Commentary Race

Love Thy Self Fiercely: How Self-Love Makes for Better Health Care

Amber J. Phillips

Self-love can help build the confidence that I and other Black women need when facing a medical industry that often doesn’t understand us.

This piece is published in collaboration with Echoing Ida, a Strong Families project.

Two years ago, one of my close friends recommended that I read bell hooks’ All About Love, and it literally changed my life. The book is the first installation of her trilogy about love and the intersections of race, gender, and sexuality. In the last installation, Communion: The Female Search for Love, she writes, “the most feminist action any female can take on her behalf is doing the work of creating positive self-esteem, the foundation of self-love.” During my journey through these books I began to do the work of fiercely protecting my self-esteem to build a stronger foundation of self-love. My work toward greater self-love included holding in higher regard my physical and mental health. I worked out more, ate better, and practiced better self-care (which can be hard for me as an organizer who sometimes works odd and long hours). In embarking on this journey, I realized that as a Black woman, I was raised to “carry” and present myself in a very particular way, despite sometimes lacking the self-esteem internally that I always displayed outwardly.

Since Black bodies, especially female Black bodies, are always up for scrutiny, our mothers try to protect us by teaching us how to care and attend to every little detail when it comes to our hair, clothes, and even posture as a way to appeal to the world as people worthy of respect. These acts are brilliantly described as “respectability politics” and, though often an effective defense mechanism against harsh criticism, have resulted in acceptable facades that often mask internal illnesses.

While I can see that now, I grew up admiring my mother who would wake up hours before starting her ten- to 12-hour work day to put a perfect crease in her work pants, meritoriously apply her makeup, and place every strand of hair in its rightful place. She was and is a diva to say the least. Despite her careful attention to her outer appearance, my mother is terrified of going to the doctor, as are many of the women in my family. She is a woman who agonizes over seeing the doctor and often only goes when something is hurting too severely for her to work. This lands her in an emergency room instead of the more affordable office of her primary care physician. Through my mother, I can see how I deal with my own inner fear and mistrust that I mask by trying to create a seemingly perfect appearance.

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Being my mother’s daughter, even down to carrying her diva gene, I’ve had to actively fight my own fear of proactively making doctor appointments. This is an issue that is so common in Black communities and yet is being ignored as the health care and Affordable Care Act (ACA) enrollment conversations continue to take place in the media. In all the frenzy to get people to enroll, the president paints a rosy picture for some while ignoring that this health-care discussion is particularly important to historically marginalized multicultural communities, specifically Black women, whose health goes far beyond whether we have insurance coverage.

Though the Obama administration has nearly solved the functionality of the ACA website as a barrier to enrollment and extended the enrollment deadline to March 31, the fear and distrust communities of color have toward our medical system may prove to be a greater roadblock if they continue to be ignored. Black people and indeed many of others of non-European descent harbor fear and distrust of doctors—and we have every right to be fearful. Dr. Harriet A. Washington has compiled a history of the medical exploitation of Black people in the United States in her book Medical Apartheid. She describes how the forced, often grotesque exploitation of Black women’s bodies led to many of the reproductive breakthroughs of our time, including birth control and preventing pregnancy complications. Her work speaks to the nation’s long history of heinous medical crimes of abuse and experimentation on Black Americans that included the Tuskegee Syphilis Experiment, the eugenics movement, and countless other examples where we were victims of our health-care system instead of patients who received quality care. More recent studies show that “mainstream American medicine has absorbed traditional racial stereotypes about African Americans and produced misguided interpretations of black children, elderly black people, black athletes, black pain thresholds and other aspects of black minds and bodies.” From historical exploitation to the current medical industry’s stereotypical understanding of Black people and our health, African Americans often harbor anxiety about receiving health care in a Western medical context. Within this reality, and considering the financial barriers to accessing care, it is no wonder that African Americans have and continue to care for ourselves and avoid seeing the doctor for fear we may be coerced, stigmatized, or receive news of an illness we cannot afford to treat.

