But despite this widespread influence, Vilarosa felt the limits of the country’s understanding. I, along with almost every black woman of childbearing age that I knew, read the piece and kept talking about it. Trapped in the American narrative of individualism, I learned from it the same invalid lesson that Villarusa Essence supported: “to work within the medical system and get out of what you can”, not to “challenge that system” but to seek “fair treatment.” Self-advocate. ” I did all this in my own pregnancy, with the story of the landroom in front of my mind. I have religiously taken prenatal vitamins; Although I was advised to lose weight during my pregnancy, I followed the doctor’s instructions; I hired a Dula, and got a doctor who looked like me, and chose a hospital famous for its low rate of cesarean section. I was still in the hospital a week before my daughter was born – a painful time marked by a painful medical intervention that I sometimes feel like I’m still coming to terms. I’ve done everything, “I’ve taken care of enough.” Everybody’s telling me black mothers don’t care. Instead of acknowledging the external causes of my suffering, I have made it an internal shame.
“Under the skin” offers an alternative understanding of this pain, for which there is a long history. Black pain is not the fault of the individual, and never has been, but the result of structural racism embedded in the practice of medicine in this country. Many doctors avoid being confronted with this fact. After hearing Vilarosa’s description of the painful delivery in the landroom, a team of white Midwestern doctors only questioned why Vilarosa was allowed into the delivery room at all. “Was that your takeaway?” He replied. “Denial of racial bias can be so extreme that no one will believe you even if you have the evidence.”
In this remarkably admirable book, there is no simple answer or platitude. Even as Vilarosa outlines countless ways for black people to fight for their own health, from social workers to community activists, from Daulas, he focuses on the nature of a structural problem that cannot be changed by personal choice. In 1992, Vilarosa asked Audrey Lord that he agreed that racism in America was “dying.” In response, the Lord “warned me that when something dies, it does not just fade; It fights to the death, grabs life desperately and goes out ugly. “If racial prejudice in medicine diminishes, Vilarosa concludes, it must be” becoming ugly. “
Under the skin: The hidden toll of racism on American life and the health of our nation, By Linda Vilarosa | 269 pages Doubleday $ 30
Caitlin Greenidge is the feature director and author of Harper’s Bazaar, most recently, in the novel “Liberty”.