Addressing the COVID Pandemic in Marginalized Communities | PCOM
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A Pandemic Within a Pandemic 
Addressing Marginalized and Minoritized Communities to Foster Recovery

July 6, 2021

PCOM alumni discuss the effect of the COVID-19 pandemic on marginalized communities and offer solutions

by David McKay Wilson

In six sketches that follow, College alumni share—personally and professionally—how long-standing disparities in marginalized and minoritized communities have exacerbated the impact of the COVID-19 pandemic. They expose the pandemic not just as a health crisis, but also a human, economic and social crisis. And they suggest approaches for healing.

Anne Kathryne Belocura, MS/Biomed ’20 (DO ’25) (PCOM Georgia)

Community Organizer, ANSWER Coalition; Medical Assistant, Viral Solutions, Decatur, Georgia

“There’s an idea that’s pervasive in American culture that Asians are a monolith. That’s what has helped my healing [as a Filipina whose family emigrated to Albany, Georgia, when I was 8]—helping to organize protests and mass demonstrations that spread awareness about the upsurge in anti-Asian violence. Anti-Asian hate crimes have increased by 150 percent, as Asians have been scapegoated in the pandemic. … At these demonstrations, community activists from grassroots organizations are building coalitions, working across racial lines and nationalities because we understand that we are stronger when we’re united. Recently, I’ve helped to organize a pan-Asian cultural festival in Decatur, Georgia, where we featured speakers and performances from different Asian communities. What’s been really important for everyone to acknowledge is that it isn’t just Asian people who attend these events. It’s always a diverse group of people who come out to support us. It has been so inspiring to have been able to connect with people, to talk about our unspoken truths—and the discrimination that so many minorities face. … I plan to return to PCOM in the fall to begin classes toward my osteopathic medical degree. I’ve worked this year at a COVID testing site where I’ve seen that the virus doesn’t discriminate. At my work, I’ve observed that there are patients—often immigrants and Black people—who are more distrustful of medical doctors, which is understandable. Sadly, the medical field has done people of Color a disservice with a history of discriminatory practices and unethical research practices. … I’m considering a career in primary care/internal medicine. I want to be on the first line of defense for patients, to be able to form relationships with them and help educate the community. I would like the opportunity to help bridge the gap between the medical profession and marginalized communities who have been hurt. Acknowledging the racist history in the medical field is the first step toward that healing. What would follow would require us to listen to our communities and ask the people how we can serve them, which would entail a greater degree of humility from healthcare providers. … One initiative that my organization has been doing is registering people in the West End Atlanta neighborhood, which is predominantly Black, to get vaccinated. As expected, we’re getting some pushback because of misinformation, but it’s essential to do this work because mass education has been so lacking during the pandemic. It’s important to have these one-on-one conversations, because as much as they might be learning from me, I’m learning so much more from them.”

Robert Evans, DO ’98

Osteopathic Physician; Community Activist; Motivational Speaker and Author; Television/Radio Personality; Healthcare Consultant; and Founder, Community Wellness Centers of America, Queens, New York

“There has been hesitancy for African Americans to take the COVID vaccine and that’s related to the way Black and Brown people have been treated historically. There was the incident in Nigeria in the mid-1990s during a meningitis outbreak when children were treated with an experimental drug without informed consent. Many of the Black children died. There was the collection of thousands of blood samples by the United States, the United Kingdom and France—without informed consent—during the Ebola outbreak in Africa. When the Africans inquired about the samples, they were told it was an issue of national security and could not be discussed. And there was the Tuskegee study of untreated syphilis in Black men in the 1930s. … For Black Americans, there has been hesitancy about the COVID vaccine because systemic medical racism and predatory experimentation have generated distrust of a healthcare system that was never built to serve us. … African Americans died and are still dying from COVID at disproportionately higher rates than their white counterparts. Disparities in the healthcare system contributed to comorbidities that made us more vulnerable to the virus: diabetes, hypertension, cardiovascular disease, obesity. Public health advocates cannot simply ask Black people to believe in a healthcare system that, in so many ways, has failed to care for us at a fundamental level. They need to do more than supply inoculations; they must work to build trust through education and disease management, through discounted or free medication, by helping people build up their bodies and make them less susceptible to serious illness. … In my professional experience, healing comes from accessibility to quality care. I can take care of a hundred patients a day, but without the hospitals’ dedication to both my practice and the community, without legislators holding hospitals accountable, it will not change patients’ outcomes. I realized that a long time ago. That’s why I’m building infrastructure in areas where others will not go—in the heart of Black and Brown communities. That’s the healing that will last. … I am passionate about my role as an osteopathic physician. Our profession’s founder, Dr. Andrew Taylor Still, took up arms against slavery during the Civil War and, as a physician, was active in the abolition movement and an ally of Free State leaders John Brown and James H. Lane. We, as his successors, should entrench ourselves in the fight against racism especially in health care. For the osteopathic philosophy was built on healing those who need it the most.”

