The Mudsill, Vol. 1, No. 7
April 15, 2021
In this issue…
Susan M. Reverby and Evelynn M. Hammonds, historians of medicine, examine how invocations of “Tuskeegee” to explain “vaccine hesitancy” obscure more telling forms of structural racism.
Fiction writer Melanie Griffin offers a sprightly tale of a whale watching excursion gone purposefully wrong.
Michael Langford, essayist and craftsman, meditates on the meaning of craftsmanship in writing and life.
Our cover image, “Mandate, Discarded” was taken by photographer Valerie Adams.
Taking a Medical History: COVID, “Mistrust,” and Racism
By Evelynn M. Hammonds and Susan M. Reverby
As the vaccine rollout for COVID-19 began earlier this year, concern with what was being labeled “vaccine hesitancy” started to fill the commentaries and news stories by the thousands. Much of it focused on the seeming irony of these concerns in African American communities, most hard hit with illness and deaths in this pandemic. For once, history seemed to be explanation for these worries. In some ways, this made sense. After all, when confronted with an individual patient’s medical concerns, health care practitioners take a history with relevant questions to come to a diagnosis and propose therapies: what are the symptoms, when did they start, how are they manifested?[1] When Black Americans present their medical concerns as a population, however, the wrong questions are asked, an inadequate history is taken, and the diagnosis and the treatment plan often fails. COVID proved this yet again.
The disparities became more apparent as many states released data by race on who contracted and died from the new virus, and then as with the vaccine trials the haphazardly planned vaccination programs themselves revealed other inequities. Much of the concern focused on the issues of “trust.” [2] To diagnosis the problem, the histories taken led to what film director George C. Wolfe commented on in another context that fits here: “how can you move forward when you’re still haunted by the past.” [3] The explanations fell upon the legacies of at least three notorious medical events in United States history: white Alabama physician J. Marion Sims’ use of enslaved Black women in the 1850s for his pioneering multiple gynecological surgeries without anesthesia and without their consent; the U.S. Public Health Service Study of Untreated Syphilis, known primarily as the Tuskegee Study, where from 1932 to 1972 hundreds of Black men were used to research the effects of untreated latent syphilis while they were told they were being “treated;” and the creation of HeLa cells in 1951, the first human cell line, from the body of cancer victim Henrietta Lacks without her or her family’s knowledge. [4]
It is not simply, however, knowledge of, or even just rumors of these historically infamous studies that lead to mistrust among Black Americans of clinical trials, vaccine study enrollments, government inducements for medical information, or the health care system in general. Rather it is the fact that deeply flawed ideas and practices about the meaning of race, unexamined assumptions about racial differences, and the ways in which these ideas have become naturalized in medicine and public health that produce the “everyday racism” Black Americans have experienced for centuries. [5]
We write this as two medical historians who have published and taught on the history of racism and American health care for decades, and on some of these studies in particular. Neither of us would deny the importance of these historical events, or the others less famous, that do indeed haunt the past medical and public health experiences of Black Americans. But over and over, it is something about this increasingly distant past of various horrific and infamous medical cases, rather than the routine and deeply embedded structural racism, that seems to matter in discussions, essays, and even education about the fraught relationship Black Americans have to the medical care system. As we face what is becoming a crisis over the distribution of approved vaccines, there are real limits to continuing to bring up this past without identifying and making visible the actual barriers in front of us now.
