When nurse Eric Kusiak walked into his night shift at the University of Iowa Hospitals & Clinics on June 6, he found the hospital grounds defaced with graffiti. He was frustrated and confused. The hospital had just publicly shared support for peaceful protests taking place nationwide in the wake of George Floyd’s death in Minneapolis.
But, he told himself, these actions weren’t personal; they were symptoms of a deep-seated problem.
“I think as a country we’re waking up to the fact that not all racism is overt,” said Kusiak, explaining that racism permeates healthcare just as it does other American structures and institutions. “We’re seeing the damages of passivity today when we compare the health of white people versus people of color. That is a direct result of allowing covert racism to grow, and we’re seeing that it can be just as deadly as overt racism.”
Activists say that the impact COVID-19 is having on black Americans underscores the problem. The latest overall COVID-19 mortality rate for black Americans is 2.3 times as high as the rate for whites and Asians, and 2.2 times as high as the Latino rate, according to APM Research Lab.
But healthcare workers, like seemingly large swaths of society, are no longer remaining silent.
White Coats for Black Lives was created following the deaths of Michael Brown and Eric Garner in 2014, in response to the industry’s silence on racism and police brutality. The movement is “devoted to embodying the responsibility of the institution of medicine to counteract systemic and interpersonal racism and its effects on the practice of medicine and the health of our patients,” according to the founding organization’s website.
Following Floyd’s death on May 25, hospitals began organizing ceremonies to take a knee, an action that just a few years ago created a national firestorm when quarterback Colin Kaepernick began kneeling during the national anthem before NFL games. They’ve also participated in moments of silence.
Just a day before the vandalism at the University of Iowa campus, Dr. Nicole del Castillo helped lead a #WhiteCoatsforBlackLives protest at the hospital for Carver College of Medicine residents and staff. They knelt for nearly 10 minutes. According to del Castillo, the demonstration was both a show of solidarity with the Black Lives Matter movement and a call to action for change within the hospital.
“We are currently … looking internally at our community, seeing ways that we can make improvement,” said del Castillo, adding that the hospital is surveying employees to identify issues of concern.
While medical professional lobbying groups have historically shied away from directly calling out systemic and institutional racism, several organizations released official statements encouraging members to be vocal.
“The Code of Ethics for Nurses obligates nurses to be allies and to advocate and speak up against racism, discrimination and injustice,” Ernest Grant, president of the American Nurses Association, wrote in an online commentary for Modern Healthcare. “This is nonnegotiable.”
And a statement from National Nurses United said: “There are inherent health risks in protesting amidst a pandemic, but we know that the risks of systemic racial and economic injustice outweigh the dangers for many.” The document advised best practices to protest safely. Many healthcare workers volunteered as medics to support protesters.
“I’ve been doing social justice work probably longer than I’ve been nursing,” said Asantewaa Boykin, a registered nurse at UC Davis Medical Center. “In my head they’re one and the same, so it only makes sense to organize in that way to provide people medical assistance if they need it.”
During a special virtual meeting this month, the American Medical Association’s board of trustees and House of Delegates passed a resolution taking a stand against racism and police brutality. Among other things, the AMA pledged “to confront systemic racism and police brutality,” marking the first time the organization recognized those issues as public health threats.
Nicole Mitchell, director of diversity and inclusion at Cedars-Sinai, said hospitals can start by building a safe space for employees to speak their minds.
“The goal is to take some of these ideas back to our executive diversity and inclusion council, which is a mix of leaders from across the organization, and start to think about how we can put these into action and start to make really sustainable change in our organization,” Mitchell said.
Aside from implicit bias training for leadership, students and staff, del Castillo hopes that the University of Iowa Hospitals & Clinics will take steps to improve outcomes for marginalized communities, including addressing security issues that may hinder access to care.
But how will real change be measured?
“If we can create a sense of belonging no matter what your background is, that will speak volumes, and people will talk about that feeling,” Mitchell said. “And then you won’t have to worry about the numbers, because you’ll start to see that change.”