WEBVTT

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[sil.]

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[music]

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Because of the color of
my skin, everybody knows

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when they see me what I am
or at least they think they

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know what I am, based on
my skin color and not

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the content of, of my intellect,
the content of my kindness

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or the person that I am,
um, is not really based

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on what\'s on the outside. And
because of what\'s on the outside,

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most people shut themselves
off to what\'s on the inside.

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That\'s something that I\'ve had to
deal with for 44 years. Um, it\'s

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nothing new. It\'s nothing
strange and it\'s pretty much,

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I, I\'ve, I expect it. I don\'t
accept it but I expect it. [sil.]

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My name is

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Keith Hartgrove and I\'m

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a victim of quadruple bypass surgery.

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I survived three heart attacks, uh,

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one of which, um, according to the
doctors, my heart stopped for a while and

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I had some extraordinary experiences during

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that period. How are you today? Good.

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Now, can we say Mr. Hartgrove? Mr.

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Hartgrove. You\'re so good. You\'re so good.

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Keith grew

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up as a all around

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boy. He was very healthy and he, uh,

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played basketball and
all the games that the

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kids played and, uh, Keith

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as a baby, was born a vegetarian

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and that troubled us. It troubled me

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and it troubled my husband
because we thought that

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children needed to have
meat and when he started to

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school, I didn\'t know what I could
send for his lunch and it was,

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um, peanut butter and
jelly, peanut butter and

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apples, and all the vegetables
and all the fruit and everything

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that I could give him. All
proteins, he had cheese

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and everything and, uh,
he grew up very strong

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and very healthy and of course he took a

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lot of teasing from his,
uh, classmates because

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they called him Mr. Cabbage or Mr.… Mr.
Peanut Butter or

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anything. I had

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a very loving childhood.
I had two parents that

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in spite of the adversity, they
had gave me a good childhood, uh,

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allowed me to be a child,
allowed me to grow in a happy

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family. We\'ve lived in

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this house, uh, for 45 years.

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Keith was just a little over 17 months

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old when we moved in here.
This is home to him

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and his two sisters. All right mom.
I\'ll see

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you later.

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Do a good job. Yes ma\'am. Oh, you know

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there\'s books out here. The
Yellow Pages and the telephone

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books. This section of Oxford is known as
the Sugar Hill section. Uh, historically,

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when, um, over the past 40 or
50 years, the middle class

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African Americans moved in, the
doctors, the teachers, and the lawyers

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lived and owned homes here.
At the same time, they

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cannot escape and their children and
their children\'s children cannot escape

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the same systemic forces that are depriving

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people of life in other sections
of the city. In Lower Roxbury,

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it\'s happening here as well, and it\'s taking
place and so we must not fool ourselves

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in thinking that we\'re guarded and we\'re
protected and there\'s a fortress,

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uh, that\'s, that\'s protecting us from
what\'s also destroying the lives

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of children and people, particularly when we
talk about heart diseases. It\'s happening

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here as well. Cardiovascular
disease in our population

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in general is the number one cause
of mortality but we know for,

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for African Americans is
that, um, not only do we

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die in greater numbers proportionally,
but we also die at younger ages

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and what\'s interesting is, you know, a number of studies
have been done to figure out well, gee, is it socioeconomic

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status, um, is it risk factors. Um,
it\'s probably some combination

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but no one can really explain away
the total difference by looking

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at those factors, um, so that
we, we can\'t fully explain

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that, that very significant
disparity. And we

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find that African American men have the
highest death rate from cardiovascular of any

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other group. Clinically, we also know
that African American people are likely,

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more likely to have high blood pressure, which
is a precursor for cardiovascular disease,

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heart attack, and other things. The other
factor that, whenever you talk about race,

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we realize we\'re not talking about the biological
functions of race but we\'re talking about

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the fact that there are other
forces in society that mitigate

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against the health of people of color because it\'s
not just cardiovascular disease where we see these

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disparities but also in cancer and other diseases,
where African Americans have higher death rates.

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So the, we, we think about it, we
think well, maybe it\'s the African

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American people are poorer and therefore
have less access to healthcare and that is

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one of the reasons but we also know that a
number of studies have demonstrated that

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African Americans in the healthcare system
get a different class of care. For whatever

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reason, providers seem to treat people of color
differently, either in terms of diagnostic

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services or in terms of what kinds
of interventions they get, and

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so we recognize that race represents a more
complex mix of factors than just whether

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your skin is black or what
your ancestry is. [music]

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We have two services at church, an 8:00

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service in the morning and an 11:15.
So after the

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8:00 service, I never come
home because I\'m part of the

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finance committee but
something said to me go home

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and, uh, for a few minutes in between the
service and maybe get a cup of coffee or

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something and, and then come back. And I

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did. The, the phone was
flashing and it was the nurse

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from the Carnegie Hospital and, um, she

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was telling me that, uh, Keith
was there at the hospital

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and that, uh, he hadn\'t
been feeling well and

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she thought that I should know it
and get there so see about it.

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Oh, I got so upset and I called the hospital
and they thought, they told me they

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thought he was having a heart
attack and, uh, that he had

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not been feeling well and that
they were looking after him in the

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emergency. So I called, uh,
Cheryl, my oldest daughter

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and, uh, told her that,
uh, Keith had had a heart

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attack and, and did not get to
work and he had driven himself

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to the hospital. They didn\'t know
how he did it. Dad, were you going

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faster than this? No, I was going about
this speed. There was traffic like there is

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now. Oh.

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And how could you tell that you\'re
having a heart attack? It hurts.

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It hurts? It hurts. It hurts a lot.
It hurts a lot?

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Yeah.

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It was very hard for me to drive because
I had to shift gears with my right

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hand. My left arm was hurting so bad, I
couldn\'t really use it, so I had to shift

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and go back to driving with my right hand.
So I had to just keep my left hand

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down. So if you can imagine shifting
and then putting your hand back up

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and shift again and hand back up. It

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was pretty hard. First thing
I thought, thought about was

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am I gonna make it? Second
thing I thought about was

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should I be

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driving? And I started thinking

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about, you know, if I pass out on my way,

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would anybody notice what was going

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on and would they be able to get
somebody to help me in time.

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And then I really

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started feeling bad about
taking the chance of

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driving, \'cuz I thought, you know, well, I
could hit somebody standing in the street

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or I could run a red light and smash into

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somebody and take them with me.
So I started

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feeling really bad and I tried to,
you know, just focus on making it.

