The disease is preventable, though, due to vaccines and effective treatments for conditions that can precede the cancer. That’s why health care workers and even the World Health Organization are focusing on Miami’s Little Haiti to try to save lives.

The rate of cervical cancer in Little Haiti is 38 per 100,000 people — more than four times Florida’s overall rate, 8 per 100,000, according to a in July 2018.

One of the authors, , the associate director for population sciences and cancer disparity at the University of Miami’s Sylvester Comprehensive Cancer Center, came up with the idea to bring HPV testing to areas of Miami-Dade County where women are less likely to get regular screenings for cervical cancer at a gynecologist’s office. Human papillomavirus is thought to be responsible for .

Kobetz’s work and that of her colleagues, using a recreational vehicle dubbed , grabbed the attention of the WHO. The international health organization announced in August 2020: to eliminate cervical cancer by encouraging countries to get 90% of girls fully vaccinated with the HPV vaccine by age 15; to have 70% of women screened for HPV by age 35 and again by age 45; and to treat 90% of women with pre-cancerous conditions. The WHO believes cervical cancer can be eliminated within the next century if countries meet those targets by 2030.

In Miami, the WHO is relying in large part on public health infrastructure already in place, including the effort initiated by Kobetz. In Little Haiti, this work is happening at a medical clinic called the Center for Haitian Studies, located on a commercial street in the rapidly gentrifying immigrant neighborhood.

On the outside of the building, “CHS-Health” is written in big blue letters. A few small convenience stores and a tax service business are nearby, but most surrounding shops are clothing boutiques and hip cafes or restaurants.

On a weekday morning, the clinic’s street-facing windows filled the waiting area with sunlight, and community health worker Valentine Cesar struck up friendly conversations in Haitian Creole with patients as they waited.

The patients have an easy rapport with Cesar, who works for the University of Miami’s Sylvester center. At the Center for Haitian Studies, she teaches people about preventing cervical cancer by focusing on HPV. Specifically, Cesar shows women how to test themselves using a kit she hands out at the clinic. “We have a little jar, and this is a cotton swab,” she said.

The process isn’t much different from using a tampon and is certainly easier than getting a pelvic exam, which is the other way to test for HPV. Self-collected samples are sent to a lab. If the results are positive, Cesar deploys her considerable people skills as she delivers the news.

She acknowledges the panic that comes when she tells people they have HPV. “We explain to them that the fact that you’re HPV-positive, that doesn’t mean that you have cancer,” she said.

It does mean that a woman needs to be vigilant about her health, though, and needs to be monitored for cancer, pre-cancerous conditions, and other problems that can be caused by HPV. Cesar and her colleagues will encourage HPV-positive patients to get care at the Center for Haitian Studies or other federally qualified health centers. The clinic is the Sylvester center’s primary referral partner in Little Haiti because of the cultural and linguistic competence of the staff.

The Sylvester center’s Game Changer vehicle supports the Little Haiti clinic’s education efforts and parks behind it on scheduled days. On other days, the vehicle brings a similar message to different communities in Miami.

“We’re able to promote our services through our various community health workers that go out and talk about what we do, hand out flyers, and have educational materials,” said , the former director of the Sylvester center’s Office of Outreach and Engagement. “All of that helps us to bring about knowledge and awareness about our services and what we do.”

On a tour of the Game Changer vehicle, Trevil pointed out the video on HPV that was playing and pamphlets that people can use to learn about the virus. The vehicle has a main area with space for sitting, as well as areas for private exams or consultations.

Trevil understands why Haitian women sometimes avoid seeing a doctor. “They have the belief, ‘If I’m going to the physician’s, I’m going to find out some bad news,’” Trevil said. “‘I would rather not go.’”

As health educators, Trevil and Cesar try to talk people out of this avoidance motivated by fear.

Trevil says research shows the self-tests for HPV can help more women accept other tests that benefit their reproductive health. “So we started to use this test as a way to address some of the sensitivities and some of the reluctance in women to actually have a Pap test done,” Trevil said.

