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Truth and Reconciliation in Medicine

Learning Objectives
1. Describe strategies for organized medicine to acknowledge and redress past harms
2. Discuss data and narratives to advance health equity conversations within obstetrics and gynecology
1 Credit CME

This panel conversation, moderated by co-chairs of the AMA's Truth, Racial Healing, and Transformation Task Force: Dr Niva Lubin-Johnson and Dr Matt Wynia, is part of a continued effort to acknowledge and redress past harms in medicine. Panelists include Michelle Browder, Executive and Artistic Director of the More Up Campus, a monument to the mothers of gynecology, Anarcha, Lucy and Betsy, who were enslaved women operated on by J. Miriam Sims in the 1840s; J.C. Hallman: the author of the forthcoming Say Anarchai; and Dr Lee Sharma, a gynecologist in private practice in Auburn, Alabama.

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Video Transcript

Aletha Maybank, MD, MPH: All right, next up is our fireside chat relating to our work that was discussed by Dr Madera yesterday on truth, healing, and reconciliation. Our strategic plan to advance equity actually states that no organization and no set of organization-wide commitments to embedding equity or anti-racism can succeed without first initiating an honest accounting of AMA's past and/or persistent practices that excluded, formally or informally, physicians based on race, ethnicity, gender, sexual orientation, ability, and country of origin, and even where you practice as—or where you train as international medical graduates. And we know that some of our policies cause longstanding harm to historically and marginalized communities, and our policies have not always been well-aligned with equity and justice, you have heard. We have had silence at certain times in the past that have been highly detrimental.

Jim announced yesterday on executing a policy again that was passed by this house in 2021 that we launched the Truth, Racial Healing, and Transformation Task Force. This work works towards truth and reconciliation that really began over 15 years ago and provided a foundation for us really as the center to where we started as it relates to the strategic plan and the equity work in this present time. In 2005, there was a writing group on the history of African Americans and the medical profession. It was a group of independent panel experts who were convened by the AMA Institute of Ethics to analyze the roots of racism within American medical organizations. This was very instrumental actually for supporting the development and the creation of the apology that AMA issued to the National Medical Association that was created because Black physicians were excluded. And that apology was issued in 2008. And again it set the foundation for us as the strategic plan.

So I want to acknowledge you know Dr Matt Wynia you're going to hear about him in a second. He was leading the Ethics Institute at that time. Dr Niva Lubin-Johnson also was very much a part of AMA and NMA in leadership. Dr, not Dr—Harriet Washington. So we have our task force, and many of our task force members are here, or some of them are here. Can some of the task force members stand if you're here, anywhere? I don't know where you're sitting, but I know you're around in different places. Hands are up. Yeah, thank you. They're kind of, they're not everywhere.

But Harriet Washington, who is a task force member, she was supposed to be here today, but she had to leave early for a family emergency. But I really wanted to acknowledge her because I met her way back in 2006, actually when her book, Medical Apartheid, was first published. And it was really the first time that many of us were exposed to just the history of medical experimentation on slaves and folks within the Black community over a long period of time. But she really also exposed the story of Dr J. Marion Sims, who served as an AMA president in 1876. We're going to hear more about that on this panel. I just want to always acknowledge and center, give credit and recognition to those who have led this work in terms of advocacy, which brings me to actually see the picture here. If you've noticed, if you're able to see as you walked in, a replica of this amazing, phenomenal, you don't really have words for it, inspiring, moving, validating piece of artwork and beauty that Michelle Broder, who's sitting here in the front row, who's going to be on the panel, created. Just really acknowledging, again, the advocacy of those who oftentimes have been the most marginalized. That's how movements have been started. That's who starts movements in this country. It is not typically institutions. It's not institutions. It's those who have been historically most marginalized. They are the ones who are calling attention to injustice. And those are the ones who really need to listen and provide voice—not provide voice, but to provide space for us to listen to in our institutions.

So as we move forward in this conversation, this is the task force as a whole. We had our first meeting a couple of weeks ago. I want to also acknowledge Dr Willie Underwood, who is one of our board liaisons. I know I just saw him walking. and Dr Alex Ding, who's also one of our board liaisons. I want to recognize the current chair, our outgoing chair of the AMA board, Dr Sandy Fryhofer, for really helping us get to this point, and Dr Jim Madera as well, for getting to the point of having this task force and where we are in the MITE team, and Dr Jocelyn Sargent, who is the director of restorative justice and medicine. And we have a position of that at the AMA, restorative justice and medicine. So pretty I think profound and leading at this time.

So I'm going to ask our two co-chairs of the committee and task force, rather to come up who are going to help support moderating this conversation. Dr Niva Lubin-Johnson is a Chicago based internist a clinical consultant. She is the one hundredth and 19th president of the National Medical Association. She is a delegate from the Illinois State Medical Society and past chair of AMA's women physicians section and the Minorities Affairs Section as she was recently elected to a fellowship in the Institute of Medicine in Chicago.

And Dr Matt Wynia is an infectious diseases internist and is the director of the University of Colorado's Center for Bioethics and Humanities. Previously, Dr Winnia was director of our Institute of Ethics at AMA. So we welcome you and thank you.

