There is a great tragedy being played out in many an inner city these days. My experience with Grady was brief but vivid, for a naive Canadian being introduced to racial politics of the US, colored by the unique history of the city at the center of the Civil War (or the War of Northern Aggression, as I was quickly taught.)
Poor inner-city blacks, socialized and acculturated to being poor inner city blacks, are accustomed to seeking all their health care at Grady. For nearly a century, providing this health care has been regarded a charitable act, frequently delivered by benevolent whites. Who knows? Perhaps this was considered the price of maintaining the peace.
The wounds of racism have healed better in the South than some other parts of the country, but the injuries were far worse to being with. This is where the social unrest of the Civil Rights Movement had its roots, not 10 blocks from the hospital. This was Martin Luther King's first stomping grounds, the place he spent his formative years, a place central to much of his life.
And yet, poor blacks get their health care at the emergency room. This is where I met a homeless diabetic who had enough sense to develop DKA on the coldest nights of the year. This is where I met a woman whose first name is a sexually transmitted disease her mother must have liked the sound of. And the one legged hooker with a pressure sore the size of Rhode Island.
These are not dumb people. These are people who don't know better because they've never been shown better. Put aside morality for a moment, put aside questions about who gets your hard-earned tax-money for a minute and you'll realize these are resourceful, intelligent people who are so messed up by their circumstances, they can not do any better. They are shaped by a dysfunctional system. The last thing they need ER primary care.
Buried at the bottom of the NYTimes article is the following:
Some black activists and elected officials had warned that the governance change would shift control of the hospital from black political leaders to white business leaders. The hospital’s problems, they said, are financial and not political.So is that what this is about? Gradually over the years, Grady came to be controlled by prominent African-American activists and business players. The state and counties continue to fund an incompetent, inefficient, insufferable and impossible health system because the alternative is likely to be construed through the lens of American race politics.
And still, poor black men, women and children get substandard care because there is no incentive to actually improve what's available. God help minority populations when the important thing is maintaining control of the system, rather than delivering the service.
I suppose it is natural and inevitable for a previously oppressed populations to want to control their own community's assets and resources. I have seen this before; in Native communities in Quebec's North, with the French and English struggle in Canada and to a lesser extent with Latinos in the US. The control of health care by the target minority group does not ensure the delivery of appropriate care. How often and to what extent is the same scenario played out by County and public hospitals across the country?
A hyper-realist is saddened.