Lessons From 1865: What Clinicians Can Learn From Juneteenth

Takeaway

This weekend we can work toward unlearning inaccurate history, practice critical reflection, engage in transformative conversations, and plan to take action that will promote health equity for all patients.

Passion in the Medical Profession | June 17, 2021 | 5 min read

By Ijeoma Nnodim Opara, MD, Wayne State University; Chad Lewis, MD, MPH, University of Iowa; Ramla Namisango Kasozi, MD, MPH, University of Minnesota; and Raymond Givens, MD, PhD, Columbia University.

On June 19, 1865, nearly two months after General Robert E. Lee surrendered at Appomattox and the Civil War effectively ended, Gordon Granger, a Union general marched into Galveston, Texas and proclaimed that under “General Order No. 3” all enslaved African Americans were to be freed immediately. This order was delivered under martial law, because even though President Lincoln issued the Emancipation Proclamation over two and a half years earlier on January 1, 1863, the state of Texas continued to force Black slaves to toil under their illegitimate and nefarious rule well after the Confederacy lost the war.

“Juneteenth,” a portmanteau of June 19th, later became a date of celebration when freed Black Texans defied terror and violence to secure their freedom in one of the most revolutionary grassroots efforts of the Reconstruction period. Today, African Americans across the nation celebrate Juneteenth by gathering with family members to share meals, play games, practice cultural traditions, and reflect on the connection of history to the present and future.

Unfortunately, many Americans’ education of national and world history is incomplete and inaccurate, wherein the nation’s dark and brutal history of settler colonialism, genocide, chattel slavery, state-sponsored violence, and racism has been muted, erased, or white-washed. We must remain committed to illuminating, uncovering, and unpacking history in order to right the wrongs that persistently prevent our country from achieving its full potential—the potential encased in the American dream.

The national reckoning with its history of structural racism has reverberated through many sectors of society, from the streets to the White House. This has forced policy makers, government officials, and healthcare professionals to acknowledge the injustices and inequities codified in all aspects of American life and the systems that govern in, including medicine and healthcare. As clinicians, there are at least six important lessons we can learn from Juneteenth that will help us give the highest quality care for all our patients through critical reflective practice and transformative action.

1. Unlearn history.

Most of us weren’t taught about the lasting impact of settler colonialism, slavery, and white supremacy on our society, how they continue to shape our present and inform the distribution of resources and opportunities according to race. Rather, we were taught a sanitized version of history which we need to unlearn in order to understand how structural racism, systemic oppression and injustice, which is encoded in the founding tenets of this nation, cause inequity in housing, education, healthcare, finance, and criminal justice. These systems inform the social determinants which drive the majority of health outcomes and disproportionately impacts marginalized and minoritized communities. Unlearning in order to re-learn history grants us the ability to unpack solutions to address root causes of disparity.

2. Practice critical reflection.

This is a process of identifying, questioning, and assessing deep-seated assumptions upon which our beliefs are built. As we use a critically reflective lens to understand how historical realities impact contemporary structures, we can unpack our roles within a system that perpetuates oppression, acknowledge how we benefit from these systems in our daily decisions, albeit inadvertently. Through this intentional practice, we can better recognize and arrest our biases that can manifest in our interpersonal encounters with patients, colleagues, and trainees. We are then better equipped to engage in transformational conversations.

3. Engage in transformational conversations.

As we become more informed of how historical realities resulted in societal systems that inequitably and unjustly assign value to and determine opportunities for people based on their physical appearance, it’s important to engage in conversations within our spheres of influence to raise the consciousness within the spaces we occupy. By participating in authentic, honest, and humble conversations, we can create opportunities for transformation to occur so that concealed power structures can be uncovered and dismantled. These conversations often lead us to take courageous action.

4. Take courageous action.

We must understand that we have the power, privilege, and responsibility to be an agent of change. Courageous action begins with acknowledging that medicine is systemically racist by design, which results in inequitable outcomes. A byproduct of that acknowledgement is a series of actions committed to restorative and reparative justice in collaboration with key stakeholders within medicine and across various professions disciplines and sectors. This should be led by healthcare professionals, scholars, activists, BIPOC community organizers, and other leaders.

5. Take an antiracist stance by centering equity and justice in practice, education, research, and policy.

Tremendous work has been done by Black physicians, scholars, organizers, and activists to demonstrate what antiracist medicine, medical education, and research practice looks like. We must all explore these perspectives, heed their calls to action, support their work, and amplify their voices.

Specifically, we should strive to eliminate race-based medicine in our clinical algorithms and learn a more appropriate application of race that is conscious of the role of structural racism as the vector of disease and health disparities that protects white populations while increasing the risk of BIPOC for poorer outcomes.

6. Demand institutional changes that uphold equity, antiracism, and belonging, in the recruitment and retention of faculty, staff, and trainees.

Build in systems of accountability within all your spheres of influence. Create and maintain safe, affirming, nourishing workplace, training, and healthcare environments where BIPOC, LGBTQ+, and other healthcare professionals, trainees, and patients of marginalized identities can thrive.

Juneteenth is a monumental occasion for reflection upon American history that is filled with meaning and is a potent reminder that there is still so much work to be done. For Black physicians, it’s a time of joy and celebration and to remember the incredible strength, creativity, organizational brilliance, and genius that allowed our ancestors to survive the impossible. All clinicians, regardless of their background, can use this holiday as a reminder to make or reinforce a commitment to lifelong reflective practice and courageous collaborative transformative action that will improve conditions for all our patients to thrive. Here, here, here, here, here, here, and here are some resources to help with self-development.

Other references:

Race Based Medicine

https://www.nejm.org/race-and-medicine

https://www.tandfonline.com/doi/full/10.1080/15265161.2020.1851811

Misrepresenting race in Medical Education

https://www.nejm.org/doi/full/10.1056/NEJMms2025768

Race conscious medicine https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32076-6/fulltext

Racial justice in research

https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/

Institutional change for justice

https://www.nejm.org/doi/full/10.1056/NEJMp2021072

http://bostonreview.net/science-nature-race/bram-wispelwey-michelle-morse-antiracist-agenda-medicine