Women's Health Matters

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Black Women's Health

In March, our guest expert in Le Club's Ask the Expert segment was Dr. Josephine Etowa, PhD, RN, RM, faculty member at Dalhousie University School of Nursing, in Halifax, NS.

Dr. Etowa's employment history spans across international, diversity and community development issues.

She has diverse midwifery and nursing background, which dates back to her career as a midwife and a Public Health nurse in Nigeria. In Canada, Dr. Etowa has worked in a number of capacities including as a nurse, an educator, a lactation consultant and a community-based and academic researcher. As a founding member and past chair of the Health Association of African Canadians (HAAC), she has been involved in a number of community development initiatives to advance the mandate of the organization, which evolves around improving the current status of knowledge about African Canadians.

Over the past few years, Dr. Etowa has worked on a number of research projects addressing African Canadians' health issues. These include: a participatory action research on the childbirth experiences of African Canadian women; a synthesis research on Black women's health; a capacity building project on immigrant women's health; a Black women's health research in remote and rural NS communities; and an exploration of issues of sexual identity and sexual health of African Nova Scotians living with breast or prostate cancer.

She has recently completed a three-year project, which examined menopause and the midlife health of African Canadian women living in Nova Scotia. Her doctoral dissertation examined the worklife experiences of Black nurses, and the need to increase diversity within health care.

Here are Dr. Etowa's answers to your questions about Black Women's Health:

Q: Why is it that muscle enzymes (CK) are high in people of African descent?

A: Greater activity of creatine kinase (CK) reported in skeletal muscle of Black untrained individuals has been reported to be almost twice the activity found in white people. Strenuous exercise has been associated with an increase in the circulating level of CK.

These enzymes increase the cell's capacity to function under high demands. Generally, well-trained athletes have a lower level of CK as compared to untrained individuals. However, it is not currently known why the muscle enzyme activity is higher in people of African descent.


Q: How does racism impact black women's health?

A: There are numerous examples of how racism impacts on Black women's health including: access to health services; access to healthy environments (social, physical, economical, etc.); and the stress of everyday racism, sexism - and often - poverty. All three of these latter factors are major determinants of health.

Black women face health struggles in an environment of ignorance. Little is known about the health of Black women, except that they tend not to access medical health services for preventive or chronic care.

Black women face cultural insensitivity and lack of understanding by health professionals. Racism involves attitudes, practices and other factors that disadvantage people because of their race, colour or ethnicity. Some forms of racism are obvious, but are ignored because people do not know how to deal with them.

Other forms of racism, such as discrimination in policies, are less obvious. These more subtle forms of racism disadvantage members of certain races, whether intentionally or not.

Racism is a determinant of health - not only through its direct effects on individual, family and community health and well being - but also through systemic, institutional and individual racism, and a simple lack of health professional cultural competence.

Individual racism takes the form of individual attitudes, beliefs, values and behaviours such as prejudice, bigotry, belittling, stereotyping and jealousy. Systemic racism takes the form of the practices, customs, rules and standards of organizations - including governments - that unnecessarily disadvantage people because of their race, colour or ethnicity.

These interlocking expressions of racism and lack of cultural competence are experienced by Black women in health care policy, programming and professional practice, as well as research.

In fact, race or visible minority status is proven to be a principal determinant of access to social status and resources, personal identity and mortality and morbidity in North America.

This fact is consistent with a sociological tradition that names social inequality as the primary source of vastly different distributions of health and well-being.

Although racism has been a long-standing preoccupation in political, ethical and social science discourse, health researchers have only recently begun to investigate its effects on the individual's well-being.

Disadvantaged class background, inadequate income, and unemployment - all consequences of systemic racism - are also determinants of health that have significant impact on the lives of Black women.

The consequences of gender oppression cannot be separated from racism, nor from economic disadvantage. Nevertheless, gender oppression continues to exist in systemic, institutional, and individual practices - all of which have a significant impact on health and well being.