Matthew Wynia, MD, MPH: Thank you so much. So my task in, I was told, less than two minutes is to set the context for this conversation. And there are a couple of ways to go about that. But instead of trying to actually recap the history of the AMA's actions and inactions in this space I want to just tell you a quick story in two thousand, either 2003 or 2004, I actually don't recall, I was at a specialty society meeting and the AMA and the National Medical Association and the National Hispanic Medical Association were in the process of standing up what would become the Commission to End Health Care Disparities. And we were devoting a good deal of resources to this at the AMA, and I presented this to the health disparities group that was working at this subspecialty meeting and tried to encourage people to join with us on this work. And as we broke up and left the meeting, a colleague came up to me and said—and it was an African-American woman—she said, you know, Matt, I appreciate what you're trying to do with the AMA right now, but I will never be a member of the AMA because my grandfather wanted to join the AMA and was not allowed to.

And there's a quote, a well-known quote from William Faulkner that the past is never dead. It's not even past. And that moment for me was when I realized this is not dead. This isn't passed. The AMA's actions of 100 years ago, they don't just resonate today. They exist, they are living today in our ability and our inability to work together. And that was a really important moment for me as a white guy who knew a little about this history, but was not deeply, honestly, invested in it until that moment.

The other thing I want to talk about in framing this is a little bit about the metaphors that we use. When we were working on this project on the history of African-American exclusion from the AMA and the state medical societies, I worked a lot with a guy named Ron Davis. Some of you will have known Ron. He was the president of the AMA in 2008, a preventive medicine doc from Detroit who died far too early of pancreatic cancer. But Ron and I had conversations about whether a journey was the right metaphor for the work that the AMA was doing. Part of the reason we were worried about this metaphor was because there are different ways of thinking about journeys. And if you're the one who is driving the bus, it's pretty easy to say when someone from the back says, “Where are we in this journey?” and you say, "Well, we've made a lot of progress. We're getting there. Look how far we've come." But if you're sick in the bus, that's not an answer you want to even hear. And those two perspectives make the metaphor of a journey difficult sometimes.

And I was reminded of this when Aletha put up the metaphor that Isabel Wilkerson uses of a house, of a house that has a broken foundation. I think there are ways in which that metaphor is very useful. And I think all metaphors are useful. All metaphors are wrong. Some are useful. You've probably heard this around models. The metaphor of the house also leads some people to say, you know what? This house is fundamentally flawed. The structure from the ground up is bad. We should burn it down, because that's honestly sometimes feels easier than the hard work of renovation in a house that sits on a faulty foundation. I think the metaphor that the AMA has chosen for the work today is better, and that's the metaphor of healing, right? We're talking today about healing and transformation. We're thinking about our country as one with a chronic illness. Chronic illnesses have multiple factors. They are complex. They are hard for us as clinicians. But this is a metaphor I understand. I'm sure there are weaknesses to this metaphor as well. I know there are. But I think it's a useful way for us to think about the difficult work in front of us. There is not a pill that we're going to take as a profession that is going to fix this. It's a process of healing and transformation that we're all embarking on. So that's the frame that I would put around the conversation as we get started today and try to learn from the panelists that we're about to call up. And I'm going to turn to Niva to introduce the panelists and for her own opening remarks.

Niva Lubin-Johnson, MD: Good afternoon. So first I want to share a little bit of history of kind of how we got here today. And I'm going to start with the fact that Matt started with the commission in health care disparities. One of the positions on the commission then was for the chair of the minority affairs section. So I was chair of the minority affairs section 2014 to 2016. I believe it was 15 because I got to go to my first meeting. Everybody else before me had got to go to nice exotic places. I'm a Chicagoan and the meeting was here in Chicago. That should have been a clue. I got to the meeting and the first thing we hear is that a decision has been made to sunset the commission. So now I'm here in a place where I was hoping not to be and now it's not going to be anymore. But I'll say this, God doesn't close a door without opening a window because that following House of Delegates meeting, a resolution was passed by the New York delegation to have a study on health equity and that study led to the Center for Health Equity. So that's a little bit of history. Alright. Yes.

Now, more history. How we got to this task force. This task force was created pursuant to the June 21 House of Delegates Council on Medical Education Report 5, promising practices among pathway programs to increase diversity in medicine, which was number 11 directive, that our AMA established a task force to guide organizational transformation within and beyond the AMA toward restorative justice to promote truth, reconciliation, and healing in medicine and medical education. The task force will be established as the Truth, Reconciliation, Healing, Transformation Task Force, report to the AMA Board of Trustees, share its progress with the Board at appropriate intervals, have at its focus truth, reconciliation, and healing as it relates to AMA, have no delegated AMA authority and serve for a period of two years. So, the task force was created and appointed in the first quarter of this year. The second quarter, as you heard and saw a photo of, was our first virtual meeting, which was organizational and introductions. Our next meeting in the third quarter will be in person in Albuquerque, New Mexico. and our fourth quarter meeting will be right after the House of Delegates adjourns at Gaylord in Maryland. So, and we will meet quarterly over the next two years. We will have two virtual meetings per year and we'll have two in-person meetings per year. Our task force consists of 19 persons including the board ladies' odds, Matt and myself, and others who represent members of the House of Delegates, also groups that have been, that are minoritized and have been minoritized over the years, and also what we like to call our experts related to this issue. That's a bit about the task force. I also want to offer a definition of truth and reconciliation, which is accountability and recognition and the actions taken to make things right.

Alright. With that, briefly about the session. Today we will acknowledge and redress past harms in medicine. Not all because we don't have a lot of time. And I will say we probably going to go to 4 o'clock, a few minutes beyond our supposed ending time so we can hear from our panelists as much as possible. First we have Michelle Browder, who is Executive and Artistic Director of the More Up Campus and creator of the Mothers of Gynecology, a monument to the mothers of gynecology, Anarcha, Lucy and Betsy, who were enslaved women operated on by J. Miriam Sims in the 1840s. Michelle owns and operates More Than Tours, a social enterprise that provides educational and interactive tours to students and tourists, exposing the rich and sometimes haunting history of Montgomery, Alabama.