Patient Nicole Daceus took a self-test for HPV this year after noticing the Game Changer vehicle and the Sylvester center’s name on it. Health fears are not the only hurdle, Daceus said. “People avoid the doctor if they don’t have health insurance or their immigration papers,” Daceus said.

No one at the clinic will ask patients about their immigration status, though, something Cesar and Trevil try to make sure patients know.

Sylvester center staffers educate mothers about this to encourage them to get their young teenagers vaccinated against HPV. The vaccines for children are given inside another RV, parked a few feet from the Game Changer — the University of Miami’s pediatric mobile clinic. It focuses on care for uninsured children and sets up near public schools, houses of worship, and community centers.

“We work in tandem with one another because the mobile clinic is able to provide vaccines, and this way we can make HPV prevention a family affair,” Kobetz said. “Age-eligible boys and girls can get vaccinated.”

Richard Freeman, who works in the WHO’s office of the director-general, visited the vehicles behind the Center for Haitian Studies earlier this year. Freeman said this work is vital to the WHO’s global effort to end cervical cancer. No one, Freeman added, should die from a disease that tests and vaccines can prevent.

“Cervical cancer is the one cancer that we can actually eliminate,” Freeman said. “We have the tools, and all it is is a choice of whether or not we’re going to put those tools into use. If we catch this cancer early and we detect it on time, it’s curable. And so we want to see all of these interventions coming, not just here in Miami. We want to see the supply of HPV vaccines also made available and also affordable in countries that have a higher burden of cervical cancer.”

This story is part of a partnership that includes ,  and KHN.

This <a target="_blank" href="/news/miami-little-haiti-joins-global-effort-to-end-cervical-cancer/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

In South Florida, when people want to find a Black physician, they often contact Adrienne Hibbert through her website, .

“There are a lot of Black networks that are behind the scenes,” said Hibbert, who runs her own marketing firm. “I don’t want them to be behind the scenes, so I’m bringing it to the forefront.”

Hibbert said she got the idea for the website after she gave birth to her son 15 years ago.

Her obstetrician was white, and the suburban hospital outside Miami didn’t feel welcoming to Hibbert as a Black woman pregnant with her first child.

“They had no singular photos of a Black woman and her Black child,” Hibbert said. “I want someone who understands my background. I want someone who understands the foods that I eat. I want someone who understands my upbringing and things that my grandma used to tell me.”

In addition to shared culture and values, a Black physician can offer Black patients a sense of safety, validation and trust. Research has shown that racism, discrimination and unconscious bias continue to plague the U.S. health care system and can cause of racial and ethnic minorities.

Black patients have had their complaints and symptoms dismissed and their pain , and they are for specialty care. Older Black Americans can still remember when some areas of the country had segregated hospitals and clinics, not to mention profoundly unethical medical failures and abuses, such as the 40-year-long .

But even today, Black patients say, too many clinicians can be dismissive, condescending or impatient — which does little to repair trust. Some Black patients would prefer to work with Black doctors for their care, if they could find any.

Hibbert is working on turning her website into a more comprehensive, searchable directory. She said the most sought-after specialist is the obstetrician-gynecologist: “Oh, my gosh, the No. 1 call that I get is [for] a Black OB-GYN.”

For Black women, the impact of systemic racism can show up starkly in childbirth. They are as likely to die after giving birth as white women in the United States.

is a Black OB-GYN at Jackson North Medical Center in North Miami Beach, Florida. He said he understands some women’s preference for a Black OB-GYN but said that can’t be the only answer: “If every Black woman wanted to have a Black physician, it would be virtually impossible. The numbers are not there.”

And it’s also not simply a matter of recruiting more Black students to the fields of medicine and nursing, he said, though that would help. He wants systemic change, which means medical schools need to teach all students — no matter their race, culture or background — to treat patients with respect and dignity. In other words, as they themselves want to be treated.

