The violent deaths of Breonna Taylor, George Floyd, and others in 2020 prompted calls for an overhaul of policing and sparked a national debate. But theirs weren’t the only losses last year that spotlighted racial inequities, or that have spurred demand for fundamental change in some of society’s most essential services.
The disproportionate impact of the coronavirus pandemic on the Black community and people of color may have generated fewer headlines than the deaths at the hands of law enforcement officers, but it has galvanized a campaign to dismantle the long-standing racism that organizers say adversely impacts health care for minorities.
The initiative is being led by twin sisters Dr. Brittani James and Dr. Brandi Jackson, whose medical career paths are indicative of their willingness to challenge conventions: James is one of only 2-3% of Black women doctors in the country, while Jackson is one of only 1% of Black psychiatrists (less of them women).
Seeing so few others like themselves in the medical world prompted the siblings (appropriately born in Twinsburg, Ohio) to launch Med Like Me in 2018. The online hub was created to help members of minority groups—LGBTQ as well as racial—pursue a career in medicine. And then came COVID-19.
Overseeing clinics in some of Chicago’s impoverished communities, James knew from experience that health care services “weren’t strong” pre-pandemic. And then “the floor fell out,” she says. “If people think this is a pandemic thing,” she says of the lack of adequate care, “they’re missing the boat. This was the floor falling out on an already broken system.”
Changing the system
In addition to its physical impact, the pandemic’s economic and domestic stresses created a mental health crisis—an area of need too often not acknowledged or addressed in the Black community. Why has that been the case?
“There’s sometimes a thing we call learned helplessness,” says Jackson, who has specialized in mental health. “You just learn that you’re going to keep banging your head against the wall, keep speaking truth, and nothing’s going to happen. It took real-time video for us to be believed about being murdered in the streets…” And for Black women, there is the feeling they can’t share their vulnerable places because of all their responsibilities: “We’re holding up the world.”
People have a breaking point… and I worry that we have crossed ours.
DR. BRANDI JACKSON
With all that in mind, COVID-19 lit a bigger fire in the two women. “We pivoted from saying, ‘Black folks, do this to get into medicine,’ to saying, ‘The system is busted. How do we change the system?’” James says. “And so we fundamentally shifted our gaze to the very industry that we feel is literally killing us.”
This is not hyperbole, she insists. “Literally,” she says, “through lack of access, through people who don’t understand our community, who are giving subpar care to folks based on the color of their skin.” The segregation in the health care system can be traced all the way back to Jim Crow and then slavery, she says. “What we’re saying is we’re not going to be able to find health and well-being in society until we heal racial trauma in ourselves and in our country.”
It’s not enough for doctors to just tell people to eat healthy if they don’t have access to good food because they have been redlined into concentrated areas of poverty. “We have to come out of our examination rooms to say, ‘What’s going on here?’”
That is the driving vision behind IAM: The Institute for Antiracism in Medicine, which the sibling doctors founded last year with another Chicago-area M.D., Jessica Richardson. Through the organization, they want to help overhaul medical education
“We’re creating a curriculum from scratch that actually tells the true history of our profession and the ways in which we are actually propagating racist harm as opposed to healing,” says Jackson. “It’s really hard for people to come to terms with the fact that we are also bringers of harm. So a lot of our education through other doctors is about that.” There is also a public-facing aspect to the initiative, “to teach you how to regain your own health as a Black person in this country,” Jackson says.
IAM doesn’t pull its punches. One article at the group’s website states baldly, “By failing to recognize and address the racism in our field and in ourselves, we as physicians and medical scientists are failing to uphold one of the foundational charges of our profession. We are contributing to the destruction of the very people we are charged to heal.” Widely accepted yet fundamentally racist concepts, research, diagnostic tools, and treatments are “rampant” in current medicine, the article says.
IAM made headlines earlier this year for challenging comments by the editor-in-chief at the prestigious Journal of the American Medical Association questioning the existence of racism in medicine. He later stepped down.
Creating two Americas
As the country opens up again after more than a year of lockdown, James and Jackson have concerns. Vaccination rates are lagging among Blacks, putting them at greater risk. Indeed, “we’re creating two Americas—vaccinated and not vaccinated—and vaccinated America is mostly white,” James says. It leaves her worrying that things may get worse.
She recommends getting a shot. “Based on what I have seen and what we know so far, it is a better bet to go with that than it is risking COVID.” Yes, you can get COVID-19 and survive, but there are serious long-term issues for some—impaired heart and lungs, memory issues.
My goal is not to scare you,” says James. “My goal is to give you the straight talk, no chaser, so you can make the best decision.” Among the factors to take into consideration: your family members’ ages and vulnerability, your own health, the health of those in your family, your work situation. “There’s a lot to weigh… get [the information] from your doctor, from somebody you trust, who knows what they are talking about.”
Part of the hesitation many Black people have about getting vaccinated is because of their history of being treated poorly by health care providers, the sisters say. “We often ask people, ‘Why don’t you trust the vaccine?’” James adds. “I want to know what has medicine done to be trustworthy?”
