Health Humanities Undergraduate Research

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Historical Analysis

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(Wailoo, 2018) 

• The women Sims treated–Anarcha, Betsey, Lucy, and others–developed painful fistulas; Sims sough them out to explore a new surgical solution. (par. 4)

• Then I made this proposition to the owners of the negroes: ‘If you will give me Anarcha and Betsey, I agree to perform no experiment or operation on either of them to endanger their lives, and will not charge acent for keeping them, but you must pay their taxes and clothe them. (par. 4)

  • quote by Sims discussing the arrangements on which he “acquired” the women he experimented on

• Under Sims, each woman underwent up to 30 operations over 4 years, allowing him to refine his technique. They were provided no anesthetics. (par. 5)

• For some physicians of that time, the black body was seen as “more insensible to pain” and more tolerant of hard labor, as Sims’ contemporary, Dr Samuel Cartwright, insisted. (par 8)

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(Khabele et al., 2020) —Quotes

• From 1845 to 1849, Sims performed experimental surgeries, without their consent and without the benefit of anesthesia, on at least 14 enslaved black women. (sec. 1)

• After 29 unsuccessful surgeries on Anarcha Westcott, Sims reported his first successful vesicovaginal repair (sec. 2)

• Although the use of ether as a general anesthetic was novel at the time of Sims's surgical experimentation, it was publicly demonstrated in 1846 (3 years before his first successful repair), and Sims was aware of its use (sec. 1)

• Eventually, Sims moved to New York City and then traveled throughout Europe, where he offered vesicovaginal repair under anesthesia to mostly wealthy white women (sec. 1)

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(Armstrong, 2005) —Quotes

• A detailed poem written by one of the slave women described the horrific experiments they had to endure to further Dr. Sim’s discoveries

• Dr. Sims was working to perfect the operation to repair vesicovaginal fistulas, and he attempted his techniques on slave women sent by their masters

• The poem from a slave woman’s perspective says Dr. Sims “gets four strong field hands to hold me down, kneeling, he doesn’t say nothing to me” (lines 33-35) and details how Sims says “shut up gal and a hand over the mouth” (line 38)

• She goes on to describe her pain, saying “he cuts me inside—I feel the blood runnin’ down my legs to the floor—then he picks up the curved needles—and it goes on and on till I pass out” (line 42-45)

• Focus was placed on Anarcha, whom Sims “operated on 34 times, each time without anesthesia (paragraph 3)

• Quotation describes the atrocities of Sims' work by stating “But what sets Dr. Sims apart from other surgeons of his times was the repetitiveness with which he experimented Anarcha and slave women who were sent to him by their masters” (paragraph 6).

Bock (2021) Quotes

• This article describes the connection between the deeply racist past of the practice of gynecology and how its effects are seen in modern-day life.

• Dr. Deirdre Cooper Owens stated “Physicians in the South developed the field of obstetrics and gynecology as quickly as they did because of their access to enslaved bodies” (paragraph 2), this shows how the use of slave women did progress the field, however it was in a horrific and nonconsensual way

• Dr. Sims “conducted most of his research on enslaved women without their consent or anesthesia” (paragraph 5)-- details the atrocities of his actions

• Additional examples of physicians who performed experiments on slave women without their consent or anesthesia are Drs. Ephraim McDowell, John Peter Mettauer, and Francios Marie Provost (paragraph 8) “McDowell was the first person to successfully remove an ovarian tumor. Mettauer performed the first successful repair of the vesico-vaginal fistula. Prevost was the second American to perform a successful Caesarean section” (paragraph 9)

• Cooper Owens described how horrific the treatment of these women was saying “There was brutality and cruelty to go around, especially from the perspective of enslaved women who had to undergo experimental surgeries that lasted for years after being taken away from their homes, families, friends and communities” (paragraph 10)

• “His patients remain mostly unknown except for three first names: Lucy, Anarcha and Betsey.” (paragraph 10)

• Not only would Sims make his patients suffer through his invasive procedures, but he would then tell “his enslaved patients they must now work as his assistants” (paragraph 11)