“The golden rule says, ‘Do unto others as you would have them do unto you,’ so that the heart of a doctor needs to be that kind of heart where you are taking care of folks the way you would want to be treated or want your family treated,” he said.

George Floyd’s murder in Minneapolis in May 2020, and the subsequent wave of protests and activism, prompted corporations, universities, nonprofits and other American institutions to reassess their own history and policies regarding race. Medical schools were no exception. In September, the University of Miami Miller School of Medicine revamped its four-year curriculum to anti-racism training.

New training also became part of the curriculum at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton, where students are being taught to ask patients about their history and experiences in addition to their bodily health. The new questions might include: “Have you ever felt discriminated against?” or “Do you feel safe communicating your needs?”

“Different things that were questions that we maybe never historically asked, but we need to start asking,” said , senior associate dean for medical education at Florida Atlantic.

The medical students start learning about racism in health care during their first year, and as they go, they also learn how to communicate with patients from various cultures and backgrounds, Wood added.

These changes come after decades of racist teaching in medical schools across the United States. Adams, the OB-GYN, completed his residency in Atlanta in the early 1980s. He recalls being taught that if a Black woman came to the doctor or hospital with pain in her pelvis, “the assumption was that it was likely to be a sexually transmitted disease, something we refer to as PID, pelvic inflammatory disease. The typical causes there are gonorrhea and/or chlamydia.”

This initial assumption was in line with a racist view about Black women’s sexual activity — a presumption that white women were spared. “If the same symptoms were presented by a Caucasian, a white young woman, the assumption would be not an STD, but endometriosis,” Adams said. Endometriosis is not sexually transmitted and is therefore less stigmatizing, less tied to the patient’s behavior.

That diagnostic rule of thumb is no longer taught, but doctors can still bring unconscious racial bias to their patient encounters, Adams said.

While they revamp their curricula, medical schools are also trying to increase diversity within their student ranks. Florida Atlantic’s Schmidt College of Medicine set up, in 2012, a , the state’s historically Black university. Undergraduates who want to become doctors are mentored as they complete their pre-med studies, and those who hit certain benchmarks are admitted to Schmidt after they graduate.

Dr. Michelle Wilson took that route and graduated from Schmidt this spring. She’s headed to Phoebe Putney Memorial Hospital in Albany, Georgia, for a residency in family medicine. Wilson was drawn to that specialty because she can do primary care but also deliver babies. She wants to build a practice focused on the needs of Black families.

“We code-switch. Being able to be that comfortable with your patient, I think it’s important when building a long-term relationship with them,” Wilson said.

“Being able to relax and talk to my patient as if they are family — I think being able to do that really builds on the relationship, especially makes a patient want to come back another time and be like, ‘I really like that doctor.'”

She said she hopes her work will inspire the next generation of Black doctors.

“I didn’t have a Black doctor growing up,” Wilson said. “I’m kind of paving the way for other little Black girls that look like me, that want to be a doctor. I can let them know it’s possible.”

This story is part of a partnership that includes , and .

This <a target="_blank" href="/health-industry/black-obstetricians-racism-health-care/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“Being a full-time musician means you have three other side jobs, you know?” he says.

James moved to Austin about eight years ago and got health insurance for the first time this year. He pays $22 a month, after the $200 subsidy he gets through the Affordable Care Act. Even that is a lot, because he earns only $15,000 a year. He gets help paying his monthly premium through a local nonprofit.

“We still have to worry about counting the quarters and the pennies when we leave these venues,” he says. Health insurance doesn’t come easily.

Austin thrives on its as the live music capital of the world and is making far more than quarters and pennies from music. The city the commercial music industry pumps $1.6 billion into the local economy every year.

But Austin has a lot of people like James struggling to afford life here.

“A lot of people didn’t understand just how dire that situation is,” says Nikki Rowling, the founder and CEO of the . “We have hard data that shows it.”

