For Underserved Communities, Quality Healthcare is Built on Trust

For the first 35 minutes of last week’s panel discussion on COVID-19’s impact on the African American community in the Bay Area and beyond, I didn’t say a word.

Given the level of expertise and intelligence in the room, my goal was to simply keep from embarrassing myself. I’d brought notes, and I took more as esteemed guests discussed things like bills soon to hit the floor, the influence of lobbyists on the process, and the government’s overall role in the disproportionate health outcomes for African Americans. 

Considering the substandard health outcomes for all Americans, combined with this country’s systemic racism, these results shouldn’t be surprising. But as I listened to the panel, which aired live on the local ABC station, I realized it’s not just about health policy and statistics. It’s also about the credibility of the messengers, and the trust (or lack thereof) African Americans have for medical workers.

When it was my time to speak, I stressed the need for reputable individuals to address the populations most impacted by the coronavirus. People like Jamal Trulove, who’s been working with Elina Kostyanovskaya and the Science Policy Group at UCSF to pass out masks and hand sanitizer in prisons and underserved Bay Area communities.

You might know Trulove from his role in The Last Black Man in San Francisco. You might also know that he was once wrongly sentenced to 50 years to life; when his case was overturned, he was awarded millions of dollars by the SFPD. His story is well-known in the neighborhood—he’s someone people are familiar with and trust. That makes it easier for him to reach people in the midst of a pandemic.

I also mentioned a woman who practices traditional Chinese medicine in Berkeley, and who recently journeyed to Navajo Nation in Arizona to heal an Indigenous Medicine Woman. Although her story isn’t directly about the African American community, it’s related to the idea that healthcare providers can’t simply pull up in underserved communities and expect to have an impact. Trust has to be established first.

Thuy Nguyen was just leaving Arizona as she told me how her past few days of service came about. A Dine’ Medicine Woman had fallen ill and was put in contact with Nguyen  for assistance. Knowing that Navajo Nation had been hit especially hard by this virus (it’s reported more than 2,400 COVID-19 cases as of May 4, a higher rate per capita than any state aside from New York and New Jersey), Nguyen wasted no time in loading up her car with masks, gloves and herbs. She drove overnight to the reservation and worked for three days, sunup to sundown.

Nguyen was familiar with people on reservation, as she had previously done work there. Their initial connection came by way of an invitation from Chief Justice Robert Yazzie after he heard Nguyen give a lecture; both parties noticed the overlap in their practices. 

“In modern medicine, you’re fighting everything,” said Nguyen during a phone call. “In Chinese medicine, you’re understanding the balance, harmony and why things are occurring in relationship with one another… In that way, it’s very compatible with Native and Indigenous thinking.”

(I thought to myself: sounds on par with the words from the elders in my community.)

Nguyen told me it’s about “restoring” the concept of healing. “Not ‘changing,’ but ‘restoring.’ Because that was the original way,” said Nguyen.

And in order to put that philosophy into practice, trust needs to be established. “I could have all of this medicine and give it to people, but it’ll all go in the trash if people don’t trust me,” Nguyen said.

The cross-cultural connection doesn’t work for everybody, so she’s working with “progressive pockets” within the Navajo Nation. She knows all about the notion held by certain people about the healthcare industry “brainwashing people of color” to turn away from traditional practices and “become dependent on this bigger medical system.” That’s true for the Asian community, as well, she said.

“It’d be one thing if modern medicine knew exactly what it was doing, but we’ve seen that this system is flawed, and the people most impacted end up being… us,” said Nguyen.

The Medicine Woman is getting better now, according to Marley Shebala, an independent journalist based in Navajo Country. “It was a combination of Dine’ medicine and Chinese medicine, but what made a difference is who was doing the treatment,” said Shebala.

I asked Shebala what Nguyen brings that makes her stand out? Shebala responded, “herself.”  There’s a difference between a doctor who cares and one who doesn’t, Shebala said—and that’s true in all forms of medicine.

I asked Shebala if there’s anything “the people” should know about the underlying concept of medicine from the Traditional Chinese or Indigenous perspective. She abruptly asked: what people?

I shot it straight and told her that I was asking as a black man whose community is also under siege. Listening to different oppressed groups’ perspective on how to navigate this pandemic is my genuine interest.

From the notes she’d gathered in talking to traditional healers, she advised me on some basics: get rid of salt, take actions that will strengthen my lungs and clear my system of mucus. Most importantly, take the threat of the coronavirus seriously.

“This virus is a terrible way to die,” said Shebala. “Not only do you suffer, but you suffer by yourself.”

It’s not that I, or my peers, don’t take the virus seriously—it’s that there’s a serious pile of issues in front of us. Health disparities tied to wealth disparities. Trust issues with governing officials and the medical industry, as a whole. And a lot folks I know, myself included, question the legitimacy of certain news agencies who are supposed to relay this important information to us. And I’m a journalist!

I see that there are efforts to do something about it by people in office, on different levels. Sen. Kamala Harris is looking to set up a task force to address racial disparities from the impact of COVID-19 on the federal level; something mayor Libby Schaaf has already done here in Oakland.

And I see ongoing debates about the philosophical approach black folks should take when it comes to this virus, and healthcare overall. Last month, Van Jones caught heat for promoting the narrative that personal responsibility is paramount, without fully acknowledging a lack of investment from the system that governs us. Not to mention the lack of trust we have for that system.

In the end, looking at racial disparities in health outcomes is a mixture of all of the issues above.

And if the government, healthcare providers or anyone else wanted to do something about it, they’d work toward earning black people’s trust. A great place to start would be by helping us when we need it the most. Which isn’t just during a pandemic.