• Thanks to his team of enslaved women, who were described as “smart and dignified” Sims was able to perfect his technique for repairing vesicovaginal fistulas, however in subsequent articles, “Sims staff and patients were depicted as white”. Cooper Owens describes this as an erasure that occurred “visually and historically”. (paragraphs 12 and 13)

• Important quote to highlight: “Interest in the reproductive health of black women ended once slaves were granted freedom” !!!!! (paragraph 14)

• “Black women have higher rates of death and complications from pregnancy and childbirth. The rates of mortality and morbidity are very high”- Cooper Owens (paragraph 15)

Ojanuga (1993)

• I think it is important to highlight that the condition Dr. Sims was working to find a cure for resulted in black women as a result of “poor nutrition, lack of prenatal care, and births at an early age”

• “The enslaved women were not asked if they would agree to such an operation as they were totally without any claims to decision making about their bodies or any aspect of their life”--highlights the lack of consent!

• Lucy’s story: “Lucy was operated on without anaesthetics as Sims was unaware of the advances which had been made in this area of medicine. The surgery lasted for an hour and Lucy endured excruciating pain while positioned on her hands and knees. She must have felt extreme humiliation as twelve doctors observed the operation” (+ includes info for rebuttal)

• THIS IS SO IMPORTANT: “Many white women came to SIms for treatment of vesico-vaginal fistulas after the successful operation on Anarcha. However, none of them, due to the pain, were able to endure a single operation”

  • combats claims below made BY SIMS that the procedures “were not painful”

• Rebuttal: Ephraim McDowell asked a white woman for consent to conduct an abdominal operation and used sulfuric ether as anesthesia AND THIS OCCURRED AT THE SAME TIME AS SIMS

• “Sims’ use of slave-women as experimental subjects as by no means the order of the day”

(Chan, 2023)

Quotes:

• Sims’s work relied heavily upon his experimentation on and the labour of enslaved women. Presently the erected statues, namesake conferences, and contemporary scholarship that memorialize his legacy reproduce the implicit and explicit erasure of the violence of slavery within his personal publications (par. 1)

• Sims’s representations are distinct in that he depicts the labour and alleged consent of enslaved women to maintain a sentimental self-representation and thus, his innocence, despite his participation and role as an enslaver within the medical plantation (par.2).

• Sim’s self-representation is dependent on a rhetoric of sentimentality that at once secures his authority as a medical practitioner and propagates a narrative of innocence that contributes to the legacy of erasure within the institution of Western medicine, wherein the female patient’s subjective experience and affective movements are dismissed or removed from medical history and public memory (par. 2)

  • argued by Chan an explanation of how the manipulative writings of Sims allowed his legacy to stand for so long

• In Sims’s autobiography, the conflation of the “self-made man” with the “sentimental” narrator functions to reaffirm his professionalization and social mobility through an affective call to readers to legitimize his presence in textual space (par. 5).

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Defenders of Sims

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(Wall, 2020)

• “The second assumption is that because Sims’s first patients were slaves, they must have been unwilling participants who could not consent to treatment. As a legal matter, consent to operate on a slave had to be obtained from the owner, but as a practical matter, slaves could assent to treatment by cooperating with a physician or surgeon in their shared quest for healing” (1302)

• “In the New York Medical Gazette of January 1854, Sims wrote: “I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs—the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not” (1302)

  • Claims that the procedures were consensual, although the women were ENSLAVED

  • only evident that the slave owners consented not the women themselves

• “Eventually, they became Sims’s surgical assistants, helping him to operate on one another until they were all finally cured” (1302)

  • assuming that these women were not forced to be the assistants of Sims or that they did not only do that to help their friends

• ‘[Sims] stated “I never resort to them [anesthetics] in these operations, because they are not painful enough to justify the trouble, and risk attending their administration”’

  • false assumptions that the invasive procedures were “not painful”

  • point proven wrong by the testimonial poem of one of his victims

Wall (2006)

• The source uses Sims’ narration as evidence, but it was apparent that Sims’ lied based on other sources…?

