​In my first blog of 2017, I recounted the story of finding my husband unresponsive on the floor the day after Christmas. When he finally came to, he reluctantly agreed to let me get a wheelchair from the hotel lobby.

After settling him into the car, I asked, “which hospital do you want to go to?”

What seemed like a very straightforward question at the time was, upon later reflection, one that demonstrated a major issue related to healthcare access.

1. Insurance – While insurance provides folks a degree of coverage it also can impose restrictions that limit options related to where people can seek care. Some are forced into networks with limited access to specialists or with doctors that are culturally insensitive.

They may not even feel empowered to seek medical attention! The  Affordable Care Act (ACA) is not perfect, but it is a first step towards providing all US citizens with basic coverage. There are many parts that need repair including prohibitive copays levied by insurers, but allowing citizens to go without coverage leads to cost-shifting and burdens the healthcare system, ultimately leading to higher costs. Click here to contact your legislator and petition them to save the ACA. 
​
~One Drop of knowledge

The movie "​12 Years a Slave" aired on BET Network tonight. I have always made a conscious effort to stay away from movies that depict the brutality of slavery. To think that human beings could treat other humans with such cruelty makes my heart pain. Despite the accolades and award-winning casts, I never saw the movie Amistad or watched the mini-series Roots. 12 Years was no different – I just couldn’t bring myself to open myself to the emotions that might surface.
 
My first opportunity to watch 12 Years was in 2014 on a flight to Botswana. I decided not to watch, fearing how I might react, especially being confined on a plane for 14 hours. Would I cry uncontrollably or scream from the top of my lungs?!? I was afraid of feeling alone and vulnerable on that long international flight.
 
As a flipped channels tonight, something forced me to stop at BET and to watch 12 Years. Over the past two weeks I have spent focused attention on modern day medical atrocities performed against blacks. . Eugenics, J. Marion Sims, radiation experiments, and Tuskegee – experimentation by the US government that ended a few years after I was born!

Let me briefly share a few medical “highlights” from the year.  My daughter was on track to graduate from college in May 2014, but became quite ill at the end of 2013.  She took a medical leave, returning home to endure 2 surgeries and countless appointments with doctors from at least 4 different specialties. Emotionally, this was an interesting time for me since there was some pre-existing mother-daughter tension.  I must say that having her home was indeed a blessing. While she recovered physically, we both took steps to heal our relationship.  It was great!! 

Perhaps my husband wasn’t getting enough attention or felt a bit left out. In 2013, I wrote a blog entitled Walking a mile in their shoes, where his predisposition to foot ailments was mentioned.  Well, the foot problems returned and worsened! Just after our daughter left for school, my husband went in for a surgical procedure. Let’s just say things didn’t go as planned and he has since undergone 2 additional surgeries and is still recovering.

I share these few medical issues, not even exploring the emotional and mental challenges, so that readers, whether new or returning to this blog, know that I understand the difficulties that some face related to health and wellness.  For my family, things became so challenging that I couldn’t find the “space” to write.   I even tried going to a counselor to help me sort through the mental clutter but found the experience less than helpful.

As I am finishing up a 20 day fast, part of an annual consecration and renewal encouraged by my church, I here and now recommit to writing this blog regularly. I recommit to fully developing this forum so we can openly discuss the issues that impact the health and wellness of our communities. #racism. #inequity.  #Ferguson. #EricGarner. #itooamHarvard. #TrayvonMartin. #bigotry. Let’s have some healing conversations.

Will you engage with me?

                       ~One drop of knowledge can ripple through an entire community~

Did you see Google’s doodle today??  Yes, the month of February is here and so begins the month-long observance of Black History Month.  Kudos to Google for beginning the month with a tribute to Ms. Harriett Tubman!  She was an amazing abolitionist – a strong woman who personally helped free many slaves via the Underground Railroad.  She also worked as a Union spy to help the more global cause of freedom. Here is a link to quick video and accompanying article that sheds a little light on her life and work.  Although the opening sentence uses the gentler term bondswoman to describe her status at birth, we all know she was born a slave.  The physical abuse she endured as such lasted her entire lifetime, but did not diminish her desire and ability to help other slaves gain their freedom.

Yesterday, January 31, 2014, marked the 149th anniversary of the 13th Amendment to the US Constitution - the constitutional amendment that formally abolished slavery 2 years after President Lincoln issued the Emancipation Proclamation declaring the end of that dehumanizing race-based institution.  It still took several additional constitutional amendments and years of fighting against discriminatory practices to get where we are today.

