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When I first assumed the role of president of The New York Academy of Medicine last September, I never imagined that one of the first public issues I’d address would be the fate of an old Central Park statue across the street from my office. But our ongoing opposition to the bronze of 19th century doctor J. Marion Sims is particularly relevant during Women’s History Month. He symbolizes the continuing inequity in health and health care for women of color – an issue our Academy is striving to fix.
Described by some historians as “The Father of Modern Gynecology,” Sims refined his treatment of vesicovaginal fistula through repeated experimentation on enslaved women, using no anesthesia or numbing procedures. Sadly, almost two centuries later, black women still bear the brunt of unusually high rates of complications and deaths in childbirth from a system that is failing to meet their needs. As protester chants against the statue drifted up to my office, I wished that energy could also be channeled into improving care for struggling women today.
Only blocks from the statue’s new home in Green-Wood Cemetery, where Sims is buried, is a hospital where unequal care for childbearing black women is starkly evident. Serving an overwhelmingly black patient population, SUNY Downstate Medical Center registered one of the highest rates of complications for hemorrhages in childbirth across three states, according to a two-year investigation by ProPublica, a non-profit newsgroup specializing in independent investigative journalism. The ProPublica study analyzed two years of hospital inpatient discharge data from New York, Illinois and Florida.
When New Moms Get Sick, Race—and Hospitals—Matter
Video: The Fight Against Severe Maternal Morbidity in Brooklyn
CityViews: A Call to Action on Racial Disparities in NYC’s Maternal Health
… as well as our 2017 series:
Death’s Disparities: Health Inequality in New York City
“On average 34 percent of women who hemorrhage while giving birth in New York hospitals experience complications. At SUNY Downstate Medical Center, it is 62 percent,” noted the ProPublica report.
The investigation noted that the hospital disproportionately serves black mothers who are at a higher risk of harm – and they are dying at a rate more than triple that of white mothers from causes such as infections, birth-related embolisms and emergency hysterectomies.
In East Brooklyn, Brookdale Hospital Medical Center performed C-sections on 35 percent of first time mothers with low risk deliveries – an operation that places both mothers and babies at risk for complications. This rate compares to a federal recommended limit of 24 percent. Like SUNY Downstate, Brookdale disproportionately serves black women with high risk of complications.
These risks are borne out by reports by the New York City Department of Health and Mental Hygiene. “Black non-Latina women had the highest rate of severe maternal morbidity – three times that of White non-Latina women,” noted a four-year study released in 2016 by New York City health care researchers.
The causes for the disparity are complex, involving issues that are both medical and social. Many black women suffer from chronic health problems like hypertension, diabetes, heart disease, or obesity, which complicate pregnancy. Precarious housing, lower education levels and difficulties in accessing health care might aggravate these health problems.
More difficult to quantify is the effect of systemic racism on the health of black women. One study noted an increase in very low birthweight infants among women who experienced racial discrimination at work, during job searches, at school, obtaining medical care and getting service in stores and restaurants. The chronic stress of daily discrimination and anxiety over unfair treatment takes its physical toll on the health of the mother and the gestating child.
In an effort to tackle some of these problems, New York City officials in December convened a new committee to review deaths and childbirth complications, the Maternal Mortality and Morbidity Review Committee. Protocols were introduced for treatment of maternal hemorrhage, hypertension and venus thromboembolism. The health department also offered free doula services and prenatal care to aid and support pregnant women. Last month, Governor Cuomo proposed that the state establish a maternal mortality review board to investigate each maternal death in New York and make recommendations to reduce pregnancy related complications and reduce racial disparities.
But improving maternal mortality and morbidity among black women must involve a broad, multipronged approach, with investment in community-based interventions to address the social factors that contribute to inequities in health. To that end, The New York Academy of Medicine hosted a Maternal Mortality summit last month to spotlight ongoing efforts and recommendations for policy and practice changes. Attendees included an array of government officials, hospital associations, community organizations, health practitioners and other stakeholders. The program, available via webcast, included discussion of ways in which structural racism contributes to disparities in maternal mortality, and strategies to mitigate those harms.