• Reasoning states that Sims was permitted to perform experiments on slave women because he asked the owners for consent, (not the patient so it does not matter)

• States the women wanted to have their conditions fixed and were glad to participate–sources prove this is false

• consent/anesthesia was not prevalent during this time–can be rebutted with sources above, false claim

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Modern Statistics​​

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(Wailoo, 2018) —Quotes

• 2 years ago [2016] a provocative report was published that noted that medical students and residents at a leading institution held unfounded and deeply mistaken beliefs about blood of black and white patients coagulating at different rates, skin of black patients being thicker than skin of white patients, and African Americans having lower sensitivity to pain (par. 15).

(Badreldin et al., 2019)

• Study to evaluate racial/ethnic differences in women’s pain scores postpartum and the administration of inpatient and discharge opioids (abstract)

• Study conducted was on women who were hospitalized for delivery from December 1, 2015 to November 30, 2016 (par.4)

• Women who reported a pain score of less than 5 were compared to those who who reported a pain score of 5 or higher (on a scale of 1-10). (par. 8).

Quotes:

• Conclusion: Hispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain (abstract).

• Minority individuals have been shown to receive less opioid treatment than non-Hispanic white individuals for similar levels of pain and similar conditions (par. 2).

• Non-Hispanic white women were significantly less likely to report a pain score at discharge of 5 or higher than both Hispanic and non-Hispanic black women. Yet non-Hispanic white women received significantly greater MMEs/d [oral morphine milligram equivalents] as inpatients than Hispanic and non-Hispanic black women (par. 11).

• Non-Hispanic white women were also more likely to receive an opioid prescription at discharge than Hispanic and non-Hispanic black women (par. 11).

• Non-Hispanic black women were significantly more likely than non-Hispanic white women to report pain scores of 5 or higher and were significantly less likely to receive an opioid prescription at discharge (par. 13).

(Bryant et al., 2010)

Table 1:

• Black women found to have higher rates of

  • Fetal demise

  • preterm birth

  • FGR (fetal growth restriction)

  • Maternal Mortality

  • Maternal Morbidity

  • Hypertensive disorders

  • maternal obesity and diabetes

• Found to be more likely to

  • enter into prenatal care AFTER the first trimester

  • have cesarean delivery

Analysis:

• In 2006 the total US rates of preterm birth was 12.8%. 18.4% of this was black women. (337)

• More likely to present late to care (339)

• More likely to have to rely on public insurance sources (339)

• Maternal Mortality 2005 (338)

  • N-H White: 11.7/100,000 live births

  • Hispanic: 9.6/ 100,000 live births

  • N-H Black: 39.2/100,000 live births

• How is the maternal mortality rates explained? Is it because black women are more predisposed to higher risk conditions?

  • “[Studies] found that black women in the national sample did not have higher prevalence of preeclampsia/eclampsia, postpartum hemorrhage, placenta previa, or placental abruption, but for all 5 conditions, black women had case-fatality rate 2.4-3.3 times higher than that of white women” (338).

    • This tells us it is an issue in the quality of care, not in the predisposition to conditions.

    Bougie (2021)

    • “Race is not a factor for illness and death, but racism, bias, and discrimination definitely are.”

    • “There is no known genetic connection between skin color or melanin concentration and !!! biological causes of maternal illness or death”, Crear-Perry

    • “We tend to conflate race with class and assume all the problems are due to poor women of color lacking access to care, but Black women at all income and educational levels experience bad maternal outcomes,” Redmond

    • Racism, classism, and gender oppression are at the forefront of reasons why there are unequal health outcomes in the maternity field.

  • • This resource’s objective was “to identify the presence of racial commentary in relation to endometriosis and other gynecological conditions in several prominent textbooks within the field of obstetrics and gynecology” (paragraph 1)

    • The researchers performed a historical analysis of 8 OB/GYN textbooks from 1960 to 2020. The research noted the commentary that was used to describe conditions such as endometriosis, endometriosis and race, and the race factor in other gynecological conditions.