I am proud of Google for starting off the month celebrating Harriett Tubman.  In general, the contributions of women are diminished or not discussed.  Even more so for the courageous acts of bravery by black women who were denigrated for centuries.  So in keeping with this theme, I too, will celebrate the accomplishments of black women this month.  

Just as last February my blog focused on the accomplishments of blacks in medicine (see archives), the tradition will continue.  But I will lead off the series with one of my favorite black female physicians -
                                Dr. Vivian Pinn.  

Stay tuned!!

                            ~One drop of knowledge can ripple through an entire community

Earlier this week, I attended the 21st Annual Duke Student National Medical Association (SNMA) Martin Luther King, Jr. Banquet.  Each year, the students of the SNMA invite their medical school colleagues, the school/hospital administration, and the community to celebrate the life and legacy of the Rev. Dr. Martin Luther King.  Typically, the keynote speaker is some bigwig who has made a name for themselves in healthcare and/or health equity.  This year, the keynote speaker was me!

What an incredible honor be asked to return to my alma mater!!  It was an amazing homecoming, but I was a bit nervous speaking in front of so many of the physicians who watched me grow up as a medical student. What made the evening even more special – the event marked the culmination of a year-long celebration commemorating the 50th anniversary of the admission of black students at Duke University. 

In 1963, five students integrated the undergraduate campus of Duke University; that same year, Dr. Del Meriweather integrated the medical school. Those brave students matriculated at Duke amidst much controversy; consider that the Civil Rights Movement in full swing, many of the prime battle grounds localized to the southern states.  A critical decision had to be made by the trustees and leadership of the University in order for those 6 students to matriculate.  Their measured presence – the perseverance and dedication of those students -- laid the groundwork for future generations of blacks to enroll at Duke University.

Duke medical school has an amazing record of diversity, due in large part to the hard work of the Dean of Admissions, Dr. Brenda Armstrong. But my remarks highlighted the fact that integration is just the first step; the goal for every institution should be inclusion - which means a lot more than just allowing a few black students to matriculate into a medical school. It means more than hiring a trainee or faculty member from a background traditionally underrepresented in medicine.  Inclusion means the creation of an environment that supports the success of each individual, regardless of their race, color or creed.  

Since the health system was segregated at all levels: delivery system, health professional education system, health policy infrastructure, there is still so much that needs to be done to level the playing ground for blacks and other underrepresented ethnicities in medicine. The population of some racial/ethnic groups is expected to more than double between 2000 and 2050.  Hence, as the population of racial and ethnic groups increases, knowing how to serve people with different values, health beliefs, and alternative perspectives about health and wellness will become imperative for the delivery of optimal health care. Nothing else can promote disparities research faster than having members of the populations most affected well-represented among clinicians and researchers.

                    ~One drop of knowledge can ripple through an entire community

On November 2, 1983, after a 15-year campaign, President Ronald Regan signed into law a bill declaring the 3rd Monday in January a federal holiday celebrating the life of the Rev. Dr. Martin Luther King Jr.  Here we are in 2014 – 31 years after the law was passed, 28 years after the holiday was first observed, and 14 years after all 50 states officially recognized the holiday.   Perhaps the holiday became more palatable to some once it became associated with a call to volunteer service.

While, volunteering and service to community are incredibly laudable, my fear is that the historical importance of Dr. King and the Civil Rights Movement will continue to be diluted.  The American history I was taught in high school was so watered down that I had no inkling about the horrors that blacks faced in the U.S.  My ignorance was compounded by the fact that elders in my family who were born and raised in the south were so traumatized that they never spoke about what it was like living in the segregated south.  

It is disheartening to see how uneducated many in the U.S. are about the pre-civil rights era, and the continued struggle that black people have to develop some form of equity for themselves and their families.  To hear (read) comments such as “black people need to just get over it”, underscores the challenge of making any progress towards social justice in this country.   Even generations of blacks are insensitive. It wasn’t until I went to college and began actively studying this segment of history that I gained some understanding of the great leaders and great sacrifices that were made during this time.  Sacrifices of men, women, and children that have gifted me with freedoms denied to my forebears.

The black and white images may allow some to believe that the impact of slavery and segregation on the mental health of black people has long faded. But the stain of oppression and injustice is still ever present.  I read with fascination this diary entry, the unknown author openly confessing his ignorance of Dr. King’s legacy, and how his father summarized the impact of this great man in one sentence. There were so many parts of this writing that I identified with, including the behavioral patterns I saw and were taught by my parents.  Survival mechanisms – completely ingrained.  

If you think these survival instincts fade over time, think again.  The problem is, that some of these learned behaviors are actually counterproductive in the modern era as they exude a lack of confidence and may make black folks more vulnerable to exclusion.

