John A. Rich: Black men, trauma, and nonviolence

Now that I’m out of grad school and back in the workforce, I can appreciate the unique public health perspective that Drexel’s School of Public Health imparts upon its students. Other schools don’t focus as heavily on health disparities, trauma, and adverse childhood experiences. One of the reasons these issues are at the center of Drexel’s philosophy is because of the presence of the Center for Nonviolence and Social Justice, headed by John A. Rich, MD, MPH. John Rich, director of the Center for Nonviolence and Social Justice

Dr. Rich grew up in a middle-class home--his mother was a teacher and his father was a dentist. After completing his undergraduate degree at Dartmouth and earning his MD at Duke, he became an emergency room doctor at Boston City Hospital.

While at Boston City Hospital, Rich saw a steady stream of young Black men come through the emergency room with stabbing and gunshot wounds. He also began to realize that everyone, including the other medical staff, saw these men as perpetrators rather than victims. The general consensus was that these men had done something to get themselves injured instead of what was obvious to Rich: these young Black men were truly victims.

Because of his compassionate streak, Rich began interviewing these men to learn more about their lives and what led to them returning to the ER over and over. He learned that the injuries that brought them to him were often due events outside their control--a robbery, a few wrong words to the wrong person, a simple accident that escalated to violence. After talking with them as they received treatment, Rich realized that the men were suffering from post-traumatic stress syndrome. Even worse, their injuries were stitched up and they were sent right back out to the same environment that brought them to the ER.

Rich wrote a book about these experiences called Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men. I read this book as part of a class I took with Sandra Bloom (who works closely with Rich). Reading it was easily the most emotionally moving and motivating activity I participated in at Drexel.

In 2006, Rich was awarded a MacArthur Fellowship for his work:

John Rich is a physician, scholar, and a leader in addressing the health care needs of one of the nation’s most ignored and underserved populations—African-American men in urban settings. By linking economic health, mental health, and educational and employment opportunities to physical well-being, Rich’s work on black men’s health is influencing policy discussions and health practice throughout the United States...By focusing on the realities of the lives of young African-American men, John Rich designs new models of health care that stretch across the boundaries of public health, education, social service, and justice systems to engage young men in caring for themselves and their peers.

Now, Rich is a professor and head of the Health Management and Policy department at Drexel University School of Public Health. He is also the director and founder of the Center for Nonviolence and Social Justice, a non-profit dedicated to applying principles of non-violence and trauma-informed care to public health practice and evaluating the results of the programs that embody those values.

While I was completing my MPH, I unfortunately did not work with Rich--in fact I'm not sure I ever even met him. However, I had the good fortune of having Dr. Jonathan Purtle, who worked closely with him and others at the Center, as my academic advisor. Honestly: reading Rich’s book and working closely with his colleagues changed the way I understand public health, and, frankly, myself and the world around me.

John Rich has changed the way we understand urban Black men’s health. As the gospel of trauma-informed care spreads throughout public health, medicine, and public policy, I hope we will see a more compassionate view of Black men radiate throughout these institutions. We know that what we’ve been doing for these men hasn’t been working--and John Rich has shown us how to make changes that will actually help.

The HIV Breakthrough, Prenatal Care, and Hope for the Future

On Sunday, news quickly spread that a young child in Mississippi had been cured of HIV. As a newborn, the child tested positive for HIV and the specialist, Dr. Hanna Gay, administered a high dosage of drugs within hours of the child’s birth. After continuing on antiretrovirals for about a year, the child and mother stopped treatment. When they resurfaced months later, the mother stated she had continued the child’s treatment. Surprisingly, the child’s HIV test came back negative. A series of increasingly sensitive tests showed the virus was undetectable. This discovery could overhaul the way mother-to-child (also known as perinatal) transmission is treated. If the results are reproducible, the drug dosage and combination has the potential to stop the 300,000 cases of HIV in newborns reported annually worldwide. What’s unique about this case is that the mother received no prenatal care prior to entering the hospital in labor. Generally, pregnant women with HIV require special treatment considerations in order to prevent mother-to-child transmission. Doctors and expectant mothers weigh the costs and benefits of continuing treatment, keeping in mind that transmission does not usually occur until late in pregnancy or during delivery. This mother and child enjoyed none of the protections of drug treatment until after the birth of the child—and yet they are the center of one of the most promising HIV breakthroughs.

About 25% of infants born to mothers who do not take AZT and other drugs during pregnancy will be infected with HIV. But if the mother undergoes treatment while pregnant, only 2% of newborns will be test positive. Now, with the possibility of mega doses of drugs after birth reducing infection rates even more, we may be working toward eliminating mother-to-child transmission altogether.

Prenatal care is crucial. But in Mississippi, where the child was born, the Kaiser Family Foundation reports that women of color who give birth in the state are far less likely to receive prenatal care until late in their pregnancy or until they go into labor.

Lack of care until late in pregnancy or lack of prenatal care altogether is highest in American Indian (27.8%) and black mothers (22.8%), followed by Hispanic (23.0%) and Asian mothers (14.1%). Compared to the 9.1% of white women who go without care until their child is close to full-term, the inequity is disheartening. And the numbers are not unique to Mississippi. These prenatal care patterns are consistent with the patterns of the country at large. Paired with the CDC’s findings that black women have the highest rate of mother-to-child infection (9.9 per 100,000 births), ethnic and racial disparities in prenatal care matter.

This possible turning point in treatment means that even if an expectant HIV-positive mother receives no prenatal care and gives birth to an HIV-positive child, the child may have a fighting chance to live HIV free. We know that ethnic and racial minority women do not receive prenatal care at the same rates as white women. This potential new treatment option gives hope that HIV-positive women who do not receive prenatal care—women who are disproportionately from ethnic and racial minority groups—may be able see their children live HIV-free.