Healing the Nation's "Broken and Scattered" Hoop

We met on a foggy spring day in 2016 when Rupa, a physician at the University of California, San Francisco was on her way to work and saw Edwin, a community organizer and critical race theory scholar, along with four others, on hunger strike outside the Mission police station. A handwritten sign on the sidewalk announced, "Frisco 5 Hunger Strike. Day 3. Stop Racist Police Killings." What neither of us knew that day was that Rupa would become doctor to all of the Frisco 5, and we were about to begin a journey that would lead to the resignation of the San Francisco police chief and contribute a drop into the mighty river of activity that is the uprising of 2020.

Over the years before the hunger strike, San Francisco had become unfamiliar to people like us who were born there or were longtime residents. San Franciscans from Latinx and Black communities were struggling to remain in their homes. Our neighborhoods which were historically undesirable, had become the place to be for the tech elite who were drawn to the culture and warm vibe brought by our working-class communities. We watched as rent prices increased and evictions increased. We watched as Black elder Iris Canda was evicted from her home at 100 years old, to make the building more profitable to the landlord. Gentrification brought financial capital to the city. It also brought immense cruelty to our people, the most egregious being the rise in extrajudicial killings of Black and Brown people by the police.

"It is time to focus our funding on systems of care and justice."

The Frisco 5 Hunger Strike was organized in response to the killing of several young Black, Brown, and Indigenous members of the community by the San Francisco Police Department. To this day, not one officer has been held accountable for this violence. The community was suffering greatly as a consequence of the trauma stemming from the killings. The lack of police accountability or any avenue to obtaining justice further traumatized families and the community. The same cops still patrol the same neighborhoods where Alex Nieto, Mario Woods, Luis Gongora Pat, and Amilcar Perez Lopez once lived.

Each day of the hunger strike drew the police and their violence into sharper focus in San Francisco. More people started showing up at the police commission meetings to denounce the violence. On day 13, there was a march with the hunger strikers pushed down the street in wheelchairs because of their weakness. These actions created new alliances amongst Black and Brown community members to fight the police violence that was causing severe trauma with long lasting impact. The strike ended after 17 days, and all five were hospitalized. During that time, another young Black woman was murdered when the police fired into her car. Jessica Nelson Williams was killed, activists stormed and shut down City Hall, and the police chief resigned.

What started as a doctor-patient relationship between us has become a friendship and an active collaboration in our work for health and justice with common vision and common cause. Together, we seek to directly address the most upstream causes of suffering in order to create the most downstream health for our entire society. As with any illness, when the body of our society is suffering, proper treatment requires the utmost diagnostic precision.

Back in the 1800s when infectious diseases were the leading cause of death globally, the word miasma was used to describe a cloud of sickness that spread amongst communities. This was before we knew that bacteria, viruses, parasites and fungi were causes of illness. Our ability in medicine to precisely diagnose the cause of disease has allowed us to develop methods to control infectious spread and to create effective treatments. Just as we would never name COVID19 "a miasma," we must be precise around the naming of the other pandemic threatening our safety.

As we watch our nation heave in the fallout from Black and Brown people disproportionately and unjustly being killed by police, we see institutions widely denouncing systemic racism. Systemic racism granted the officer who killed George Floyd the confidence and authority to injure people of color in a number of documented episodes of past misconduct. But the disease we are seeing is more specific than systemic racism. It was police violence that killed George Floyd. Naming this disease is essential to developing a strategy to heal it. In 2018, the American Public Health Association made an unequivocal policy statement declaring police violence as a public health issue. All medical institutions must have the courage to name it, so we can heal it.

Over the past several years police departments have engaged in various styles of reforms such as bias training and the use of body cameras and so-called "less lethal weapons." But you don't need a weapon when all it takes to kill a man is a racist attitude and a knee. In spite of police reforms there has been no decrease in the national rates of police killings in the US, and these killings disproportionately target Black, Brown and Indigenous people. This fact is no surprise when you realize that the origins of policing are founded in protecting property, and fulfilling that goal by controlling the lives and movements of Black and Brown bodies. All you have to do is look at our protests: when Black and Brown people and those in solidarity go to the streets, the police will assault them in order to protect buildings; when white men with AR-15's storm a state capital, the police welcome them with open arms and protect them. In that case, the property is the expectation of freedom for White people, where Black and Brown folks could never expect the same.

In the founding of this nation, deputized individuals formed slave patrols to capture runaway slaves. Again, what they considered their property. What's more disturbing, however, is that during chattel slavery the slave patrols were ordered to keep the slaves alive and not damage the property; and today, because we are not considered property, there is no order to keep Black and Brown people alive as they see us as disposable and without value. This is the sickness. The invention of official police departments is relatively new. The first one was established in Boston, Massachusetts in 1838 in order to protect property. Corporations with cargo ships who would normally hire private security to protect its property, decided it was worthwhile to convince the city to use taxpayer money instead to protect the ships. And it wasn't just Black communities the police haunted. The deputized sheriffs used to control indigenous peoples on their ancestral lands. Even after the abolition of slavery in the US, the 13th amendment has made an exception and allowed for slave labor of prisoners for pennies on the dollar, which is one way some Fortune 500 companies make their fortunes. The US comprises 4% of the world's population, but our prison population makes up 25% of the world's prisoners, and most of those people are Black and Brown. This is not an aberration of the system of policing. This is the system functioning exactly as it was intended. It cannot be reformed. It must be abolished with new forms of community safety created in its place, where health and wellbeing are centralized.