Next, J.C. Hallman is the author of the forthcoming Say Anarcha. I believe I saw a table with his books as I was entering the room. He discovered the first evidence that proved the existence of the young enslaved woman known as Anarcha, the so-called first cure of the diabolical father of gynecology, J. Marion Sims. Say Anarcha is a biography that excavates and centers Anarcha's history, Anarcha's story, and provides a much-needed corrective to the false narrative of Sims' career.

And finally, Dr Lee Sharma, a gynecologist in private practice in Auburn, Alabama. Her areas of interest include clinical diagnosis and education and theory, conflict resolution, women's health, health policy, data analytics, and health advocacy. My co-chair will ask the first question.

Wynia: Thank you. First of all, I want to say thank you all for being here. [APPLAUSE] Michelle, I'd love to start with you. And there are so many questions I would like to ask about the art, but we wrote out a couple of questions and agreed on them in advance. So I'm not going to deviate from the script yet. Could you start us off with an example of truth and reconciliation type work and how it played out and what we could learn from that in the medical field?

Michell Browder: Wow, well, thank you all first of all for having me. And I am an artist, I'm a creative, and so I'm just going to give you the truth like we all need it right now. And as far as, it's humanity. I think the whole thing that we've been hearing for me is the fact that you will know the truth and the truth will set us free. And right now, I think that this room full of healers, we have to first heal the healers. And so when I think about truth and reconciliation, I think about Johannesburg. I think about the apartheid. I think about the fact that people need to come to the table and not just reckon, because we're in this movement right now to reckoning with truth, but we need to turn around. We need to repent. We need to acknowledge. That is my ideology as a creative, is that somehow we need to come to the table and acknowledge what has been done and what is happening right now in today's time in terms of the experimentation and how we're marginalizing people. That's my definition of truth and reconciliation. Yeah.

Lubin-Johnson: All right. I have the second question, and it is to Mr Hallman here to my right. As the author of the forthcoming book, Say Anarcha, can you tell us more about how you have recovered, reacted to, or shared lost or forgotten narratives?

J.C. Hallman: Thank you so much, and thanks for allowing me to be part of the chorus of voices that have been going on here for days. My book was just released a couple days ago, and I'm going to quote one sentence from the New York Times review, which was just published the other day. ”Say Anarcha is an important book and deserves to be widely read, especially by those in medicine." I think she's talking to you.

I launched into the writing of this book about 8 years ago, And I did so, I think, very much in a spirit of truth and reconciliation, in the sense that I could tell right away that it was a dual story, it was two sides. There was the story of J. Marion Sims, which was in desperate need of re-examination, and there was the story of Anarka, the young so-called first cure, who had changed the world only to be forgotten by it. And I went into the examination of Sims' life recognizing that he'd been written about before. There was a dissertation-turned-book in the 1960s by a guy named G.J. Barker-Benfield. There was another dissertation-turned-book in the 1980s by Deborah Coon McGregor. There was, of course, Harriet Washington's book, which used Sims as a kind of fulcrum figure for a very broad examination of the use of African Americans in medical research. And then there was Deirdre Cooper-Owen's book, which was also a dissertation-turned-book in 2017, which came right at that moment when the long effort to bring the Sims legacy to Bear finally went viral in 2017.

All of those books were about broad subjects other than Sims. And so what was apparent was that there could be a deep dive. You know, most of the work on Sims had focused on the period of the Alabama fistula experiments and there was a whole other portion of his life that had gone not fully explored. And so I embarked on that deep dive and I found a lot of things. I found mainly that virtually everything about this guy that he was heralded for was false. We could do panels on lots of those different things, so I'm not going to go into them, but in pointing to the fact that he was the president of this organization in 1876, I'll simply point out that that came immediately after he'd been thrown out of his own hospital for having a mortality rate that was too high and it was a board of women, the Board of Lady Managers as they were known, that made that happen. And if there's one thing that I would like for people to take away about the work that I did on Sims, it's that we're not projecting modern values into the past when we criticize him. His harshest critics were colleagues, were contemporaries. His harshest critics were people who were sitting right beside him as he worked because they were his assistants. And even other doctors, other contemporaries, even former presidents of this organization, Alexander Stevens, who was the second president of the AMA, and a guy named William O. Baldwin, who was about the 20th president of the AMA, were very harsh critics of Sims in his own time. And a doctor from here in Chicago, a guy named A. Reeves Jackson, who was the lead surgeon of the Women's Hospital of Chicago, said of Sims that so much loss of health and loss of life resulted from his work and that of his disciples that it far outweighed whatever clinical advances might have come from him.

So examining, reexamining his life was pretty easy and you could do that in a relatively traditional way. And I was calling on sources, I was looking at letters, I was looking at not only Sims' writings, but the writings of the people who knew him, and I was finding resources that I'd never seen used in any other work on Sims. All that was very traditional, but you couldn't do that for Anarka. So in writing her story, I had to, what felt like, invent a different kind of history. Now, of course, I wasn't inventing anything because, you know, biographers have what they call speculative biography. And there's the work of Sadiya Hartman. If any of you don't know her work, it's amazing work, bringing a very robust creative spirit to bear on the body of fact to celebrate lost lives. And so what I did with Anarka was kind of two-pronged. I first conducted a very, very extensive search for primary source records. As was stated, Sims was the only source on Anarcha, so everyone who'd ever written about Sims or said anything about him or said anything about her was relying on him.