Indeed, the constant reminders of these experiments may be an impediment to change in both the medical community and the public. The highlighting of these horrific events does not explain much of anything other than to acknowledge some limited knowledge or “cultural competency” about the roots of Black anger and pain over a history of medical and public health neglect. It fits within the limitations of knowing a little bit of history about a culture that somehow supposedly overcomes “bias and stigma” to create the communication skills to link patients and their providers. [6]
Real issues of structural racism are hidden when Sims, Tuskegee, and Lacks are evoked, just as learning a few medical words in Spanish or knowing about food deserts does not make researchers and practitioners competent in the racism that shapes our society. Almost like the dated “culture of poverty” arguments from the 1960s and 1970s, which posited that poverty created lifestyles and family structures that could not be overcome, we think it is time to stop using iconic events of medical abuses to explain contemporary fears.[7]
If we are to take systemic racism in the medicine and public health , a different set of questions need to be asked when we take the “history.” The queries should be about the disrespect and dismissal experienced at an individual’s last medical encounter, or the treatment of a family member at a nursing home, that builds on a lifetime of racist experiences that matter in creating distrust. It is all the episodes of “everyday racism” that work across race, gender, and class undergirding our stratified society including lack of decent housing and education, transportation, food and exercise access, mass incarceration, and enforced poverty that has proven over and over to be what creates disparate health outcomes. Despite generations of searches to prove “the logic of difference” in Black bones, hearts, lung capacity or genetics, disparities and social epidemiology research has demonstrated the structural creation of ill-health and its epigenetic effects that carry on through generations.[8]
Although this is not the intention, evoking these historical studies also labels those who acknowledge them as looking backward to some distant worry that should not affect a more “modern” people now. It makes it seem as if change is not possible because this burden of history cannot be overcome. These studies do matter, but they matter for what they show that is happening now not just what was done in the past.
The horror stories throughout our history matter in laying bare the underlying disrespect and flawed science of racial differences. Racial differences in experiences matter as the current political upheavals over excess Black deaths from disease or the police make clear. Including a historical perspective that can tell us where we have been and how we as a nation have failed to incorporate lessons from previous epidemics that revealed the role of systemic racism in perpetuating health inequalities is critical. Further, as state after state is trying to determine how to deal with the expanding epidemic within their prisons and jails, the need to see the public health consequences of our racial mass incarceration system becomes even more important, too. [9]
Physician and public health advocate the late H. Jack Geiger wrote over twenty years ago, that history is important “because it underscores the extent to which racism – fluctuating in intensity, shifting in content, but ever present - is still a major public health problem and a challenge to the goals of medicine and science.” And he continued, the failure of efforts to address racism, “reflects an abandonment of racial justice and equity as national goals. It is not just history.” [10] “Cultural competency” demonstrated by invoking a few terrible historical examples does not show “structural competency” in understanding why Black mistrust exists in the face of an untrustworthy medical and public health system. [11] It does because of real experiences of the everyday, experiences alas that more and more Americans of every racial/ethnic group are beginning to acknowledge every day.
The Biden administration has a great opportunity – to both recognize the historical basis of Black communities’ mistrust while acknowledging the structural issues that make our current system untrustworthy. As the roll out of vaccines again breaks down around racial lines where Black Americans are currently being vaccinated at a lower rate than whites – we need to do everything possible to close this gap and close it now. [12] Evidence is already beginning to show that if the distribution is done in local health centers or community settings, African Americans and other people of color will show up. The issue is access not hesitancy. [13]
There has to be more of an equity lens that prioritizes vaccines in the health centers, pharmacies and public spaces that are in Black communities, the prioritizing of vaccination, or better yet decarceration, in prisons and jails, and a commitment to really understanding where mistrust comes from. It means re-examining the racist assumptions built into algorithms and devices that health care practitioners are taught to think of as “factual.” [14] It requires real and sustained funding of public health and primary care to prevent the co-morbidities that lead to racial health disparities and early deaths. This cannot be a one shot (or in this case two shots) solution, either. We have to ask the right questions to get to diagnosis and treatment, and take the proper histories.
[1] Rosenberg CE. The Tyranny of Diagnosis: Specific Entities and Individual Experience. Milbank Q. 2002;80(2):237-260. doi: 10.1111/1468-0009.t01-1-00003
[2] Warren RC. Forrow L. Hodge DA. Truog, RD. Trustworthiness before Trust---Covid 19 Vaccine Trials and the Black Community. N Engl J Med 2020; 383:e121
doi: 10.1056/NEJMp2030033
[3] Buchanan K. First Look: Viola Davis and Chadwick Boseman in ‘Ma Rainey’s Black Bottom.’ New York Times, September 30, 2020, https://www.nytimes.com/2020/09/30/movies/chadwick-boseman-ma-raineys-black-bottom.html.