Our own history of medicine has troubling roots from the same tree, which will constantly plague attempts to achieve health equity--unless we address this history head on. Western medicine was institutionalized at the same time Europe was colonizing Africa, Turtle Island, the Pacific Islands and Asia. Medical care was offered as a way for Europeans to feel better about the violence that is characteristic of colonial rule. In 1926, French General Hubert Lyautey described medicine's role in colonialism: "If there was one thing that enobled and justified it [colonization], it is the actions of the doctor."

Before colonialism, traditional medicines kept diseases in balance with traditionally managed ecosystems and ways of interacting. These were disrupted as newly established colonial trade routes moved resources and infectious diseases along with them, such as cholera and Trypanosomiasis, or sleeping sickness. Colonialism has changed all the ways we relate to the earth and to each other, changing our biology through centuries of altered societies, economies and ecologies.

"Health equity is impossible to achieve until we alter the structures that have ensured the ongoing suffering of people of color."

In the US, the dismissal of traditional indigenous medicines and the casting aside of concepts of the patient as a person with autonomy in favor of German pharmaceutical models of biomedical science were codified in the Flexner Report, which still serves as the guiding accrediting document for US medical schools. If you're wondering why your doctor talks at you instead of with you, the Flexner Report plays a large role in the development of these attitudes. This same report was used to force the closure of several Black medical schools in the early 1900s through devastating remarks about the Black schools and demeaning comments about Black physicians. Today, while Black Americans make up 13% of the US population, they are only 5% of practicing physicians. And data shows that when Black people have Black doctors, they get better care. The very structure of suffering of Black, Brown and Indigenous people is built into the architecture of societies created in times of colonialism. And colonialism's legacy is evident in every scourge, be it a viral pandemic, climactic events, police violence or exposure to environmental toxicity such as the ongoing water crisis in Flint, Michigan. Health equity is impossible to achieve until we alter the structures that have ensured the ongoing suffering of people of color.

The task ahead of us is to heal the legacy wounds of genocide and slavery which we now see yawning open and festering before us. The coronavirus pandemic rages in this land most tragically amongst Black and Latinx communities and in the Navajo Nation, where settler violence has ensured the abject poverty of many. In the territories of the Dine people, access to running water is scarce and the land has been poisoned by uranium mining. In cities across the nation, as protestors line up peacefully to denounce the killings of Black and Brown people by police, they are themselves subjected to police violence, sprayed with chemical weapons banned under the Geneva Convention and sprayed with rubber bullets which carry a 3% mortality rate. These weapons that are used against us are bought with our tax dollars.

Watching the number of little armies that have cropped up all over the US these past two weeks to stop people from exercising their First Amendment right, we must begin to critically question how much funding has been put in militarizing our local police forces as doctors and nurses have had to wear garbage bags and go without N95 respirators during the COVID pandemic. The ongoing lack of PPE has led to over 600 deaths and over 60,000 infections of healthcare workers--and most of these, again, are people of color. Spread of infection and death amongst healthcare workers is completely preventable with availability and proper use of PPE, and we must hold those in power accountable for this failure.

This is a true moment of reckoning as a nation. It is a moment of interrogating our values and how those values are reflected in our funding choices. It is time to create a culture of care. With over 40 million people without jobs and without healthcare insurance, applications for Medicaid have soared. Single-payer healthcare is the most cost-effective and logical step, so that no one has to go without the medicines and care they need. Any version of a public option does not prevent medical bankruptcy, which is still the leading cause of personal bankruptcy in the US. With budgets tightening from the economic impact of COVID, we can move funding away from policing and carceral punishment towards community-based approaches to safety, as the Minneapolis City Council boldly announced they would. It is time to focus our funding on systems of care and justice.

Oglala Lakota Hehaka Sapa wichasa wakhaNG, commonly known as Black Elk medicine man, recounted from old age his witnessing of the massacre of Wounded Knee when he was a youth in 1890:

I did not know then how much was ended. When I look back now from this high hill of my old age, I can still see the butchered women and children lying heaped and scattered all along the crooked gulch as plain as when I saw them with eyes still young. And I can see that something else died there in the bloody mud, and was buried in the blizzard. A people's dream died there. It was a beautiful dream...for the nation's hoop is broken and scattered....there is no center any longer. The sacred tree is dead.

The nation's hoop is what we must heal together, starting with the original wounds in this land. The sacred tree must be revitalised. Nothing less than this will allow us to move forward without the specter of the past continuing to raise its unjust head--we must earnestly identify how we bring reparations and reconciliation.

"The nation's hoop is what we must heal together, starting with the original wounds in this land. The sacred tree must be revitalised."

The wounds we are confronting are ones that are too great for any of us to heal on our own. We must do it together. We are at a reckoning point in history, where we must decide how we will continue as a nation and how we will continue as inhabitants on this planet that supports all of our lives. We must outline a culture of care to prioritize the care of our people, the care of all living communities--human and other, and the care of our earth. We must start by dismantling systems that are causing trauma and by creating new structures that can center health, justice, and wellbeing.

And this work starts with the proper naming of the sickness at hand. Today, as former doctor and patient, scholar and artist, comrades in the struggle--we start here. Racism and police violence are a threat to our public health. May we work together to heal these wounds so we never have to hold another sign that says, "Stop Racist Police Killings."