Q: Dr. Etowa, I am a Black Jamaican woman, and my question is: Why are black people prone to Keloid? I have had a couple surgeries, and each time after the healing process I develop Keloid.

A: No one knows exactly why keloids form, but they tend to run in families, suggesting a genetic link. What is known is that keloids can develop after any kind of injury or trauma to the skin - surgery, cuts, scrapes, burns, severe acne, vaccinations, infections and even insect bites.

Sometimes as our skin heals, instead of just the right amount of replacement tissue forming around an injury site, the tissue continues to grow and grow. This "overhealing" can result in the raised scars that are more common in people of African and Asian descent than in Caucasians. The raised scars are referred to as keloids. A keloid is abnormal because the scar extends above and beyond the site of the original injury. Normal scars stay confined to the site of injury.

There is no one truly effective treatment for keloids, so its management remains controversial. They may be reduced in size through a corticosteroid injection or application of topical retinoids, or removed by freezing with liquid nitrogen (cryosurgery).

However, new keloids often develop at the site of the treatment. Simple surgical excision and closure can cause a re-occurrence of the problem in approximately 50 percent of individuals. Keloids can be reduced in size by applying a sheet of silicon gel over the growth.

Keloids that are disfiguring because of location and colour may be improved through pulse dye laser treatment. Recent evidence shows promise for a combination of four management strategies; surgical excision, followed with triamcinolone acetaonide injection to the surgical site during the second week of the operation. Slight pressure and silicone gel are then applied for four months. Only one out of nine people had keloid recurrence in the study that used this combination method.


Q: I am a student working on a term paper related to Black women. Where can I find more research information about the health of Black women?

A: The thing that works best for me is to first use the Google search engine for "research information about the health of Black women". This gives some useful websites with links to sites that provide information on Black women's Health issues such as: www.blackwomenshealth.org.

In addition, it would be a good idea to visit the library and speak to the librarian regarding available databases and search engines. This is especially useful if you are looking for published peer-reviewed research.


Q: Are there any trans-cultural differences in Black women's experiences of menopause?

A: Menopause is a natural part of aging involving the cessation of menses. It marks the end of our reproductive years and the beginning of our non-reproductive years. The physiological and physical changes that occur during this transition period are complex. All women experience this complex process of menopause. Although a universal and biological process, every woman's experiences are unique.

Our biological processes are affected by our minds to some degree. Menopause involves a body-mind connection that results in us experiencing physical and emotional changes simultaneously.

The mind/body changes we undergo do not evolve in a vacuum. Our history, culture, geography, social class, race, ethnicity, age, and personal experiences often shape them.

Thus, the meaning of menopause is culturally determined for different women.

Attitudes and feelings towards menopause vary across cultures. Women from one ethno-cultural group may have more positive menopause experiences than some from another group.

Many women who grow up in western society are pressured to feel they must live up to well-defined ideals of youth and beauty. We are often afraid of getting old because we think we will lose others' respect, be looked down upon, and be seen as individuals with little social worth.

In some cultures, such as indigenous cultures, age is venerated and older women are sought out for their wisdom. Menopause is perceived quite differently in cultures where a woman's years of aging are seen as "golden years of deference and respect."


Q: What are the major causes of depression among black women?

A: Women are twice as likely to suffer from depression as men, and the rate of depression among Black women is almost 50 percent higher than among their White counterparts.

Depression is typically not about just one thing, but rather, many things, or as described by one woman in my study - "zillions of things." It often constitutes a "chain reaction" of life circumstances, and emotional and physical changes, taking place in Black women's lives.

Difficult life circumstances, such as the death of a loved one, concern for family members, work-related stress, racism and unresolved conflicts from the past have all been associated with depression. The biological changes in depression include changes in the brain chemistry and hormone secretion.

When certain brain chemicals (neurotransmitters) go awry, they affect an individual's moods, thoughts, body functions and behaviour in challenging ways. Some people have inherited vulnerability to the condition. The interplay of these life circumstances may compound women's feelings of being "blue," or "down," and result in depression when it goes beyond the normal human responses to temporary sadness.