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It seemed like a really long time,
especially here in, in Carnegie

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Square because this is a traffic place.
You know, cars kind of

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get congested here. That was kind of

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scary for me \'cuz that\'s when I realized
that I could hurt somebody. I could just

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not be alert enough to
stop when I needed to or

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be able to stop when I needed to. That
bothered me a lot. Then I tried to figure

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out, well, here I could
go either straight or

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take a left and I just didn\'t know what
was better, whether I should do something

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that would possibly keep me going
or try to save other people\'s

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lives, you know? Um, \'cuz by
this time, point I really knew

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that I shouldn\'t have
been driving but, um, at

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this point, it was kinda like too late. I had to do
something. I couldn\'t leave my car here and just

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try to get an ambulance or get somebody to
call an ambulance for me and leave my car.

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Um, so this is the route I took.

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The road less traveled.

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By the time I got here, I knew

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there was no question I
was gonna make it but I,

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uh, I prayed a lot. [sil.]

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And he got to the hospital
and apparently just

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got out of the car. He did not pay
as he went in, you know, he just

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drove into a spot that he could stop.
[music]

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Disproportionately, African
American men, primarily,

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and women as well, die
from heart disease and

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when I think of my, my own family,
both sets of my grandparents

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died of heart disease, uh,
prior to the age of 50.

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In our faith, we connect the
body and the spirit and their

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inseparable. And so if one
talks about having a healthy

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spirit, one must also possess
a healthy body. We can

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do things like embody a quality,
literally bring into our

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bodies exposures to toxic substances, to
hazardous conditions or to interpersonal

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stressors, not to mention the effects of the
ways that different forms of institutional, um,

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inequalities such as residential segregation or
occupational segregation affects possibilities for

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living standards and then all the things that
are contingent on that. We can embody those

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aspects of inequality or conversely embody
those aspects of privilege and then end

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up with biological manifestations, biological
expressions as it were, in this case, of race

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relations. So that while there may not be innate
fundamental differences between, say, African

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Americans and whites, there may be still biologic
differences that are acquired because of the fact of

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living in a racist society. I
always thought of myself as, uh,

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um, a pretty healthy individual, you know?
Uh, being vegetarian

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and, um, you know, really kinda

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enjoying not having to eat greasy
foods and stuff like that, you

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know? Um, I thought I was
doing pretty well. But

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stress, you know, you, you feel it and you

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don\'t pay it any attention
but all the time,

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it\'s like a, it\'s like a time bomb.

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It\'s ticking. You can hear it
in the background but you don\'t

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pay it any attention and
then all of the sudden,

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you have to. Stress plays a very

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important role in, in all of our lives and
certainly when you\'re in a social environment

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that causes you to sort of be
on guard much of your time.

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Whether or not you\'re even aware
of it on a conscious level, um,

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has some physiological effect on, on
our bodies. There\'s no question about

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it. Um, has it been measured? Um,

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it probably hasn\'t been quantitated (ph),
um, to the extent that it would be

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recognized, uh, in wide scientific circles
but certainly anyone who lives in

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America and has gotten to
age 15 or 20 or 30 can

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give you countless numbers of incidents
that have been both subtle and overt.

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So the mind and body are connected
and it would be hard to say that,

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um, people would not be internalizing
some of the stress that they, that they

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encounter in their workaday lives
and their, and their social lives.

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Um, uh, and just about everything they do.
I have a question that I\'ve

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developed. How often do you think about your
race? And I have, uh, looked at it among white

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respondents and black respondents and the distributions
are quite different. Uh, in one group of white

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respondents, 50% said that they never think about their race.
The options were how often do you think about your race:

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never, once a year, once a month,
once a week, once a day, once an

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hour, or constantly. In this group of white
respondents, 50% said they never think about their race

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and only .3% said they constantly think about
their race. For the black respondents,

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23% said that they constantly think about their
race and if you take once a day or more frequently,

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more than 50% thought about their race at least
once a day, whereas a small, much smaller percent

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said never. It was actually 11%, which
quite surprised me and I think those 11%

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probably are living in racially segregated settings
where they\'re not thinking about their race, but

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are being impacted by institutionalized racism. But
it\'s quite a different thing. So you have, you have a

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conversation about race, it\'s easy for white
people who don\'t think of themselves as

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having race to talk about race but if you
were to have a conversation about racism

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and how it adversely impacts not
just the stigmatized races, but all

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of us, this whole nation. Think of the
resources that are wasted because

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we are discarding all of
the talent, all the human

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wealth that we have in, in ghettos
and barrios and reservations. We\'re,

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we\'re, as a nation, behaving as if we could get
along very well, thank you, without all that

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genius. It\'s been well
recognized, particularly with

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work that was prompted by the horrors of
World War II and fascist ideology that

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you began to get even more scientific analysis and
statements saying that there are no such things as distinct

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biological racial \"groups.\" That
is a myth and it\'s a fallacious

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and dangerous myth. That\'s not to say that
we as a human species vary in a whole

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variety of different traits but the assumption is that
if you have, for example, a certain \"skin color,\"

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that automatically means, you know, something
else about that person\'s biology and basically

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that\'s not true. First of all, race
doesn\'t measure genetics. Okay?

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Race is a social construct.
It\'s not a biological reality

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and the way that we see race in this country has
changed over time. I mean, many groups that

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were not white are now white. You know, groups
have moved from Asian to very, you know,

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so there, there are different ways
that we see race. I\'m black in this

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country. I\'m told that if I went to Brazil, I would
be white. And actually, sometimes, I\'ve thought maybe

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I\'d go try that for a little while, you
know? In South Africa, I would be colored

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and it, with the same genetic endowment, if I
stayed in any of those countries for a long time,

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my health would take on the pattern of the group
to which I was assigned, not having anything to do

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with my genes. Health wise, racism

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has been a burden. It\'s been a

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struggle. It\'s taken it\'s toll
and I, I\'ve beared the weight

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and now I wear the scar of it.

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Race as a category only emerges
at a particular historical

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moment. Uh, there had been some color
prejudice. There had been some color

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differentiation but race as a category, I
mean, was first introduced by François

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Bernier in a paper in 1688 in France

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and, uh, doesn\'t become part of, uh,
so called scientific discourse, uh,

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until, uh, Linnaeus in 1735 and his

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natural history and of course he\'s one
of the towering figures and, uh, um,

00:21:20.000 --> 00:21:24.999
by the 18th century, you\'ve
got a full scale discourse

00:21:25.000 --> 00:21:29.999
of racial hierarchy, Europeans at
the top, Africans at the bottom.