The Titan Music Group recently conducted a large survey and several focus groups of musicians in Austin; it produced the for the city. The census found that 20 percent of Austin musicians live below the . More than 50 percent qualify for federal housing subsidies, and nearly 19 percent lack health insurance.

A lot of Austin musicians rely on the for help.

“Close to 60 percent of our membership doesn’t even qualify for the subsidies that are given through the Affordable Care Act,” says Reenie Collins, the alliance’s executive director. And Texas didn’t expand Medicaid, which would have helped those musicians below the poverty line.

Her organization helps in two ways. This year, HAAM gave Kalu James and about 300 others money to afford their premiums for plans bought on the exchange. It also coordinates low-cost health care for about 2,000 members every year. It partners with doctors and hospitals to give these musicians medical, dental, vision, hearing and mental health care.

Backstage at the Moody Theater, dobro player is getting ready to go onstage.

“Travel anywhere in the United States,” Caven says, “you tell them you’re from Austin, [and] they almost always say, ‘Austin City Limits,’ you know? This is very much the identity. And if we lost that, we’d just be another up-and-coming city with no personality.”

Caven is an executive at the Seton hospital network, an organization that partners with HAAM. He is also a physician and treated musicians in Austin for almost 20 years. Caven’s band, , is performing at a local “battle of the bands” to raise money for HAAM.

“Some people feel like you just ought to work hard enough to have health insurance,” he says. “But working in a safety-net hospital, like I do, you see people that come in. They’re working really hard — working sometimes two and three jobs to support their family.”

Thanks to fundraisers and other private donations, HAAM’s Collins plans to triple the number of musicians who will get help with their premiums next year. She’s also a passionate advocate of Medicaid expansion, which would help many musicians in Austin.

“Many, many people think, ‘Oh, HAAM’s not needed anymore.’ Well, that’s not really true,” she says, “because Texas did not expand Medicaid.”

While more people since the rollout of the exchanges, Texas still has the highest uninsured rate in the country — about 17 percent.

This story is part of a partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/insurance/musicians-struggle-to-buy-insurance-in-a-city-that-thrives-on-music/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

The disease is preventable, though, due to vaccines and effective treatments for conditions that can precede the cancer. That’s why health care workers and even the World Health Organization are focusing on Miami’s Little Haiti to try to save lives.

The rate of cervical cancer in Little Haiti is 38 per 100,000 people — more than four times Florida’s overall rate, 8 per 100,000, according to a in July 2018.

One of the authors, , the associate director for population sciences and cancer disparity at the University of Miami’s Sylvester Comprehensive Cancer Center, came up with the idea to bring HPV testing to areas of Miami-Dade County where women are less likely to get regular screenings for cervical cancer at a gynecologist’s office. Human papillomavirus is thought to be responsible for .

Kobetz’s work and that of her colleagues, using a recreational vehicle dubbed , grabbed the attention of the WHO. The international health organization announced in August 2020: to eliminate cervical cancer by encouraging countries to get 90% of girls fully vaccinated with the HPV vaccine by age 15; to have 70% of women screened for HPV by age 35 and again by age 45; and to treat 90% of women with pre-cancerous conditions. The WHO believes cervical cancer can be eliminated within the next century if countries meet those targets by 2030.

In Miami, the WHO is relying in large part on public health infrastructure already in place, including the effort initiated by Kobetz. In Little Haiti, this work is happening at a medical clinic called the Center for Haitian Studies, located on a commercial street in the rapidly gentrifying immigrant neighborhood.

On the outside of the building, “CHS-Health” is written in big blue letters. A few small convenience stores and a tax service business are nearby, but most surrounding shops are clothing boutiques and hip cafes or restaurants.

On a weekday morning, the clinic’s street-facing windows filled the waiting area with sunlight, and community health worker Valentine Cesar struck up friendly conversations in Haitian Creole with patients as they waited.

The patients have an easy rapport with Cesar, who works for the University of Miami’s Sylvester center. At the Center for Haitian Studies, she teaches people about preventing cervical cancer by focusing on HPV. Specifically, Cesar shows women how to test themselves using a kit she hands out at the clinic. “We have a little jar, and this is a cotton swab,” she said.