This nation has come a long way.  But let’s not get it twisted: Racism Still Exists!  And it is negatively impacting the mental and physical health of those who experience it (see article).  So yes, volunteer away on MLK Day. But please remain mindful of the struggles that birthed such an amazing leader.  And let us work to heal the mental and emotional wounds that are still ever present so we can fully realize the dream that Dr. King had envisioned.

                        ~One drop of knowledge can ripple through an entire community

Today, the Mass General Hospital Committee on Racial & Ethnic Disparities celebrated its 10 year anniversary by hosting a disparities forum.  The President and CEO of MGH, Dr. Peter Slavin opened the event lauding Boston’s outgoing Mayor Thomas Menino for his 20 years of service to the city of Boston and his commitment to eliminating disparities in health and health care.  

In 2002, the Institute of Medicine released its report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care”. This landmark report (view report briefs here) outlined the huge variations in care for patients in the U.S. based on race/ethnicity.  This work, commissioned by Congress, collated years of data and concluded that many minorities were less likely to receive basic health care.  The report also highlighted the inequities related to receipt of life-saving procedures and many other medical interventions considered to be standard of care at that time.  There was a call-to-action by the committee members to establish consistency and equity in healthcare; using evidenced based medicine to create appropriate guidelines for care.  The hope was that all patients, including minority and medically underserved communities, would receive the same care, thereby eliminating some of the huge gaps in care and treatment outcomes.

Immediately, Mayor Thomas Menino heeded this call-to-action and brought together several of the Boston teaching hospitals to discuss their role in eliminating disparities.  The Mayor remarked that Dr. Peter Slavin was one of the first to respond.  As part of that effort, the MGH Committee on Racial and Ethnic Disparities in Health Care was initiated in the spring of 2003.

While committee co-chairs, Dr. Joseph Betancourt and Ms. Joan Quinlan, spent a few moments discussing the accomplishments of the committee (see website for more information), the major focus was on Mayor Menino; thanking him for his dedication to health equity and his support of a variety of initiatives at MGH and throughout the city. I immediately thought of  Ms. Quinlin stated that there were too many to name, but gave a top 10 list which included:

• Ban of sugar-sweetened beverages in school
• Smoking ban in restaurants
• Initiative to prevent teen smoking
• Youth Summer Jobs program
  

MGH has been the largest employer for the summer jobs program and during the hospital’s 200th year anniversary celebration in 2011, initiated a Bicentennial Scholars Program that provided intense college prep and scholarships to more than 20 high school students who had participated in the Mayor’s summer jobs program.  The MGH scholars program supports talented minority students who are interested in pursuing careers in medicine or biomedical research.

Today's forum was a lovely event that ended with remarks from the Mayor and closing remarks from Dr. Betancourt – reminding folks that while much has been accomplished, healthcare inequities still exist.  Therefore, the fight to end disparities must go on.

                 ~ One drop of knowledge can ripple through an entire community

As a child, my family went to a predominantly black church in a poorer section of Long Island, NY called Wyandanch, located within the Town of Babylon. Despite living in the north, there were still a few of the older black women who held on fiercely to their southern roots.  I can still visualize the mounds of fried chicken, baking pans full of mac-n-cheese, and the pots of collards cooked with ham hock that were staples during Sunday church gatherings.  And yes, the desserts – sweet potato pie, cheese cake, peach cobbler – just to name a few.  At times, I would hear the grown folk talking about so-and-so not having the cobbler because they had “a touch of the sugar”.  Couldn’t understand why someone would prefer to have a little sugar instead of eating a yummy dessert.  Didn’t realize until I was older that the conversation was not about a sweetner, but about diabetes mellitus!

                                                                     What is diabetes? 

Diabetes is a disease that affects the chemistry of your body.  Our bodies can be likened to sophisticated machinery that requires specialized care to ensure all of our “fluids” are properly maintained.  Glucose is a simple sugar that is one of the main sources of fuel for our bodies; most is derived from the foods we eat, but glucose can also be produced in our liver and kidneys.  While we need to have enough glucose to keep our bodies functioning, levels that are too high can disrupt the chemical balance of the body and, over time, cause significant damage to many different body parts. The main regulator of glucose levels is a hormone called insulin.

Glucose levels can be measured in the blood, so when your doctor gets a blood test to check your chemistries, your blood sugar level is also being evaluated.  High blood sugar can be caused because someone does not produce enough or because their body is not responding to the insulin that is produced. As with most illnesses, diabetes is a spectrum of diseases - meaning there is more than one type of diabetes and it impacts people differently. 