00:21:30.000 --> 00:21:34.999
By the 19th century, it becomes not simply
quote-unquote science but becomes part of popular

00:21:35.000 --> 00:21:39.999
discourse, uh, in ways that had not
been the case 200 years before at

00:21:40.000 --> 00:21:44.999
all. Um, take a great African like
Augustine, of the, the fourth or

00:21:45.000 --> 00:21:49.999
fifth century. He was an African,
probably roughly the same color I was,

00:21:50.000 --> 00:21:54.999
part of the Roman Empire. Nobody
made that big a deal about it.

00:21:55.000 --> 00:21:59.999
You see? Race didn\'t matter as much.
Hue hardly mattered as much. He was a

00:22:00.000 --> 00:22:04.999
Roman, Imperial, elite, from Carthage,

00:22:05.000 --> 00:22:09.999
northern Africa, you see. Didn\'t
make that big a difference.

00:22:10.000 --> 00:22:14.999
A lot of my work is on the
impacts of racism on health

00:22:15.000 --> 00:22:19.999
and conceptualizing how racism could impact on health.
I mean, a lot of people say, you know, racism,

00:22:20.000 --> 00:22:24.999
you know, what do you mean by that? How can that be
health? And that\'s because most people think only

00:22:25.000 --> 00:22:29.999
of, like, personally mediated,
or what I call personally

00:22:30.000 --> 00:22:34.999
mediated or interpersonal prejudice and
discrimination as racism and I think about racism as

00:22:35.000 --> 00:22:39.999
three levels and all three of which can impact on
health. The first is institutionalized racism.

00:22:40.000 --> 00:22:44.999
The second is personally mediated racism
and the third is internalized racism.

00:22:45.000 --> 00:22:49.999
So my kind of quick definition of
institutionalized racism is differential

00:22:50.000 --> 00:22:54.999
access to the goods, services, and opportunities
of society by race. Um, it manifests

00:22:55.000 --> 00:22:59.999
in terms of material conditions,
access to power, and societal norms.

00:23:00.000 --> 00:23:04.999
And this is the kind of racism that doesn\'t
require that an individual did something.

00:23:05.000 --> 00:23:09.999
Um, it\'s, uh, often manifest
as inherited disadvantage.

00:23:10.000 --> 00:23:14.999
Um, it\'s, uh, a Martian could come
and look at the distribution of

00:23:15.000 --> 00:23:19.999
goods and resources in this country and say there\'s something
systematic going on here by race. There\'s evidence of that.

00:23:20.000 --> 00:23:24.999
Personally mediated racism I
define as differential assumptions

00:23:25.000 --> 00:23:29.999
about the abilities, motives, and intents of other
people by race and then acting on those differential

00:23:30.000 --> 00:23:34.999
assumptions. So that\'s what most people think of when they say racism.
That\'s the prejudice, the different idea and the discrimination,

00:23:35.000 --> 00:23:39.999
the different action. And it doesn\'t have
to be intentional. That\'s a very important

00:23:40.000 --> 00:23:44.999
aspect. And then internalized racism I define as
acceptance by members of a stigmatized races of

00:23:45.000 --> 00:23:49.999
the negative messages about our own
abilities and intrinsic worth and

00:23:50.000 --> 00:23:54.999
it\'s basically accepting, um, the
limitations to our own full humanity. I can

00:23:55.000 --> 00:23:59.999
remember in the fifth
grade I had a teacher who

00:24:00.000 --> 00:24:04.999
told me you\'ll never be anything. You\'ll
never amount to anything. You\'ll always be

00:24:05.000 --> 00:24:09.999
a nobody. I didn\'t realize how much

00:24:10.000 --> 00:24:14.999
that affected me until I was older

00:24:15.000 --> 00:24:19.999
but it always rang in my head, you know?
And I always felt

00:24:20.000 --> 00:24:24.999
like well, I can only go so far.
I only can do so much.

00:24:25.000 --> 00:24:29.999
You know? And although I tried
to prove her wrong, it always

00:24:30.000 --> 00:24:34.999
had a negative effect and
I never realized how

00:24:35.000 --> 00:24:39.999
much of a negative effect but, you
know, if you\'re told enough times

00:24:40.000 --> 00:24:44.999
by enough people you\'re
nothing, you\'re nobody,

00:24:45.000 --> 00:24:49.999
after a while, you begin to believe
it and it does limit you. Okay,

00:24:50.000 --> 00:24:54.999
ladies. Listen up so I can take
attendance real quick. Now

00:24:55.000 --> 00:24:59.999
I have the opportunity to say to
kids, I believe in you. I know

00:25:00.000 --> 00:25:04.999
you can do it. I know if you put
your mind to it, there\'s nothing you

00:25:05.000 --> 00:25:09.999
can\'t do. [sil.]

00:25:10.000 --> 00:25:18.000
Yes!

00:25:20.000 --> 00:25:24.999
Those are some of the things that I\'m
addicted to, to being able to say

00:25:25.000 --> 00:25:29.999
to kids and believe it
and understand that, you

00:25:30.000 --> 00:25:34.999
know, some of them have never heard it.
Some of them have never

00:25:35.000 --> 00:25:39.999
been told I care about what\'s happening

00:25:40.000 --> 00:25:44.999
with your future. I did good, didn\'t I? Did

00:25:45.000 --> 00:25:49.999
I do good? I just avoided
a very embarrassing

00:25:50.000 --> 00:25:54.999
moment. I was able to defeat six girls

00:25:55.000 --> 00:25:59.999
in a foot race to keep
me out of a dress. The

00:26:00.000 --> 00:26:04.999
bet was if they beat me, I had to
wear a dress all day and if I won,

00:26:05.000 --> 00:26:09.999
they have to do two page
black history reports. So,

00:26:10.000 --> 00:26:14.999
I think it was worthwhile, me being a little
bit out of breath to get them a little more

00:26:15.000 --> 00:26:19.999
education and have fun while doing it.

00:26:20.000 --> 00:26:24.999
What? Again? Yeah. Wait, wait, wait, wait.

00:26:25.000 --> 00:26:29.999
Wait, wait. Hold on.