The process isn’t much different from using a tampon and is certainly easier than getting a pelvic exam, which is the other way to test for HPV. Self-collected samples are sent to a lab. If the results are positive, Cesar deploys her considerable people skills as she delivers the news.

She acknowledges the panic that comes when she tells people they have HPV. “We explain to them that the fact that you’re HPV-positive, that doesn’t mean that you have cancer,” she said.

It does mean that a woman needs to be vigilant about her health, though, and needs to be monitored for cancer, pre-cancerous conditions, and other problems that can be caused by HPV. Cesar and her colleagues will encourage HPV-positive patients to get care at the Center for Haitian Studies or other federally qualified health centers. The clinic is the Sylvester center’s primary referral partner in Little Haiti because of the cultural and linguistic competence of the staff.

The Sylvester center’s Game Changer vehicle supports the Little Haiti clinic’s education efforts and parks behind it on scheduled days. On other days, the vehicle brings a similar message to different communities in Miami.

“We’re able to promote our services through our various community health workers that go out and talk about what we do, hand out flyers, and have educational materials,” said , the former director of the Sylvester center’s Office of Outreach and Engagement. “All of that helps us to bring about knowledge and awareness about our services and what we do.”

On a tour of the Game Changer vehicle, Trevil pointed out the video on HPV that was playing and pamphlets that people can use to learn about the virus. The vehicle has a main area with space for sitting, as well as areas for private exams or consultations.

Trevil understands why Haitian women sometimes avoid seeing a doctor. “They have the belief, ‘If I’m going to the physician’s, I’m going to find out some bad news,’” Trevil said. “‘I would rather not go.’”

As health educators, Trevil and Cesar try to talk people out of this avoidance motivated by fear.

Trevil says research shows the self-tests for HPV can help more women accept other tests that benefit their reproductive health. “So we started to use this test as a way to address some of the sensitivities and some of the reluctance in women to actually have a Pap test done,” Trevil said.

Patient Nicole Daceus took a self-test for HPV this year after noticing the Game Changer vehicle and the Sylvester center’s name on it. Health fears are not the only hurdle, Daceus said. “People avoid the doctor if they don’t have health insurance or their immigration papers,” Daceus said.

No one at the clinic will ask patients about their immigration status, though, something Cesar and Trevil try to make sure patients know.

Sylvester center staffers educate mothers about this to encourage them to get their young teenagers vaccinated against HPV. The vaccines for children are given inside another RV, parked a few feet from the Game Changer — the University of Miami’s pediatric mobile clinic. It focuses on care for uninsured children and sets up near public schools, houses of worship, and community centers.

“We work in tandem with one another because the mobile clinic is able to provide vaccines, and this way we can make HPV prevention a family affair,” Kobetz said. “Age-eligible boys and girls can get vaccinated.”

Richard Freeman, who works in the WHO’s office of the director-general, visited the vehicles behind the Center for Haitian Studies earlier this year. Freeman said this work is vital to the WHO’s global effort to end cervical cancer. No one, Freeman added, should die from a disease that tests and vaccines can prevent.

“Cervical cancer is the one cancer that we can actually eliminate,” Freeman said. “We have the tools, and all it is is a choice of whether or not we’re going to put those tools into use. If we catch this cancer early and we detect it on time, it’s curable. And so we want to see all of these interventions coming, not just here in Miami. We want to see the supply of HPV vaccines also made available and also affordable in countries that have a higher burden of cervical cancer.”

This story is part of a partnership that includes ,  and KHN.

This <a target="_blank" href="/news/miami-little-haiti-joins-global-effort-to-end-cervical-cancer/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

In South Florida, when people want to find a Black physician, they often contact Adrienne Hibbert through her website, .

“There are a lot of Black networks that are behind the scenes,” said Hibbert, who runs her own marketing firm. “I don’t want them to be behind the scenes, so I’m bringing it to the forefront.”