[4] Cooper Owens D. Medical Bondage. Athens, GA: University of Georgia Press, 2017; Reverby SM. Examining Tuskegee. Chapel Hill: University of North Carolina Press, 2009; Skloot R. The Immortal Life of Henrietta Lacks. New York: Crown, 2009.
[5] Essed P. Understanding Everyday Racism. New York: Sage Publications, 1991.
[6] Neff J et.al. Structural Competency. MedEdPortal. 2020; 16, 10888. Doi: 10.15766/mep_2374-8265.10888.[7] Valentine CA. Culture and Poverty Critique and Counter-Proposals. Chicago: University of Chicago Press, 1968.
[8] Hammonds EM. Herzig RM, eds. The Nature of Difference. Cambridge: MIT Press, 2009; Braun L. Breathing Race into the Machine. (Minneapolis: University of Minnesota Press, 2014; Krieger N. Stormy Weather: Race, Gene Expression, and the Science of Health Disparities. Am J Public Health. 2005 December; 95 (12):2155-2160. doi: 10.2105/AJPH.2005.067108.
[9] Hoos D. Reverby SM. Zeller B. Fullilove R. Opinion: It’s Time for NYS to Act on Decarceration in Prisons to Curb COVID-19. CityLimits, January 4, 2021, https://citylimits.org/2021/01/04/opinion-its-time-for-new-york-state-to-act-on-decarceration-in-prisons-to-curb-covid-19/.
[10] Geiger HJ. Annotation: Racism Resurgent—Building a Bridge to the 19th Century. Am J Public Health. 1997 November, 87(11):1765-1766. doi: 10.2105/ajph.87.11.1765-a.
[11] Metzl JM. Hansen H. Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality. Soc Sci Med. 2014 Feb; 103: 126–133. doi: 10.1016/j.socscimed.2013.06.032
[12] Racial Disparities, Inconsistent Policies Shape Picture of the Vaccinated. KHN Morning Briefing. January 27, 2021. https://khn.org/morning-breakout/racial-disparities-inconsistent-policies-shape-picture-of-vaccinated/.
[13] “Trauma: Racism in Health Care,” NBC Channel 10 Boston, March 31, 2021.
[14] Vyas DA. Eisenstein LG. Jones DS. Hidden in Plain Sight---Reconsidering the Use of Race Correction in Clinical Algorithms. N Engl J Med 2020; 383:874-882 doi: 10.1056/NEJMms2004740.
Evelynn M. Hammonds, PhD, is the Barbara Gutmann Rosenkrantz Professor the History of Science, Professor of African and African American Studies, and Chair of the Department of the History of Science and Medicine, Harvard University. She is the co-editor of The Nature of Difference: Sciences of Race in the United States from Jefferson to Genomics (2008).
Susan M. Reverby, PhD, is the Marion Butler McLean Professor Emerita in the History of Ideas and Professor Emerita of Women’s and Gender Studies, Wellesley College. Her most recent books are Co-Conspirator for Justice: The Revolutionary Life of Dr. Alan Berkman (2020) and Examining Tuskegee: The Infamous Syphilis Study and its Legacy (2009).
The Left-Handed Whale Watchers
by Melanie Griffin
I see the man pause at the telephone pole that stands between us. He leans closer to it, studies something stapled to its body, smirks out a tiny smile that etches onto only half of his face. Then he reaches out with his left hand and tears something off. It goes into his jacket pocket.
I wait what I considered a reasonable amount of time after wandered off before I go to the pole myself. (Ten Mississippis, long as the river itself, from when he disappears around the corner.)
It’s covered in a number of things, mostly paper, some lamination, one or two welded badges from whoever had originally erected it. Black and white, full-color, but the vast majority a uniform sun-bleached sort of grey.
I’m overwhelmed until my eyes find the only piece that dangled a fringe of tearable strips, each sporting an identical phone number. The flyer says they connected to the Left-Handed Whale Watchers.
I grab a strip and pull. It gives way easily, what with all our rain lately.
Then I take it inside.