00:26:30.000 --> 00:26:32.999
You have to be fair to the children.
One more time. (inaudible)

00:26:33.000 --> 00:26:34.999
No, how about me and you?

00:26:35.000 --> 00:26:39.999
I get a head start from here. No.

00:26:40.000 --> 00:26:44.999
W.E.B. Dubois prophesied
at the turn of the century

00:26:45.000 --> 00:26:49.999
that the race issue would
be the prevalent and the

00:26:50.000 --> 00:26:54.999
pressing issue that would
consume the entire century and

00:26:55.000 --> 00:26:59.999
he was right. And it still is the case.
African Americans

00:27:00.000 --> 00:27:04.999
continue to, uh, lead lives
that involves the burden of

00:27:05.000 --> 00:27:09.999
racism, discrimination,
economic poverty, residential

00:27:10.000 --> 00:27:14.999
segregation, substandard education. All
of these stressful factors continue

00:27:15.000 --> 00:27:19.999
to play a very, um, major role

00:27:20.000 --> 00:27:24.999
in producing heart diseases.
Heart diseases is, is not

00:27:25.000 --> 00:27:29.999
only genetic, it\'s not only
hereditary, it\'s not only physical,

00:27:30.000 --> 00:27:34.999
but it is also, um, institutional based.
It\'s culturally, it\'s societally.

00:27:35.000 --> 00:27:39.999
All of these factors, environmental
factors, play a role,

00:27:40.000 --> 00:27:44.999
plays significant roles in
increasing and in perpetuating heart

00:27:45.000 --> 00:27:49.999
diseases among African Americans.
It\'s hard for

00:27:50.000 --> 00:27:54.999
me to admit racism has diminished me.
I wanna

00:27:55.000 --> 00:27:59.999
be strong. I wanna, I wanna be able
to stand up to the, the test and

00:28:00.000 --> 00:28:04.999
say oh yeah, I\'ve weathered the storm
and I\'ve come out and I\'m, you know,

00:28:05.000 --> 00:28:09.999
some kind of hero or something.
Uh, I don\'t see myself that way.

00:28:10.000 --> 00:28:14.999
I see myself as beaten. Uh, beaten down but

00:28:15.000 --> 00:28:19.999
not overcome. Um, just I\'ve had

00:28:20.000 --> 00:28:24.999
my bout with it. I\'ve dealt with
it to the best of my ability but

00:28:25.000 --> 00:28:29.999
I\'m weathered, you know? Um, like

00:28:30.000 --> 00:28:34.999
a rock that, you know,
sits by the shore. Um,

00:28:35.000 --> 00:28:39.999
every time it gets hit by a wave,
you know, it\'s a little bit

00:28:40.000 --> 00:28:44.999
less than it was before. That\'s how I feel.

00:28:45.000 --> 00:28:49.999
Um, I\'ve weathered all the waves. I\'m still

00:28:50.000 --> 00:28:54.999
here, but I\'m not the same rock

00:28:55.000 --> 00:28:59.999
I was when I started and, uh,

00:29:00.000 --> 00:29:04.999
I feel that. And that\'s not easy to admit.

00:29:05.000 --> 00:29:09.999
And, um, I\'d be a lot better for my
children. I have an 11 year old boy

00:29:10.000 --> 00:29:14.999
who right now would love for me to run and
play basketball with him. Can I get the

00:29:15.000 --> 00:29:19.999
foul? The flagrant foul?

00:29:20.000 --> 00:29:24.999
Huh? And I\'ve done it but I tell you, I pay

00:29:25.000 --> 00:29:29.999
a price and I\'m

00:29:30.000 --> 00:29:34.999
not so willing to do it as much anymore.
It\'s harder for me.

00:29:35.000 --> 00:29:39.999
My ball. My ball. Your ball? Yeah, my

00:29:40.000 --> 00:29:44.999
ball. Remember, it went off the court? You
touched it though! No, no, no, no. Blacks,

00:29:45.000 --> 00:29:49.999
African Americans if you will,
in this country received

00:29:50.000 --> 00:29:54.999
less than optimal care for
heart disease than our white

00:29:55.000 --> 00:29:59.999
counterparts do. Uh, I, uh, and, and,
we can only ascribe, we, we, we can

00:30:00.000 --> 00:30:04.999
only associate that with racism. I mean, what else
could be accounting, uh, for that? Turning the

00:30:05.000 --> 00:30:09.999
question to how racism affects health, from
that, there are racial ethnic disparities

00:30:10.000 --> 00:30:14.999
in health, is a major mind shift and is
one that I think is beginning to happen

00:30:15.000 --> 00:30:19.999
in public health and it\'s happened only
because of an extremely long legacy

00:30:20.000 --> 00:30:24.999
of people who have been arguing along these lines but these
are not new ideas. But they are ideas that we have to work

00:30:25.000 --> 00:30:29.999
with in our generation because this is where we
are and this is now and we\'re only here because

00:30:30.000 --> 00:30:34.999
of all the work and struggles of people who have come
before. The issue of race and class in the health system

00:30:35.000 --> 00:30:39.999
has existed since the beginning of the
health system in the United States. Uh,

00:30:40.000 --> 00:30:44.999
the health system was structured
on the basis of race and class and

00:30:45.000 --> 00:30:49.999
what Michael and I found in
our research is that the

00:30:50.000 --> 00:30:54.999
African American experience in the
health system in many ways has

00:30:55.000 --> 00:30:59.999
paralleled our citizenship status
and as we know, we really did

00:31:00.000 --> 00:31:04.999
not get the voting rights
until the mid to late 1960\'s

00:31:05.000 --> 00:31:09.999
and it was during that same period
of time that the healthcare

00:31:10.000 --> 00:31:14.999
facilities in the United States
were desegregated by law.

