ATLANTIC CITY — Ronsha Dickerson put it like this: An urban black woman makes a prenatal appointment. This is not her first pregnancy, and she has Medicaid.
Before she even walks in, the doctor has judged her.
This discourages her from talking to or even going to the doctor in the future, said Dickerson, 41, a mother of six and the doula leader for the Southern New Jersey Perinatal Cooperative’s Healthy Women, Healthy Families grant program.
“When a woman becomes pregnant, especially a black woman, she becomes categorized,” Dickerson said. “She has the weight of the world on her shoulders, and she’s going into the space where she is not being looked at as a name. She’s being looked at as a case.”
Dickerson and other area health care workers say increasing cultural competency and eliminating systemic provider prejudices would go a long way toward improving outcomes for minorities across the country, especially in Atlantic City, which suffers from high rates of infant mortality, diabetes, kidney disease and heart disease.
Culturally competent care respects diversity and cultural factors among patients that can affect health, such as language, communication styles, beliefs, attitudes and behavior, according to a 2014 article by the U.S. Department of Health and Human Services.
Dr. Diane Timms, program director for Maternal Fetal Medicine and vice chairwoman of the Department of Obstetrics and Gynecology at AtlantiCare Regional Medical Center, said building a culture of trust helps make sure patients from Atlantic City are getting the right care when they need it.
“I think patients are looking for providers who look like them, who understand where they come from, who understand those family traditions, and we need to understand a way to engage with that,” Timms said.
Timms said cultural competency is a national issue and doctors should be aware that it’s an inherent bias, not something that is purposeful, and a provider may not realize they are doing something that could be perceived as harmful.
She said health care professionals are recognizing this and finding ways to expose physicians to different cultures, so they can understand them and their needs. AtlantiCare has implemented online education, employee resource groups representing different ethnicities and a diversity and inclusion council.
“I just think it’s important that we’re having the conversation,” Timms said. “Because it’s not until you’re open to talking about it that you can make change.”
The state-commissioned report released last year on the path Atlantic City must take to become prosperous specifically targeted public health and showed a significant gap between the health of black and white residents. The report suggested remedial steps be taken to explore the reasons for the disparities and improve outcomes.
To understand why black Americans are disproportionately prone to poor health conditions, ask the community, said Destiny C. Wood, director of women’s health services for Southern Jersey Family Medical Center.
“We’re trying to come up with all these different ideas, reinvent the wheel, when we should really be hearing from the community. I really don’t think there’s anything we’re trying to find that they don’t already know the answers to,” said Wood.
For more than a decade, researchers have been studying the effects of culturally sensitive health care on patients and have found positive impacts on health behaviors and outcomes for both majority and minority patients, as well as an increase in adherence to treatments. A 2012 study suggests disparities in health outcomes could be improved through cultural competency training. It cited older studies that have found minority and low-income patients were more likely to report poor communication with their providers, and doctors were less likely to engage black patients in conversation than white patients.
Wood said that as a registered nurse and longtime health professional and as a black woman and mother of six, she has experienced firsthand the lack of cultural competency by doctors and workers, who prejudge and who don’t communicate well with or dismiss the concerns of minority patients.
The solution lies in providers understanding the values, beliefs and traditions of other cultures.
“We all have biases, whether we realize it or not, but it takes for someone to really show you and acknowledge that they’re there. And all of that is a major factor to why patients do or do not seek care,” Wood said.
Some programs are underway aimed at engaging with mothers in Atlantic City, especially those more prone to negative health outcomes.
Inside the Leadership Studio on Tennessee Avenue, local women are invited to attend free Baby and Me Yoga classes, then stay for a free breastfeeding support group.
The classes are funded through the SNJPC’s Healthy Women grant, but reaching their target audience, black women, has been hit and miss.
“It’s been challenging, but we’ve gotten more support in the medical community in the last couple of months,” said studio co-owner Kathy Whitmore. “The cooperative has done outreach from their end.”
Amanda Ventura, of Absecon, who teaches the yoga class accompanied by her 9-month-old son Michael, said they are trying different approaches to spread the word about the yoga, and she planned to visit community groups and churches to meet the moms. She is also hoping to offer yoga in the area parks to spread the word that yoga isn’t just for white ladies in Lululemon pants.
Sarah Chaikin, a lactation consultant from SNJPC who has been leading the breastfeeding group after yoga, said she has also been having a difficult time reaching black moms. She said because of that, they are looking for a black breastfeeding educator or peer counselor to fill the role.
“I’m an older white woman. It’d be nice to have someone who is from the community, knows the community resources and has a better connection with the community,” Chaikin said. “That’s the missing link.”
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