At one point this past fall during protests over the Sims statue, it was suggested that sculptures be erected of the enslaved women he used for his research in place of Sims. It is an appealing idea, but let’s also use this moment in time to delve into ways to effect real change. Improving health care for black childbearing women is the best way to remember those voiceless enslaved women experimented on by Sims long ago.
Dr. Salerno is the President of The New York Academy of Medicine and former President and CEO of Susan G. Komen. She is a physician executive and one of the nation’s pre-eminent leaders in health and health care.
7 Comments
East Harlem Preservation
Dr. Judith Salerno wishes “that energy could also be channeled into improving care for struggling women today?” As latecomers to the campaign to remove the Sims statue, the New York Academy of Medicine practically missed the movement altogether so it’s not surprising, then, that Dr. Salerno seems unaware that the majority of women involved in our effort were already doing incredible work around reproductive justice for women of color and are calling for much more than a tribute to Sims victims. We also want to honor women of color who have made great medical inroads benefitting the our community—Dra. Helen Rodriguez-Trias and Dr. Rebecca Lee Crumpler, for example. Dr. Salerno would have known this had her organization “supported” the campaign from the beginning rather than at the very end. P.S. Any idea when the statue will be removed? The city is ignoring us, once again. Perhaps the New York Academy of Medicine can get Mayor de Blasio on the phone for us so we can continue to “effect real change?”
Bohdan Oryshkevich, MD, MPH
Better late than never, but better never late.
Dr. Salerno should become aware of the fact Marion Sims was, in fact, the president of both New York Academy of Medicine and of the American Medical Association.
Dr. Salerno is correct to point out that maternal mortality is high in Brooklyn. But it is also true that New York’s Manhattan medical schools and hospitals have stacked the cards and the flow of money against Brooklyn’s safety net hospitals. I have my doubts whether the NYAM will address this issue.
Marion Sims was, indeed a controversial figure. Yet, he made significant medical advances in the South while New York City’s hospitals, led by Columbia’s Presbyterian Hospitals denied admission to medical school by free blacks qualified to enter them. In addition, these same medical schools also preached scientific racism.
In comparison to the medicine practiced in NYC in that era Marion Sims does not appear regressive and cruel.
It is easy for New York’s segregated medical schools and hospitals today to smear Marion Sims but will they transform their philosophy to a more progressive philosophy?
Gina Ravosa
Dr. Oryshkevich – thank you for your observations on safety net hospitals and medical school admission policies. In the Academy’s ongoing and future work on maternal mortality, we anticipate these will be part of the conversation. As a note of correction, Dr. J. Marion Sims was not ever the president of The New York Academy of Medicine.
Bohdan Oryshkevich, MD, MPH
Dear Ms. Ravosa,
I do not know if Marion Sims was the President of the New York Academy of Medicine.
I have not seen the ledgers or the records of the NY Academy of Medicine.
However, the Annals of Surgery had a long article on the broad range of accomplishments of Marion Sims. The accomplishments of Marion Sims were genuine at the time, controversial today, but achieved in an era of slavery, scientific racism, and undoubtedly at the expense of unfortunate enslaved black women.
The Annals of Surgery article on Marion Sims also lists him as having been the President of the New York Academy of Medicine, the American Medical Association, and the American Gynecologic Society.
https://www.ncbi.nlm.nih.gov/pubmed/?term=core+competencies+sims+marion
https://insights.ovid.com/pubmed?pmid=22514000
full text of article: https://1drv.ms/b/s!AgAEn1pbwhx7iLFQDd2cP3AeF3XxBg
I have not as yet discovered a confirmation of this assertion. Nor have I spent much time on this endeavor. The Annals of Surgery article may be wrong. I do not know.
There is no doubt that Marion Sims, when in New York City, was the founder of the of Women’s Hospital now part of St. Luke’s and of what is now Memorial Sloan Kettering Hospital. After moving from the South and working in Europe, he became a prominent and illustrious member of the New York City medical establishment.
There is also little doubt that Marion Sims was a member of the New York Academy of Medicine. He presented his findings and papers before the New York Academy of Medicine at least once.
https://archive.org/details/b22274868
http://www.centralparknyc.org/things-to-see-and-do/attractions/dr-j-marion-sims.html
Is it an accident or a coincidence that his statue is across Fifth Avenue from the New York Academy of Medicine? Did the New York Academy lobby for the relocation of this statue to Fifth Avenue?
