Building Trust with the Underserved Community in a Time of Pandemic
Chris Davis, MD, MPH
COVID-19, like so many other diseases, strikes communities of color disproportionately. As of April 1, most of Milwaukee’s COVID-19 cases and deaths have been in the African American community.
Here’s a frightening, real-life illustration: On February 29, 2020, about 200 friends and relatives attended the funeral of Andrew Jerome Mitchell, a retired janitor, in the small, rural, poor, underserved community of Albany, Georgia. It was one of two funerals held at the same chapel over the course of a few days. Andrew came from a large family and the room overflowed. The mourners shared a potluck and told stories. No one was known to be ill at the time. After the funeral, everyone went their separate ways. In the ensuing weeks, dozens of the mourners – and then their contacts – became ill. Over the past four weeks, over 600 people eventually contracted COVID-19 including six of Andrew’s siblings. The local hospital was overwhelmed. So far, at least twentyfour have died including Andrew’s 51-year-old great-niece. The death rate per capita is nearly that of Wuhan at the height of the outbreak.
Ninety percent of the victims in Albany were African American.
Albany offers a cautionary tale for Milwaukee. A 2019 Wisconsin Collaborative for Healthcare Quality report confirms that Milwaukee’s lowest socioeconomic communities (primarily African American and Latinx) have measurably worse levels of blood pressure control, blood sugar control, immunization rates, appropriate heart disease management, and life expectancy than whites. So when a disease like COVID-19 strikes hardest at individuals who have “preexisting conditions,” communities of color are disproportionately affected. As a society and a community, we expect everyone to work to “flatten the COVID-19 curve.” We recognize, though, that the vulnerable are the least prepared to practice social distancing since they disproportionately work in service and personal care industries and fulfill “essential” functions. Many cannot stay home for weeks since they are one paycheck away from homelessness. These people (people!) suffer the centuries-old consequences of health and educational inequities and are separated from the rest of society by income disparities, embedded racism, housing insecurity, nutritional deserts, inadequate transportation, low literacy rates, and a lack of adequate health insurance.
MCW depends on – and benefits from – its ties to the community. We know people are fearful and grieving. They thirst for clear, evidence-based information to keep themselves and their loved ones healthy and alive. They need supplies and accompaniment. Milwaukee’s underserved deserve true leadership and, since the bonds of trust between the underserved community and medicine are fragile, essential leadership must come from within the community itself. To this end, many within MCW are working to support our underserved communities and their leaders.
As an organization, we pledge to communicate essential, factual, timely, and community-appropriate information and to leverage our strengths to provide meaningful resources.
To put this in Kern Institute parlance, it is not a question whether we will serve either our community or serve our front line healthcare workers. Rather, the question is yes and. Doing so is a matter of justice as we treat others, not only fairly but also by accounting for different levels of need. We are marshaling medical students and non-front line MCW community members to serve the underserved community by providing protective masks and offering education. We hope that by “showing up,” we play a small role in healing generations of well-deserved mistrust between the African American and Latinx communities and medicine.
Our missions are to help every member of the community through the COVID19 pandemic, to not overlook the forgotten, and to build ties that will solidify trust on which our common future depends.
Resources mentioned in this essay:
Click here for "Days After a Funeral in a Georgia Town, Coronavirus ‘Hit Like a Bomb’" New York Times March 30, 2020
Click here for "A Coronavirus Spike In A Big City, And In A Small One" National Public Radio – All Things Considered March 31, 2020
Click here for the Wisconsin Collaborative for Health Care Quality
Christopher Davis, MD, MPH is an Assistant Professor of Surgery (Trauma and Acute Care Surgery). He is a faculty member of the Community and Institutional Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.
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