And so when I first went to Alabama and found records showing that she'd existed from 1828, 1828 plantation inventory. And eventually, Michelle and I looked at those records together. It's a moment I'll never forget. That was the first time anybody had seen anything that even just proved her existence. And eventually, I tracked her story, found in probate offices and archives and private management collections, found her popping up, and managed to piece together her story. The biggest bit of news about her was probably the fact that she was never cured—the so-called first cure of the father of gynecology was never cured. And eventually I managed to trace her story all the way to where she was buried in a remote forest in the northern neck of Virginia.

And I had that archival skeleton of her life, but her life needed to feel lived. You needed to feel lived. And you needed scenes. You needed characters. My book is very heavily researched. But it needed to be a story. It needed to be experiences and not just data and facts. And so to finish the story of her life, I called on the WPA slave narrative materials, the interviews of thousands of enslaved people that took place in the late 1930s. And this was an amazing trove of information. And the goal of those materials was that they would be used by creative writers and by historians. And so I was trying to fulfill the lofty goals of their having been gathered in the first place by employing those voices, almost more like a curator than a writer, to create a version of Anarcha that felt human and real and present. And I talk about that in the introduction. I talk about the process. This is my Anarcha, this is a version of Anarcha's life, as is the case with many histories and biographies. It's always Lincoln, a life, or the Civil War, a biography, or a history.

And so I talk about that, but I think what's important to remember is that her story, as it was told by Sims, was a complete fiction. What stood as factual history for 170 years was completely false. And the last thing I'll say in answer to that question is that, so in addition to producing the book, which is intended for a lay audience, it's a story, it's scenes, it's characters, it's lived experiences, but in addition to that, I've created a couple of online resources: a online archive of notes and sources, 5000 citations, so traditional citations, but also images that correspond to everything I was looking at when I was writing. And then also there's a YouTube channel that really tells more of the story of how I managed to find Anarka and retrace her full story. So I think that answers the question and just begins the conversation about how we found that procedure.

Wynia: Yeah. It is, by the way. I got mine on Thursday night, which was as I was packing to come to the meeting, of course, so I haven't finished it yet. But it is an amazing work and really fun—I don't know if fun's the right word—but compelling to read, so appreciation for that. Dr Sharma, I wonder, would you be willing to tell us a little about the work that the Medical Association of the State of Alabama has been doing around this story? Because this actually precedes JC's work by a little bit, or precedes the intersection of your work by a little bit. As I understand it, last year, MASA adopted a resolution seeking to advocate for the removal of one of the Sims statues, of which there are several around the country. The one in New York famously was taken down a couple years ago, but this is still a work in progress, the one at the Capitol building in Montgomery. And how does that intersect with the conversation truth and reconciliation in our profession?

Lee Sharma, MD, MA: Absolutely. First I want to thank Dr Maybank and Kimberly Ramseur for allowing me to be here and I won't lie, I'm having a major fangirl moment right now on the stage with JC and Michelle. I have a picture of myself and my daughter at the Mothers of Gynecology. I have your book in my backpack. And being able to be here and be part of this narrative and be part of this story I think is really important as a physician.

The AMA House of Delegates passed the resolution in 1937 that would encourage the state of Alabama to raise funds to put the statue of J. Marion Sims on the state grounds in 1939. The resolution from the HOD is historical documentation and it's embarrassing to read it today. It talks about Dr Sims being not only the father of gynecology but a brilliant revolutionary surgeon. And unfortunately, that was the narrative that I had as a student and resident. My father was a general surgeon who practiced in Montgomery and he practiced 8 minutes away from where the Mothers of Gynecology monument now is. He is also a surgical historian, so you can imagine. I heard about Dr Sims from a very young age. And the stories that I heard were primarily about not only the revolutionary advances that he made, but also his willingness to help these patients. When I became a resident and I was in the operating room and using a Sims speculum, a Sims dilator, a Sims retractor, the story of Dr Sims becomes even more and more cemented.

As a teacher, as an educator, I would talk to medical students and residents about Dr Sims. And when we started becoming in the consciousness of understanding what he actually did, doing 30 plus surgeries on one patient without anesthesia and without consent is not surgery. That's experimentation. The willingness to understand that the narrative that I had shared with so many people that I grew up with is wrong, that requires grace, not just for me, but to understand that I have to extend that to my students, to the people who gave me that narrative, and then to use that as an opportunity to actually change the structure of the House of Medicine. So when the Medical Association of the State of Alabama made the step to actually advocate for taking the statue down—and that resolution comes through the caucuses, so we're sitting in the caucus and this resolution comes up—one of the things that I had to do was to talk with my colleagues about the fact that on a very fundamental level, this resolution meant a lot to me because I was correcting a wrong that I had committed. And I had an opportunity to help my colleagues understand because I'm a gynecological, I'm a gynecologic surgeon. This story probably was more prevalent and more powerful for me than a lot of other people and I don't know how many OBGYNs in the audience who grew up hearing about Dr Sims. I actually do know some OBGYNs that had never heard this story until people like J.C. and Michelle brought it to our consciousness which is really also very, very good that we have people who are willing to actually share the voices of Anarcha, Betsy, and Lucy.

