Inequity can be traced as far back as the early 20th century, when Black doctors were not allowed to work in Tulsa’s hospitals

Registered nurse Darlene Reynolds was reminding one of her homebound patients to eat more fresh fruits and vegetables to get control of a diabetes diagnosis.

The patient lived in a north Tulsa ZIP code with one of the lowest life expectancies in the county. There are no grocery stores or walking trails near the home, and transportation is difficult due to other disabilities.

“She asked me, “Why do you keep talking about all this? I don’t have any fresh fruits or vegetables, and I can’t get them easily.’ I have canned food. This is what I have to survive. I eat what I have,’” Reynolds said.

Reynolds quickly changed course. She went to the pantry and showed how to reduce the sodium by pouring out the canned liquid and soaking food in tap water.

“What I learned was that I have to meet people where they are,” she said.

Those are the types of obstacles health care providers north of Admiral Boulevard face with their patients. The usual recommendations for leading more healthful lives are often out of reach or difficult to get for residents.

Tulsa’s historical inequities between north and south neighborhoods include provider access and health outcomes. The past 20 years have focused on improving a life expectancy gap, but it is stubbornly stuck at a decade less of life for those in north Tulsa.

This disparity tracks to the segregation of the early 20th century, when Black doctors and nurses were not allowed to work in Tulsa’s hospitals. In 1918, Frissell Memorial Hospital was built at 314 E. Brady St. for Black medical providers to serve Black residents.

The brick building near the bustling Black Wall Street was reduced to rubble and ash during the race massacre three years later. It was replaced with a makeshift clinic by the National Guard Armory for a day or two.

National Guard Maj. Paul Brown, a Tulsa doctor told management at Morningstar Hospital, predecessor to Hillcrest Medical Center, it would find room for Black patients. More than 60 Black patients were cared for in the basement. Shortly after, a nearby empty building was converted into the Cinnabar Hospital for Black patients.

The American Red Cross opened Maurice Willows Hospital later that year at 324 N. Hartford Ave., which evolved into Moton Memorial Hospital and now Morton Comprehensive Health Services.

Since then, the health care landscape in north Tulsa has mirrored the economic trends, with hospitals and private practices expanding to the south.

The perceived inequalities became factual with the release of a report from the University of Oklahoma-Tulsa showing a breakdown of life expectancy by ZIP codes in the county. Between 2000 and 2002, it found a nearly 14-year gap between the north 74126 ZIP code and the south 74137.

The alarming data touched off a flurry of projects to boost access to medical providers.

The Tulsa Health Department opened a $10 million North Regional Health Clinic; $15 million from a city tax package helped build the Morton Comprehensive Health Services building; and the $20 million OU Wayman Tisdale Specialty Health Clinic opened. The Westview Medical Center expanded; Crossover Health Services opened and investments were made to the Hutcherson YMCA.

By 2015, that gap narrowed to 11 years, according to a report from a partnership between the health department, OU-Tulsa and the George Kaiser Family Foundation.

Though a formal analysis hasn’t been conducted since then, indicators point to a persistence of this difference.

Tulsa Health Department Chief Operating Officer Reggie Ivey serves as chairman of a north Tulsa community coalition seeking to eliminate health disparities.

Ivey said clinical access accounts for about 10% of a community’s health. The bigger affects are in behavior (30%) with healthier food options and exercise opportunities and in neighborhood social and economic factors (40%) like low unemployment and high-performing schools.

“There was an intentional focus on bringing more medical providers to north Tulsa, which is a part of the work, but it’s not the only thing needed to improve the health of a community,” Ivey said.

The traditional health care model focuses on patient education, genetics and provider access. The coalition found that’s not enough.

“This frame of thinking does not work,” Ivey said. “Our approach now says we need to be more upstream in improving health outcomes where you have to focus on things such as classism, racism, sexism and immigrant bias. Because all of these ‘isms impact institutions, and they also impact neighborhood conditions and our schools.

“They impact our entire society, but oftentimes there is not a focus on those sorts of things because they are uncomfortable to talk about; they are uncomfortable to deal with. And it also causes those who are providing health care services and resources to have to look at their own biases.”

Simply, continued health disparities are from factors outside an exam room.

“The choices patients make are representative of the choices they have,” said Jabraan Pasha, M.D., a graduate of Booker T. Washington High School, who serves at OU-Tulsa School of Community Medicine as director of student recruitment and pipeline programs and as an associate program director for the internal medicine residency program.

Pasha has become an internationally sought speaker on implicit bias, approaching the subject from a scientific view in a positive light.

“We need to de-stigmatize it and recognize that implicit bias is normal and we all have it,” Pasha said. “It’s dictated by the way our brains work and evolve. It’s OK, and no one should feel ashamed or bad about it.”

Several recent studies — including those from Stanford University, University of Miami and Penn Medicine — have shown that Black patients have better outcomes with Black medical providers. Only 6% of medical school graduates nationally are Black.

Recruiting students from under-represented populations starts in elementary school, says Pasha. OU-Tulsa hosts several math- and science-related clubs and programs to generate interest in young students.

But much work must be done within the existing health care fields to break down bias. Pasha cites studies from countries with universal health care showing similar health disparities among race.

