Dr. Danielle Marino wants to prevent colon cancer, and as part of that mission she wants people to undergo a colonoscopy.
But she knows that many people of color who are at high risk for the disease want nothing to do with doctors because for decades they were a source of abuse.
“I wanted to understand more about how racism has affected healthcare and how I can work to overcome those things,” said Marino, who recently completed Structural Racism in Healthcare and Research, a free five-week course at the University of Rochester Medical Center.
The course was offered through the Clinical & Translational Science Institute, which bridges the work of researchers and the doctors, nurses and other health professionals to use science to help people.
The idea behind Structural Racism in Healthcare and Research was to explore how the history of racism shaped the relationship between the doctors/researchers and their Black, Indigenous, and People of Color patients or research participants. The concept was introduced more than two years ago but gained urgency over the intervening months.
What separates the course from a purely academic exercise is that the content was developed by professionals in the community. The university put out requests for facilitators through the African American and Latino health coalitions, which are convened by Common Ground Health.
“It showed the university is being more inclusive,” said Karen Rogers, founder and chief executive officer of Exercise Express and one of the facilitators. “URMC is a staple in the community. That they’re looking at more opportunities to become more diverse is excellent.”
The course also was open to members of the community and 24 participants were split evenly among medical professionals and laypeople and racially and ethnically diverse.
“I think the expectations when I come into anything that has to do with race is that it’s going to be challenging because everybody enters the space and the conversation at a different place,” said facilitator Traci Terrance, licensed clinical social worker who holds a doctorate and is a clinician in the URMC Departments of Psychiatry and Family Medicine and is with Sankofa Family Counseling Services.
“That’s people of color included,” she said. “I think we’re all in a different place on our journey. … To a degree that’s what I got from the facilitators code facilitators. We were certainly at times at different places of understanding about the privilege that we bring to the work and in our lives.”
John Cullen, director of diversity and inclusion for the CTSI, said he and his colleagues used the book Medical Apartheid by former Rochester resident Harriet Washington to develop a general description. It was up to the facilitators to develop the material.
“We wanted to be able to educate the participants on factual data, as well as historical events that have occurred,” said Mary Bisbee-Burrows, a public health specialist who holds a doctorate in education. “And also the importance of it and then what can we do to change the trajectory. Because it’s one thing to know this information and have, you know, you know, just be familiar with all this sometimes horrific history, but where are we going to do about it?”
The other facilitators were Lucia Castillejo, executive director of the Monroe County Medical Society; Alicia Evans, founder of LeGray Dynamic; and Katie Reed, registered nurse education manager for Blossom: Modern Home Care Solutions of WNY.
Facilitators were given creative control, and different ones teamed up each week to present the topics: laying the groundwork for community engagement; definitions of race, racism and health inequities; history of racism in healthcare and research; understanding and overcoming racism in modern medicine; using a framework of cultural resilience for healthcare and research.
“It would be an opportunity to educate individuals that may or may not be knowledgeable of exactly what structural racism is and what part they may play in it,” said Rogers.
Terrance, who co-facilitated the closing session that focused on resilience, said she wanted people in health care or research to understand that they come to their work with bias.
“If you are looking at communities of color through this deficit-based lens, then you’re already at a disadvantage when it comes to working with us,” she said. “I also wanted them to understand different aspects of resilience … that you can consider our ability to walk between two different worlds, a world or a system that was not designed for people of color, but we still manage and know how to navigate it. How can you use what we bring through that lens so that you can approach us or engage us in a different way.”
Can one person restore equity to the medical establishment?
“During the course, there was a moment where I felt like wow, this is such a big problem, how can I do anything,” Marino said. “It felt overwhelming.”
Marino said the course brought out what she called “big feelings,” but it also gave her hope. “There’s all these people sitting around and talking about the same problem. The fact that they even have this course, which five years ago never would have been thought of, I think is really optimistic.”
Participants are in the process of evaluating the course so organizers and facilitators know where they can improve.
Already, they have heard a need for opportunities during each session to create ways to put the knowledge and feelings to use.
“I do think that’s something we need to help them figure out,” said Terrance. “I think we’re at a point where we’re at least having conversations about what our next steps are. We could be all in our heads about this stuff, but if it doesn’t translate to action, you may as well not even be talking about it.”