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Mama Might Be Better Off Dead: The Failure of Health Care in Urban America
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Laurie Kaye Abraham. 289 pages. Chicago, Illinois: University of Chicago Press; 1993. $22.50.
At a time of almost daily pronouncements of health care issues emanating from the White House and the media, the immediacy of a book with this subtitle can hardly be questioned. Does this book contribute to an understanding of the manifest problems within the health care systems in this country or to the solution of any of them?
Ms. Abraham is a health care reporter who obviously devoted much effort to the preparation of this book. She seems to have spent much time getting to know the "Baneses," a poverty-stricken multigenerational family of African-Americans. The family has a series of almost insurmountable health, financial, drug, and alcohol problems, which seem to be dwarfed by problems encountered when addressing the governmental and charitable health and welfare systems.
Ms. Abraham is at her best when conveying the "Catch-22" elements of attempting to obtain benefits from a health and welfare system that is viewed as chaotic by many of its consumers (as well as by Ms. Abraham).
The author addresses subject matter that includes a very narrow description of the Banes family neighborhood. The text subsequently provides a rather good exposition of renal dialysis from the patient's view. A later chapter on renal transplantation is much more thorough and penetrating. A chapter on the fitful nature of primary care in a clinic setting is spotty, perhaps because it attempts to cover too many subjects. A chapter on the diabetic grandmother's depression is excellent. It portrays the passive acceptance of this depression by the family. It also tells of their total lack of awareness of any method by which to obtain assistance to address it. The chapter on the inner-city emergency room could well describe that in almost any large city and adds little to the book.
Perhaps the most sympathetic view of the health delivery system is given in the chapter devoted to Chicago's Mount Sinai Hospital. Although containing considerable criticism, the chapter also displays much understanding and even some humor.
In addition to its exploration of the failures in immunization programs for the poor, the chapter on preventive care for children contains a provocative paragraph that must be addressed. It documents the unwillingness of an African-American to use a clinic located in an adjacent Hispanic neighborhood. Although the culture gap between poor African-Americans and relatively affluent whites may seem huge, it appears that the communication gap between African-Americans and Hispanics is nearly insurmountable.
Additional subjects include distrust of white doctors by African-Americans, attributed to the fear of being used as the subjects of experimentation; the dilemmas of life-sustaining technology; the lack of involvement of poor patients in the decision-making process; and a touching final chapter on the death of the diabetic, double-amputee grandmother.
This book seems well researched and has many annotations[346]. Although the book provided few answers, I found the exposition and documentation of the problems a thought-provoking experience.
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