Same World, Different Stories (Including Pictures)
As you could tell from last week’s post, I’ve been surprised by the relatively low Covid-19 vaccination rate in Philadelphia and in the U.S. generally, particularly among poorer Black and Latino Americans who have already suffered disproportionately from the virus. Despite the fact that vaccines are widely available here, twice as many White residents (28%) have been vaccinated than either Black (14%) or Latino (12%) residents in the City as of the last week in May.
I couldn’t understand why.
While there is some understandable vaccine hesitancy given organized medicine’s use of minorities for experimentation in the past, this hesitancy might contribute to but hardly explains why the vaccination rates are so low when the jabs can be gotten fairly easily and the protection they afford is startlingly high.
Last week, I wrote about the kind of “trusted messengers” that Washington could be sending to Red-State Americans who are on the fence about vaccines (“When the Heart Needs Persuading”). I also gave a thumbs-up to the government's efforts to use barbers in African-American neighborhoods in Philadelphia and elsewhere because they're already well-positioned to reach some Blue-State skeptics, particularly men. But still—despite the ease of vaccination since early March—why are so few in the black and brown communities stopping at a local pharmacy or their neighborhood clinics to avoid the terrible consequences that other family members and people they know have suffered?
What was I missing here? Or more particularly:
Why do people fail to act in their self-interest when it’s pretty easy to do what’s good for them?
I followed up with a nurse I know who works in North Philadelphia, which has some of the highest concentrations of poverty in the City and many Black and Latino residents. Her take was essentially as follows. Poor communities have always been ill-served by organized medicine because it has failed to meet poor people “where they live.” Living in poverty in modern-day America means struggling to put food on the table, to stay safe when you step outside, and to get what your children need from the public school system. Poor people often have long neglected medical problems, lack easy and affordable access to healthy food, and have insecure housing arrangements. They are juggling a lot of variables to stay healthy. “Getting this vaccine is just another thing that poor people who live near my clinic ‘have got to do,’” she said, “And given everything else on their plates, it doesn’t always get done.”
She could also have said that health care in America is a profit- making endeavor, that there has never been much profit in treating poor people, and for them to get what they need from the health system has always been a financial and logistical struggle. All of that plays into getting (or not getting) a vaccination too.
After talking to my nurse friend, I watched a podcast that ran this week featuring Paul Farmer, who's an epidemiologist and anthropologist at Harvard, a physician at Brigham-Women’s Hospital, and the co-founder of Partners in Health, an NGO that provides health care around the world to those who are sick and living in poverty. Farmer, one of the most passionate and effective experts at the intersection of medicine and public health, was being interviewed at the Free Library of Philadelphia about his new book, which chronicles his involvement in fighting the Ebola outbreak in West African communities that had always been neglected by the organized system of medical schools, teaching hospitals, and regional health centers.
Farmer was blunter about what was going on here than my nurse-friend had been. When it comes to health care, people at the prosperous end of the income spectrum in developed countries don’t even begin to understand the constellation of needs that poor people have, let alone understanding the kinds of care it will take to meet them. The first thing they (well, we) need to do is listen to people in these communities to understand what they’re facing before responsive medical services can be offered—and neither the listening nor the offering are as common as they need to be today. In other words, getting a vaccine from a medical system that has never been responsive to poor people is not as easy as it may sound to us.
If you watch his interview, you’ll see that Farmer is like a barely restrained force of nature. What drives him to bring “public health” to places like Haiti, Rwanda and neighborhoods like Kensington in Philadelphia bubbles just below the surface of his brilliantly measured demeanor, although sometimes he can’t help himself, like when he mutters: “Don’t we need to know something about the communities that our gleaming hospitals abut?”—giving us his view that we still know little or nothing.
I recommend your spending an eye-opening hour in Farmer's company. You can also find a short rundown of his breathtaking work here.
I was still thinking about the rich and poor divide when it comes to vaccination while driving to the store through some of Philly’s poorer communities on Friday. It’s a route I’ve taken at least once a week since last March when virus-related restrictions went into effect. Among other things, it takes me past the Chelten Hills Cemetery, where week after week I’ve noticed how one of its formerly barren corners has slowly filled with new graves featuring plastic flowers, flags and balloons but no apparent grave markers that looked more permanent. Remembering (through photos I'd taken) my visit to a "Potters Field" in New Orleans, I wondered whether this too was a place where people without resources are being buried much closer to my home today.
Well I drove back there yesterday and discovered what was, in fact, a new burial place for impoverished Philadelphians who had died over the past year, maybe from the coronovirus, maybe from other causes. There were no headstones or formal grave markers. It is easy to think that since we’re living in the same place we’re also enjoying the same social benefits. With my nurse friend and Dr. Farmer, this was one more reminder that we’re not.
What follows are pictures of five of those gravesites, although there were many, many more that I could have photographed.
Viewing these final resting places helped me to better appreciate a world where I live that’s different than mine. What do they have to tell me (or any of us, really) about the disparities and stories that puzzlement over different vaccination rates has made it harder to keep driving past?
To reframe (and then answer) my earlier question—why not get vaccinated, when it’s something that I think is relatively easy and certainly good for you?—well maybe it’s neither "that easy” nor "that good” when you’re part of a community that's been chronically underserved by the medical establishment, and maybe what I should do is become more curious than I’ve been about why that is.
These pictures were another way to follow my curiosity.
Dad, “Your Mama Proud” painted on a small stone, and the man's photograph
Face and hand
Prayer rug and lights
Dad, Brother, and some kind of street sign
Prayer rug and flowers
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Thanks for reading and looking. I’ll see you next Sunday.
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