As navigators and organizations continue to go into communities of color to enroll people in the ACA, we need to acknowledge the historical and current failures of the medical care system in communities of color as well as push for cultural competency to further increase Black communities’ access to care. This looks like ensuring that medical professionals are trained to be culturally competent and aware as well as intentionally making attempts to rectify the fear communities of color feel toward the medical system. This will go a long way in encouraging people of color to do more than enroll in health care but to proactively access medical care that sees us as whole beings. We must understand and promote that quality health care is culturally competent health care.

The Urban League of Portland as well as the Oregon Health Authority Office of Equity are two examples of organizations that are taking steps beyond just connecting communities of color to health care. They are working to connect health-care policy with advocacy to promote cultural competency through programs like their Community Health Worker Program: We Are Health Movement, which links people with health care as well as providing them with a guide or health worker to assist them in navigating our health-care system to make it a more pleasurable and less fearful experience.

While intentional programs like these might improve the situation, overcoming the residual impact of multiple generations’ exploitation and mistrust requires that we approach our bodies with love and care. Perhaps that is what my mother and so many other women are trying to do: In an effort to push down the fear, mistrust, and disdain we have been taught to absorb, she chose to press her kinks and crease her pants. And before bell hooks, my mother used to encourage me to love the skin and body that I’m in, always saying, “It’s the only one you have” as I entered my doctor’s office. Mantras like these build the confidence that I and other Black women need when facing a medical industry that often doesn’t understand us.

My pursuit toward building a strong foundation for self-love is something I battle and navigate through everyday. In this journey, I’ve had my successes, set-backs, and flat-out failures. However, I always remind myself that I have already accomplished the hardest part: identifying that I wanted to see a change in my life, realizing that I have the power to make the change, and making the decision to simply take the first step toward whole health. I’ve decided that I want to live long so I can raise hell long enough to see some of the changes I’m fighting for come to fruition. In conversations with my mother, I have encouraged her to allow her overall fierceness to be the catalyst for a proactive sashay into her doctor’s office. It’s conversations like these that provide the support we need—being there for each other as we seek to overcome our fears and demand better treatment from our medical system and health-care professionals.

My hope, as we move away from talking about the failures of the ACA website, is that we begin to hold more of the important conversations about how to proactively utilize our health care once we have access. The more conversations we have, the more these barriers can be lifted and issues of cultural competency can be addressed in our doctors’ offices. We must continue to connect that self-love isn’t just about our physical appearance but the well-being of our entire bodies and lives, and we deserve to be cared for with respect. So let’s make sure to do more than enroll in the ACA by the March 31 deadline. Let’s make our doctor’s appointments as easily as we throw up a flawless selfie on Instagram (with or without a filter), without any hesitation. We owe that to ourselves.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

Commentary Sexuality

Black Trans Liberation Tuesday Must Become an Annual Observance

Raquel Willis

As long as trans people—many of them Black trans women—continue to be murdered, there will be a need to commemorate their lives, work to prevent more deaths, and uplift Black trans activism.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

This week marks one year since Black transgender activists in the United States organized Black Trans Liberation Tuesday. Held on Tuesday, August 25, the national day of action publicized Black trans experiences and memorialized 18 trans women, predominantly trans women of color, who had been murdered by this time last year.

In conjunction with the Black Lives Matter network, the effort built upon an earlier Trans Liberation Tuesday observance created by Bay Area organizations TGI Justice Project and Taja’s Coalition to recognize the fatal stabbing of 36-year-old trans Latina woman Taja DeJesus in February 2015.

Black Trans Liberation Tuesday should become an annual observance because transphobic violence and discrimination aren’t going to dissipate with one-off occurrences. I propose that Black Trans Liberation Tuesday fall on the fourth Tuesday of August to coincide with the first observance and also the August 24 birthday of the late Black trans activist Marsha P. Johnson.

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There is a continuing need to pay specific attention to Black transgender issues, and the larger Black community must be pushed to stand in solidarity with us. Last year, Black trans activists, the Black Lives Matter network, and GetEQUAL collaborated on a blueprint of what collective support looks like, discussions that led to Black Trans Liberation Tuesday.