Should not the New York Academy of Medicine be a bit more forthright in its past connections to Marion Sims?
It is also true that in the ante-bellum era when Marion Sims moved to New York City, the New York City medical establishment was replete with scientific racism.
https://columbiaandslavery.columbia.edu/content/10-columbia-p-and-s-race-science-and-black-students
It may seem strange that a paternalistic racist from Alabama was possibly more progressive than the New York medical establishment of that era. After all, he freed his slaves. Were any members of the New York Academy of that era proponents of scientific racism?
It is very sad that Dr. Jo Ivey Boufford, the President of the New York Academy of Medicine, and the former President of the neo-segregationist NYC Health and Hospitals Corporation would hypocritically denounce Marion Sims and leave the false impression that the statue of Marion Sims was an unwanted presence in front of the New York Academy of Medicine.
https://nyam.org/statement-statue-j-marion-sims
https://nyam.org/media/filer_public/ef/35/ef35b29c-5bac-4c9b-8af7-5dd657405bd0/mayor_bill_de_blasio_re_removal_of_sims_statue.pdf
https://nyam.org/from-the-president-january-2018
There is no doubt that maternal mortality is a problem in New York City and New York State. It has been the subject of a well-researched Amnesty International Report. Where has the NY Academy of Medicine been on this issue?
http://www.amnestyusa.org/reports/deadly-delivery-the-maternal-health-care-crisis-in-the-usa
A recent study from Harvard points out the predatory segregationist nature of Manhattan’s hospitals against the safety net hospitals of Manhattan and the outer boroughs
http://www.ncbi.nlm.nih.gov/pubmed/28152644
http://www.nysna.org/sites/default/files/attach/419/2017/09/RestructuringH%2BH_Final.pdf
Is not the New York Academy of Medicine the location where the leaders of these predatory hospitals meet?
The New York Academy of Medicine post above emanates from its department of Marketing & Communications. Perhaps, the New York Academy of Medicine should call upon an impeccable independent medical historian to elucidate its own troubling relationships with Marion Sims. Perhaps, the New York Academy of Medicine should also re-evaluate its own positions on the contemporary medical issues and challenges confronting New York City medicine and public health.
Hypocrisy will not solve New York’s tremendous health care and public health challenges and inequities.
Bohdan A. Oryshkevich, MD, MPH
Bohdan Oryshkevich, MD, MPH
I have now found documentation that the President of the New York Academy of Medicine, Seth Dr. Hirsch lobbied for and succeeded in placing the statue of Marion Sims in front of the New York Academy of Medicine in 1934.
It was in storage at the time. It had previously been removed from Bryant Park and was discovered to be in storage.
The Bulletin of the NYAM had a celebratory article at the time.
To read this article in full follow this link.
https://1drv.ms/b/s!AgAEn1pbwhx7iLEGvql94fz4Cg3AmQ
Bohdan A. Oryshkevich, MD, MPH
Maureen Connor
Dear Dr. Oryshkevich:
While it is valuable to call out the fact that major hospitals in Manhattan hold a monopoly on funds targeted for medical schools at the expense of those in the other boroughs (and it would be helpful to substantiate that claim with links as you have for most of your other above claims, there are other conditions that should be kept in mind when considering the context of Sims medical experiments. I would like to recommend the recently published book Medical Bondage:Race, Gender, and the Origins of American Gynecology by Deirdre Cooper Owens
The description below is copied from the University of Georgia Press website.
https://www.ugapress.org/index.php/books/medical_bondage
The accomplishments of pioneering doctors such as John Peter Mettauer, James Marion Sims, and Nathan Bozeman are well documented. It is also no secret that these nineteenth-century gynecologists performed experimental caesarean sections, ovariotomies, and obstetric stulae repairs primarily on poor and powerless women. Medical Bondage breaks new ground by exploring how and why physicians denied these women their full humanity yet valued them as “medical superbodies” highly suited for medical experimentation.
