Yesterday we shared one of two art submissions that are part of the National Academy of Medicine’s health equity project called Visualize Health Equity. Today we are shining a spotlight on Cristina Valentin, UConn M.D. Candidate, Class of 2019. Below is an essay she wrote that is part of a new permanent online gallery.
-Are you Indian?
-No, I’m Puerto Rican.
-Well, there are a lot of Puerto Ricans outside where I live and they’re disgusting.
One would think that this elderly woman verified my ethnicity to decide whether or not to make that statement, but this patient at my clinical site proceeded to complain about the Puerto Ricans who lived in the inner city where she now lives. I was merely taking her social history. I had just asked her how she spent her typical day, only to find out that she did not enjoy the experience of walking her dog because she did not like walking among my people.
“They litter, they do this, and they do that. The women are all right, you see them out with their children or getting their groceries, but the men… Sometimes I am the only white person on the bus! I feel like I need an escort. There are Puerto Rican aids in my living facility, and they’re all right, but then you go outside and you see that… You just cannot help but start feeling a certain way about the whole race! They made me a racist!”
Remaining calm was rather easier than I would have expected. I was barely offended. After all, I was not unaware that people like this woman existed. In fact, right around the time I moved to the continental USA, a group of my Puerto Rican friends and I had been told that “you girls changed my view on Puerto Rican women.” The man’s implication was that he had previously viewed Puerto Rican women as vulgar. Too much was wrong with that view. I settled on merely pointing out that there was some selection bias, so to speak, in the observations he recalled to generalize that Puerto Rican women lack sophistication. For example, if I simply walked by this man in the mall, he would make no notice of me and thus not register me as a Puerto Rican. If I was being loud, dressing provocatively, or engaging in any other behaviors that he deemed unattractive or lacking of class, he would notice me and add me to his mental list of Puerto Ricans. Thus, this mental collection of Puerto Rican women would only include those whose behaviors stood out to him because he saw them in a negative light. Thankfully, the man agreed.
I figured this lady would not be as receptive. She had previously been criticizing the food that was available to her at the retreat, the people whom she could not stand there, and finally the neighborhood. I wished that she could have recognized that it was just the neighborhood that was rough, rather than a whole ethnicity. I also wished that she had wondered why so much of the Hispanic population lived in poverty, rather than dismissing an entire nationality as disgusting. I let her ramble on, wondering what would be the appropriate way to react or how much I should stand up for myself and for the people of my nationality. I felt helpless: I knew a discussion on prejudice would have gotten me nowhere. I limited myself to commenting that the specific behaviors she was observing from her Puerto Ricans neighbors were more likely than not a result of their socioeconomic conditions, rather than the blood that ran in their veins. Of course, that did not change her mind and any further discussion would not have made for a good oral presentation to my preceptor. I finally regained control of the interview and wrapped up.
In our pre-clinical curriculum, it has been discussed that experiences of racism are detrimental to the health of minorities, both directly —by affecting their mental health or physical safety—and indirectly, though their interactions with health care professionals. We have also discussed implicit bias among healthcare professionals, which can affect how their patients are treated. However, the other side of the coin had never been discussed: when it is the patients who discriminate. The easy response to offensive interactions such as these would be to turn a deaf ear and just treat the patient’s medical condition. That is what I did. I could have acted in the manner in which I believe a decent human being should act in general. I could have pointed out that there were a multitude of factors that she was not considering before making a generalization about my people: the historical context of the Puerto Rican migration to the United States, the quality of the jobs available to them, and the cultural, social, and economic hardships they faced. I did not do this. Caught between my duty to understand this patient and my desire to defend my people, I ultimately proceeded to act like the doctor that I was training to be. All I could do about my frustrations was write, and hope that this woman left with a better view of my people.
To view the full gallery, click here.