“That isn’t from health care access, but from other factors,” Pasha said.

Health care bias is what drove Nyitti Avington into the care of nurse practitioner Anita Williams, who owns the A&M Healthcare Clinic at Westview Medical Center, 3606 N. Martin Luther King Jr. Blvd.

Avington believes white health care providers were not listening or taking her seriously. She began avoiding health care unless it was an emergency. Through word-of-mouth, she heard about the practice at Westview, which has Black providers.

“I love the culture here,” Avington said. “I have other choices, but I come here. The first time I walked into the clinic, I felt relieved. … I can be honest without being judged or lectured or self-conscious.”

Williams, a McLain High School graduate, opened the clinic after feeling unfulfilled at other health care institutions. Part of the attraction to Westview was getting support from the clinic for the business side of the practice. She now has nine employees with plans to expand to an east clinic.

“I walked away from a six-figure salary because this is what God told me to do. And I love, love what I do now,” Williams said. “I thank God he allowed me to have my own practice. I had felt like patients were being treated like numbers. I wanted to make a difference.”

Williams doesn’t bring in a computer when she meets with patients in exam room. She doesn’t have a time limit.

“Patients will not come back if they are not treated with dignity and respect,” Williams said.

For better patient outcomes, providers ought to be interested in understanding bias, said Syeachia Dennis, M.D., the assistant dean for equity and community engagement and professor in the Department of Family and Community Medicine at OU.

“We are never going to have enough Black and brown physicians to treat all Black and brown people,” Dennis said. “So everybody has to learn; everybody had to learn cultural humility, understanding how to communicate with people and understanding some of the barriers to health equity.

“That is the responsibility of everybody who is in health care.”

The Tisdale clinic brought in specialists, added primary care and is re-launching a community advisory board. Dennis said all north Tulsa providers are grappling with having resources outside an exam room.

“Whether that is the food deserts, lack of jobs, unemployment or poor schools, all those social determinants of health a physician or clinician cannot directly impact,” Dennis said. “People in north Tulsa are facing challenges that don’t exist in south Tulsa.

“It’s multi-layered and has to do with access, social determinants and racism. All those things are why the disparities exist. It’s complicated, so the answer to that is multi-layered.”

The long-awaited Oasis Fresh Market at 1717 N. Peoria Ave. is expected to help with fresh food options. Exercise programs at the Hutcherson YMCA and newly installed bike trails are part of keeping people active.

Other community improvements are a rapid bus transit line, the Peoria-Mohawk Business Park at Peoria Avenue and 36th Street North and pockets of housing development. But, it’s far from a major transformation.

“We understand it’s not just a local problem but a national problem,” Ivey said. “This country intentionally structured its system to repeatedly exclude certain groups of people from full participation and representation based on race and ethnicity.”

Westview Medical Center business manager Brian Woodard said recruiting providers remains a challenge. The clinic added a pediatric practice in 2009 after Woodard couldn’t find a pediatrician for his own children.

“You can drive down Utica Avenue, and it’s doctor after doctor after doctor. You can drive down Memorial Drive and see rows of dentists,” Woodard said. “There is nothing out here. We have spots here and there, but there are not enough doctors to serve all the people.”

When Crossover Heath Services, 940 E. 36th St. North, opened in 2014, other clinics were welcoming.

“Most people from a business standpoint would think there would be competition,” Woodard said. “But there is more than enough here to serve all the people. We saw that when we opened the pediatric practice. We couldn’t keep up with the demand.”

At Morton, Reynolds stays busy doing home visits and serving as a case manager to connect patients with community resources. That often means going well beyond health care.

Once, she intervened on behalf of a couple expecting a child who were homeless because an apartment manager would not return calls. In February, a grandmother who is disabled and raising four grandchildren, some sick with COVID-19, was unable to get water delivered for days after a city waterline break.

“Sometimes it takes someone to advocate for our patients whenever they are in need. They are sometimes not taken seriously,” Reynolds said.

Morton’s creation after the race massacre has created loyal patients through the decades. About 40% to 50% are uninsured, but officials expect about 75% of that group to qualify for Medicaid once the state implements expansion.

However, Chief Executive Officer Susan Savage joins a long list of providers opposed to the state’s decision for Medicaid to be managed by private companies.

“I have not heard anyone say how this actually impacts that patient who has not had access to insurance prior to Medicaid,” Savage said. “I‘ve heard we’re going to see improved delivery of services, great efficiency and it’s good for health care.

“But I haven’t heard anyone talking about how that patient will benefit from a system that is going to be quite bureaucratic and quite cumbersome when the Health Care Authority has done an outstanding job of managing Medicaid.”

Morton operates its own transportation system to get patients to appointments, offers a diabetes classes has partnerships with the Salvation Army, Tulsa Housing Authority and Family and Children’s Service to reach more patients.

“The people who come through our doors often have life circumstances that are hard, so a health problem may be symptomatic of other bigger issues,” Savage said. “It can make me cry seeing the level of commitment people have trying to find a way to help somebody in need that is not judgmental. … My ethics say to me that health care is a right, not a privilege.

“It should not be a factor of one’s economics.”

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