00:31:15.000 --> 00:31:19.999
So prior to that, um, it was a completely

00:31:20.000 --> 00:31:24.999
segregated health system and it
really wasn\'t until the late 1960\'s

00:31:25.000 --> 00:31:29.999
that African Americans began to
get even access to the lower

00:31:30.000 --> 00:31:34.999
tiers of the multi-tier system in the
United States and that tiering exists

00:31:35.000 --> 00:31:39.999
today. Well, we\'ve coined a term for it.
It\'s the blind sport. It\'s the blind spot

00:31:40.000 --> 00:31:44.999
in the U.S. health system. It\'s almost, uh,
almost equivalent to the viewpoint that

00:31:45.000 --> 00:31:49.999
the South Africans had about
apartheid, uh, until recently. Uh, uh,

00:31:50.000 --> 00:31:54.999
and until this blind spot,
uh, is, is, uh, uh,

00:31:55.000 --> 00:31:59.999
eradicated wherein dialog is established
and people can really learn the facts, uh,

00:32:00.000 --> 00:32:04.999
uh, energizing this problem or,
and the structural defects

00:32:05.000 --> 00:32:09.999
that, uh, have, uh, uh, facilitated
this problem, uh, and,

00:32:10.000 --> 00:32:14.999
uh, cultural competence courses
and, and multicultural

00:32:15.000 --> 00:32:19.999
exercises to help correct the bias clinical
decision making that goes on routinely on a

00:32:20.000 --> 00:32:24.999
day to day basis then we\'re
really not going to do

00:32:25.000 --> 00:32:29.999
very much. Uh, like you said,
this is a, a 381 year old

00:32:30.000 --> 00:32:34.999
problem, uh, in the United States.
Uh, deeply ingrained, uh,

00:32:35.000 --> 00:32:39.999
in the medical social, and the
scientific western culture. Uh,

00:32:40.000 --> 00:32:44.999
and, uh, until real substantive corrective
actions are taken, uh, to approach

00:32:45.000 --> 00:32:49.999
it that way, then, uh, we\'re gonna
have a very difficult time, uh,

00:32:50.000 --> 00:32:54.999
uh, eradicating or correcting. Uh, and
we\'re hopefully, perhaps we can begin

00:32:55.000 --> 00:32:59.999
engaging and moving toward the road
toward justice and equity in healthcare

00:33:00.000 --> 00:33:04.999
for, for everyone in America. Basically
beginning probably around 11 years

00:33:05.000 --> 00:33:09.999
ago, that was when the first data, the first really
good data started coming out about these disparities in

00:33:10.000 --> 00:33:14.999
treatment and the first studies were really done on
administrative data and what I mean by that are kind of

00:33:15.000 --> 00:33:19.999
chart review type of data. Data you can get
from, you know, files that Medicare uses, um,

00:33:20.000 --> 00:33:24.999
and what we\'ve seen over those kind of
ensuing 10 years are more and more data,

00:33:25.000 --> 00:33:29.999
including my own, that really show
that African Americans are diagnosed

00:33:30.000 --> 00:33:34.999
less frequently when they have signs and
symptoms, um, that really point towards

00:33:35.000 --> 00:33:39.999
heart disease. The diagnosis of
heart attack is not, uh, made, um,

00:33:40.000 --> 00:33:44.999
at the same rate, uh, when it would be appropriate
to make it. Um, there are data to suggest

00:33:45.000 --> 00:33:49.999
that, um, there may be underutilization
of cardiology procedures in

00:33:50.000 --> 00:33:54.999
African Americans who have a very high risk
factor, you know, a great number of risk

00:33:55.000 --> 00:33:59.999
factors. Um, there was a study
published, um, that looked at,

00:34:00.000 --> 00:34:04.999
uh, scenarios in which
actors, um, basically,

00:34:05.000 --> 00:34:09.999
uh, presented, all with the same symptoms.
So they basically gave the same history,

00:34:10.000 --> 00:34:14.999
um, talked about having the
same symptoms, etc., and

00:34:15.000 --> 00:34:19.999
physicians, uh, who viewed these
videos were, were far less likely

00:34:20.000 --> 00:34:24.999
to refer African American
patients, um, for further

00:34:25.000 --> 00:34:29.999
testing and that was even, the disparity
once again was greatest for African American

00:34:30.000 --> 00:34:34.999
women. When we think about racism
in, as it effects medicine, we know

00:34:35.000 --> 00:34:39.999
that the people who become doctors have
grown up in the society at large and that

00:34:40.000 --> 00:34:44.999
there may be subtle attitudes,
subtle held beliefs

00:34:45.000 --> 00:34:49.999
that lead them to certain decisions in medical
decision making that are different for

00:34:50.000 --> 00:34:54.999
of color from people who are white. I don\'t
think for the patient that\'s perceived

00:34:55.000 --> 00:34:59.999
as hostility. It\'s perceived as a caring provider
but at the point where a decision is made,

00:35:00.000 --> 00:35:04.999
there seems to be some influence of race.
The physician

00:35:05.000 --> 00:35:09.999
that was charged with stabilizing me,
that two days that I spent at Carney

00:35:10.000 --> 00:35:14.999
before being shipped to Brigham
Women\'s Hospital for my

00:35:15.000 --> 00:35:19.999
surgery, um, was spent with Dr.
David Dobroski.

00:35:20.000 --> 00:35:24.999
My doctor, Dr. Taylor, called him
and said don\'t let me brother die.

00:35:25.000 --> 00:35:29.999
Dr. Dobroski took that really to

00:35:30.000 --> 00:35:34.999
heart. I think he was more
worried about me than I was.

00:35:35.000 --> 00:35:39.999
Sometimes people come in with heart attacks, it\'s
very clear based on their EKG that that\'s what

00:35:40.000 --> 00:35:43.999
we\'re dealing with. It\'s a very simple
decision, uh, to give (inaudible)

00:35:44.000 --> 00:35:45.000
therapy but, uh, in his

00:35:45.001 --> 00:35:49.999
case, it wasn\'t so cut and dried and straight
forward and so I think a lot of, uh, the

00:35:50.000 --> 00:35:54.999
concern he saw was, uh, really my, uh,
uh, deliberating, agonizing over,

00:35:55.000 --> 00:35:59.999
you know, what, uh, what\'s gonna be the best
therapy for him. Am I really sure, uh, that,

00:36:00.000 --> 00:36:04.999
um, this is what I\'m dealing with? Is he really having a heart
attack? If I, if I give him this therapy and there\'s some

00:36:05.000 --> 00:36:09.999
complication, um, that obviously
is not something I wanted to do.

00:36:10.000 --> 00:36:14.999
So, uh, I was concerned in many
levels about him and what was

00:36:15.000 --> 00:36:19.999
going to happen and whether I was
correctly diagnosing what was going on.