***
Before I get in touch, I have to practice. I naturally favor my right hand, as do 90.2% of people worldwide. But if I’m to get to this whale watching, I figured I better at least seem legitimate.
Day 1: Handwriting wants to go the wrong way, chopsticks won’t close, scissors are fighting back.
Day 2: Finally clamped a shrimp. Rice still eludes.
Day 3: All they’ll really ask for is my signature, right? I mean correct? That, at least, seems up to the task.
So on Day 4 I call the number. It takes several tries with my left thumb, and the way the phone feels against my left ear is repellant, but I don’t want to sound like a fraud to the chirpy woman who answers.
“Left-Handed Whale Watchers, how may I help you?”
I can hear her smile, which makes me feel bad for my deception. But then again, they’re the ones who advertise.
“Yes,” I say. “I’d like to order one ticket to your whale watching, please.”
“Okie dokie,” she says. “That’ll be $50.92.”
It’s a large chunk of what I allow myself to spend frivolously each month. But this should be worth it. (Unlike the bathmats.)
I feed her my credit card information, which she repeats back in perfect sync. Maybe I should get a secretary. Or at least someone who can take dictation, that seems useful.
“Alright, our next tour leaves tomorrow at nine twenty-five a.m. off the west — thingy — oh, you know. Place at the harbor.” She gives a little laugh. “My brain,” she says. “Just — pfffft sometimes, you know? I need coffee.” She laughs again, this time trailing off when I don’t respond. “Anyhoo, you can’t miss us. We’re practically the only boat that moves anymore.”
“Okay,” I say. (Maybe an artificial intelligence system would be a more prudent investment.)
“Call us if you have any questions,” she says.
“I will,” I say.
“Buh bye now!” Click.
I put my own phone on the counter. Nine twenty-five is late for me in the mornings. I get up what a former partner called “obscenely” early to soak in as much silence as I can carry. I need it to last me the whole day. Sometimes I get coffee. (But never at four o’clock in the afternoon. THAT is obscene.) But usually I just sit and look at the walls, absorbing their blankness.
I have plenty of time to do that on the day of the whale watch. At a preset alarm, I pull a rain poncho over my head and grab my waterproofed bag. (Research indicates that whales are spouty.)
I’ve made it outside and into the driver’s seat of my car before freezing up with a problem that suddenly occurs to me. It pops open in my brain like a disappointing bubble.
The woman on the phone had called this “the next available” tour. There must be dozens more scheduled by now — at the very least, a standard day of the week that any left-hander can choose infinite months out.
What if I’ve chosen the wrong one?
I shake my head as hard as I can, but the only thing to dislodge my doubt was logic. If this isn’t the right tour, I can try again. And again. And again.
***
The right boat is easy to find. We are a sleepy town, and it’s the only rig awake when I get there.
I park on the roped-off gravel and stay in my car, assessing the crowd. It skews towards two ends: the young and ironic (judging by haircuts), and the old and sincere. I don’t quite fit into either, but I am used to, even somewhat content with, that. Only I can see the entire spectrum objectively.
As I slide my eyes to the sea, tracing where the dark rolling surface meets the sky quilted with low-hanging clouds, I hear a voice cry out distinct above the others.
It’s him. I know this in the nanosecond my gaze snaps over to confirm. My stomach starts to knot, but anxiety is quickly overtaken by a righteous anger that burns through my throat. It feels like destiny.
I clench my left hand, balling up all the power I’ve been training into it. I have to use it judiciously so it won’t run out before I truly need it.
So I don’t worry about using my right to unlock my seatbelt and propel myself out of my car. On the agreed consensus of the whale watching websites I consulted, I have belted a fanny pack around my middle to hold my necessities, so both of my arms swing freely as I walk towards the gathering crowd. I plaster on my work smile (which, like a well-made black ballerina flat, is useful for so many other places beyond the office).
A few people notice and smile back when I join the edges, but no one waves or says anything or moves out of their sub-cluster of the group. Good. I want to appear friendly but mysterious.