Sharee L. Livingston, DO ’01

Chair, Obstetrics and Gynecology, and Chair, Diversity, Equity and Inclusion, UPMC Lititz; Co-Founder, Diversifying Doulas Initiative, Lancaster County, Pennsylvania

“When I began practicing as an obstetrician/gynecologist in 2006, I took care of women through all phases of their lives, including childbirth. While most outcomes in obstetrics are happy events, bad things unfortunately occur during childbirth. I saw maternal death upfront and this shook me to my core. But I have learned to convert experiencing emotion into being empirical. And during COVID, I especially converted that emotion into action. … I obtained Lancaster Cares Response Fund support through Lancaster County Community Foundation and the United Way to lessen the impact of COVID on communities of color. I co-founded a program that aimed to decrease maternal morbidity and mortality with free care to pregnant women of color from doulas, who are non-medical birth companions. Black women are three to four times more likely to die during childbirth than white women. And affluent white women have traditionally gained the benefits of doula care, at a cost of $1,000 to $1,400 for the entire experience, which includes seeing women twice before delivery, being present during labor, and then twice postpartum. Studies show women who have doula care are less likely to have preterm labor and postpartum depression, and more likely to have vaginal births and to be breastfeeding after four weeks. … Our program also trained 36 Black and Brown doulas who have developed independent businesses. So far, we’ve provided free doula care to 60 pregnant women of color. Now we are fundraising and continuing to fill the tank to provide more free care and train more doulas of color. Doulas can save hospitals money too. If the C-section rate drops, that helps everybody. … COVID was undoubtedly difficult, but my organizations were able to take advantage of the federal pandemic funding to address the needs of women of color, who are typically on the front lines, who can’t work from home, and who often lack access to preventative health care. Everybody wants babies to be safe. And everybody wants pregnant women to be safe. For those most impacted by maternal morbidity and mortality, we found one thing during the pandemic that can help.”

A. Scott McNeal, DO ’88

President and Chief Executive Officer, Delaware Valley Community Health, and Member, PCOM Board of Trustees, Philadelphia, Pennsylvania

“As I witnessed the devastating effects that COVID was having on low-income, underserved people of Color, it reinforced all of the reasons why I chose a career in public health. As president and chief executive officer of Delaware Valley Community Health (DVCH), a multidisciplinary primary care organization and one of Pennsylvania’s largest Federally Qualified Health Centers (FQHCs), I’m extremely proud of the integral role my organization played in the region’s public health response to the pandemic. With a patient base of over 45,000, we ensured that our high-risk communities received an even higher level of care by keeping them from contracting or spreading the virus, while continuing to manage their acute and chronic diseases. …We pivoted to a telehealth model over a single weekend, opened outdoor/walk-up COVID testing stations at four of our eight sites and kept most of our offices open for those patients that needed to be seen in-person. These efforts kept emergency rooms from being overloaded and preventing risky or unnecessary hospitalizations. When vaccines became available, FQHCs led the way for distribution to at-risk communities. My organization has distributed over 15,000 vaccines utilizing all three approved manufacturers; we received both state and federal vaccine supply. … FQHCs are in every state and US territory. This country has long relied on FQHCs to be the safety net for primary care and public health strategy. History has shown that certain communities are always harder hit by epidemics/pandemics because of cultural and linguistic barriers; low levels of education; high rates of poverty; and other contributing factors, such as housing issues, unemployment and poor nutrition. This pandemic has demonstrated how reliable the FQHC safety net is, and despite the devastating toll that the pandemic has taken, it would have been much worse without the work FQHCs do every day in caring for our communities. … As demand for the vaccine has now dropped, DVCH continues to provide educational events and other tactics to improve vaccination rates. Although we share information through social media and our website, we have many patients that can’t or won’t access the information, so we also make phone calls and perform community outreach. We’re using a low-volume, higher-touch approach to reach vulnerable patients. It’s very labor intensive, but most FQHCs already have this infrastructure in place. We use the same strategies for chronic disease management. We’re also going to church groups, nursing homes, daycare centers and senior centers. Just as we were prepared for this pandemic, we will be prepared for any future threats.”