    • The results of the research were as follows: “The analysis demonstrates that racial commentary has been consistently present in gynecology textbooks in the selected time period, though the frequency and nature has shifted” (paragraph 3) and that while there was a “decrease in endometriosis racial commentary while noting an upshift in other sections such as osteoporosis, pelvic infection (pelvic inflammatory disease, HIV/AIDS, HSV, etc.)” (paragraph 3)

    • The conclusion of the research was that “racist ideas about the prevalence of endometriosis are still pervasive in textbooks today, despite being widely discredited and rooted in methodically flawed studies” (paragraph 4)- shows how racist history plays a role in education of medicine and increases implicit bias

    Clare (2022)

    • This resource was written in response to a previous article that had cited race as a risk factor for postpartum preeclampsia, which is a condition in which one develops high blood pressure after childbirth, Dr. Clare stated, as the title says, “Race as a social construct should not be cited as a risk factor for postpartum preeclampsia”

    • Dr. Clare noted that “Inequities in health outcomes on the basis of race and ethnicity are not because of biological differences but because of structural racism” (paragraph 1)

    • This resource also notes that the false beliefs about physical differences between Black and White individuals continue to be prevalent among medical students and residents as “A 2016 study of 222 medical students noted that students believed there were differences in the nerve endings of Black and white patients, and hence, Black patients had more tolerance of pain: (paragraph 1)

    • The resource describes how the teaching that racial groups are thought of as “inherently diseased” t is what leads to “healthcare bias and stereotyping in clinical settings, racially tailored clinical practice, and therefore, racial health inequalities”. (paragraph 2)

    • It then goes on to describe how this is the origin of race-based medicine and how it results in racial inequities.

    Hoffman (2016)

    • This resource “reveals that a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy. It also provides the first evidence that racial bias in pain perception is associated with racial bias in pain treatment recommendations” (paragraph 1)

    • The resource details that “extent research shows that relative to white patients, black patients are less likely to be given pain medications and, if given pain medications, they receive lower quantities” (paragraph 4)

    • “Physicians were more likely to underestimate the pain of black patients (47%) relative to nonblack patients (33.5%)” (paragraph 6) -important for noting the modern-day disparities

    • Stems from the racist beliefs that originated from slave owners and scientists/physicians at that time

    • Dr. Samuel Cartright, who was a physician in the 19th century also did not believe in using anesthesia on his Black people stating ““Negro disease [making them] insensible to pain when subjected to punishment” The resource then details that “Other physicians believed that blacks could tolerate surgical operations with little, if any, pain at all” (paragraph 7)-- additional historical analysis

    • “Study 2 also reveals that white medical students and residents who endorsed false beliefs showed racial bias in the accuracy of their pain treatment recommendations. Specifically, participants who endorsed more of these beliefs reported that a black (vs. white) target patient would feel less pain and they were less accurate in their treatment recommendations for the black (vs. white) patient” (paragraph 7) of the study 2 section; so so important shows the correlation between racial bias and misinformation on the role race plays in health and misdiagnosis and inaccurate results as well as racial bias.

    • The results of the studies displayed that “beliefs about biological differences between blacks and whites—beliefs dating back to slavery—are associated with the perception that black people feel less pain than do white people and with inadequate treatment recommendations for black patients’ pain” (paragraph 1 of conclusion remarks)(--important as it displays the connection we are discussing, between racist history and the connection to the treatment of black people within healthcare

    (Jospeph 2021)

    • Detailing about the importance of representation in healthcare and how it can impact the treatment of minorities in healthcare, this quote “A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals” (paragraph 1)

    • Several influential systematic reviews have shown that healthcare providers’ implicit racial bias is associated with lower quality patient-provider communication which can affect patient satisfaction and contribute to health disparities” (paragraph 7)--. This shows the connection between the effect of implicit bias and the patient experience with a provider when they are of a different race and the provider has a preconceived notion of them because of their race

    • “An important finding is that clinical educators themselves do not feel proficient enough to deliver training about race and discrimination. Gonzalez et al. [51] conducted 21 in-depth interviews with faculty who had the experience of teaching implicit bias or had an interest in facilitating discussions and found that they felt they lacked the skills and knowledge to appropriately discuss bias especially when students were resistant to learning about bias or expressed strong emotive reactions which present challenges within the learning environment”--SO IMPORTANT highlights the importance of medical schools having educators who understand racial disparities and know how to accurately teach their students.