Although not mysterious enough to attract attention. I take out my phone and pretend to fiddle with it. (Applications are the devil, and my phone connects to neither data nor wifi. It’s a superfluous expense.) By the time the short ponytailed blond claps once in a deliberate way like a camp counselor, I am panicking the slightest bit. It seems I forgot the most important accessory.
“No camer?” The closest old man to me had said a few minutes earlier. His face is carved into a permanently friendly expression, but I can sense suspicion nestled into his stare.
Camera! Fuck!
I had done a frantic visual inventory of the crowd, as thorough as I could without moving, and realized my mistake.
Trying to stay calm (BREATHE, dammit), I had pointed my work smile at the old man. “I’m more here for the, ah, live experience,” I had said. Then I’d held up my phone in my left hand and made a vague gesture with it. “Plus, you know—“
He had nodded, but with a sheen of superiority and a pat on the (left) side of the boxy lens hanging from his neck. “Prefer the good ol’ reliable myself,” he’d said, and I’d pretended to hear my name on the other side of the group to avoid more shop talk.
Thus having skillfully evaded my first confrontation of the day, I line up with the others as the blond herds us towards the loading ramp like a good-natured sheepdog. I know where he is at all times, but I don’t show it. I keep my right hand clenched rigidly at my side. I know it looks odd if one catches it from the side, but it keeps wanting to jerk up and do stuff like accept one of the plastic cups of red wine that are floating around on waiters’ arms.
I don’t take any alcohol because it dulls the senses. I shove both of my hands into the front pouch-pocket of my hoodie and stare out at the water in what I will to be poetic solitude on my countenance.
“Couldn’t ask for better weather, eh?” The ponytailed guide startles me out of it. She looks where my face is pointed and takes a huge sniff of the salt air. Her nostrils flare and deepen the frown on her face the tiniest bit, like something has lodged into her sinuses but she can’t tell where.
But that turns over into a manic grin a nanosecond later, and she slaps our section of the boat railing. It wobbles.
“Okay!” she says to the rest of the boat. Yells, really. “Let’s head ‘em out!”
I shuffle away from her as the boat starts moving. I’m trying to avoid that buddy-with-the-teacher effect I’ve somehow attracted my whole life (for no real reason other than odd-numbered crowds and never being anyone’s first pick). The floor of the boat sways beneath me, and instead of gracefully stepping aside, I trip and fall. Into somebody.
“Whoa there,” a voice above my hair says. It echoes through the ribcage my skull rests on until I recoil away from it. I recognize the sound. The smell. The shirt pattern up close.
It’s him.
But he doesn’t know it’s him. He just offers his (left) hand that’s been emptied by transferring his drink (to the right). A way to pull me off the floor, where I sprawl hoping to dissolve into the sea mist and float away with the rest of it when it decides to move on from wreathing our heads and shoulders.
“C’mon,” he says, urgently, almost to the point of impatience. He has his eyes locked on the edge of water that’s visible from our middle point, scanning it back and forth in the sight line patterns I remember from the orientation packet we were all emailed a few days ago.
Just as I’m reminding myself to grab his left hand using my own, the leader says, “Thar she blows!” with all the gusto of the first ever ship worker to do so. Big but smooth waves rock the boat, and he gives me up as a lost cause so he can go gawk at the poor exploited creature just like everyone else on this godforsaken hunk of wood.
My therapist says to use my words, so here they are: Angry. Mad. Pissed off. Furious. Burning up. Fire. Lava. Explosives.
Everything runs through my brain and my heart like an infinite loop of hurt. I can only think of one way to break it.
I rush back to him, gaining my sea legs as I go without noticing until in the afterburn of adrenaline when I’m done. But I’m not yet. I hold my arms straight out in front of me, both of them, leading with my hands in identical fists, sharing the equal domination of revenge.
They run into him first. He’s startled, and more pliant than he should be because of it. But I don’t let him remember his real strength before the sum total of mine slams his body overboard.
All the camera flashes snap me out of the red tint that has been tunneling my vision, and I see that he’s in the water.
“Oh my god,” he says, then repeats it faster and faster as a long grey wrinkled piece of island surfaces next to him.
