When it came to obtaining health care during the 1918 flu epidemic, black communities in America, hampered by poverty, Jim Crow segregation and rampant discrimination, were mostly forced to fend for themselves. Opportunities for inpatient care have proven to be scarce, leaving many dependent on family care and, where applicable, the small but growing ranks of black nurses.
When the 1918 flu epidemic began, African Americans were already plagued by a barrage of social, medical, and public health problems, says Vanessa Northington Gamble, physician and medical historian at George Washington University. Among the challenges she identified in her 2010 study of the African American experience of the 1918 influenza pandemic: “racist theories of black biological inferiority, racial barriers in medicine and public health, and poor health.
Some 675,000 people were infected in the United States and 500 million worldwide during the 1918 pandemic, according to estimates by the Centers for Disease Control and Prevention. Precise figures showing how many African Americans have contracted the disease – or died from it – are not available; cases are still scarce, as very few of these victims have had contact with institutional health care providers or agencies.
Some research suggests that African Americans may have been less likely to catch the 1918 influenza virus. “One of the theories we put forward is that segregation worked like a quarantine,” Lakshmi explains. Krishnan, a physician and medical historian at Georgetown University, who co-authored an article comparing the racial disparities of COVID-19 versus the 1918 influenza pandemic. Since pandemics “have always disproportionately affected Blacks, Natives and Latinxes,” she says, this made the 1918 flu “a bit of an anomaly” from an epidemiological perspective.
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Most hospitals refused blacks
But while African Americans were less likely than white Americans to contract the disease, they were much more likely to die from it if they caught it.
The main reason: Black Americans received substandard care in separate hospitals – if they could even be admitted. “Few hospitals accepted black Americans, and those who sent them sent them to the basement for treatment,” says Marian Moser Jones, a public health specialist at the University of Maryland. There, they probably languished in rooms not intended for the treatment of patients, not receiving all the resources and timely medical care that white patients received in the main wards.
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Only a small number of black hospitals existed at the time – and only in large metropolitan areas. They included Freedman’s Hospital (now Howard University Hospital) in Washington, DC, Provident Hospital in Chicago (the first black-owned and operated hospital in the country), or Lincoln Hospital in New York. And while pioneering the training of African-American doctors and nurses – Provident, for example, was the country’s first nursing school – they tended to be understaffed and under-resourced compared to white hospitals.
Most African Americans have ended up being treated in their homes by family members and midwives. The cramped and harsh living conditions engendered by poverty, racism and discrimination have made it difficult to provide care for loved ones and prevent the spread of infection. “African Americans didn’t have the funds for a private day nurse,” Jones says. “It was before health insurance. So many people suffered and died at home, or suffered and survived at home.
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Communities tried to take care of their own
Health historians paint a picture of the heroic efforts of a few black nurses and doctors who work to serve their communities. They also recognize the role of black churches, women’s groups, newspapers and community leaders in emphasizing education and prevention, and in mobilizing local volunteers.
“There was a very community-based response to ensure the health of sick black people and to make sure that they realized this was a serious illness,” says S. Michelle Ogunwole, internal medicine researcher general at the Johns Hopkins School of Medicine and co-author of “Historical Insights on Coronavirus Disease 2019”.
An example: the National Urban League has set up neighborhood programs to try to help black Americans living in cities. According to Gamble’s report on the epidemic, he hired a trained nurse in Columbus, Ohio to provide free home care for flu victims. The Chicago branch has organized volunteers to perform the same function. In one case, the report says, volunteers arrived at a home where a mother and her five children were beaten, only to find that two of the children had already died. “The volunteers cleaned the house and also called a nurse.
Baltimore’s black community was hit early and hard – with higher infection rates than other cities, Jones says. With cemeteries full and coffins piling up, the city has called in sanitation workers to help manage the backlog. When they refused, the mayor enlisted the help of the War Department, which sent more than 300 African-American soldiers – who were still assigned, Jones says, to “the most unwanted, the most horrific and the worst jobs. more demanding in terms of labor ”.
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Black nurses, sidelined elsewhere, have become a force
Black nurses have played a major role in caring for victims of the black community, despite discrimination. Nursing schools in the South refused them entry, while schools in the North admitted them in symbolic numbers. After the United States entered World War I, the military and the American Red Cross fired black nurses when they tried to volunteer, Jones says.
“By the time the flu came on, there were nearly 3,000 black women with top notch training that rivaled that of white nurses,” she adds.
But eventually, as more white nurses shipped overseas to military hospitals in Europe during World War I, and the pandemic took hold, a nursing shortage developed at home. “Many [African American nurses] were called up to serve in hospitals, private nursing and military hospitals, where they had previously been excluded, ”says Jones, who wrote about their efforts in a study of black nurses during the 1918 influenza pandemic .
Among them: Frances Reed Elliott, the first black nurse to join the Red Cross nursing service. Sent to the Tennessee countryside to finally realize her dream of working in the healthcare industry, she reportedly learned to drive a car in just one day so she could make home visits to patients in black and white communities. After several months of service there, she eventually contracted the flu on her own and was admitted to Freedman’s Hospital in Washington, DC, where she had completed her training. Elliott recovered and pursued a long career in public health.
When the influenza pandemic ended, it did not lead to any public health or medical initiatives to improve the poor health of black Americans, Gamble says. It also hasn’t led to any changes in opportunities for black healthcare professionals – with a few exceptions.
“They remained separate in the black medical world.”