Jackson wants to tell her medical peers to go back in time because “that’s pretty much the only hope, because you began to harm the Black community in ways that cannot be erased or forgotten a long time ago. So it is disingenuous, as many of my professors have been doing, to say, ‘Well, you know, they just don’t want it. We tried.’ OK, but tell the whole story, which is why you have no trust.”
Actually, James has found that patients are not so resistant to considering the vaccine once they feel heard and informed. After taking the time needed to answer all their questions, she has seen some of her patients change their minds. “That tells me that nobody’s talking to Black folks the way they need to… you’re talking at Black folks, but you’re not actually listening to what we’re asking.”
Her advice to anyone who doesn’t feel heard: find another doctor. “I know that’s easier said than done for a lot of us, but I’m very serious; that is not somebody that you should be letting be a steward of your health.”
Improving health education
The doctors name their biggest health concerns for the Black community: mental health, women’s health in general and maternal mortality in particular. “We have rates three times that of white women,” says James, recalling her own experience as a mother with preeclampsia whose delivery pain was dismissed. “I’d been in school for 11 years and still was not believed by the care team that was taking care of me.”
If James and Jackson speak bluntly about the failings they see in the medical profession, they are equally direct when discussing the place and impact of the pharmaceutical industry on the nation’s health.
“Ours is a system of health care built on capitalism—racialized capitalism at that,” Jackson says. “And any time you’re putting money as an intervener between health and not having health, you’re in dangerous territory.”
On this topic, as often happens when they’re talking, one sister takes over from the other. “I hope we can move to a place where… we can all agree that we should not be profiting on human suffering,” adds James. “We need to realign our incentive that you only make money when people are getting healthier, and that’s not what we have.”
Health education isn’t lacking only in med school. They see a deficiency in K-12 too. “How much hurt, sadness, loneliness could be prevented if we had the basic tools of mental health taught at a young age,” observes Jackson. “I don’t hear enough talk about mental health in schools, how it could really save our children and ultimately us as adults.” That is a disservice especially to Black people, she believes, because “we have a lot mentally that we’re up against.”
Then there is nutrition, a largely overlooked “bedrock” of good health, says James. Teaching people about good food and how to prepare it, explaining the dangers of high blood pressure and diabetes are other fundamentals. “We’re not doing a good job of making sure people understand the basics about their body and their health.”
Overcoming the odds
Both women had curiosity and a love for science from an early age, setting off rockets in the bathroom and turning one of their mother’s jewelry boxes into a bug hospital (sadly, most of the “patients” died). The identical twins were smart—4.0 GPAs—but with no one in their family in medicine modeling it as a career path, it would be years before they ever considered it a field they could pursue.
After studying in South Africa for a time, James did a rotation at New York Presbyterian Hospital in New York City, where at 21 she saw her first Black woman doctor in the flesh. “Before that I had only seen [character Dr. Miranda] Bailey on Grey’s Anatomy,” she remembers.
“You can’t be what you can’t see,” James says. But that NYC encounter made her realize “this is really something I can do. It just really became real and then sharing that with Brandi, literally that just changed our whole world.”
For Jackson, growing up “I just knew I wanted to use my intelligence for something that was going to actually help people and serve humanity. I knew that part, but the execution was a little fuzzy.”
While they may not have had medical role models in their family, the sisters credit their parents for instilling in them a determination to do their best and dream big. They “told us we could do anything we wanted, even if they didn’t know the way,” says Jackson. That parental affirmation went so deep that, for a time, Jackson told everyone that when she grew up she was going to be a bluebird and mom and dad didn’t correct her.
“We were studying metamorphosis, and I thought I could literally change into something,” she explains with a smile. “That’s the power of parents who just relentlessly will not say you can’t do it. And that’s probably the real reason we’re doctors at this point.”
After graduating high school—sharing the salutatorian address—and attending Cornell, they went their separate ways (University of Illinois at Chicago for Jackson, the University of Michigan Medical School for James) before reuniting as residents in Chicago.
It wasn’t an easy journey to their current positions—Jackson the chief behavioral health officer at Howard Brown Health and James a family doctor on Chicago’s South Side, which was one of the areas hardest hit by the pandemic. “It’s an exercise in gut strength to face what you have to face to become a doctor in the country if you’re Black,” says Jackson, “because you’re not only seeing the racism done to your people, you’re having it done to you at the same time.”
The struggles have been worth it, though, Jackson says for them both: “Our entire purpose is to increase and improve the health of our community.”
OUR WAYMAKERS:
Dr. Brittani James
Our parents, obviously, but also our extended family. Our great-grandma used to make little healing salves and things for the community; she would probably have been a doctor in a different time. I have to give a shout out to my obsession, Angela Davis, who is just my guiding light, my hero. You just feel an instant solidarity with folks, and those people just really lift me up, just reading their work or hearing about them.
Dr. Brandi Jackson
I have a mentor, Dr. Niva Lubin-Johnson. She’s an internal medicine doctor, a Black woman, past president of the National Medical Association, which is essentially the organization Black people started when they wouldn’t let us into the American Medical Association. She has been taking me to brunch for over a decade since I was a first-year medical student who didn’t know anything or anyone. She picked my name out of a bowl at a mentorship event and proceeded to find me.
