Structural Competency & Villarosa

Linda Villarosa uses “chart talk”, narrative about Landrum’s personal experiences, and facts and figures about the medical structures at play in order to interweave a story about racial disparities in reproductive health. We see Villarosa’s use of “chart talk” as she describes Landrum’s experience with stillbirth, noting her blood pressure readings and specific symptoms and medications. This is an instance where we see “chart talk” as useful alongside personal descriptors in order to enhance our understanding of Landrum’s story.

We can also use Villarosa’s piece to further our understanding of Metzl and Hansen’s structural competency. As opposed to the more widely known cultural competency, structural competency is described as “the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health”. For instance, we can understand from Villarosa’s article that Landrum’s stillbirth was due to the structural racism in the hospital and medical institution as a whole which failed to recognize the symptoms of pre-eclampsia in time.

We also see the introduction of structural solutions to structural problems that Metzl and Hansen discuss in Villarosa’s article. We see the introduction of doulas and organizations which advocate for mothers of color. We also hear about Monica Simpson, who testified on behalf of black mothers in front of the UN. These are all different ways that “observing and imagining structural intervention,” as Metzl and Hansen discuss, is made a reality in application about black mother and infant mortality. Additionally, we hear about the structural inequalities in medicine from Landrum when she discusses seeing an OBGYN in the white areas of town rather than near her home.