00:36:20.000 --> 00:36:24.999
So all of that was going on but probably I had
a sour look on my face most of the time. So I

00:36:25.000 --> 00:36:29.999
think that was probably, um,
what gave him some concern. We

00:36:30.000 --> 00:36:34.999
have not, I think, faced some of
the hard reality that there\'s

00:36:35.000 --> 00:36:39.999
probably bias in the way that we treat

00:36:40.000 --> 00:36:44.999
patients, um, and how do we begin to understand
that and how do we begin to understand it in a way

00:36:45.000 --> 00:36:49.999
that leads us to changing behavior.
And I think we just haven\'t gotten

00:36:50.000 --> 00:36:54.999
there. [sil.]

00:36:55.000 --> 00:36:59.999
During my

00:37:00.000 --> 00:37:04.999
time in the hospital and in
recovery, I had a nurse who

00:37:05.000 --> 00:37:09.999
I, I considered to be pretty
prejudiced and during

00:37:10.000 --> 00:37:14.999
that eight hours, you know,
there was, there were points

00:37:15.000 --> 00:37:19.999
where I was really angry and really

00:37:20.000 --> 00:37:24.999
quite upset with the treatment
that I was getting but

00:37:25.000 --> 00:37:29.999
I realized that because we had
a one-on-one relationship and

00:37:30.000 --> 00:37:34.999
she was directly in charge of my
well being, I could only get so

00:37:35.000 --> 00:37:39.999
mad. I could only, uh, say so much to her

00:37:40.000 --> 00:37:44.999
because she had the power of
life and death over me. It

00:37:45.000 --> 00:37:49.999
was a very humbling experience. It
made me realize that, you know,

00:37:50.000 --> 00:37:54.999
at any point, she had
the power and I would,

00:37:55.000 --> 00:37:59.999
I could do nothing. I was powerless.
Racism is

00:38:00.000 --> 00:38:04.999
alive and well and kicking and hurting.
It exists and that\'s

00:38:05.000 --> 00:38:09.999
the, the biggest hurdle for white
folks to understand. Part of it

00:38:10.000 --> 00:38:14.999
is because white folks, by virtue of their whiteness
and they don\'t have to do anything else, are

00:38:15.000 --> 00:38:19.999
benefiting from a racist system. Many
doors that say closed to me open up

00:38:20.000 --> 00:38:24.999
when the white person approaches and they don\'t even realize
there was a door there. It\'s not only that the door

00:38:25.000 --> 00:38:29.999
is opening, they don\'t even know that there was a
door. That\'s the biggest hurdle, is understanding

00:38:30.000 --> 00:38:34.999
that racism is alive and well and exists in this country.
It\'s affecting people adversely. It\'s affecting the whole

00:38:35.000 --> 00:38:39.999
nation. Sure, it\'s always there in your everyday
context. That, that\'s really what it means to, uh,

00:38:40.000 --> 00:38:44.999
to be black in America, to be at risk of,
if you\'re at risk, you have to be very

00:38:45.000 --> 00:38:49.999
cognizant and alert to what\'s coming at you

00:38:50.000 --> 00:38:54.999
at the microsocial level, on the
ground, on the larger macrosocial

00:38:55.000 --> 00:38:59.999
level, in terms of policies and
various activities at the workplace,

00:39:00.000 --> 00:39:04.999
with the police and so on. Um,

00:39:05.000 --> 00:39:09.999
but it\'s not, you know, it\'s not the
kind of thing that just gets you

00:39:10.000 --> 00:39:14.999
down, you know? You keep moving.

00:39:15.000 --> 00:39:19.999
There are times when you,
um, let your guard down,

00:39:20.000 --> 00:39:24.999
as it were and, and not necessarily feel

00:39:25.000 --> 00:39:29.999
like, um, you should have your
guard up or you should be,

00:39:30.000 --> 00:39:34.999
um, um, that filter should be in place and
then something happens and it\'s like oh,

00:39:35.000 --> 00:39:39.999
okay. I remember now. You know? My

00:39:40.000 --> 00:39:44.999
fault, I should have, you know, instead
of, uh, not left myself vulnerable.

00:39:45.000 --> 00:39:49.999
Um, I don\'t want you to think that people walk
around in a paranoid state but it\'s, as I said, it\'s

00:39:50.000 --> 00:39:54.999
there sometimes not even on a conscious
level. Uh, it\'s very nice that

00:39:55.000 --> 00:39:59.999
people treat me very well most of the time
when I have my white coat and stethoscope on

00:40:00.000 --> 00:40:04.999
but it\'s still not unheard of, it is still not
unusual for me to be walking down the street

00:40:05.000 --> 00:40:09.999
and to be associated with gang, a gang
member, to be associated with a drug dealer,

00:40:10.000 --> 00:40:14.999
to be associated with other negative
aspects in our community. Uh, not everyone

00:40:15.000 --> 00:40:19.999
who drives a BMW and lives in a black
community is a drug dealer or a pimp.

00:40:20.000 --> 00:40:24.999
Uh, uh, and, and that\'s the way we\'re looked at,
to be honest with you. I still have to deal with

00:40:25.000 --> 00:40:29.999
discrimination. I still have to deal
with racism. I still have to deal with,

00:40:30.000 --> 00:40:34.999
uh, institutional racism. I still
have to deal with the fact

00:40:35.000 --> 00:40:39.999
that, you know, there are
people that I deal with that

00:40:40.000 --> 00:40:44.999
just don\'t like my black face.
You\'re going to hear these

00:40:45.000 --> 00:40:49.999
things. People are gonna call you names
and whatnot. You\'re going to experience

00:40:50.000 --> 00:40:54.999
not receiving the job that you want.

00:40:55.000 --> 00:40:59.999
I said but that\'s okay. It,

00:41:00.000 --> 00:41:04.999
it will all come out right in
the end and, uh, it bothered

00:41:05.000 --> 00:41:09.999
him. It bothered him but, uh, underneath,

00:41:10.000 --> 00:41:14.999
underneath. He had to overcome
it because I told him

00:41:15.000 --> 00:41:19.999
he had to overcome it. I said I\'ve
gone through the same thing. And

00:41:20.000 --> 00:41:24.999
that even in this world where there\'s a lot of
oppression, there\'s some things that I can take on and

00:41:25.000 --> 00:41:29.999
do for myself and my community and
my family that will reduce my

00:41:30.000 --> 00:41:34.999
likelihood of dying of cancer, reduce my likelihood
of dying of cardiovascular disease and I,

00:41:35.000 --> 00:41:39.999
I\'m, I\'m not sure that in a community wide way,
we\'ve accomplished that. To simply say racism is

00:41:40.000 --> 00:41:44.999
a given. It\'s not just you. It\'s
not just your individual behavior.