“It’s okay!” the guide says over all the worried muttered and his panicked mantra. “She just wants to help!” The guide’s smile is artificially wide, and muttering something into a headset none of us are positioned to quite see. A buff guy in a wetsuit comes rushing out of a door holding a raft above his head, but she puts a hand on his shoulder when he gets to the rail, and the buff guy stops.
I finally gather the courage to look over and see what I’ve done. In the water, he’s petting the whale. His right arm is hooked to its back, his left hand is scratching it down like he’s trying to find the spot on a dog’s back that makes the leg jiggle. He’s wet, dripping, and I can’t imagine he’s anything warmer than freezing.
But he’s smiling. He’s grinning.
And everyone else is eating it up, too, cooing whenever the whale breathes its geyser of snot into the air so it falls down on all of us. Him most of all.
***
They kick me off because I forget and sign the police report with my left hand.
He’s across the harbor, toweling his hair and talking to a few people who look much less official than the officers who surround me. I see him glance my way once or twice. The first time his face stays naked and confused, but by the next it’s hardened into something impenetrable, harder to read than anger.
I don’t try. I’ve done my part.
Melanie Griffin is a writer who works at a library and researches fraud for a podcast. Her short fiction has been published in a number of online literary journals since 2011, and she has never actually thrown anybody overboard (yet).
Valerie Adams is a freelance creative from Richardson, Texas. When she’s not immersed in words or behind the lens, she can frequently be found with her trusted companion cat Flower.
Craft Is What We Do
by Michael Langford
The way two disparate ideas come together in a well-written essay, three if you’re really having a good day, fascinates me. Whether it is simile, metaphor, or synchronicity … all that matters to me is getting these thoughts out of my head, composing them into a coherent whole, and moving on. On a whim this winter, I started a Medium account (where I found you), after years of being frustrated by Wordpress … more recently I have taken on a role writing about timber framing for a website that sells plans, tools and kits to the ambitious and unsuspecting. Finding a voice, a tone that communicates without feeling contrived or condescending or awkward, then rolling with it.
BREAD on the WATERS
For several years, I have been baking sourdough bread. Over the past year I have gotten really good at it, as all my neighbors will agree. One of the earliest realizations is that levain (starter) is a culture, and that culture must be fed and nurtured frequently or it will die. Proofing (allowing the dough to rise) depends on conditions, particularly temperature. Occasionally, I will let a loaf over-proof. Recently, I found that if I combine that old sour dough with fresh young dough, I have effectively saved the older dough while simultaneously given the younger dough a boost of developed yeast. As a result, the combined loaves will proof quicker, and rise higher while baking … even better than a single loaf made by my normal method. There’s a parable in this…
TIMBER FRAMING
Anyone who has taken apart a timber frame will have remarked the distortion in the old pegs, particularly where the peg holes were draw-bored. Hand-shaved tapered pegs that started out straight become bent or cranked over time, cumulative stress (sometimes acute) takes a toll on their resilience. Dismantling the frame, re-fitting the joints, making necessary repairs … ensuring that its corners are square, shoulders bearing their assigned loads, loads properly distributed … and finally re-assembling that frame with fresh new pegs of locust or hickory. Nothing quite like driving home stout pegs into well-placed draw-bores … to feel and hear the rising timbre of the entire structure.
This little frame stands for now on top of my carport. I cut it about five years ago … since then it’s been assembled and disassembled twice; raised on another site, then back here again … turned 180º so that the carving on the main beam is now visible from the street. If my frames can bear up to dis-mantling and re-assembly, if I can find ways to improve them every time … I humbly suggest that the Guild’s structure could benefit from the same practice. Craft is not just something we talk about, cræft is what we do. Craft is a culture, and if we don’t feed it, it dies. Consider, if you will, the Japanese practice at the Shinto temples of Ise.
“Keep true to the dreams of thy youth.” —Schiller
Michael Langford dropped out of college to practice the craft of carpentry. He traveled the world before ending up back in the same college town, with the woman he loved, whom he lost to cancer a while back. He still lives there, with his dog, in a house he keeps working on.