    • “It found that when non-African American students were exposed to disparaging racial remarks and jokes about black patients, they were significantly more likely to express racial bias [60]. These results suggest that the impact of the hidden curriculum may have a significant impact on healthcare professionals’ racial bias, but further studies in other countries and disciplinary groups are needed to explore this further.” - this highlights how important the medical school curriculum is and how vital it is to not have implicit bias play a role in the education of medical students

    • Solutions: “Some studies suggest that in addition to being encouraged to become more aware of their personal biases, healthcare students should be taught bias reduction strategies and that these should be framed appropriately to reduce self-blame and shame” “By incorporating implicit racial bias training across the curriculum, evidence shows increased acceptance and reduced resistance to race discourse and shows promise for the long-term reduction of implicit racial bias in healthcare [63]” “the development of an inclusion strategy to show commitment to reducing bias, from hiring and retaining diverse faculty to admissions and assessment committees. In addition, they suggest that leadership may benefit from an organizational mandate to combine the use of diversity training and the IAT to identify and address bias throughout the workforce.”

    NIH Study (2021)

    • This resource focuses on the “urgent need to address racial and ethnic disparities in maternal deaths” and details how many of the conditions are preventable, such as preeclampsia and eclampsia, which are blood pressure disorders that negatively impact black women more than white women, and are a major cause of the high number of maternal deaths seen in black women

    • “Late maternal deaths — those occurring between six weeks and one year postpartum — were 3.5 times more likely among Black women than white women”-important statistic

    NIH study (2021)

  (Prater, 2022)

  • “Specifically, Black women had 3.9 times higher odds of perceived discrimination, and had 10 times lower odds of perceiving they had substantial control over their healthcare choices” (1307).

  • “Compared to other women of color, Black women reported higher rates of perceived discrimination (31% vs 11%, aOR 3.9 [1.2–12.1], p < 0.05) and lower perceived control over health choices (84% vs 98%, aOR 0.1 [0.0–0.8], p < 0.05)” (1306-1307).

  • “Black participants were more likely to report their providers were not listening to them and were treated with less respect than others. This reflects either overt acts of racism or more likely implicit biases that affect healthcare providers’ interpersonal interaction with patients” (1308).

  (Grobman, 2015)

  Quotes-

  • Ethnic disparities in health care have been defined as differences in the quality of care received by particular groups who have similar health insurance and the same access to a doctor when there are no differences between these groups in their preferences and needs for treatment (par. 1)

  • Many studies have demonstrated the marked black–white difference that exists in both infant and maternal mortality (par. 2)

  • …black women are more likely to have pregnancy-associated mortality even after accounting for severity of who reached complete dilation (par.2)

  • Non-Hispanic black, Hispanic, and Asian women all had significantly greater odds of experiencing a severe postpartum hemorrhage or peripartum infection than non-Hispanic white women (sec. 3, par.1)

  Testimonies​

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    “Disconcerting results from Ubel et al. show that while many medical students are concerned with the moral aspects of performing nonconsensual pelvic examinations at the start of their training, ‘students who have completed obstetrics–gynecology clerkships place significantly less importance on seeking permission from women who are to be anesthetized before performing pelvic examinations’. This implies that medical students who are asked to participate in this training practice are learning not only the skills of obstetrics–gynecology but a moral lesson regarding when informed consent is and is not required.” (sec. 2)

    • essentially this tells us that students that are taught to disregard consent for these practices are more likely to implement this into their own practices as physicians

    • we are still being taught to disregard consent for the sake of “medical education” just as Sims did

  • “400 medical students from five medical schools in Philadelphia, 90% of whom admitted to having performed a pelvic exam on an anesthetized woman” (sec. 1).

• Insight into how acceptance of non-consentual procedures from history can lead to the overlooking of consent for modern day education. Defenders of Sims say that what he did is justified as he did it "for the sake of scientific discovery" and this modern day "educational practice" is defended by the same excuse.