00:41:45.000 --> 00:41:49.999
It\'s, racism is a given but within that context, there\'s
some things you can do. I think that\'s liberating for

00:41:50.000 --> 00:41:54.999
folks because they recognize that there\'s some
system changes that have to come about but that

00:41:55.000 --> 00:41:59.999
those system changes shouldn\'t limit
their desire to get knowledge, their

00:42:00.000 --> 00:42:04.999
desire to get information, their desires to improve
their community so that it\'s a place that they can

00:42:05.000 --> 00:42:09.999
exercise and live in healthy. If you
don\'t demand better produce, if you

00:42:10.000 --> 00:42:14.999
don\'t demand better cuts of meat, if you don\'t
demand certain things, then yeah, it can be

00:42:15.000 --> 00:42:19.999
very expensive to, um, to eat properly
but, um, we only have one body

00:42:20.000 --> 00:42:24.999
and, uh, I, I can\'t stress enough that
there are ways to do it. There are ways

00:42:25.000 --> 00:42:29.999
to, to make substitutions and changes
in, in the things that we, that we feed

00:42:30.000 --> 00:42:34.999
ourselves. Um, it was easier
to grab something quick,

00:42:35.000 --> 00:42:39.999
then grab something healthy.
It was easier for me to just

00:42:40.000 --> 00:42:44.999
continue to work instead of
sitting down to have a meal. It

00:42:45.000 --> 00:42:49.999
was easier to eat on the run,
under stressful situations rather

00:42:50.000 --> 00:42:54.999
than to sit down and
take some time to treat

00:42:55.000 --> 00:42:59.999
myself better. Hello? What
this has taught Keith

00:43:00.000 --> 00:43:04.999
is that if he doesn\'t change, he\'s
going to die a young man. Uh, he

00:43:05.000 --> 00:43:09.999
pretty much had a heart attack, uh, seven years
ago, uh, didn\'t change very much for a number

00:43:10.000 --> 00:43:14.999
of different reasons, uh, and had another
heart attack seven years later. Uh,

00:43:15.000 --> 00:43:19.999
I think Keith realizes that he\'s got to make
some major changes in his life. He\'s got

00:43:20.000 --> 00:43:24.999
to make sure that he is insured, for
example, so that he can get the medications

00:43:25.000 --> 00:43:29.999
that he needs and he can feel free to come
see doctors like myself, not only when he\'s

00:43:30.000 --> 00:43:34.999
in trouble, but also just to have frequent
check ups. We take better care of our

00:43:35.000 --> 00:43:39.999
cars as a whole than we do our bodies.
We would never let our cars go

00:43:40.000 --> 00:43:44.999
more than the required or recommended
mileage before we get a tune up

00:43:45.000 --> 00:43:49.999
yet most men don\'t see doctors on a
regular basis as a whole. What we need to

00:43:50.000 --> 00:43:54.999
do is educate ourselves. Um,
what we need to do is understand

00:43:55.000 --> 00:43:59.999
our family histories and
understand that we don\'t have to

00:44:00.000 --> 00:44:04.999
lose our traditions, we don\'t have to lose
our selves as a community, but we do have to

00:44:05.000 --> 00:44:09.999
get healthier or else we\'re not gonna
be here. In order to achieve what we

00:44:10.000 --> 00:44:14.999
need to achieve, it\'s not just gonna be
the medical community. It\'s going to be,

00:44:15.000 --> 00:44:19.999
you know, it being recognized
as a major public health

00:44:20.000 --> 00:44:24.999
issue and there needs to
be the kind of awareness

00:44:25.000 --> 00:44:29.999
and advocacy around it that probably
has some grassroots activity

00:44:30.000 --> 00:44:34.999
as well, um, in order to make
this kind of a, a, a real

00:44:35.000 --> 00:44:39.999
significant priority. We need to start,
start putting our fears away and

00:44:40.000 --> 00:44:44.999
we need to start using our sixth sense to really
figure out who has got out best interest at heart and

00:44:45.000 --> 00:44:49.999
who has not got our best interest at heart and
most importantly, we need to stop being turned off

00:44:50.000 --> 00:44:54.999
by the entire system. Racism is never going
to end but that doesn\'t mean we should

00:44:55.000 --> 00:44:59.999
stop looking for good health care because there
are too many racist individuals out there

00:45:00.000 --> 00:45:04.999
because if we do that, we\'re gonna
lose the war. We\'ll win the battle

00:45:05.000 --> 00:45:09.999
but we\'ll lose the war and we\'re gonna die,
continue to die young, uh, earlier, than other

00:45:10.000 --> 00:45:14.999
people. Talk to your friends, you know? Talk to those
who are around you. You know, if you\'re a person who

00:45:15.000 --> 00:45:19.999
goes to church, talk to the people in your
church. Begin to share information and

00:45:20.000 --> 00:45:24.999
experiences because I think that sometimes those
are some of the most positive educational

00:45:25.000 --> 00:45:29.999
experiences, um, and can really
help people begin to validate

00:45:30.000 --> 00:45:34.999
what they\'ve been feeling,
um, and to also get some

00:45:35.000 --> 00:45:39.999
good information. For
every Keith Hartgrove,

00:45:40.000 --> 00:45:44.999
there can also be thousands of other
African American men and women that

00:45:45.000 --> 00:45:49.999
can also experience the victory
that was experienced by Keith.

00:45:50.000 --> 00:45:54.999
That\'s our quest. That\'s our mission. Keith
is the living witness that it can be

00:45:55.000 --> 00:45:59.999
done but we all must be
committed to it as well. We do

00:46:00.000 --> 00:46:04.999
have choices and, um, I think

00:46:05.000 --> 00:46:09.999
having the experience that I had, uh,
made me realize that I have to be a lot

00:46:10.000 --> 00:46:14.999
more active in how I do things,
how I treat people, how

00:46:15.000 --> 00:46:19.999
I go through this world and show the

00:46:20.000 --> 00:46:24.999
love of God to other folks. [music]

00:46:25.000 --> 00:46:33.000
I\'ve been singing with the men\'s

00:46:35.000 --> 00:46:39.999
chorus sort of off and on for
the last three or four years.

00:46:40.000 --> 00:46:44.999
I\'m not the kind of person
that wants to be noticed or,

00:46:45.000 --> 00:46:49.999
you know, I just wanna participate
because I do love to sing. I do

00:46:50.000 --> 00:46:54.999
love the spirit of camaraderie.