Hibbert said she got the idea for the website after she gave birth to her son 15 years ago.

Her obstetrician was white, and the suburban hospital outside Miami didn’t feel welcoming to Hibbert as a Black woman pregnant with her first child.

“They had no singular photos of a Black woman and her Black child,” Hibbert said. “I want someone who understands my background. I want someone who understands the foods that I eat. I want someone who understands my upbringing and things that my grandma used to tell me.”

In addition to shared culture and values, a Black physician can offer Black patients a sense of safety, validation and trust. Research has shown that racism, discrimination and unconscious bias continue to plague the U.S. health care system and can cause of racial and ethnic minorities.

Black patients have had their complaints and symptoms dismissed and their pain , and they are for specialty care. Older Black Americans can still remember when some areas of the country had segregated hospitals and clinics, not to mention profoundly unethical medical failures and abuses, such as the 40-year-long .

But even today, Black patients say, too many clinicians can be dismissive, condescending or impatient — which does little to repair trust. Some Black patients would prefer to work with Black doctors for their care, if they could find any.

Hibbert is working on turning her website into a more comprehensive, searchable directory. She said the most sought-after specialist is the obstetrician-gynecologist: “Oh, my gosh, the No. 1 call that I get is [for] a Black OB-GYN.”

For Black women, the impact of systemic racism can show up starkly in childbirth. They are as likely to die after giving birth as white women in the United States.

is a Black OB-GYN at Jackson North Medical Center in North Miami Beach, Florida. He said he understands some women’s preference for a Black OB-GYN but said that can’t be the only answer: “If every Black woman wanted to have a Black physician, it would be virtually impossible. The numbers are not there.”

And it’s also not simply a matter of recruiting more Black students to the fields of medicine and nursing, he said, though that would help. He wants systemic change, which means medical schools need to teach all students — no matter their race, culture or background — to treat patients with respect and dignity. In other words, as they themselves want to be treated.

“The golden rule says, ‘Do unto others as you would have them do unto you,’ so that the heart of a doctor needs to be that kind of heart where you are taking care of folks the way you would want to be treated or want your family treated,” he said.

George Floyd’s murder in Minneapolis in May 2020, and the subsequent wave of protests and activism, prompted corporations, universities, nonprofits and other American institutions to reassess their own history and policies regarding race. Medical schools were no exception. In September, the University of Miami Miller School of Medicine revamped its four-year curriculum to anti-racism training.

New training also became part of the curriculum at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton, where students are being taught to ask patients about their history and experiences in addition to their bodily health. The new questions might include: “Have you ever felt discriminated against?” or “Do you feel safe communicating your needs?”

“Different things that were questions that we maybe never historically asked, but we need to start asking,” said , senior associate dean for medical education at Florida Atlantic.

The medical students start learning about racism in health care during their first year, and as they go, they also learn how to communicate with patients from various cultures and backgrounds, Wood added.

These changes come after decades of racist teaching in medical schools across the United States. Adams, the OB-GYN, completed his residency in Atlanta in the early 1980s. He recalls being taught that if a Black woman came to the doctor or hospital with pain in her pelvis, “the assumption was that it was likely to be a sexually transmitted disease, something we refer to as PID, pelvic inflammatory disease. The typical causes there are gonorrhea and/or chlamydia.”

This initial assumption was in line with a racist view about Black women’s sexual activity — a presumption that white women were spared. “If the same symptoms were presented by a Caucasian, a white young woman, the assumption would be not an STD, but endometriosis,” Adams said. Endometriosis is not sexually transmitted and is therefore less stigmatizing, less tied to the patient’s behavior.

That diagnostic rule of thumb is no longer taught, but doctors can still bring unconscious racial bias to their patient encounters, Adams said.