So I'm very, very happy to say that the resolution passed the state, a medical association of state of Alabama session unanimously in April of 2022. And we are devoting efforts in the organization to have actually helped to get rid of the law that's keeping that statue on state grounds. It is a state law, the American, the Alabama historical preservation act in 2017, anything that's been there over 40 years, we have to get that law changed to get the statue moved. But now we are devoting our state's resources to doing that.

The other thing it's done within our medical association is it's given us a very strong impetus to work towards health equity in our state. Our Council on Medical Service actually is leading work on telemedicine health equity. How can we correct disparities? How can we provide resources to our clinicians? It's also helping us work with our state. Alabama has the highest percentage of maternal mortality in the United States. I'm really sad that I'm having to say that, but the flip side is, with us embracing the fact that we are correcting the narrative, that we are moving the statue, we are telling the truth about what Dr Sims did. That is giving us the power to help our patients in our state. So it's been so incredibly powerful, what you two have done, and what it's allowing us to do as physicians.

Lubin-Johnson: Thank you all for your answers. (audience applauding) And now, the moment you've been waiting for, we will take five questions from the audience. You may line up in mics two and five. Okay, I see three, four on the floor. No, do I see?

Maybank: I'm going to take one little leap because I can do this. I want to hear Michelle to tell her story, though. It's very important. No, wait, we need to hear it, seriously.

Browder: Yeah.

Maybank: The why and the how and the future, and then I think important to go to questions, but it's critical. Okay.

Browder: Thank you. I was just, you know, going with the flow, but the way I found Anarcha, Lucy, and Betsy was when I was in college. I was an art student at the Art Institute of Atlanta, and it was that famous Robert Tom painting—I don't know if you all have seen it, but it's Robert Tom, well, actually he's the creator here, the illustrator—but it's of J. Marion Sims holding a speculum with a Black girl. It's important for us to say that they were girls, age 17. And then Lucy and Betsy. Some people argue that it was vice versa. But they were peeping behind the sheet. And allegedly this painting was supposed to have been done or created to mimic the backyard hospital of J. Marion's and of his, you know, his hospital, but it was a makeshift hospital that he created in the backyard of his office.

And I approached my professor, I asked him what did this mean at the age of 18. I'm like, you know, I'm intrigued by this. You know, my parents are like Black Panthers, you know, so they taught us the history of Black folk in the diaspora. We all knew that, but we're not talking about breeding farms in our curriculums. We're not talking about this. And so when I asked my white professor, what did this postcard mean? He told me to go figure it out. He's very dismissive. And I said, "Okay, white man, I'm going to go figure it out." So I went to go figure it out. I went to anybody from Atlanta, you know about the Shrine of the Black Madonna. I went there to learn at the age of 18, what is this, right? They told us, you know, Dr King had a dream and Rosa Parks had aching feet. That is the extent of our education. Y'all know it, believe it, right? And so when I found out that there were breeding farms in Montgomery, Alabama, when I found out that these girls were experimented on at the age of 18, one year older than Anarcha, I got upset, right? So I go back to college over my six or three-month break. I go back and I create my whole portfolio off of these three girls, Anarcha, Lucy, and Betsy. What I learned about the African diaspora and the trafficking and sex trafficking of Black girls and the enslavement and the legacy thereof. And my professor said that your portfolio is too Black. He said, "You need to diversify." See, I got anger management issues and I almost I punched him in the face, but I left that alone. And I went on and I said, you know what? I'm going to jump out, I'm dropping out of here because he wanted me to stay an extra six months and recreate my portfolio and I refused.

So when I moved to Montgomery, Alabama in 2000, my parents, first Black that was appointed by George Wallace, my father, was first Black prison chaplain. So they called me home for some help. They needed some help when dealing with formerly incarcerated people. So I went home and as I'm studying iconography of downtown Montgomery, Alabama, J. Marion Sims is at our state's capital. I almost stroked out. My blood pressure hit 200. And I said, how could this be? So I said, you know, I was triggered all over to create something to honor these women.

And during COVID, I'm out talking to my horses. I got nine horses, and I'm talking to one of them. And he turned around and answered me. And I was like, it's time for me. I said, you know, what are we going to do about this pandemic? You know, just, you know, and that horse turned around and said to me, I don't know. And I was like, it's time, it's time, it's time for me to fly on out here to San Francisco. And that's where I learned how to weld by Burning Man artists. But when I came back home, I had half a head of Anarcha and I had half pair of legs and I completed this project to honor these three enslaved girls who were sex trafficked and mutilated. My hope is that this piece of art would be a piece that we can have a truthful conversation, that we can come together and thankfully, MASA—I call it MASA, I'm sorry, MASA, the Medical Association for the State of Alabama. I'm sorry, because that's how I talk about y'all. But, you know, MASA came on up, said they're going to give us $25 000, and we appreciate but we got to go further because what has happened, can I tell the story, Dr Alethea Maybank? Yeah, I'm sorry, I'm a college dropout, so y'all got to excuse me, I'm going to be real. Can I tell the story?

She said yes. So, after we erected this monument in September of '23, my fabricators and my team that I had to, you know, help me do this heavy lifting, I said, I want to teach. I want to bring people together and talk about this history, but teach people what it actually meant. we need y'all as healers to be healed by knowing the truth. And we had about 125 people to show up. This year we had Dr Aletha Maybank, we had Dietra Cooper-Owens, we had Nikole Hannah-Jones of The 1619 Project that came together to talk about this atrocity and what's happening in maternal health care today. And so we started this whole movement to confront the truth. And in that, these ancestors actually came to me and said, we should have a convening in the backyard of this hospital, or the backyard hospital where J Marion Sims created these experimentations on these girls.