Depression is not widely discussed or understood among Black women - some believe it is not a topic of daily conversation because Black women are too busy coping with survival to deal with emotional issues.

Others suggest the topic is avoided because of the fear of it being labeled as a "mental illness" and the taboo associated with that label.

Women use the word "depression" to describe a wide variety of occasions when they feel "something's wrong," when they feel self-doubt, "can't let go of things," are unhappy, sad, overwhelmed, lonely, or blue.

In addition, Black women often feel that acknowledging depression may be seen as a sign of weakness, when we as women - and especially as Black women - are just not meant to "fall apart." We are supposed to be "strong" for everyone and everything!


Q: I read recently that, according to the American Heart Association, the risk of dying before the age 60 from either heart disease or stroke is four times higher for Black women than it is for White women. Should black women in Canada also be concerned?

A: Black women in Canada should be concerned. Not only should we be concerned by the statistics reported in the US but also we should be concerned that we currently have no such data in Canada. We therefore do not know if the situation here is better, worse, or the same. This is true for other major health conditions such as diabetes, obesity, kidney disease, arthritis, lupus, breast cancer and high blood pressure leading to stroke and heart disease.


Q: Is the 'Strong Black Woman" a myth or a reality?

A: Black women are often caught in the tradition of being "Strong Black Women," and taking care of others - children, grandchildren, parents, grandparents, spouses, extended family, community members, and colleagues - at the expense of looking after themselves.

In one of my recent studies, Black women were ambivalent about the ideological construct of the "Strong Black woman" which has perpetuated the notion that Black women have limitless strength and can "endure all."

Both those who viewed this notion as a "myth" and those who saw it as a "reality" agreed that the external and self-imposed expectations they felt to be the pillars of family and community have resulted in a negative impact on them.

Historically, Black women, unlike many of their cross-cultural contemporaries, have had to work just as hard as their men, take care of their and other peoples' children, and find a way to impact the struggle for the entire race. They have had a history and a present that have made them question their worth while simultaneously trying to provide their children with a reason and the tools to live. Theirs has been a quest for survival in the face of what seemed like, and often were insurmountable odds but many triumphed and lived to tell about it.

What they told however, was a story that did not speak about the pain and the suffering they endured. They did not speak about the sexism and the patriarchy that existed in their worlds. The focus of their battle was to be viewed as women and to be found worthy as mothers and as wives.

In their attempt to salvage what was left of their respect for themselves, Black women utilized the one somewhat positive myth constructed by the White elite to define themselves.

The anger arising out of stress and the burden of expectations finds voice in a widely distributed article, which declares "The Strong Black Woman is dead!" Here is an excerpt:

While struggling with the reality of being a human instead of a myth, the strong black woman passed away. . . she died from: being silent when she should have been screaming . . . being sick and not wanting anyone to know because her pain might inconvenience them. . . She died from hiding her real feelings until they became monstrously hard and bitter enough to invade her womb and breasts like angry tumors. . . . She died from being misinformed about her mind, her body and the extent of her royal capabilities. . . . Sometimes, she was stomped to death by racism and sexism, executed by hi-tech ignorance while she carried the family in her belly, the community on her head, and the race on her back.


Q: I wonder whether you have any knowledge about how you could assist Black women and other women of colour in preventing diabetes. Studies have shown that diabetes is common in these communities, and it gets more complicated when a woman is pregnant.

A: Black women have less access to health-care services and to resources for self-education. In order to assist women with the prevention of health conditions such as diabetes, there must be an element of education. And in order to provide relevant educational material health care providers must be informed.

Any program that facilitates health promotion and prevention strategies requires that information on the health status of Black women - and indeed all women of colour - be known. This will inform health service planners and health educators about the needs of the members of these communities as well as provide information on progress as it is made in any educational initiatives.

At the individual level, Black women need to maintain a healthy lifestyle and address risk factors such as smoking, drinking and being overweight. They need to exercise regularly, follow a well-balanced diet and visit their health care professional regularly, especially if they have a family history of diabetes.


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