April 20, 2022
Page 9
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o piNioN
Indictment of our health care system
Being Black can cost
an arm and a leg
By Oscar H. Blayton
COVID-19 is not the only epidemic
plaguing America’s Black community today.
The respected medical journal, The
Lancet, has reported, “The epidemic of
amputations among Black communities
across the USA is a brutal reminder of
the enduring complications of [diabetes]
among underserved populations…” Other
prestigious publications have character-
ized this epidemic as an indictment of our
health care system.
Diabetes is one of the most common
causes of amputation because it leads to
peripheral artery disease, or PAD. PAD
in the legs is the narrowing or blockage
of the vessels that carry blood from the
heart. With the decrease of blood flow,
the feet and legs are at a significant risk
of gangrene.
Diabetics undergo 130,000 amputa-
tions each year in the U.S., with these
patients most often being low-income
and underinsured.
Numerous studies have shown that
Black folk have their legs amputated at
a much higher rate than whites with the
same health problems. Some studies have
shown that Black folk with diabetes re-
ceive amputations at nearly three times
the rate of white patients, particularly in
the rural South. Others claim that the dis-
parity is four times greater. These dispari-
ties exist even when the data is controlled
for the fact that diabetes is more prevalent
among African Americans.
Dr. Foluso Fakorede, a cardiologist in
Bolivar County, Miss., who specializes
in cardiovascular management, has been
waging a campaign to bring awareness
to the fact that failure to provide caring
treatment for Black and poor people with
PAD results in amputations that could
have been prevented.
Dr. Fakorede reports that on one occa-
sion, he examined the left foot of a Black
patient with uncontrolled diabetes and
found that the tops of his toes were dark,
his sole was yellow and oozing, as the
foot was literally rotting due to diabetes
constricting the blood flow to his foot
and preventing an infection from heal-
ing. Upon examining the patient’s chart,
Dr. Fakorede found that a consulted sur-
geon had begun his written recommen-
dation by stating casually that the patient
had “limited options” other than amputa-
tion below the knee.
This patient recently had lost his right
leg below the knee, and it seems that the
surgeon had little concern that anoth-
er amputation would place the patient a
wheelchair for the rest of his life.
Looking further into this patient’s re-
cords, Dr. Fakorede discovered that no
screening had been done on this patient at
the time of his first amputation to deter-
mine if his left leg was at risk and if inter-
vention might help improve the health of
the remaining limb.
Realizing the lack of interest in avoid-
ing preventable diabetic amputations in
Mississippi, Dr. Fakorede created the Am-
putation Prevention Institute. He even put
up a billboard on the side of a highway
alerting people to the fact that amputa-
tions could be preventable and alternate
courses of treatment could be pursued.
He also has tried to convince physicians
to perform more thorough evaluations of
PAD patients before cutting off their legs.
With proper attention, Dr. Fakorede
saved the leg of the man with the rotting
foot and he only lost one toe.
About 37 million people in America
have diabetes, and Mississippi has one of
the highest rates in the country. The vast
majority have Type 2 diabetes and their
bodies resist insulin or their pancreas does
not produce enough, thus making their
blood sugar levels rise and their arteries
become constricted.
Genetics plays a role in the condition,
but it also has been reported that poverty
can double the odds of developing diabe-
tes and dictating a higher risk of amputa-
tion. Black people who live in food des-
erts, where there is a lack of availability
of nutritious food, tend to consume high-
fat meals, sugary foods and do not get
enough fiber. And when you add to that a
lack of opportunity to engage in adequate
exercise, the risk of diabetes increases
exponentially because obesity is also a
significant contributing factor.
These disadvantages combine with an
array of public policies, from insufficient
access to health care to racist biases re-
sulting in cuts in public health funding.
Policy decisions like these maintain dis-
parities, particularly in the South, that
result in diabetic amputations, which are,
by one measure, the most preventable sur-
gery in the country.
Even though Title VI of the Civil Rights
Act of 1964 protects individuals from dis-
crimination in various areas of health care
and services, disparities persist in the pro-
vision of health care because caring treat-
ment comes from a compassionate heart,
not a code of law.
And then there is the profit motive.
There is more of a financial incentive to
amputate than not. Because policies set
out by hospitals, insurers and the govern-
ment don’t require surgeons to consider
limb-saving options before cutting, the
amputation epidemic continues, particu-
larly among the poor and people of color.
A procedure known as an angiogram can
inform a physician as to whether there is
sufficient blood flow in a leg to warrant
an intervention that could save it. It was
through the use of an angiogram that Dr.
Fakorede was able to save the leg of his
patient with the rotting foot. But an am-
putation pays more than an angiogram.
It is reported that nationwide, half of the
amputees do not get an angiogram before
losing their leg to surgery.
The tragedy of an unnecessary ampu-
tation does not end with the loss of a leg.
Mortality rates rise after these amputa-
tions, partly because many amputees stop
walking. Exercise is essential to good cir-
culation, and it helps to control blood sug-
ar and weight. The less active an individ-
ual is, the greater their risk of heart attack
and stroke. Being placed in a wheelchair
can take years off one’s life.
Dr. Marie Gerhard-Herman, an associ-
ate professor of medicine at Harvard Med-
ical School and a cardiologist at Brigham
and Women’s Hospital, told a reporter that
it made her “sick to her stomach” that, in
certain parts of the country, patients were
not getting angiograms prior to amputation
and those decisions appeared to be made
along racial and socioeconomic lines.
America constantly touts its world-
class health care. But that level of care is
not for us. And unless we begin to strong-
ly demand that adequate health care is our
due, it will never be for us.
Oscar H. Blayton is a former Marine
Corps combat pilot and human rights ac-
tivist who practices law in Virginia.
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