So I go down. I call the office. And there's a white gentleman down at 33 Perry Street. And I'm like, hey, can we have a convening in the backyard of this hospital so we could teach this history? And the guy that answered the phone said, go down. The owner is there right now. Go to that space and ask him. And I did. And when I showed up, he was a tall white man that looked like Mike Pence. I take a deep breath. And I got out of the car, and I told him what I wanted. And he says, “Oh, I thought you were here to buy the building.” I was like, “No, just looking for a convening.” He says, “Well, I'll tell you what, you could do that.” And I said, “Well, let's go back. You said the building is for sale, where J. Marion Sims actually owned the site?” And he said, "Yes." And I said, "Hmm." I said, "What's wrong with the building?" He says, "We don't want it. There's paranormal activity happening in the building.” (audience laughing) "There's people walking around, we can hear voices." He was like, "If you tell anybody, I'll deny it." I said, "I'm telling everybody." (audience laughing) And he says, "Don't tell," but I did.

And so I said, "Well, what's wrong with the building?" I said, “Is there expenses? Is the roof falling in?” He was like, “Ms Browder, we just don't want it.” I said, “Sir, I think I need that building.” He said, “What would you do with it?” I said, “I would create a space for doulas and midwives to offer some resources for people who are pregnant who need help and support.” And I said, “And upstairs I'll have a place for first year residents and residencies and students who are trying to be these doctors. and I would offer some form of bridging the gap with midwifery and OBGYNs.” Y'all need to stop this fighting' y'all got goin' on. So he said, "Ms Browder, I sure do like that idea." And I said, "Shut up, Mike." (audience laughing) Before I knew it, I'm sorry, JC, I'm just, let me pull it together. So I said, "Shut up, Mike." And he was like, "My name is Jim." (audience laughing) And I said, well, he says, “If you're going to do all of that with this building Ms Browder, I'll let you have it for $75 000. Talk about reparations and truth. He said, if anybody needs this building, it's you.” So I said okay.

I said, “Now, I'm a Black woman in Montgomery, Alabama. They won't give me no loan because everything I have I own.” So you know, there's a problem with there, too. So I said, “Can I make an offer?” He said, “Make your offer.” I said, “Can I give you $35 000, and then you can carry the loan for me since you're first son of finance, you're a predatory lender. You understand what I'm saying?” So he was like, “I'll tell you what, call me back on Monday. Let me go talk to my wife.” I called him back on Monday. Little Miss Gone With the Wind gets on the phone. And she's like, “Michelle, what you going to do with this building?” I gave her my whole rap. And she said, “Girl, we're so proud of you.” She turned Black real quick. “We're so proud of you.” And she said, “Can you just give us that $35 000? Because we want to support the work of truth. We want to support what you're doing in healing and make us a partner.”

So I now own the site. Is that okay? And I'm going to need y'all to come on down so you can get healed because we are in a state of emergency with health care. I don't need to tell y'all that, you already know. But the healing comes from you first and that healing comes from acknowledging what we've done to Black folks and Indigenous people and immigrants in this country around health care. And then after you're healed, you can be set free to do more, be more and fight harder. Thank you. (audience applauding) Hold on, just stand right there, let me get a picture of y'all, hold on. (laughing)

Lubin-Johnson: Okay, I'm sorry, go ahead, sit down there. All right, thank you so much. First, Dr Maybank's for asking that and for you for sharing. It was definitely well worth the time. All right, now it's two questions. And I'm going to be specific. It's going to be one for J.C. Hallman and one for Dr Lee Sharma. That's it. All right, thank you. Microphone two.

Jasmin Eatman: Awesome, thank you so much. My name is Jasmine Eatman. I am an MD PhD student at Emory University in Atlanta and the MSS liaison to the minority affairs section. But I just wanted to, before my question—

Lubin-Johnson: No comments. -No comments. A question, one minute.

Eatman: Okay, one minute question. My question would be, for either J.C. Hallman or Dr Sharma, how do we incorporate truth, reconciliation, and healing in medical education? Because honestly, as a medical student, I can say, and I'm not going to incorporate any comments, but what I will say is that Ms Browder is responsible for the education that I have received about the field of OBGYN, and that was well into my medical education. She's financed me and sponsored me to go to that conference, and I thank her for that. I want to publicly thank her for that. But I do feel in part failed by the medical education system for the fact that I could not receive that through my training. So I'd like to ask how we can better incorporate these facets into medical education for the next generation? Thank you.

Sharma: Jaz, this is a great question. And I will preface this by saying that one of the first things I did after Michelle had opened the Mothers of Gynecology is I took my daughter. She's 22 years old, she just finished her first year of law school. And when I took her, I told all of my medical students, I'm taking her first because the first time I see this, I'm going to get really emotional. And I want to do this with you. because this is going to be really hard for me. I broke down. When I walked onto the site and I saw an archivist in Lucene, I might do it again. I broke down. And the idea that no one had told me the story, I resonate with that so hard. And you know what? What my responsibility is now, as somebody who is trying to bring truth and reconciliation into the practice of medicine, is sharing that story and that experience with as many students, residents, and colleagues as possible.