“Patrisse Cullors [a co-founder of Black Lives Matter] had been in talks on ways to support Black trans women who had been organizing around various murders,” said Black Lives Matter Organizing Coordinator Elle Hearns of Washington, D.C. “At that time, Black trans folks had been experiencing erasure from the movement and a lack of support from cis people that we’d been in solidarity with who hadn’t reciprocated that support.”

This erasure speaks to a long history of Black LGBTQ activism going underrecognized in both the civil rights and early LGBTQ liberation movements. Many civil rights leaders bought into the idea that influential Black gay activist Bayard Rustin was unfit to be a leader simply because he had relationships with men, though he organized the 1963 March on Washington for Jobs and Freedom. Johnson, who is often credited with kicking off the 1969 Stonewall riots with other trans and gender-nonconforming people of color, fought tirelessly for LGBTQ rights. She and other trans activists of color lived in poverty and danger (Johnson was found dead under suspicious circumstances in July 1992), while the white mainstream gay elite were able to demand acceptance from society. Just last year, Stonewall, a movie chronicling the riots, was released with a whitewashed retelling that centered a white, cisgender gay male protagonist.

The Black Lives Matter network has made an intentional effort to avoid the pitfalls of those earlier movements.

“Our movement has been intersectional in ways that help all people gain liberation whether they see it or not. It became a major element of the network vision and how it was seeing itself in the Black liberation movement,” Hearns said. “There was no way to discuss police brutality without discussing structural violence affecting Black lives, in general”—and that includes Black trans lives.

Despite a greater mainstream visibility for LGBTQ issues in general, Black LGBTQ issues have not taken the forefront in Black freedom struggles. When a Black cisgender heterosexual man is killed, his name trends on social media feeds and is in the headlines, but Black trans women don’t see the same importance placed on their lives.

According to a 2015 report by the Anti-Violence Project, a group dedicated to ending anti-LGBTQ and HIV-affected community violence, trans women of color account for 54 percent of all anti-LGBTQ homicides. Despite increased awareness, with at least 20 transgender people murdered since the beginning of this year, it seems things haven’t really changed at all since Black Trans Liberation Tuesday.

“There are many issues at hand when talking about Black trans issues, particularly in the South. There’s a lack of infrastructure and support in the nonprofit sector, but also within health care and other systems. Staffs at LGBTQ organizations are underfunded when it comes to explicitly reaching the trans community,” said Micky Bradford, the Atlanta-based regional organizer for TLC@SONG. “The space between towns can harbor isolation from each other, making it more difficult to build up community organizing, coalitions, and culture.”

The marginalization that Black trans people face comes from both the broader society and the Black community. Fighting white supremacy is a full-time job, and some activists within the Black Lives Matter movement see homophobia and transphobia as muddying the fight for Black liberation.

“I think we have a very special relationship with gender and gender violence to all Black people,” said Aaryn Lang, a New York City-based Black trans activist. “There’s a special type of trauma that Black people inflict on Black trans people because of how strict the box of gender and space of gender expression has been to move in for Black people. In the future of the movement, I see more people trusting that trans folks have a vision that’s as diverse as blackness is.”

But even within that diversity, Black trans people are often overlooked in movement spaces due to anti-Blackness in mainstream LGBTQ circles and transphobia in Black circles. Further, many Black trans people aren’t in the position to put energy into movement work because they are simply trying to survive and find basic resources. This can create a disconnect between various sections of the Black trans community.

Janetta Johnson, executive director of TGI Justice Project in San Francisco, thinks the solution is twofold: increased Black trans involvement and leadership in activism spaces, and more facilitated conversations between Black cis and trans people.

“I think a certain part of the transgender community kind of blocks all of this stuff out. We are saying we need you to come through this process and see how we can create strength in numbers. We need to bring in other trans people not involved in the movement,” she said. “We need to create a space where we can share views and strategies and experiences.”

Those conversations must be an ongoing process until the killings of Black trans women like Rae’Lynn Thomas, Dee Whigham, and Skye Mockabee stop.

“As we commemorate this year, we remember who and why we organized Black Trans Liberation Tuesday last year. It’s important we realize that Black trans lives are still being affected in ways that everyday people don’t realize,” Hearns said. “We must understand why movements exist and why people take extreme action to continuously interrupt the system that will gladly forget them.”

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