A urologist shares her journey from the Caribbean to championing health care and equity in Massachusetts
Dr. Oneeka Williams
A dream deferred does not have to be a dream abandoned. I grew up in Guyana and Barbados, the daughter of a woman who dreamt of going to medical school. The resources to do so weren’t available to her, so my mother became an incredibly passionate science teacher and poured her love of science into me from a very young age. I am the realization of her dream.
When I was 13 years old, I realized I wanted to be a doctor — a realization that came in tandem with the first of many roadblocks. Physics, a prerequisite for medical school, was not offered at the all-girls school so I transferred to an all-boys school as the first girl in my twin brother’s high school class. There I excelled not only in physics but in all my other science and math classes as well. I graduated from high school and matriculated at Johns Hopkins University as a biophysics major, only to be told by the premed advisor during my orientation week that I would not get into an American medical school— sadly, a not-uncommon experience for Black students. Nonetheless, I persisted, and came to Harvard for medical school four years later.
I had an epiphany: I love treating patients in their entirety.
I fell in love with surgery when I entered the operating room during my general surgical rotation as a third-year medical student. During an outpatient urology rotation at the West Roxbury VA, I saw firsthand that urologists worked to not only restore their patient’s health, but also their hope.
I had an epiphany: I love treating patients in their entirety.
I enjoy a multidisciplinary approach to patient care, offering both surgical and medical options. I value treating diverse patients — young and old, male, and female — and I love establishing long-lasting relationships with my patients.
As a urologist, I take care of the organs of the genitourinary tract, including the bladder, kidneys, pelvic floor, prostate, testes, ureters, urethra and some aspects of the vagina. Urologists treat patients with cancer, infections, stones, malformations or any other dysfunction affecting these organs.
Stark disparities
One in eight men in the U.S. will be diagnosed with prostate cancer during their lifetime. Black men are more likely to be diagnosed with prostate cancer, more likely to be diagnosed at a young age or at a severe stage, and more likely to die from prostate cancer compared to white men. Black patients are more likely to have more advanced bladder cancer when they're diagnosed, compared to whites. Black men and women are more likely to get kidney and renal cancers than whites.
The reasons for disparities are multifactorial, and some are unknown. For example, while we know there are some genetic mutations that play a role in the increased risk for prostate cancer in black men, there is still not a clear biologic explanation. Research is ongoing.
We do know poverty and other social determinants of health disproportionately affect Black Americans. We know Black people face barriers in receiving medical care. We know access to healthy food, exercise, education, safe housing are linked to socioeconomic status. And we know that lack of access is correlated with a wide range of health conditions.
We also know Black people in the U.S. experience and carry the chronic stress of the current and historical experiences of systemic and structural racism. And we know hypertension, heart disease and other illnesses may be associated with stress.
During the ongoing pandemic, we have seen inequities in health care play out with devastating results.
People of color have suffered far higher COVID-19 infection, hospitalization and death rates. Racial bias in the medical system is a contributor to the quality of care that Black patients receive, across all socioeconomic levels. Just this week, I spoke to a 51-year-old Black man who had been diagnosed with prostate cancer. During his visit with the urologic surgeon, he was told that Black men have more aggressive prostate cancer because they are more promiscuous. This is a deeply dangerous myth, connected to centuries of exploitation and abuse of bodies of color. It has brutal ramifications for health care. Obviously, if your surgeon tells you your cancer is more aggressive because you are promiscuous, it’s difficult to trust that their bias will not affect the quality of care that they administer.
Many Black Americans approach the health system with distrust. Our experience is that we are treated differently, that we are not cared for equitably. Thus, some Black patients don’t feel comfortable going to doctors, and when they do, they may not trust a doctor’s recommendations for treatment.
Empowering yourself as a patient
As a patient, you can actively advocate for yourself and approach your provider with positive expectations of shared decision-making. Take a family member with you if possible, or ask if they can join by phone or video. If you are seeing a urologist for the first time, there are some simple questions you should ask:
• What is my diagnosis and what is the plan?
• What else could this be and how will you exclude other possible diagnoses?
• What should I expect and is there any concern that this could turn into something that is debilitating or life-threatening?
• What warning signs should I be aware of and when do I follow up?
• What can I do to improve my outcome?
Before your visit, you can seek out trustworthy information from reliable sites like the Mayo Clinic and the American Urological Association. Talk with your primary care provider about mitigating some risks through cancer screening options. It is important to know family history, as it is significant factor in risk for prostate cancer.
It’s also important to pay attention to changes in your health, and discuss them with your primary care provider. The most common presenting sign of bladder cancer is blood in the urine. Recurrent urinary tract infections or increased urinary urgency and frequency can also be indicators.
DR. PHILOMENA ASANTE
Addressing inequities in health care
The medical establishment can take concrete steps to address inequities in medicine.
For instance, the pharmaceutical industry can elevate more scientists of color and introduce thought leaders and representatives from the Black community to encourage more participation in clinical trials. The current lack of representation in many clinical trials hampers our ability to understand how new treatments may affect Black patients – an issue that will be increasingly important in the era of personalized medicine.
It is important to increase the pipeline of Black students going into medicine. Our children must be exposed to role models that encourage them to believe they too can be doctors. We must create mentorship programs for high school and college students to establish clear pathways to medical school, and to support them after they graduate. The R. Frank Jones Society within the American Urologic Association is a vehicle for advocacy, improving representation and research on urologic diseases directly affecting communities of color, and creating opportunities for mentorship and professional advancement for Black urologists.
Economic barriers that limit access to medical education must be addressed. Black medical students are three times more likely than White medical students to come from families where the income is less than $50,000. There must also a holistic approach to medical school applicants considering the entire student, rather than a narrow approach focused on scores and grades.
Medical schools must teach the roots of health disparities, and the historical context within which the distrust of the medical system has developed. That's the path to improving the cultural competencies of White doctors.
Implicit bias must be acknowledged as a fact of life. We’re all products of our environment and the messages by which we were surrounded. Confronting bias is the first step to undoing it and decreasing its impact. That elevated consciousness also means being aware of race-related risk factors and disparities to provide competent and equitable health care that can close the gap.
All levels of our society, including the health system, must actively advance antiracist policies to correct existing inequities.
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