STORY BY KATHLEEN F. PHALEN
A community of men
IT USED TO BE THAT PEOPLE IN Chicago’s Woodlawn neighborhood had jobs. Used to be living in this South Side area was like living in most any American community: friends sitting on the stoop talking and laughing; businesses and shops thriving. That’s the Woodlawn Eric Whltaker, MD. MPH. remembers. The Woodlawn where Grandma lives. The Woodlawn he’s come back to. But now the jobs are gone, the buildings on his grandmother’s street have been boarded up or demolished, and all the things that help a community thrive are absent Instead, there are STDs, AIDS and hypertension. There’s a lot of time and little hope. And although all populations feel the pains of poverty, in this neighborhood it is African-American men who pay the highest toll.
Just blocks away, in Chicago’s affluent Hyde Park neighborhood, the life expectancy for white men parallels the national 73.3 years. In Woodlawn for African – American men it’s 53 to 58 years, according to the Chicago Dept of Public Health. Men living in Bangladesh have a greater chance of making it to age 65 than black men living in this south Chicago world.
But contrary to popular myth, homicide is not the reason. It’s heart disease, followed by malignant neoplasms.
That’s why Dr. Whitaker, after spending a three-year residency working with vulnerable populations at San Francisco General Hospital, came home to build a program that might help these men live longer, healthier lives. That’s why he started Project Brotherhood, A Black Men’s Clinic. “It’s certainly a tale of two cities,” says Dr. Whitaker, talking about the health disparity between the Chicago neighborhoods. “There’s definitely a connection between poor health and a lack of employment. Health care falls to the bottom when you’re trying to feed your family.” Dr. Whitaker knows both Chicago worlds: the one his grandparents live in, and the one he studied in at the University of Chicago Medical School in Hyde Park.
So he set out to bridge the two. Contacting Cook County Hospital, a public hospital primarily serving an uninsured population. Dr. Whltaker asked why no men were coming to the primary care clinics. There is a disparity in who uses our health services,” says Mildred Williamson, PhD, MSN, administrator of the Woodlawn Health Center, one of the Cook County Bureau of Health Services primary care clinics and the new home of Dr. Whitaker’s program. “There were no men.” Because the Bureau of Health Services — the umbrella for the Cook County Dept. of Health, John H. Stroger, Jr. Hospital of Cook County (formaly Cook County Hospital), the Ambulatory and Community Health Network of 30 clinics and others — considered community health outreach critical, Dr. Whitaker’s plan to build health services for this underserved population seemed a perfect match. So Avery Hart, MD, the division chief of general internal medicine and primary care at Cook County Hospital, hired him. “It was unclear as to why we were seeing mostly African-American women in our clinics, and Eric was asking, ‘Why, what can be done?”’
STILL, IF THE CLINIC WAS GOING TO persuade a reticent population, it had to be user friendly. Dr. Whitaker and others knew they had to go to the source: the men in the area. They talked to young men, old men, gay and bisexual men, fathers, homeless men, church-going men, addicts and recovering addicts. “We decided to ask these men what they want, how they perceive health care, and what are their barriers to care,” Dr. Whitaker says. “And we found out, across the board, they did not feel respected in the health care System.”
This is not uncommon for black men In America, says Hilton Hudson II, MD, a heart surgeon at Rockford (IL) Memorial Health System. “Color is the first thing that is noticed and acknowledged…I have seen it. They are not being addressed by an appropriate name, sometimes nurses feel intimidated. If someone tells me about a patient and they just discuss his condition, I know he is white. If he is black, they say, the black patient.’ ” Dr. Hudson, founder of Hilton Publishing, which recently published The Black Man’s Guide to Good Health (by James W. Reed, MD, Neil B. Schulman. MD, and Charlene Shucker), says this is one of many stressors that keep African-American men from feeling comfortable in additional settings. For men living in Woodlawn, it was also a problem that they never saw anyone like them at a clinic. There were no black male doctors. And going to the clinic was viewed as a threat to their virility. “The men felt vulnerable,” Dr. Whltaker says. “These folks can’t be seen coming to the clinic, they can’t let people see them as weak.” One thing they did know, though, from a cultural context, is that It is OK to go to the barber, to sit around and talk, man-to-man. And that’s how the clinic opened. With free haircuts, free food and free health care every Thursday night “If we can’t get them through the door,” says Dr. Whitaker, “we can’t impact anybody.” So the men began to gather, some getting haircuts, some just talking, same listening to Dr. Whitaker’s informal sessions. The clinic was staffed by black men, and the primary care part is in the back. Since the Black Man’s Clinic opened In late 1998, they have added seminars in anger management and parenting, and health sessions on HIV, heart disease and cancer. They help with work skills, and there are computers for preparing resumes.