While they revamp their curricula, medical schools are also trying to increase diversity within their student ranks. Florida Atlantic’s Schmidt College of Medicine set up, in 2012, a , the state’s historically Black university. Undergraduates who want to become doctors are mentored as they complete their pre-med studies, and those who hit certain benchmarks are admitted to Schmidt after they graduate.

Dr. Michelle Wilson took that route and graduated from Schmidt this spring. She’s headed to Phoebe Putney Memorial Hospital in Albany, Georgia, for a residency in family medicine. Wilson was drawn to that specialty because she can do primary care but also deliver babies. She wants to build a practice focused on the needs of Black families.

“We code-switch. Being able to be that comfortable with your patient, I think it’s important when building a long-term relationship with them,” Wilson said.

“Being able to relax and talk to my patient as if they are family — I think being able to do that really builds on the relationship, especially makes a patient want to come back another time and be like, ‘I really like that doctor.'”

She said she hopes her work will inspire the next generation of Black doctors.

“I didn’t have a Black doctor growing up,” Wilson said. “I’m kind of paving the way for other little Black girls that look like me, that want to be a doctor. I can let them know it’s possible.”

This story is part of a partnership that includes , and .

This <a target="_blank" href="/health-industry/black-obstetricians-racism-health-care/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“Being a full-time musician means you have three other side jobs, you know?” he says.

James moved to Austin about eight years ago and got health insurance for the first time this year. He pays $22 a month, after the $200 subsidy he gets through the Affordable Care Act. Even that is a lot, because he earns only $15,000 a year. He gets help paying his monthly premium through a local nonprofit.

“We still have to worry about counting the quarters and the pennies when we leave these venues,” he says. Health insurance doesn’t come easily.

Austin thrives on its as the live music capital of the world and is making far more than quarters and pennies from music. The city the commercial music industry pumps $1.6 billion into the local economy every year.

But Austin has a lot of people like James struggling to afford life here.

“A lot of people didn’t understand just how dire that situation is,” says Nikki Rowling, the founder and CEO of the . “We have hard data that shows it.”

The Titan Music Group recently conducted a large survey and several focus groups of musicians in Austin; it produced the for the city. The census found that 20 percent of Austin musicians live below the . More than 50 percent qualify for federal housing subsidies, and nearly 19 percent lack health insurance.

A lot of Austin musicians rely on the for help.

“Close to 60 percent of our membership doesn’t even qualify for the subsidies that are given through the Affordable Care Act,” says Reenie Collins, the alliance’s executive director. And Texas didn’t expand Medicaid, which would have helped those musicians below the poverty line.

Her organization helps in two ways. This year, HAAM gave Kalu James and about 300 others money to afford their premiums for plans bought on the exchange. It also coordinates low-cost health care for about 2,000 members every year. It partners with doctors and hospitals to give these musicians medical, dental, vision, hearing and mental health care.

Backstage at the Moody Theater, dobro player is getting ready to go onstage.

“Travel anywhere in the United States,” Caven says, “you tell them you’re from Austin, [and] they almost always say, ‘Austin City Limits,’ you know? This is very much the identity. And if we lost that, we’d just be another up-and-coming city with no personality.”

Caven is an executive at the Seton hospital network, an organization that partners with HAAM. He is also a physician and treated musicians in Austin for almost 20 years. Caven’s band, , is performing at a local “battle of the bands” to raise money for HAAM.

“Some people feel like you just ought to work hard enough to have health insurance,” he says. “But working in a safety-net hospital, like I do, you see people that come in. They’re working really hard — working sometimes two and three jobs to support their family.”

Thanks to fundraisers and other private donations, HAAM’s Collins plans to triple the number of musicians who will get help with their premiums next year. She’s also a passionate advocate of Medicaid expansion, which would help many musicians in Austin.

“Many, many people think, ‘Oh, HAAM’s not needed anymore.’ Well, that’s not really true,” she says, “because Texas did not expand Medicaid.”

While more people since the rollout of the exchanges, Texas still has the highest uninsured rate in the country — about 17 percent.

This story is part of a partnership that includes , and Kaiser Health News.

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