00:46:55.000 --> 00:46:59.999
Out of gratitude for my second chance,

00:47:00.000 --> 00:47:04.999
I vowed that I would do a solo and
that I want to sing something

00:47:05.000 --> 00:47:09.999
that would inspire just all the
people at the church. [music]

00:47:10.000 --> 00:47:18.000
One of, one of the gifts of a, a church

00:47:25.000 --> 00:47:29.999
community, particularly in the African
American church community, is the

00:47:30.000 --> 00:47:34.999
rich experience of fellowship, of,
of edifying one another, encouraging

00:47:35.000 --> 00:47:39.999
one another. Um, I am aware
that when Keith, uh,

00:47:40.000 --> 00:47:44.999
was hospitalized that many, uh,
parishioners made phone calls,

00:47:45.000 --> 00:47:49.999
some who weren\'t able to speak
to him, called his mother. Many

00:47:50.000 --> 00:47:54.999
parishioners, uh, went down on their knees
and prayed for Keith and encouraged

00:47:55.000 --> 00:47:59.999
Keith and when Keith returned, uh, back
to the church, when he was able to,

00:48:00.000 --> 00:48:04.999
many parishioners, uh, embraced him and
said Keith, we\'ve been praying for you,

00:48:05.000 --> 00:48:09.999
uh, and, and we, and we regard
you as a, as a walking miracle.

00:48:10.000 --> 00:48:14.999
Keith\'s life has been encouraged by
this experience, not only out of his

00:48:15.000 --> 00:48:19.999
faith in God, which is a steadfast,
deep faith, but also out of

00:48:20.000 --> 00:48:24.999
the richness of the fellowship
who, uh, when one of us, uh, is

00:48:25.000 --> 00:48:29.999
experiencing a crisis, the entire
church family is there for

00:48:30.000 --> 00:48:34.999
that person. And, and that\'s one of the,
the, the joys of being a part of it, of a

00:48:35.000 --> 00:48:39.999
church community. It has changed
his life to the degree that

00:48:40.000 --> 00:48:44.999
he wants to learn more and more about

00:48:45.000 --> 00:48:49.999
what we are here on Earth for, why we

00:48:50.000 --> 00:48:54.999
are here and, uh, he\'s gonna work out

00:48:55.000 --> 00:48:59.999
his soul\'s salvation.
He\'s gonna work it out.

00:49:00.000 --> 00:49:04.999
And this is something that people
really don\'t understand and I guess

00:49:05.000 --> 00:49:09.999
we never will until it\'s our turn to, uh,

00:49:10.000 --> 00:49:14.999
go through that experience.
Hell is a real place

00:49:15.000 --> 00:49:19.999
and it\'s up to you whether
you go there or not.

00:49:20.000 --> 00:49:24.999
I remember my heart stopping.

00:49:25.000 --> 00:49:29.999
I remember my spirit leaving my body.
I remember

00:49:30.000 --> 00:49:34.999
seeing my body laying on the table wide

00:49:35.000 --> 00:49:39.999
open, you know, ribs to the
sky and my whole, uh, chest

00:49:40.000 --> 00:49:44.999
cavity being open. I remember
saying wow, is that me?

00:49:45.000 --> 00:49:49.999
I remember that and I remember not

00:49:50.000 --> 00:49:54.999
feeling any pain but then I remember

00:49:55.000 --> 00:49:59.999
a really dark place and I remember,

00:50:00.000 --> 00:50:04.999
I remember touching the

00:50:05.000 --> 00:50:09.999
ground but the ground wasn\'t solid

00:50:10.000 --> 00:50:14.999
and I remember the sinking into.

00:50:15.000 --> 00:50:19.999
I remember

00:50:20.000 --> 00:50:24.999
sinking into this disgusting

00:50:25.000 --> 00:50:29.999
Earth, like quicksand.

00:50:30.000 --> 00:50:34.999
I remember it being so

00:50:35.000 --> 00:50:39.999
pungent in odor that, uh, it was,

00:50:40.000 --> 00:50:44.999
it was toxic. I remember

00:50:45.000 --> 00:50:49.999
sinking down. I remember seeing

00:50:50.000 --> 00:50:54.999
people suffering and hearing

00:50:55.000 --> 00:50:59.999
screams of agony and, and I

00:51:00.000 --> 00:51:04.999
struggled to leave that
place, to get out of that

00:51:05.000 --> 00:51:09.999
quicksand and quagmire, um,
and yet not really having

00:51:10.000 --> 00:51:14.999
any, anything to hold onto

00:51:15.000 --> 00:51:19.999
or any way to pull myself out of it

00:51:20.000 --> 00:51:24.999
and then I remember at one
point, just before I really

00:51:25.000 --> 00:51:29.999
drowned, I remember hearing
people calling out my name

00:51:30.000 --> 00:51:34.999
and prayers. I remember people

00:51:35.000 --> 00:51:39.999
saying Lord let him live. I

00:51:40.000 --> 00:51:44.999
remember. [sil.]

00:51:45.000 --> 00:51:53.000
This was

00:52:00.000 --> 00:52:04.999
a second chance for me and I think that

00:52:05.000 --> 00:52:09.999
the love that I showed
my father on his last

00:52:10.000 --> 00:52:14.999
days were really part of the reason
why I was given a second chance

00:52:15.000 --> 00:52:19.999
and I have, I know that I
have to be more active

00:52:20.000 --> 00:52:24.999
in those choices and how I
do things and it\'s caused

00:52:25.000 --> 00:52:29.999
me to change my life in a lot of ways.

00:52:30.000 --> 00:52:34.999
Keith Hartgrove, young brother,

00:52:35.000 --> 00:52:39.999
suffered a very critical
heart attack and the Lord

00:52:40.000 --> 00:52:44.999
brought him back. [sil.]

00:52:45.000 --> 00:52:49.999
And

00:52:50.000 --> 00:52:54.999
so, for this reason, we\'ve asked that the
men\'s choir which is now a brotherhood too,

00:52:55.000 --> 00:52:59.999
to sing first and our soloist

00:53:00.000 --> 00:53:04.999
is none other than Brother Hartgrove.
[music]

00:53:05.000 --> 00:53:13.000
[sil.]

00:55:25.000 --> 00:55:33.000
[music]

00:55:35.000 --> 00:55:43.000
[sil.]