There are 3 main types of diabetes:

The American Diabetes Association has an excellent website that reviews the basics of these diseases.  Please take a few moments to check out the site – there is an audio button to havethe site read to you!  

Despite the sweet moniker, diabetes is a very serious disease that can have devastating complications.  In the U.S., diabetes is much more prevalent among minority populations (see graphic), so it is important for these communities to education themselves about the disease and its risk factors. 

More about diabetes this Sunday, November 17th during RadioTalk on Touch 106.1FM – tune in at 9:20am to participate in the discussion (livestream: touchfm.org)!!

         ~One drop of knowledge can ripple through an entire community

On Sunday, September 8th, I had the pleasure of chatting with Sister Yvette about our health topic of the month: HYPERTENSION.  Regular listeners may have missed Sister Andrena.  She recently gave birth to her first child, so many CONGRATULATIONS on her new addition!!

It was great chatting with Sister Yvette about a common but serious condition called high blood pressure.  Blood pressure is a measurement of the blood that flows within your blood vessels. It is written as a ratio of two numbers (e.g. 119/70, 175/80).  Normal range for the top number, systolic blood pressure (SBP), is 90-119. Normal range for the bottom number, diastolic blood pressure (DBP), is 60-79. Check out this brief video that explains blood pressure. 

Although blood pressure changes during the day, high blood pressure (also called hypertension) is when your SBP is ≥140 or your DBP is ≥90 for sustained periods throughout the day. Hypertension can lead to many serious complications including stroke, kidney disease, blindness, dementia, and heart disease.

High blood pressure affects 1/3 adults over age 20 in the US. It costs the nation over $50 Billion annually in healthcare costs and lost productivity.  Blacks have highest rates of hypertension; they also develop the disease at younger ages than other racial/ethnic groups in the US. This racial disparity is likely caused a combination of biologic and environmental factors.

While there are some biologic differences in how blacks process salt and respond to different medications, some experts believe the increased risk of hypertension is due to the unique experience of blacks in America. Blacks worldwide have rates of high blood pressure that are similar to whites. In the U.S., however 41% of blacks have hypertension compared to 27% of whites. Discrimination and economic inequality are impacting this difference. Black people in the U.S are also more likely to be overweight than blacks in other countries.   See other risk factors below:

What you can do to decrease your risk

While you cannot change your race/ethnicity, age, or family history, all of the other risk factors for high blood pressure are in your control.  Reduce alcohol consumption and stop smoking!!  It is important to find other ways to reduce stress.  Prayer, meditation, and exercise are 3 alternative ways to reduce stress. Find what works for you!! Perhaps even a trial of Yoga – enter the Healthy Giveaway contest for free equipment!!

Pay attention to what you eat and increase your activity level. For those already diagnosed, weight loss and exercise can help reduce the need for medication!  The Dietary Approaches to Stop Hypertension (DASH) diet plan has been scientifically proven to reduce blood pressure.  It includes eating less fat and saturated fat as well as eating more fresh fruits and vegetables and whole-grain food. Here’s a brief overview of the DASH diet. 

One of our callers last Sunday correctly indicated the lack of good, healthy choices in certain communities.  These "food deserts" were discussed on a prior radio show - we've got to keep advocating on behalf of our neighborhoods.  Our health and our future is at stake!

                      ~One Drop of Knowledge can Ripple Through an Entire Community

September is prostate cancer awareness month.  Yesterday, on the Dr. Winkfield Facebook page (https://www.facebook.com/ DrKarenWinkfield), I posted a link to the CDC statistics on prostate cancer incidence and outcomes, to remind folks that the disease does not affect everyone equally.  Black men are diagnosed with prostate cancer more than any other racial/ethnic group, and they DIE of the disease more than twice as much as any other group.

The reasons for these disparate outcomes are multifactorial and include a combination of biology, genetics, environmental factors, and BEHAVORIAL factors.  Some black men over the age of 40 have never been screened for prostate cancer!  

                                                      Why???

Another question with a very complicated answer.  But I thought this article entitled “Culture, Black Men, and Prostate Cancer: What Is Reality?” by V. Diane Woods, et al. from Moffitt did a GREAT job outlining some of the challenges black men face with respect to prostate cancer screening, and medical care in general.  This is a qualitative study in which the researchers actually spent time asking 277 black men what factors influenced their prostate screening behaviors.  You mean, actually asking people of there are barriers??!?!  YES… go figure.

The conclusion of the study: 

Amazing what you can learn by just listening to people.  But will we as a community allow a medical system that is inherently designed to alienate entire groups of peoples continue to foster an climate that can lead to the untimely death of thousands??!!

A little food for thought.  

                              ~ One drop of knowledge can ripple through an entire community