Janine Miller, PharmD ’20

Pharmacy Practice Resident, Albert Einstein Medical Center, Philadelphia, Pennsylvania

“Racial and ethnic disparities permeate much of the healthcare system in the United States. Numerous studies have shown that African Americans and other people of color have less access to health care and receive poorer-quality care when compared with white people. In my experience, pharmacists are among the most accessible of healthcare professionals. They were on the front lines during the pandemic, and they really can be part of the fight against racial disparities in health care. … As an African American pharmacist, I have a special interest in unraveling the racial disparities associated with the treatment of chronic kidney disease, a disease that disproportionally affects minority persons and a disease that puts patients at increased risk of serious illness from COVID. … There are two race-based tracks employed to decide proper medication dosages. Many clinicians use an equation to estimate renal function that’s called CKD-EPI, which is based on serum creatine levels. When you are trying to dose-adjust a medication for someone with kidney disease, you go to the electronic medical record, where there’s an entry for Black patients or non-Black patients. Using this process, Black patients receive different dosages, based on a coefficient for African Americans that’s associated with increased muscle mass, a major determination of creatine generation. This coefficient is based on the notion that Black patients should have their race accounted for in the equation, due to previous genetic ideologies. But researchers have found that the coefficient has caused the renal function of Black patients to be misstated. And that has caused Black patients to not receive the appropriate treatment, at the appropriate times. … At times they didn’t get enough medication. At other times, they got too much medication because their actual renal function was not what the equation estimated it to be. It has ramifications, with some Black patients with chronic kidney disease wait-listed longer for organ transplants, or not staged appropriately for future treatment. … This topic has become the talk of professional circles in recent years. Some clinicians have suggested that the equation should no longer be used. I practice in North Philadelphia, where our patients are predominantly Black and Brown. To delve further into the issue, a colleague and I at Albert Einstein conducted a study [in 2019] of 210 patients hospitalized with chronic kidney disease; 177 were Black and 33 were white. Our review of their medical records found that there was a difference of 18 percent in dosage levels when using the race coefficient, compared to the Cockcroft-Gault equation, which did not account for racial characteristics. … Based on our research, we now select ‘non-Black’ on the electronic medical record for all of our patients. That way we ensure that racial bias does not play into how we dose that medication.”

Janie L. Orrington-Myers, DO ’99, FACOS, FACS

Coroner, Vigo County, and General Surgeon, Terre Haute Regional Hospital, Terre Haute, Indiana

“I’d only been practicing for a year in Vigo County when a retired county coroner asked me to run for the upcoming open seat. I turned him down. After all, I was new to the county and starting up my general surgery practice. But then others started asking. So I researched what it entailed. It’s a full-time job, overseeing a staff of five, in a county with a forensic pathologist. … The coroner rules on the cause of death—it’s either homicide, suicide, natural or unknown. Being a surgeon, I’m very comfortable with body anatomy. I investigate what the patient tells me, what I see in labs and imaging to decide how best to care for them. The coroner investigates the body while the police investigate the scene. We put all that together to get the right cause and manner of death. … I was the only physician, the only African American in a June primary against two funeral directors and a deputy coroner. I won that race and then faced a Republican police sergeant in November. … I believe that medical people should make medical decisions. It’s a process that involves the living and the dead. We want to get things right for the people who died and for their loved ones. You need someone with medical knowledge so no one gets away with murder. … I also believe you need someone who understands those who are vulnerable, who are marginalized. Working with marginalized groups demands time and respect. It is critical to understand the long-term impacts of disparities and what they can do to society. Too often, healing is an afterthought to harm. … The campaign began before the pandemic hit, so I did some meet-and-greets. During COVID, you couldn’t talk to people or press the flesh. It actually worked for me because I had my surgical practice and campaigned at night. We went on Zoom and social media; we did ads and yard signs. My slogan was, ‘The doctor is in your corner: Vote Dr. Myers for coroner.’ … The November 2020 vote was close: I won by just 191 votes out of 42,000 votes cast. I became the first African American to serve in a countywide elected position in Vigo County. I’ve kept my surgical practice, too. When my patients ask about my other job, I say: ‘Don’t worry, I’m the coroner, not the undertaker. My job to keep you alive on the operating table, not to help my other business.’ ”

About Digest Magazine

Digest, the magazine for alumni and friends of Philadelphia College of Osteopathic Medicine, is published by the Office of Marketing and Communications. The magazine reports on osteopathic and other professional trends of interest to alumni of the College’s Doctor of Osteopathic Medicine (DO) and graduate programs at PCOM, PCOM Georgia and PCOM South Georgia.