is a racist tool both documenting and perpetuating mistreatment of certain demographic groups, what is the difference that makes a difference for race-based medicine?
This piece focuses on the use case of reproductive health, but observations should generalize.
Disclaimer: THIS is NOT medical advice.
It is a rant from a former homemaker with a big fat mouth. At best, it is food for thought.
1. Poverty.
In the US, one thing Latinas and Black women have in common is they are much more likely to suffer from poverty than White women.
This can have myriad implications for medical outcomes and medical issues. A really big one is inadequate nutrition and that's a really big deal for pregnant and breastfeeding women.
While pregnant, blood volume doubles. While breastfeeding, a woman needs substantial intake of extra calories, extra fluids, extra healthy fats and extra calcium.
When I was pregnant with my first child and later breastfeeding him, I used to make cream of wheat using whole milk and add wheat germ and tofu to it. When it was finished cooking, I would toss in frozen blueberries or frozen strawberries to sweeten it slightly without making it too sugary.Blueberries have a heartier texture than strawberries and hold up better when stirring into a hot cereal.My second pregnancy was easier and I found I couldn't eat this with that pregnancy. It's REALLY rich and did not appeal to me when I wasn't desperate for nutrients.
You may also wish to figure out a protocol for politely and diplomatically inquiring about hygiene issues that can be caused by poverty and see if you can hook them up with bottled water if they live in a building with old pipes, WIC and food stamps if they aren't eating well, etc.
If you really are deeply invested, look into figuring out how to replace lead pipes in poor neighborhoods. I have read there are two Chicagos depending on the dominant race of the neighborhood and you still see high rates of lead poisoning in poor neighborhoods from lead pipes.
2. Higher rates of certain medical issues.
High blood pressure is common for Black Americans and diabetes is more prevalent in certain groups. These are both blood disorders and this is a problem when blood volume doubles during pregnancy.
Some people who aren't normally diabetic get gestational diabetes while pregnant. I have my own hypotheses about what is causing higher rates of high blood pressure in Black Americans and higher rates of diabetes but this piece is not medical advice.
If you want to specialize in treating these demographics and providing actual appropriate care, anyone serving this population needs to be well versed in how high blood sugar and high blood pressure are impacted by pregnancy and how they impact pregnancy and outcomes for mom and child.
3. Actual "race-based" differences in metabolic function.
I spent years homeless. Homeless services are typically run by relatively comfortable White people and they serve a population that skews towards other ethnicities. And they trend towards not being sensitive to certain things because it's not a problem for them.
White people are the demographic freaks capable of digesting milk and milk products, like cheese, unlike most ethnicities. But since they more or less rule the world, nutritional information consistently implicitly assumes you can digest this stuff and dairy products like milk, cheese and yogurt dominate lists telling pregnant and breastfeeding women how to get the calcium they need in large quantities during this time.
I have a genetic disorder with significant gut issues. I rarely drink milk and when I'm especially sick, I tolerate goat cheese and sheep cheese better than cow cheese. I've also clarified butter myself at home on the stove top or bought ghee.
So I'm not lactose intolerant, but I'm keenly aware that if you are having trouble digesting this stuff and desperately need an alternative, it takes substantial time and effort to research alternatives and it's probably happening at a time when you just want to crawl into bed and sleep.
If you want to serve these populations, you need to be well versed in nutritional information for how to avoid lactose and where to get calcium and healthy fats if milk from cows and milk products from cows is simply not part of the menu.
Tip: Ghee or clarified butter is lactose free. It's a safe way to get healthy fats for people who are lactose intolerant and it's also shelf stable, which can be pertinent for a population who may not always be able to pay their electric bill or may not own a fridge.
Speculation: If one of the reasons Latina and Black women do poorly with vaginal birth after Caesarean has to do with excess bleeding, calcium is essential to the clotting process. So a combination of poverty and nutritional information written by White Supremacist ASSHOLES who think only their dietary needs matter may be a large factor in this.
So put together nutritional materials for how to get enough calcium even if you don't have three skin tones like I had in youth: white, off white and lobster red. Even if you need EXTRA because you are making an entire new skeleton for baby from scratch.
My condition predisposes me to bleeds. Unlike many people with my condition, I don't get life threatening lung bleeds but I have a history of frequent heavy nose bleeding plus a history of chronic blood seepage from my sinuses. I stopped this with calcium supplements.
This is not me talking out my ass and if you are a physician and this is NEWS to you, sorry you are stuck in medieval twentieth century medicine but I'm in no way on shaky ground here.
Please note that MOST calcium supplements are not bioavailable. Calcium carbonate is the most common form of calcium supplement. It's basically what seashells are made of and it doesn't absorb well.
Also also: if you need calcium, you probably also need magnesium, vitamin D and vitamin K to properly absorb it.
Last but not least: If you need calcium, listen to Jewish kosher wisdom and "do not boil a calf in its mother's milk." Separate sources of dietary calcium from sources of dietary iron by AT LEAST thirty minutes.
No cheeseburgers, no broccoli covered in cheese or similar.
Calcium and iron interfere with each other. You aren't getting much of either one if you consume them together.
4. Communication issues.
There can be language barriers when dealing with anyone of a different demographic, even if you both nominally speak English.
For Black Americans, this is likely exacerbated by historic slavery in the US and the fact that it was generally illegal for slaves to learn to read.
My father was a high school drop out who taught college ROTC while in the Army and my mother was from a noble family that had sold the title long before I was a twinkle in anyone's eye. I am also the youngest of three kids born to older parents.
I have substantial communication skills and this helped keep me alive and get me the best possible care while coping with a deadly undiagnosed genetic disorder as a homemaker and being assumed to be a hypochondriac.
Homemakers are generally assumed to be stupid and uneducated by physicians. Reality: I took more college level math in high school than many people with bachelor's degrees have had.
I'm familiar with being not taken seriously by medical personnel and being assumed to be ignorant and a whiny bitch and not having a real problem.
If you want to adequately serve this population, you need to learn their lingo and be well versed in the kinds of problems they have so you can draw the correct conclusion on minimal feedback from the patient and you can understand them instead of expecting them to speak the lingo of a college educated White guy who is likely a classist, racist asshole in ways he's unaware of.
See also:
Medical pieces on this site you may wish to read:
My hormone sandbox is called Formulary of Life.
Also, I've written about non-dairy calcium sources elsewhere:
And in the Footnotes for Very Basic Water Infrastructure.