Resident Physician and Community Ambassador
Dear fellow physicians, health care providers, and medical students,
Black families in Fresno face a frightening crisis: Black parents are losing their children before their first birthdays at rates much higher than the national average. In Fresno County, 16 out of a thousand Black infants die before their first birthday compared to the state rate of 8.7 per thousand, according to the 2017-2019 March of Dimes Peristats. Look at those numbers in comparison to California’s rate experienced by the non-Hispanic white population of 3.4 per thousand — and you know it is time to sound the alarms. The devastating reality is that most of these losses are preventable.
As many of us know, the leading causes of Black infant mortality are preterm birth and low birth weight. In Fresno, 13.9 percent of Black infants are born prematurely as compared to the state average for their white counterparts of 7.7 percent. Those that survive often face a lifetime of complications.
Both adverse outcomes are avoidable if we listen to the Black women and birthing people we serve, if we provide resources that Black families need, and if we reaffirm and support the health choices that Black people make during their pregnancies.
We can do better.
We must do better.
Systemic racism has infected our healthcare systems and we need to come to terms with our part in upholding broken systems. It is a fact that Black families receive less patient advocacy than they deserve. Studies show that doctors and nurses expect Black people to have a higher pain tolerance — but pain is often amongst the first sign of a complication, something that can spiral. Advocating for the mom, advocating for the parent, and advocating for the family is not only paramount but a duty we as doctors must fulfill.
Spend time with your patients. Go the extra mile and let them tell you what their concerns might be, without being too quick to dismiss them. Be ready to have conversations about racism. Build a relationship with your patients and then trust will follow — but remember that trust is a two-way street.
One of the barriers I’ve seen in Fresno is the limited diversity among healthcare providers. There are not that many Black doctors or nurses in Fresno. It can be easier for patients to relate to a provider of color. But that’s not an excuse! Doctors and nurses should be able to empathize with any person in need of care because cultural congruency is important but hard to find due to limited diversity in medicine.
If you are a provider and are caring for a Black pregnant person, refer them to Fresno County Black Infant Health. At Black Infant Health, the program managers and case workers use evidence-based interventions to address not only the immediately thought of contributors to adverse birth outcomes, such as smoking, poor nutrition, and substance use, but also work to reduce stress and foster social support.
As a Black person in Fresno, I am aware of the racial dynamics that can leave my community isolated and discriminated against. As a Black doctor, I urge you to use the resources available to help Black families in Fresno thrive. I myself have committed to discussing the effects of racism in medicine and to referring every Black pregnant person I come across to Black Infant Health. And I hope you will join me in that pledge.
Dmitri Ezeuko, MD
Family and Community Medicine resident physician, UCSF Fresno