Oleoresin capsicum spray, better known as pepper spray, is a chemical weapon made from concentrated chili pepper extracts. In addition to causing intense pain and irritation of the eyes, respiratory tract, and skin, pepper spray can cause corneal abrasions and, in rare instances, death.
UpToDate, the clinical practice bible for doctors, nurses, and other health care workers, delivers just three hits for the search terms “pepper spray” and “oleoresin capsicum.” None of them provides information on treating patients exposed to pepper spray; one even recommends its use in controlling agitated patients. The omission of this treatment information, as well as a recommendation to use chemical warfare agents on patients, reflects the apathy of the medical community toward police violence in the United States, if not its tacit approval.
Ignoring police militarization and brutality directed at people of color — or participating in it through university private police forces — is especially disturbing given the long-standing tensions between academic health care systems and Black and brown communities. Despite their professed missions to serve society, academic medical centers often cause harm to surrounding low-resource communities of color. Damage has been and continues to be wrought through willful neglect, unethical human experimentation, predatory billing practices, community displacement, class-based care structures, and use of tax-exempt statuses to withhold funds from chronically underfunded communities. Segregation of health care access by race and class has exacerbated the disparate impact of Covid-19, contributing to excess deaths in Black and Native Americans.
The leaders at many medical schools and academic medical centers have released statements lamenting the killing of George Floyd and acknowledging the need to engage in the fight against racism. Even the most sincere letters contain few action items beyond “virtual reflection spaces” and “listening sessions.” While protests erupt in the streets and race-based police violence reaches a fever pitch, those in the medical community able to mitigate injury-related morbidity and mortality are generally absent from protest sites. Leaders of these centers for the most part stay inside their marbled fortresses, wringing their hands and attending town halls to discuss the very public health crisis raging outside their walls. Meanwhile, the street medics, legal observers, and journalists who are fulfilling their moral and professional obligations at protest sites have been directly targeted by police violence.
To mitigate harm, academic medical centers should provide emergency support during the ongoing protests against police brutality by delivering on-site health care for protesters. This includes setting up tents where protesters gather and providing treatment for injuries sustained due to police violence. Ambulances should stand ready to transfer those with serious injuries to hospitals without delay. Medical and nursing schools should train their students about protest medicine and equip them, and clinicians, with the ability to deliver evidence-based care for injuries caused by tear gas, pepper spray, rubber bullets, trampling, dog bites, police batons, flash-bang grenades, and more.
Schools of law should send faculty and students to act as observers and provide legal assistance. Journalism schools should send their own representatives to bear witness. The presence of large groups of sanctioned representatives from academic institutions could significantly deter police violence, protecting protesters. It could also help win the trust of communities that are often harmed by these institutions.
In addition to working to remove all types of racism from inside and outside of their communities, there is much academic medical center and medical societies can do. Here are just two examples from this week:
The American Academy of Ophthalmology condemned the weapons police are using that have already permanently blinded several protesters and damaged the eyes of many others. The academy also offered detailed, evidence-based advice to protesters on how to treat eye injuries caused by these weapons.
Yale New Haven Hospital and Yale School of Medicine, where we are students, donated 2,000 masks to the Black Lives Matter protest in New Haven on Friday and Yale volunteers distributed them. The donation was organized by resident physicians and supported by the chief medical officer of Yale New Haven Hospital and Dr. Gary Desir, chair of the department of internal medicine and the first Black person to chair any department at Yale School of Medicine. This donation is an important first step, but more must be done.
While academic centers can and should try to rebuild community trust by aiding protesters, they should not use protests as commercial or promotional opportunities, nor should they take them over. We cannot risk smothering the voices of the community members that started these grassroots movements. Instead, those in the ivory tower should leverage their considerable resources to protect the lives they say they value.
While gathering in crowds risks the spread of Covid-19, distribution of masks and hand sanitizer at protests can help mitigate this danger. People are risking their lives because this is a life or death issue for Black Americans. In eight large U.S. cities, yearly police killings of Black men exceed the national murder rate. In the U.S., police violence is the sixth leading cause of death among young Black men, and years of life lost to police violence is similar to those from maternal deaths or meningitis.
Clinicians do not battle perinatal mortality and infectious diseases with listening sessions and warmly worded emails. They do it with urgent, evidence-based medical care. It is time to cross the town-and-gown divide and take to the streets.
Carrie Flynn is a fifth-year M.D./Ph.D. student and Chinye Ijeli is a first-year M.D. student at Yale School of Medicine.
You write: “While gathering in crowds risks the spread of Covid-19, distribution of masks and hand sanitizer at protests can help mitigate this danger..” As a 76-year-old who opposes racism and police brutality, I have to ask:
Do you believe that the danger of this pandemic is real? Do you believe in effective public health measures? How could a medical professional attend a huge public gathering, when public gatherings are banned because they are medically unsafe? What a terrible example was set by those frontline healthcare workers who attended the protests after leaving their hospitals! Apparently they have less regard for human lives than they do for the First Amendment. If medical professionals do not follow public health mandates, why should anyone else?
I would like to see my grandchildren before I die. These protests and the consequent increases in infection will rob me of that opportunity. But I still forbear because my age puts me at high risk and I do not want to burden these same frontline workers by getting sick and needing their care.
And here I thought that was the whole idea. Apparently not.
Agree that medical institutions need to support public protests related to racial inequality. All lives matter! Equality is part of creating a healthy community. Medical institutions also need to reflect on their own actions, data and policies related to racial profiling, and bias. It’s there. It’s in the data related to heart disease, diabetes, infant and maternal mortalities as well as making access easily available to people who cannot miss work due to economic conditions. COVID-19 has put another spotlight on which populations have a disadvantage toward diagnosis and mortality risk. I have investigated events in medical institutions in seven different states where implicit bias was found to have delayed or changed the course of treatment resulting in poor outcomes. All institutions associated with community health and welfare need to take a look at their own performance and policies related to making the best decisions for patients/consumers regardless of race, ethnicity or income levels.
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