Category: Structural competency & illarosa

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.

Landrum is repeatedly invalidated by medical professionals, who dismiss her concern and her pain due to a racialized view of her symptoms and a poor understanding of cultural competency. The interweaving of both “chart talk” and her more personal narrative accounts is entirely necessary in order for the reader to understand her story, and the weight that it carries.

For example, when she writes about her headaches and exhaustion in conjunction with her “elevated blood-pressure reading of 143/86” it is necessary for the reader to be able to contextualize this information; this is where chart talk becomes remarkably handy, giving the reader the vocabulary necessary to understand the gravity of her situation. One drawback of interweaving this information is that it dilutes the hard-hitting pathos of her narrative. By having her recount her entire story in one chunk of emotional narrative, it would read like a political speech seeking to drive action and engender compassion in her audience. However, for our purposes, the intermingling of narrative and “chart talk” is really the backbone of a medical ethnography.

This interweaving of narrative and more scientific jargon fits into the idea of cultural competency because medical care for minorities is vastly different from the one that whites experience. As a black woman, Landrum carries an intersectional set of cultural and structural boundaries to overcome, and not only pertaining medical care. She recounts that “It was like he threw me away,” and that her symptoms were clearly being dismissed on the basis of her race, her gender, and quite probably the racial biases carried by the doctor. As soon as the reader has the chance to think that maybe this is a one-off case, an anomaly, Villarosa chimes in with facts like “black women are three to four times as likely to die from pregnancy-related causes as their white counterparts” or that every single year there are “4,000 lost black babies.” By including more logos based information, Landrum’s story is bolstered with an artillery of research that adds to her credibility and the overall impact of the article.

It is important, in seeing how connected her narrative of the loss of a child is with a failed example of structural competency, that our healthcare professionals integrate knowledge of the human body, the person in that body, and the person in the system into everyday medical care.