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• (Khabele et al., 2020)

  • Testimony of Dineo Khabele, MD

    • “My husband and I, a black couple with a Harlem address, were admitted to the hospital with indifference”

    • “I tried to ask for an epidural, but my labor pains were openly mocked. It is hard to describe how humiliating it is to be dismissed when vulnerable”

    • “All I remember is wanting to be heard”

  • Testimony of Linda D. Bradley, MD of biased treatment of black woman who was a victim of sexual assault

    • “The chief resident looked at her with the most impatient attitude and shouted at her to move to the bottom of the gurney”

    • ‘“Open your legs now,” he yelled as he tried to pry open her legs.’

    • “Her tears meant nothing to him. He did not acknowledge her pain and fear. He did not say that he felt sorry for what had happened to her”

    Trader (2022)

    • Tons and tons of testimony stories

    • Stress and fear black women face about reproductive outcomes: ““It just frightens me a little bit to, one, think about actually going through labor, but then, also, do I have to write my will within that timeframe of being nine months pregnant, or within that year postpartum? I don’t think people understand the type of stress that comes with knowing so much about what’s going on in the Black community.” (Participant 20) “We saw the news that black women are more likely to die, and now I’m scared to get pregnant”

    • Pain: “Why are the stories that I hear from my Black girlfriends about these horrible experiences with the IUD? Is it because they think differently about Black women’s pain when they’re putting these things in? Or are people not being given enough choices?”

    • Lack of listening from providers: “But I don’t necessarily like birth control. The fact that I’m always asked about it and my answer is always the same, it kind of rubs me the wrong way.” “They don’t think you know as much as they do, so they try to input their opinions and as far as what they think is the best route for you. So you’re forced to go by their opinions, rather than your research.” “provoked similar fear and anxiety, particularly when participants felt like the approach of the health care professional was “dismissive” or “passive.” When participants reflected on these negative outcomes, they wondered whether racism was at play and it contributed to their mistrust in reproductive health care.”

    • Importance of representation: “When I’m with a physician that’s a Black person or another person of color, I more so just feel like I’m just in the room as myself and not having to explain or [be] stigmatized for certain things I’m experiencing.” (Participant 3)

    • Mistrust: “I just didn’t feel vulnerable enough or safe enough to ask them those questions”

    • Look into the story of Shalon Irving

  (Friesen, 2018)

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(Saraiva, 2023)

• “When addressing the situation of Black women, one cannot disregard the historical violence and sexual abuse, work exploitation and denial of the right to life, evidenced in the denied or non-assistance in accessing public services, especially health services, in primary, secondary, or tertiary care” (sec. 1).

• “thoughts that naturalize that Black people are more resistant to pain or that they hardly get sick and, therefore, tend to minimize complaints from Black people and reduce the use of medication and anesthesia, especially in women in prenatal and childbirth procedures” (sec. 2)

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• Alyne da Silva Pimentel Teixeira

  • went to the hospital November 13, 2002

  • “Alyne was black, 28, married, and the mother of a five-year-old daughter. With nausea and severe abdominal pain, shesought medical care, was given painkillers, and was discharged to return home” (sec. 1).

    • Alyne returned to the hospital when she didn’t get better

    • there it was confirmed that her unborn child had died

  • “In the second hospital, the young woman waited several hours in thecorridor due to the lack of beds in the emergency room. She ended up dying on November 16,2002, due to a digestive hemorrhage caused by the delivery of a dead fetus” (sec. 1).

• Milene de Oliveira

  • 19 year old black woman

  • “the young woman reported unsuccess fully attempting to push for 13 hours in delivery after being admitted to the medical unit. She was harassed and embarrassed all the time, hearing that it was her fault” (sec. 1).

  • “The young woman even begged for the cesarean procedure, as she could no longer bear the pain and depleted her strength to expel the baby, but her request was denied”(sec. 1).

  • while she was in delivery the doctors told her : “Push, or else your baby will die” and “I am doing my best down here so your husband will want to have another child with you” (sec. 1)