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Following in her mom's footsteps, a doctor fights to make medicine more inclusive

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Following in her mom's footsteps, a doctor fights to make medicine more inclusive

Dr. Uché Blackstock is the author of Legacy: A Black Physician Reckons With Racism In Medicine.

Diane Zhao/Penguin Random House


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Diane Zhao/Penguin Random House


Dr. Uché Blackstock is the author of Legacy: A Black Physician Reckons With Racism In Medicine.

Diane Zhao/Penguin Random House

When Dr. Uché Blackstock was a medical student at Harvard, she had a near-death experience that gave her a sobering outlook on the state of medical care in the U.S. Suffering from excruciating stomach pain, Blackstock took herself to the E.R., where, after hours of waiting, she was told she had a stomach bug and sent home.

But in days that followed, Blackstock felt worse; it would take two more E.R. visits before she was diagnosed with appendicitis. Because it took so long for the diagnosis, her appendix ruptured, requiring emergency surgery, followed by a painful recovery that sent her back to the hospital. Later Blackstock was left to wonder: Would her treatment have been different if she weren’t Black?

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“It really took a few years of processing what had happened for me to recognize that it may have been because I was a young Black woman that this diagnosis got missed,” Blackstock says.

Blackstock is the founder and CEO of Advancing Health Equity. In her new book, Legacy: A Black Physician Reckons With Racism In Medicine, she explores systemic inequity in health care, tracing its origins back to the beginnings of Western medicine and to her own experiences as a medical student and doctor.

In March 2020, during the early days of the COVID-19 pandemic, Blackstock was one of the first medical professionals to raise the alarm that the virus was having a disproportionate impact on minority communities.

“For years, we’ve been talking about the Black maternal mortality crisis. But in terms of COVID’s impact on Black communities, that conversation had not started yet,” Blackstock says. “So I wrote my first op-ed on what I was worried about would happen to our communities from COVID within the first two weeks – before the end of March.”

But Blackstock is optimistic about the next generation of Black medical students, who she says are pushing for changes to the existing system.

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“With the killing of Mr. George Floyd and Ms. Breonna Taylor … a lot of medical schools received demand letters from their Black students about what those students thought we should be learning,” Blackstock says. “I would say medical schools are on their way. They have a tremendous amount of work to do.”

Legacy: A Black Physician Reckons With Racism In Medicine, by Uché Blackstock
Legacy: A Black Physician Reckons With Racism In Medicine, by Uché Blackstock

Interview highlights

On her mother, Dr. Dale Gloria Blackstock, who died of leukemia at age 47

My mother was a brilliant woman. She was amazing. She was a trailblazer in her own right. She grew up in central Brooklyn. She had a single mom, she had five siblings, and they grew up in public assistance and so life was always very, very difficult for her. She was the first person in her family to graduate from college and then go on to Harvard Medical School, which is something that she never even probably had thought of as a little girl. But I celebrate her and I celebrate her accomplishments. But I also recognize how both racism and poverty makes the road so much harder, and that there were other brilliant, brilliant children that she grew up with that I’m sure also could have made it to Harvard Medical School and beyond, but did not because of the practices and policies that we have in place that chronically deprive our communities of the resources that they need.

On always wanting to be a doctor because of her mom

This is what happens when you have the most loving mother who is also incredibly well respected by her patients and by her colleagues. So it was sort of like, I think both Oni and I looked at her and said, you know what? We want to be just like her. We also want to be a doctor. And I think also, we were surrounded by Black women physicians: Our pediatrician, all of my mother’s friends, on our block we had other Black women physicians. So it was a reality to me. …

Dr. Dale Gloria Blackstock with her twins, Uché and Oni — both of whom followed in their mother’s footsteps by graduating from Harvard Medical School.

Courtesy of Uché Blackstock

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Dr. Dale Gloria Blackstock with her twins, Uché and Oni — both of whom followed in their mother’s footsteps by graduating from Harvard Medical School.

