how to create racial disparities without saying it's about race

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It has been months since I’ve last posted here. Way too long. And to my blog readers, I do apologize. While no excuse for neglecting my writing practice is sufficient, the one that comes the closest is because I have been vigorously promoting my book, followed by desperately trying to catch up with the day job.


I’ve had the opportunity to speak in several venues. I’ve done lots of readings and interviews for daytime TV, newspaper and radio. I’ve felt honored to do each and every one of them, from the reading in Atlanta to an audience of just four people to the radio interview with NPR Forum’s Michael Krasny, reaching a worldwide audience


But some of the most memorable words were spoken in August by Perri Small on her live WVON 1690AM radio show, The Talk of Chicago, in the south-side of Chicago:


“C’mon Dr. Grubbs, you know it’s because we Black!”


We sat with headsets donned, microphones inches in front of our faces. Clearly, I wasn’t calling out racism directly enough as the reason why 3 Black people develop end-stage kidney disease for every White person who does, but receive only 1 of every 4 kidney transplants. Why Hispanics are not much better off.


“Nobody is going to come out and say it’s because we Black,” I explained. Nobody has to. Nobody has to because it is woven into the fabric of how things are done in such a way as by design it mostly affects the poor and people of color.


My dialysis patient, Mr. Garcia, is an example of how.


I started taking care of Mr. Garcia seven years ago when he started dialysis. He was in his late thirties and looked deceptively healthy for someone without functioning kidneys. He was also an undocumented immigrant, but somehow managed to get a lawyer who helped him gain citizenship five years later. It was at this point that I could refer him for transplant consideration.


He was initially told he was ineligible for a kidney transplant because he didn’t have sufficient “social support.” The transplant center required that potential candidates provide the names and phone number of five people who would be available and willing to help him after transplant.


“Why would you tell them you don’t have any social support?” I asked him on my dialysis rounds one day.


“Because I don’t,” he shrugged. He was unmarried and childless and his extended family was in another country. He was also fiercely proud and independent and didn’t want to burden anyone or even ask for help.


“But you have three roommates and friends. You don’t think they would be willing to do things like pick up your medicine from the pharmacy or drive you to a clinic appointment? That’s the kind of support they are talking about.”


He stared back at me wide-eyed and nodded. It hadn’t been explained to him like that.


“You better go back there and fill out that piece of paper with their names and phone numbers,” I commanded.


And he did. He had cleared another hurdle, so the evaluation continued.


Mr. Garcia is usually late for his hemodialysis treatments, which means he rarely gets his full treatment and some of his blood test results aren’t as pretty as they ought to be. The social worker at the kidney transplant center expressed concern that “this failure to comply with medical treatment” meant he would not take excellent care of a new kidney, thus wasting a kidney that 14 other “medically compliant” patients die waiting for every day.


It didn’t matter that Mr. Garcia is late because he works as a dishwasher and there is no dialysis shift that will accommodate his schedule. Not the shifts that start at 5AM, 9AM, or 1PM. And not his actual shift that starts at 4PM. Dialysis unit schedules are designed to maximize the number of patients that can have dialysis every Monday, Wednesday, and Friday and every Tuesday, Thursday, and Saturday, in order to maximize profit, not patient convenience. If Mr. Garcia worked a higher skill level job, like the kind where one couldn’t be replaced so easily or that allows more flexible working hours, or if he was part of a family that didn’t need his income, it would be easier for him to be “medically compliant.”


I called the transplant nephrologist and argued Mr. Garcia’s case. He said he agreed with me that Mr. Garcia’s reason for not being on time for dialysis was all the more reason for him to get a kidney transplant, not one to disqualify him.


But I don’t know what he or the others on the kidney transplant team will say behind the closed doors where they sit and decide who will or who will not be placed on the wait list. What I do know is that if he is not placed on the wait list, it won’t be because he is Hispanic. It will be because a society that systematically restricts where people of color live, work, and are educated ensured he would not meet the transplant center’s eligibility criteria.