These days, the clinic is packed on Thursday nights, but nobody needs an appointment. Dr. Williamson says, “I’d say there are between 20 and 50 men here every week, and now a significant portion are here to see a doctor. We’d like to be able to expand, to offer another evening session. We’d like to offer the classes more often, but funding is a problem. ”“Many times, while we’re just talking, they’ll say, ‘Hey doc, I’ve got this,’ or ‘Can you tell me about … “ says Dr. Whitaker. “If you create linkages, it’s easier for them to come to the back of the clinic.” It’s what Aaron Kipnis, PhD, professor of clinical psychology at Pacifica Graduate Institute, Santa Barbara, Calif, and author of Angry Young Men (Jossey-Bass, 1999), calls a high-context encounter.“We have found that what is most important to Native American, African-American and Latino people is not the information, but who you are and how you are. That is a high context, “Dr.Klpnis says. “Many in the white culture say,‘Here’s the information, here’s my credentials,and how I deliver it isn’t important’ That Is high content”
For black men Dr.Kipnls says, accepting content —information — will only follow context. “Many African-American men have a healthy paranoia. They are not mentally ill they are culturally awake, he says, citing the Tuskegee experiments and drug trials of incarcerated black men. “There is a whole history of them being a research subject instead of being a patient If you don’t understand another culture, how can you serve it? Why would they trust you?”
Reaching back, reaching out
ELROY AVERY, 45, STARTED GOING TO THE Black Man’s Clinic shortly after it opened. Eventually, Dr. Whitaker suggested Avery get certified as an HIV counselor and work at the clinic.
“He said he couldn’t do it,” says br. Whitaker. Overcoming his reluctance, Avery went to school and passed all of his certification exams — Centers for Disease Control and Prevention, the Illinois Dept. of Public Health and the Chicago Dept. of Public Health. Now he has a good job, making more money than he ever did. “I feel a lot better. I am more confident,” Avery says. “I was withdrawn, and people told me l had a learning disability. Project Brotherhood encouraged me to strive for more.”
Avery says Project Brotherhood teaches men to reach back and pull someone with them. “Black men have no allies,” says Larry Davis, PhD, a chaired professor of social work at Washington University In St. Louis. “They need to look to each other, to share their experiences.” Word of mouth got Livingston Cox. 45, to the Black Man’s Clinic this spring. It was one of those informal pipelines from Dr. Whitaker’s grandmother to Cox’s mother, who knew that her son, a single father, needed to stay healthy for the sake of his child. “My mother said to check it out, and I liked the idea of black men getting together, a place where we could open up and let our thoughts be known without the stereotypes,” he says.
He has since stopped smoking a habit he had picked up at age 13. And he’s got a new job with health benefits and stock options. “I haven’t had a cigarette in three months,” he says. “This program is great In this world everybody needs a place to sit down and talk, and this is a forum where men can talk about men’s stuff.” According to Dr. Whitaker, Project Brotherhood was awarded the Jim Wright Award the highest accorded by the National Assn. of Public Hospitals and Health Systems. Its initial success has also spawned a satellite location at John H. Stroger, Jr. Hospital’s Trauma Unit, which Dr. Whitaker says is taking advantage of the teachable moment that can occur after a life-threatening injury, such as shooting or car crash.
“Every Friday from 6 to 10p.m., we have a social worker who offers referrals to Project Brotherhood’s Thursday evening sessions,” he says. “The Trauma Unit at Stroger Hospital funded our initial focus groups because they,
like us, were interested in getting their patient population into long-term primary care.” Dr. Whitaker says the program has gotten some funding, and most of the workers volunteer their time. But figuring out how to continue is a major financial challenge. He’s just beginning to gather data to try and analyze the health benefits of this effort. Still, The Cook County Buerau of Health Servicesl locks to a future of more programs based on Dr. Whitaker’s model.
“We hope to continue to grow in Woodlawn, and It gives us a model to use for other groups,” says Stroger Hospital’s Dr. Halt “We want to learn how to listen to our community and discover its own perception of needs and assets.”