In Medical Bondage, Cooper Owens examines a wide range of scientific literature and less formal communications in which gynecologists created and disseminated medical fictions about their patients, such as their belief that black enslaved women could withstand pain better than white “ladies.” Even as they were advancing medicine, these doctors were legitimizing, for decades to come, groundless theories related to whiteness and blackness, men and women, and the inferiority of other races or nationalities. Medical Bondage moves between southern plantations and northern urban centers to reveal how nineteenth-century American ideas about race, health, and status influenced doctor-patient relationships in sites of healing like slave cabins, medical colleges, and hospitals. It also retells the story of black enslaved women and of Irish immigrant women from the perspective of these exploited groups and thus restores for us a picture of their lives.
Bohdan Oryshkevich, MD, MPH
https://citylimits.org/2017/10/18/understanding-new-yorks-public-hospital-crisis
The above article supplements the two references on the financing of the NYC HHC above. All three articles deal with the financial nonviability of the NYC Health and Hospitals Corporation. The NYC Health and Hospitals Corporation provides underfunded undercare for the underserved.
New York City has a system of care that is two or even three tiered. NYC health care in toto comes to about 80 billion dollars per year. Universal agreement both on the left and the right of the political spectrum is that about twenty four billion dollars of that is total waste. NYC like the rest of the country has failed to rationalize its health care delivery. This maldistribution of funds is at the expense of the poor, the uninsured, and the underinsured. It also takes place in the midst of plenty.
https://nam.edu/perspectives-2012-less-is-more
https://scholar.harvard.edu/cutler/news/how-us-can-reduce-waste-health-care-spending-1-trillion
It is certainly true that physicians have done groundbreaking medical research at the expense and sometimes to the benefit of poor patients.
But, it is also true that such experimental work sometimes took place at the expense of the rich. Marion Sims also established what later became Memorial Sloan Kettering Cancer Center, New York’s cancer hospital. It was nothing more than a fancy, expensive hotel bordering Central Park with incineration in a crematorium as the final service. As the author of the article and podcast below points out: “nobody really had any idea what they were doing.” Yet, the rich paid for and were apparently exposed to dubious care.
https://99percentinvisible.org/episode/castle-on-the-park
The early years of medicine were brutal.
Today, this nineteenth century hospital is a very expensive apartment building minus the crematorium smoke stack.
In the case of Marion Sims in the South, his work took place across racial, sex, and class lines. Marion Sims who was largely self-taught and did pioneer sophisticated obstetric-gynecologic procedures. Millions of women have benefited from these procedures. Many poor women in Africa and South Asia still do not yet benefit from this surgery. Marion Sims was good with his hands and meticulous with his record keeping. He was also ambitious and vain. That does not exonerate any offensive or chauvinistic behavior that he may have perpetrated on his subjects.
The black slave women he pioneered his techniques on MAY have benefited from his surgery. They did appear to have real gynecologic problems secondary to childbirth. They were certainly used as subjects for experimentation.
Sims apparently liberated his slaves and left the South before the Civil War.
It is also certainly true that the women he pioneered his work on deserve the fullest credit for participating in this pioneering work. It is also most probably true that poor women in the United States did not benefit from this ground breaking surgery until much later.
It is also true that at the time Marion Sims first moved to New York City, New York City medicine was equally regressive and denying admission to medical school to both blacks and black women. It was also one of the most important centers of scientific racism which believed in the fundamental inferiority of blacks.
The answer to this problem today is universal insurance where everyone has the same insurance regardless of race, sex, or economic means.
Since around 1970, every Canadian has had the same insurance for nearly fifty years. While working in Canada, I took care at one time or another of a Canadian Senator, the scion of the Molson beer conglomerate, even an NHL player, the retired and the poor and all had the same identical health insurance plan. In Canada, medical research is done through randomization and through consent in a system where no one is uninsured.
I am not an expert on and do not express opinions on how women view their bodies and how they are treated by my fellow physicians. It is for women to judge.
There is absolutely no doubt that racism, classism and sexism have permeated medicine. Women should have the right to choose their physicians like everyone else. Thankfully, women today represent close to fifty percent of current medical students and of the medical workforce.
I am familiar with the book mentioned but I am doing research on racism in New York City health care and not directly on Marion Sims.