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For example, in interviews, African-American and Latino women said they wanted "spiritually relevant" information to prevent breast cancer, which occurs twice as often in African-American women as in white women. So researchers are testing the effectiveness of distributing breast-cancer information in churches. Researchers found that in order to counter the high rates of cardiovascular disease in minorities, messages about decreasing stress must be culturally appropriate and rooted in community values.
Cunningham trains physicians who will be research leaders attached to individual communities, such as South-Central, Carson-Wilmington and the San Fernando Valley. Wells explains, "These researchers will go beyond finding the problems within communities — they will also focus on getting public policy to support this change." The program focuses on empowering community members to transform their neighborhoods into places that encourage people to adopt and sustain healthy behaviors and to avoid risky behaviors.
Once you get past the idea that passing out money on street corners solves medical problems, you have to look at the minutiae of the patient-care process to find the failures. This is what Cunningham does best.
"I did a study that showed when people are in need of food and clothing, it interferes with their ability to get medical care."
I tell him that seems obvious.
He says, "If it's so obvious, then why don't we deliver medical care at the same place we deliver food and clothes?"
I imagine the Salvation Army passing out vaccines with food baskets.
"The way we divide up these human services for bureaucracy is artificial. We treat health care and education as separate funding entities, and then we have to decide if we want to fund one or the other. Or if poor people have to get in separate lines for food and medical assistance, they have to decide, which do I need today? One way to improve the system would be just to establish a way of qualifying them once for all programs instead of checking them in for each one separately.
"My picture is that there is a system organized by need; no system where people who already have difficult lives don't have to go to 10 places to fill their needs. People shouldn't have to make a choice between starving or bleeding to death. If our government attacked this problem as thoroughly as it is attacking Iraq, we'd be much better off."
Cunningham proposes many surprising solutions to the problems he unearths in his research. He investigated how African-Americans get information about AIDS. It turns out that for this demographic, pastors and church groups are the most trusted source for medical information. "We should pass out condoms in church," says Cunningham. "Or at least pamphlets." Who else is getting dollars from the Bush administration to do research that suggests distributing condoms in church?
Back at home, Sharon Vidal describes Cunningham's family as "the black gentry." She admits that she was intimidated around them at first. "When Billy was in grade school and he got sick, his mom said, 'You can figure out which antibiotic to take. You figure it out and get it out of the drawer.'" She explains, "Being a doctor is just part of being in that family."
I ask Cunningham, "Can I talk to your mom?"
I send multiple nagging e-mails and call him twice, and I get the number.
Matilda Cunningham confirms what her daughter-in-law has already told me: The family has been churning out graduates from Howard University since the 1880s. It is probably the only African-American family in this country with four generations of physicians.
In the 1880s, Cunningham's great-grandfather was a pharmacist, but there were no doctors who would treat African-Americans in his area, so he became the de facto doctor for the community. Cunningham's great-grandparents had seven children. All of the children graduated from college — the first African-American family in Virginia that could make such a claim. Cunningham's grandfather graduated from Howard medical school in 1920. Both Cunningham's mother and his father graduated in 1951 and had practices throughout his childhood. Today Cunningham's brother is also a doctor; his sister has a Ph.D. in psychology.
I ask Cunningham's mom if it was difficult to be an African-American woman physician.
"No," she says. "It was pleasant. Everyone in our family was expected to grow up and be a physician. It was totally natural to me." She met her husband during late-night study sessions. She says, "We shared a cadaver."
I ask her about her family history before the pharmacist in 1880.
"I don't know."
I wonder out loud whether they were slaves.
"I suppose," says Matilda Cunningham. "No one ever talked about it to me. We only talked about education. Education, education, education. That was all that mattered."
Billy Cunningham did go to medical school, but he took an educational path that would not have been open to the generations before him. Cunningham knew from an early age that he wanted to be part of a group of professionals addressing the problems of racial disparities in health care. He is among the first generation to be born into a world where there are enough physicians providing basic care to the large community of African-Americans.
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