Appendices – Healthcare Disparities: Exploring Inequities Across the Spectrum

Amaka Zeiden’s Birth Story: How ignored complaints nearly cost her her life.

Amaka Zeiden's Birth Story

Lucy Ogoke

Figure 1 – Amaka Zeiden a few days before giving birth to her child Olympia. Licensed with  Creative Commons Zero (No Rights Reserved)

Disclaimer: All names in this production are fictitious. No identification with actual persons (living or deceased), should be inferred

Panic set in as my baby Olympia’s heartbeat dropped, making my heart beat rapidly as the contractions continued. It was a moment of fear, but thanks to the swift actions of the medical team, I underwent an emergency cesarean section (C-section) and safely delivered my precious child. C-sections are not uncommon and overall mine went well. I can vividly recall the incredible moment when my partner cut the umbilical cord, and our daughter was gently placed on my chest. I felt pure joy and relief, knowing that my daughter and I were both safe and healthy.

 

However, shortly after that blissful moment, everything took a turn for the worse. I have a history of thrombocytosis, or forming excessive blood clots. These clots, which can form in veins or arteries, pose a serious threat to the circulatory system and organs by blocking off blood flow to vital organs or tissue. To prevent clots from forming, I take blood thinners on a daily basis. After my C-section, the doctors advised that I temporarily stop taking them to allow my surgical wound to heal. I trusted their advice because I believed they would keep my medical history in mind; however this was not the case.

 

The day after stopping the blood thinners, I started experiencing breathing difficulties while recovering in my hospital room. Despite not wanting to worry my visiting mother, I asked my mother to find  a nearby nurse. When the nurse arrived I asked if it was possible that I was forming clots in my lungs; but the nurse did not seem too concerned about the possibility after listening to my breath sounds with her stethoscope. Feeling concerned because of my medical history, I insisted on receiving an IV with heparin, a blood thinner, and a CT scan to check for clots. Unfortunately, the nurse dismissed my health concerns, attributing them to the post-surgical healing process. However, after my continued insistence, a doctor arrived but only performed an ultrasound, not the CT scan I believed was necessary. The ultrasound did not reveal anything concerning, but I remained adamant: repeating that I needed a CT scan and a heparin drip. I remember feeling concerned that the doctors would interpret my firm insistence as aggression and take unilateral action to pacify me, such as sedation. Finally, the doctor granted my request, and the CT scan revealed the truth: several small blood clots in my lungs. The medical team immediately began administering the necessary medication.

 

How are Disparities Affecting Black Pregnant People?

Black women like Amaka are about three to four times more likely to die of pregnancy or delivery complications than white women. There are economic, social, environmental, biological, genetic, behavioral and health care factors that all contribute to disparities. The experience of black women during childbirth is further impacted by factors such as stereotyping by medical professionals, and implicit biases within the medical system. Many black women report feeling unheard and dismissed by healthcare providers, leading to concerns being overlooked and important medical decisions not being made in their best interest. This experience is a result of historical and ongoing racial biases that have permeated medical practices.[1]

 

My intuition had proved right, but the ordeal was far from over. Over the next six days, I faced a series of medical crises. First, my C-section wound reopened due to a coughing spell triggered by the clots in my lungs. It was a setback, but the medical team swiftly took action to address it. Soon after, I had to undergo another surgery, this time to treat the pulmonary embolism—a blood clot that was blocking a vessel in my right lung. To add to the complications, they discovered a large hematoma, in my abdomen which could present further adverse effects for my healing. It seemed like a never- ending cycle of challenges, but I remained determined to overcome them for my daughter.

 

In yet another operation, a surgeon inserted a filter into a major vein to prevent further clots from dislodging and traveling to my lungs. Finally, after a week filled with uncertainty and pain, I was able to return home to be with my daughter and family.

 

Key Takeaways

This scenario highlights several areas where healthcare workers can make a difference in addressing disparities and improving outcomes for patients, particularly Black women. Here are some things that healthcare workers could do differently in this situation:

 

Listen and take patient concerns seriously: in this scenario, the patient was insistent about her symptoms and the need for a CT scan and heparin based on her own medical history, but her concerns were initially dismissed. As doctors who have spent years studying the body, it can be easy to think you know better than the patient. However, it is important to address the concerns of patients and take complaints seriously. Especially after being reminded of Amaka’s history of blood clots the possibility pulmonary emboli should have been explored fully. The healthcare professions need to ask themselves why they believed it would be okay to dismiss this concern even with her medical history.

 

Address systemic and structural issues: healthcare workers should educate themselves on and advocate for systemic changes to address the social, economic, and environmental factors that contribute to disparities. This includes working towards equitable access to healthcare, improving communication and coordination among healthcare providers, and promoting policies that support better outcomes for marginalized communities. The case of Amaka should be brought up in department meetings to discuss why certain patients concerns are ignored and to prevent it moving forward factoring in these systemic issues.

 

Improve health literacy and education: enhancing health literacy among patients, particularly in underserved communities, can empower them to be active participants in their own healthcare. Healthcare professionals should provide clear and accessible information about health conditions, treatment options, and prevention strategies, ensuring that patients have the knowledge to make informed decisions. Additionally, it has been shown that black women giving birth displayed better outcomes when they had more knowledge regarding the diagnosis and complications. This can look like a nurse or physician making sure to speak with the patients about risks which are specific to them and their condition taking into account all factors that could impact the patients outcome.

 

By implementing these changes, healthcare professionals can help reduce disparities, improve patient outcomes, and ensure that all individuals receive equitable and quality care, regardless of their racial or ethnic background. [2]


  1. Canty, L. (2021). The lived experience of severe maternal morbidity among black women. Nursing Inquiry, 29(1). https://doi.org/10.1111/nin.12466
  2. Martin, N., ProPublica, & Montagne, R. (2017, December 8). Black mothers keep dying after giving birth. Shalon Irving’s story explains why. NPR. https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why

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Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Pathology by Lucy Ogoke is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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