So the next trip is going to be a carload of medical students. The next trip is going to be two of my OBGYNs that I practice with. You open that door as wide as you can and you shout that story as loud as you can. And the more you tell that story and the more you incorporate that with your students and residents, you're going to educate your attendings. You are going to educate your attendings. And that is where we start to change the structural racism that exists in our system. So I applaud you for asking the question. If you want to come down and you need a place to stay, if you want to stay in Auburn, I got a guest room. We'll motor up, we'll go and we'll visit because it, honest to goodness, if you walk on that space and there's something inside of your soul that just doesn't pour out of you, oh yes. The more we do it, the more it travels. Thank you. Thank you for the question.

Lubin-Johnson: Thank you for the question and thank you for your comment, Dr Sharma. Microphone five, it will go to J.C. Hallman. After that, our panelists will have closing comments followed by myself and my co-chair. Thank you.

Priscilla Mpasi, MD, FAAP: Great. Thank you very much. Good afternoon, everyone. Thank you for participating on this panel. My name is Dr Priscilla Mpasi. I'm the vice chair for the Minority Affairs Section and also a board trustee for the National Medical Association. As our organization is going to go through this conversation, through this progress forward on truth and reconciliation, I'd like to hear how we as a collective, especially members that are historically minoritized and under attack, can be a part of this dialogue where going through our history may be re-traumatization. Also, some of us are still under attack in this organization, whether through resolutions, whether through delegate dialogue, right? How can we be a part of the conversation that can also be harmful and traumatic for us?

Lubin-Johnson: Well, it's for Dr Hallman. I don't know how he's going to answer it, but I'll let him give it a shot.

Mpasi: I had two questions.

Lubin-Johnson: I'm sorry. It was one. You only get one.

Mpasi: No, I was saying we only had two questions and one panelist. [laughs]

Lubin-Johnson: Okay. Thank you.

Hallman: You know, I'm thinking about it from the perspective of the work that I did. And I guess I'm answering the previous question a little bit as well. I think that the way to correct the present and chart a better future is to first look to the past and make sure that, as has been said, that where we're standing now is not on top of a fractured, flawed, fraudulent foundation. And so I think there's a process of self-education that needs to happen, seeking out that truth. I don't know how many times in researching my book I encountered doctors, gynecologists, who didn't know this history. And I've been to a bunch of panels in the last couple of days here, and I've heard the exchanges when they talk about changes to the curriculum, that if you put history in the curriculum, something else has got to go, something else that might be important. So maybe there is other solutions. Maybe all of the organizations here can be doing more on the organization level after the period of the education to be engaging their membership in that important work of critically reexamining the history that we assume to be factual. And I think that happens on the level of the individual in terms of what they look at and take in and in terms of the level of the organization. I don't know, maybe there's ways to generate book clubs locally or there's ways for the AMA to make bulk purchases of books for members and make those available and have big Zoom conversations where the history is, that may be needed to go overlooked in the medical education, can be examined once doctors are out there working. I'm not sure about the solution, but I do know that the answers to the present and the future are in the past.

Lubin-Johnson: Thank you for the question and the answer. Now, for our closing in one minute, along with anything else you think you can add in one minute because we are way past over time. Thinking about what AMA can do for physicians and medical students, what is the one priority that you would like to pitch for change? And we'll begin with Dr Sharma.

Sharma: Thank you. So the focus and what we are wanting to accomplish as physicians is health equity. And one of the earlier panelists said that equity is meeting patients where they are. So I saw an infographic that had an apple orchard that had a white patient on a ladder that was getting apples and a Black patient on a higher ladder that was getting apples and they were saying this is an infographic for health equity and I disagreed with that. I think that equity looks like taking the ladder away, going and get the apples you're giving to the patient directly. Meeting patients where they are, and I'll give you this really quick example. I had a 70-year-old Black patient in the office last week, first exam, she was filling out her medical history, she left all the surgical history and all the medical history, all her medicines blank. And I have a choice at that point. I can go in there and hand it back to her and say please fill this out, or I can say maybe there's a reason why she can't. Maybe she doesn't know how to spell her meds, maybe she doesn't know how, maybe she just doesn't even know how to write those down, maybe she's scared that she's not going to give me a correct history.

So what do I do at that point? Do I go back in there and try to actually get that history or do I go on my hospital computer, I look everything down, I wrote everything down for her, I wrote looked at all of her meds, I wrote all those down for her and then I made her a copy. I made her a copy, tell her put this in your purse and next time you go to a doctor's office hand them this and tell them to make a copy. I didn't give her the ladder, I gave her the apples and the next time she walks in a doctor's office she's going to have a much better chance of getting better care because I gave her apples. So taking the narrative of J. Marion Sims, telling that story correctly, understanding that we have not taken care of Black patients in our system the way we need to, and actually giving them the apples, this is what I hope we all do. And I will tell you the story of J. Marion Sims and what Michelle and what J.C. have done and others like them to bring those voices to life has inspired me to try to do. I fall short a lot of the time, but I still try every single day and I hope you will too.

Lubin-Johnson: Thank you, Michelle.

Browder: I have ADHD, what was the question?

Lubin-Johnson: The question is, thinking about what AMA can do for physicians and medical students, what is the one priority that you would like to pitch for change?

Browder: Okay, this is an exercise. I need you all to take your hand and put it over your heart. Just say, "I see." That's it. We need you to see humanity. That's what these three girls were about. They were not people, they were property. And we're treating health care in this country as if patients are our property. No, I take that back because you would treat your property better than what you treat your patient. So we just need you to see from an artist perspective and be good humans, and if you're a good human, you're going to administer the care that you need for that individual. So that's your charge. What we say in the Baptist Church: you got a charge to keep and the God to glorify. I need y'all to see today. Thank you.

