The city of Boston has one of the most diverse populations in the United States. A variety of cultures adds a wonderful depth and complexity to the entire city. Our city has also successfully provided some of the finest research facilities and teaching hospitals to treat patients every year. But if one were to look at these components together, one would find less than fantastic results: A majority of ethnic populations have been unable to obtain the quality health care that Boston could provide.Recent socioeconomic studies and hospital assessments have revealed that there are increasing disparities between ethnic populations in the quality of health care, particularly within inner-city communities. These groups, particularly the elderly and working poor, have faced an incredible obstacle in receiving basic treatment associated not only with unaffordable health fees, but also with language barriers and limited flexibility in Medicaid programs that have made the management of effective treatment, on behalf of the providers, basically impossible.

In an effort to assess the extent of the issue, the Massachusetts State House hosted The Health Disparities Action Network earlier last month to allow citizens an opportunity to voice their concerns about the continuance of prejudice and biases that were leading to misunderstandings and clinical errors. The greater objective that morning was to persuade state representatives to take action to protect the working poor and those individuals not qualified for Medicaid by providing them access to health care.

The State-House was filled with hundreds of physicians, politicians and residents. As I walked curiously through the lines of people waiting to get coffee, I immediately felt from the eager and frustrated expressions on people's faces a sense of urgency and a desire to change. I accidentally bumped into one man. We both apologized, and extending his arm for a handshake, he greeted me with a warm toothy smile.

Lawford, the gentleman I bumped into accidentally, freely offered me interesting insight into the neglect that was slowly unraveling the well-being of his 86-year-old Jamaican mother, Julia. "They did terrible things to her," he said. I asked him who, but he did not answer me, yet. Pulling out a picture of his mother, he pointed to an elderly woman sitting between two friends her age, sharing a laugh together. "She was always happy," he told me.

Two months before it was finally removed from the U.S. market in 2004, Julia spent more than she could afford to purchase a "dependable and effective" pain-killing medication called Vioxx to treat her developing arthritis. Unable to understand the warning labels, Julia began taking the medication. Shortly thereafter, she had a stroke.

At the health facility, her condition only worsened. At the first nursing home, she was dropped on floor upon her arrival. Unable to speak, Julia could not convey her discomfort to anyone. A nurse eventually told Lawford that the nursing home wanted to avoid the expenses of transporting Julia by ambulance to the nearest hospital for an X-ray. I could not believe that a well-known and reputable health facility would do such a thing, but Lawford explained, "Why would they want to spend it on an old poor person?"

At a new health facility, Julia was given "cold baths with water that was also being used to clean her feces." When Lawford found out and complained, the administrator tried to persuade him to take his mother back to Jamaica. The most disturbing incident involved an episode of experimental treatment that was performed on his mother. The nursing home received extra bonuses from a pharmaceutical company to dispense an experimental cancer medication to one of its patients. Lawford was told that his mother was being given a medication necessary for her heart condition, but the medication caused Julia's skin to blacken and her hair to fall out. No family member had granted permission for this. Julia was left even more debilitated. Lawford showed me many pictures of his deteriorating mother to prove his case.

Patients should not have to be concerned that the medical treatment they receive will make their condition worse. In some instances, it is as simple as getting the right information across to the patient. Other times, the treatment could be improved by addressing the cultural norms of the patient. Those of us at Brandeis considering a health care profession must realize that ethnic populations need greater support and a deeper understanding. We must breach possible language barriers to effectively communicate our advice and to understand the patient's ideas, needs and questions. Physicians should develop a sense of compassion, and a willingness to identify with the patients' socioeconomic and cultural needs to complement medical understanding.



The writer is a member of the Class of 2010.