Jul 23, 20205 min read

Listening and Learning: Systemic Racism, Racial and Sexual Disparities in Women’s Health

Part 4: Historical Power Imbalances in Puerto Rican Healthcare and How they Concern Biomedical Engineers

By Erica Skerrett

In the mid 1900’s, American researchers sterilized one third of women in the Puerto Rican archipiélago, mostly while experimenting with dangerously high doses of the precursor to the birth control pill without proper consent. Although my family has lived in Puerto Rico for hundreds of years, I didn’t learn of these experiments until I was 26 years old and came across them in the caption of a painting by Amanda Graciela Torres Rodriguez at the (In)visible Organ exhibit. For a while after that, my existence seemed aleatoric — in the hands of past American researchers who viewed Puerto Ricans, Latinxs, and the poor as (in the words of Margarent Sanger) “undesirable” and therefore prime subjects to use for medical experimentation.

The pieces made are framed within a specific colonial context. In the early 1960s, efforts were made to promote contraception in women. This medical technology was first experienced in Puerto Rico, having a serious impact on the female population on the island. The piece is titled “enovid” which in turn alludes to the name of the tablet four times more powerful than the one that was later introduced to the market. The pill was a foreigh insertion in the body of the woman for the purpose of reproductive control which in many cases was not a consequence the woman was informed of. The monotype technique used in this piece is analogous to the mass production of the anti-contraceptive pill. The monotype is a hybrid technique between engraving and painting that offers an image without the need for a matrix. In this technique, the result is unique in its qualities, thus creating an image that is never equally reproducible. The result of this experimentation was the sterilization of more than a third of the women in Puerto Rico. -Amanda Graciela Torres Rodriguez

Stories like this one, and that of Marion J. Sims described in Part 1 of this blog series, highlight instrumental moments in the history of gynecology — moments in which the bodies of Blacks, Indigenous, Latinxs, and the poor are assaulted in the name of technological and medical advancement. Fast-forward to the 21st Century, and we see that those very same bodies are the least likely to receive the benefits of medical breakthroughs due to past and present-day race and class discrimination. For example, Black Americans have the highest mortality rates from cervical cancer despite our scientific knowledge of cervical-cancer stemming from the stolen cell line of Henrietta Lacks.

Henrietta Lacks | © Amanda Suarez | Amanda Suarez | Image from: theculturetrip.com

I’ve always been interested in helping to address discrepancies in diseases and in exploring both their biological etiology as well as the biotechnology used for their treatment. After undergrad, I worked as a biomedical engineer in a maternity ward in Malawi, and I found myself troubleshooting problems with the use of syringe pump, which were about disparities in medicine supplies in regional and central clinics, which were about distribution problems to Central Medical Supplies, which were connected to potential corruption charges, which were about maintaining access to international aid, which was about hundreds of years of colonization and exploitation. My engineering-focused mind was ripped open and the cracks were filled with an interest in learning about histories of exploitation and how they have created present-day health disparities. In Malawi I also witnessed how the invention and implementation of new diagnostic technology, such as rapid point-of-care test strips, could help expand access to care. I decided to attend grad school to work on the development of new technologies that could be used to reimagine bodily autonomy and healthcare access. I remember as an undergrad that I wanted my research to be apolitical, but I came to realize that ignoring politics is a luxury that allows for the continued suppression of marginalized people.

In addition to taking classes in optics and programming, I spent my first year of graduate school diving into podcasts that helped me contextualize my biomedical work. I learned from No White Saviors, an advocacy group based in Uganda who highlighted recent news stories such as that of Renee Bach. Bach is an American missionary who provided medical care to children in Uganda despite having no qualifications to do so. Although many children died under her care, she returned to the U.S. and is defended by others at her non-profit. Hearing this recent story where Western perpetrators are not held responsible for the havoc they wreak on the lives of mothers and children is a reminder of the current power imbalance that exists in global health work today.

Snapshots from No White Savior’s Instagram

Just this past weekend while listening to NPR’s Throughline, I learned of another tragedy in Puerto Rico involving experimentation by U.S. medical doctors. The podcast episode describes how, in 1931, Dr. Cornelius Rhodes went to Puerto Rico to study the widespread anemia and advance his name in the field of hematology. While there, he wrote a letter confessing to having killed several Puerto Ricans and purposefully infecting others with cancer. The discovery of this letter revealed the true nature of Puerto Rico’s relationship with the U.S. and helped give life to the rising movement for Puerto Rican independence. Healthcare cannot be apolitical, it is intertwined with imperialism, racism, homophobia, and sexism. If we as researchers are not constantly pushing against all of these forces, we risk becoming pawns to these systems of oppression.

Excerpt from the Cornelius Rhoads letter

Like Renee Bach, Cornelius Rhodes fled back to the continental US to continue his research. He worked with the American Empire to test mustard gas on Puerto Ricans off the coast of Panama, which helped lead to the development of chemotherapy drugs. In 1945, he was awarded with an appointment as director of the Sloan-Kettering Cancer Center, an institute that was founded by the same Alfred P. Sloan Foundation that today awards my diversity scholarship at Duke University.

Like it or not, every part of my own education and research is tangled into a history of suppression and violence against Black and minoritized bodies. By placing the current state of medicine and global health upon their true historical bedrocks, I see that my goal can’t just be to make it to the top of the academic ladder or to solve one or two health discrepancies, no matter how ethically I go about those tasks. My experience of learning about Puerto Rican birth control experiments at GWHT’s art exhibit, reminded me that I am fortunate to work for a center that supports my goal of democratizing healthcare by lifting up the stories and experiences of people often pushed to the margins.

This work is inherently rooted in systems of oppression, and as scientists we must to continually immerse ourselves in political conversations and movements centered on the reclamation of Black and trans bodies. We need to put in our time and money into the work of not just biomedical engineering, but also into building power through collective demands and actions to improve the material (and medical) realities of the most vulnerable if we want to truly improve domestic and global health.