Lubin-Johnson: We'll be passing the plate shortly All right. [laughter] [applause] Thank you, thank you. Mr Hallman.

Hallman: I think that what struck me when I started to look into the story of Sims and Anarcha was how absolutely chock full of calcified errors it was. There were things that were said about Sims that were just complete wrong. It was total propaganda. And there were other mischaracterizations of things that he'd done that bounced from source to source, almost like a game of telephone, to the point where when I started looking at the history, it was just absolutely full of falsehoods. So what I found was that institutions, organizations, had the hardest time accepting a fact like that, that a history, that an established history could be wrong and that change was required. So I talked before about the level of the individual, but I think that as an organization, the AMA can announce by way of a fiat or a resolution that we should never take history at face value, that particularly when it comes to the history of medicine, a necessary critical faculty needs to be brought to bear, particularly on those histories that we believe to be set in stone.

Wynia: Thank you so much to our panel. Yes, you can applaud. Thank you so much to the panel.

I want to close by referring back to the question that was asked about education. I think there are aspects of the work that we do that actually cannot be learned in a textbook. They can only be learned through art. They can only be learned through story. They can only be learned through the study of history. We don't incorporate much of that in our medical training, but we should. And the question we asked about what's the one thing we could do, I honestly think if we spent a little more time talking about narrative, talking about history, talking about art, about art as advocacy, about the ways in which other domains of knowing can inform the work that we do on a day-to-day basis in the real world, that would be the one thing I would change. Niva?

Lubin-Johnson: Thank you. So he's an ethicist, so I will never be as eloquent as him. I also want to thank you all for being here this afternoon and for our panelists also. I will say this, that I've talked about our plans for the next couple of years. One thing I hope we do, whether we do it as a task force or as I do it on my own, I'm coming to Montgomery, Alabama. I'm hoping the task force gets to, but if we don't, I'm coming. Thank you for that. I believe Dr Maybank's has some remarks also. Thank you again everyone and see you at the reception.

Maybank: Yes. Alright. Let's give another round of applause. Love warms everything to this amazing conversation. Thanks for sharing it, both Matt and Niva. Fantastic.

So I just, I want to close out as well with this particular photo. So as was mentioned, you know, the statue of Sims was removed in New York City. It was actually the year before I came here to AMA, and I didn't even know Sims was president of the AMA when this was happening, but I knew lots about the statute because as my role as deputy commissioner, it was to oversee the areas in New York City that had the greatest disinvestment throughout the years, the greatest burdens as it related to racism and every other racism, every other ism that there was. One of them was in the space of East Harlem. We had district public health offices or what we called health equity action centers. The advocates in the community of East Harlem for years had been saying and asking for the statue to come down for years, well before any of the institutions did. There was the incident that happened in the South. Some of the statues were being torn down. Then there was a lot of movement and momentum by different cities to put forward commissions to have recommendations, or provide recommendations of what statues should come down. Mayor de Blasio at that time formed a commission. The commission looked at all these statues across the city and there was only one statue that they actually recommended to come down and it was this one of J. Marion Sims, which is across the street of the New York Academy of Medicine in Central Park.

This was a day, it was in March or April, I'm not even quite remembering now. I was there representing the city, but also there in partnership with many others. The photo in the middle is Harriet Washington. She was here that day. I still get chills from this whole moment. Harriet Washington, and on the other side of her is Lynn Roberts, Dr Lynn Roberts, who is one of the sisters of the reproductive justice movement and cousin—she uses a term that I'm not going to use exactly, not necessarily a founder—but was very much connected to Sister Song. They were the founders of the reproductive justice framework and movement in this country. We were all present for that day.

The photo on the right-hand side fully, or my ... Yes, the right-hand side. We're standing and there are lots of people around, medias around, community residents around, politicians, everyone. A woman was running through inside the park, at Central Park. She passed and she stopped. She just couldn't believe it. She turned and she said, "Can I just have a hug?" Because I never in my life thought that this would come down. Every time I pass this structure, I feel traumatized by visually having to see this piece of work. She turned and I was right there and I gave her a hug.

That is the moment. It's a moment that will never leave my spirit. It's part of the why that I do this work. Sorry. Sorry. [APPLAUSE] I'm okay. Thank you. I appreciate it.

The work's getting harder, I'm going to admit. I'm exhausted. Because again, this work, as I said, I'm getting paid, I feel, sometimes to convince people to care and to see. And it just shouldn't be that way. And David Satcher, one of our former Surgeon Generals and founder of the Satcher Health Leadership Institute, has a book out called My Quest for Health Equity. And he says “We need leaders who first care enough, we need leaders who learn enough, we need leaders who do enough, we need leaders who will persevere until the job is done.” And when I say we need leaders who care enough to ensure that we remove statues, that we still have some work to do in other places across the country, and we're powerful as AMA. And these statues, you know, they have a lock on the spirit and progress of communities and its people. We need to care to listen to people that may not hold the same values and experiences and opinions of ours. And we need to care enough to lead with a sense of relevant humanity and deep love. And I appreciate in the spirit of liberation as well for all of us, with great solidarity and courage.

I really thank you all for sitting here. I am so pleased to see the amount of people that are here. It's very validating for myself and for my team and for many of the others who are working across the management team to get this work and move this work forward. With that, I say thank you. Thank you and thank you to all the panelists for here today. [applause]

Lubin-Johnson: I think Dr Maybank and her staff deserve a standing ovation. Thank you. [applause]

Video Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Enduring Material activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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