“Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present” is a comprehensive history of medical and related abuses of African Americans. In some points, the exploitation is not specifically of African Americans, but more generally of the socially and economically disadvantaged. When a clinical researcher sets out on a course of experimentation, he or she must weigh the costs and benefits. The result of this calculation is predictable when the researcher places no value on the cost to the study subjects. The culture of slavery relies on the belief that the slaves are inferior beings, so it is no surprise that medical doctors cheaply traded the welfare of black subjects for the possibility of medical progress. The cultural impact of slavery did not end with the Emancipation Proclamation. Some examples: Antebellum medical schools competed for students by advertising their access to African American patients. For instance, the Savannah Medical College boasted that its black patients provided “abundant clinical opportunities for the studying of disease.” Surgery at the Medical College of South Carolina was performed only on blacks. Beginning in 1830, Dr. Francois Marie Prevost performed 30 of 37 experimental cesarean sections on slaves. In 1852, Dr. Marion Sims, the “father of gynecology,” reported in the Journal of the American Medical Sciences that on his thirtieth attempt with slave women – probably without their informed consent and perhaps without their consent at all – he successfully repaired a vesicovaginal fistula (without anesthesia). Mr. Sims’ choice of subjects was understandable given their availability, controllability and freedom for exploitation. Human testing
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Listening matters: poor people are not mere beneficiaries
Clinical psychologist Adrien Cascarino writes on how empowerment requires a high dose of self-confidence, which is undermined when individuals are regarded as mere beneficiariesAdrien Cascarino C. is sitting in her house, anemic, tired-looking, and emaciated. Her 3 malnourished children, a 3-year-old son and two-year-old twin daughters, are sleeping, with rashes all over their skin and worms in their bellies. None of them have ever seen a doctor, they are mostly staying at home. Are they living in a remote area, too far from any potential support? Or maybe health treatment is just too expensive? They are in Vitas, Barangay 105, Tondo, a slum of Manila, capital of the Philippines. The place is reached by non-governmental organizations (NGOs) and public services. In fact, there is a free feeding program just 10 minutes away from C.'s makeshift house. Walk 10 minutes more and there is the Vitas Health Center, which offers free medicine and check-ups. You have 3 options on how you view people like C.: 1) You can either take the easy path and say "poor people are lazy, they don’t make the effort to solve their issues, that’s actually why they are poor." 2) You can take the middle and think that "poor people lack knowledge; we need to educate them and make them understand what are the right actions and decisions to make.” 3) And finally, you can consider C. as a person, someone as smart as you. Throw away ready-made answers and try to understand what’s actually happening in C.'s situation. Demotivation ATIA, an NGO founded in 2008, chose the 3rd path, assuming that socio-economic exclusion results in – rather than from –lack of self-esteem, lower cognitive functions, and consequently, very poor agency. Instead of telling C. to do what would feel right for us and therefore confirming her inability to properly raise her children by herself, we should take the time to know her, her story, and her dreams. We need to decipher her words, like this odd sentence that blurted out of her lips the first time we met: “Gusto ko lumabas pero hindi ko alam paano (I want to go out but I don’t know how)." Originally from Davao, C. migrated to Manila in hopes of eventually becoming a caregiver overseas. She believed that she could complete her training in the city and land a contract that would take her elsewhere. But by the time she completed her training, she had run out of funds. She ended up wandering the streets until she met N., who then became her partner. C. and N. live in the slums of Tondo. She had 3 children and started staying at home, waiting for N.'s P100 to P150 pesos daily income from scavenging. She felt alone and disempowered. After 9 months of weekly visits from the psycho-social counselors trained by ATIA, and hired by Enfance Foundation, a partner’s organisation of ATIA, C's family received treatment from the local health center. C. also finally met her neighbors and started looking for a job. The psycho-social counselors established a relationship with C. and N., seeing them as intelligent human beings capable of deciding what is best for themselves and their family. Not just bodies There are a dozen other stories like C.'s; tales of teenage parents, kids growing up with violence, and young Filipinos who stopped believing in the goodness of themselves and of others. Unfortunately, taking time to talk with poor people is still not considered a priority by many. Getting funding to do just that may also be difficult. Many organizations, however, have already shifted their views from merely treating poor families as nothing but mouths to feed to considering them as minds to educate. While this change is definitely an improvement, it still does not remove the condescending and paternalistic tone attached to these programs. This mindset is saying that “there is no point in listening to poor people, we just need to give or teach them what they need and they will get better.” Some people will not accept such help because they think they don’t deserve it, or because they don’t think anything can really change. Others will accept assistance and get better, but would then wait for another benefactor. Why? Because dole-out approaches don’t really improve their self-esteem or their agency. ATIA’s experience shows that by simply conversing and establishing relationships with marginalized families, we are helping them better understand their history, issues, and resources. This can make them feel in control of their life. We need to address physiological and psychological needs at the same time, not just one over the other. Empowerment requires not only a healthy body and an educated mind, but also a high dose of self-confidence, which is hampered when we consider individuals as mere “beneficiaries.” Adrien Cascarino is a clinical psychologist Clinical psychologist Adrien Cascarino writes on how empowerment requires a high dose of self-confidence, which is undermined when individuals are regarded as mere beneficiaries
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