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Courtesy of Uché Blackstock

I’m getting a little emotional, but this book is also an opportunity to give her a voice to people who may not have heard of her or have met her. I always say that when people meet [my twin sister] Oni and me that they’re meeting our mother, because this woman literally poured blood, sweat and tears into us. I think because she had grown up in poverty, because she was the first to go to college and med school, she wanted a very different life for us than she had for herself. And sometimes I worry. I remember when we turned 18, she said, “I’m so tired,” and I don’t know if she may have been in the early stages of her illness then, but she said, “I am so tired. I put so much into you both.”

On how students in medical school are often taught that there is an essential biological difference between Black and white bodies — and how that teaching impacts care

That is sort of the take home-message we get. We’re taught that there are different normal values for kidney functions, that Black patients have a certain set of normal values than non-Black patients. We’re told that about lung function; that there’s a difference between Black patients and non-Black patients. And this isn’t something that is necessarily recent. A lot of these beliefs are centuries or decades old. …

So often you would read a textbook and it would say that the risk factor for diabetes or the risk factor for high blood pressure is race. Race cannot be a risk factor because it’s a social construct. What is the factor is racism or the impact of the practices and policies of systemic racism on our communities and on our health. … A lot of these studies have come out more recently to show that that so-called “race correction” factor that is used for kidney function has actually led to a delay in Black patients being referred to for specialty kidney care. Also, it’s led to delays in putting them on kidney transplant lists. So it’s compromised their care even further. They have not gotten the health care that they need for this chronic and potentially deadly disease. It almost compounds the everyday racism that they face, that there are these beliefs that are inherent within the health care system that prevent them from getting the resources that they need.

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On the 1910 Flexner Report, which closed most of the historically Black medical schools in the U.S.

The Flexner Report was a report that was commissioned by the American Medical Association and the Carnegie Mellon Foundation. And essentially they commissioned an educational specialist named Abraham Flexner to go around to the 155 medical schools in the United States and in Canada, and to essentially standardize them, compare them to the standards of Western European medical schools. And so, of course, the Black medical schools, because of the legacy of slavery and the lack of wealth and resources, did not have the resources to remain open. So, essentially, Flexner recommended that five out of seven of those Black medical schools be closed and they were closed, leaving Howard and Meharry. …

In a study that came out in 2020, in the Journal of American Medical Association, it was estimated that those five schools, if they had remained open, would have trained between 25,000 and 35,000 Black physicians. When I read that, I started crying because that is such a large number of health professionals that could have cared for hundreds of thousands, probably even millions of Black patients, who could have mentored medical students, who could have done research in our communities. And so it is a tremendous loss when you think about the closure of those schools. But it also makes sense when you look at the percentages today of Black physicians. We are less than 6% of all physicians in the U.S. – and that is one of the reasons.

On how the Supreme Court’s 2023 ruling against affirmative action may impact Black medical students

I compare it to the Flexner Report. So you have a policy that impacts schools, led to the closure of schools, led to that tremendous number of Black physicians not being educated, essentially eras[ing] them. And I thought about the recent SCOTUS decision, it’s going to affect academic medical centers, it’s going to affect medical schools, and, I think that, long term, if it’s going to affect the diversity within medical schools, then we know that ultimately [it] will affect the number of Black physicians. And we are actually more likely to go back to our own communities to care for patients. We are more likely to work in underserved areas. … We may not see it for generations, but I think that SCOTUS’s decision is going to have a long-term impact on Black health, if medical schools and other higher-education institutions are not able to … have legal workarounds to address those changes in race conscious admissions.

On tangible ways to improve the system

Academic medical centers and medical schools … need to work on focusing on how to train students and residents to adequately and competently care for a diverse patient population. That is your priority, whether it’s in terms of developing curriculum that is focusing on anti-racism, or making sure your faculty understand how to teach in a way that really respects the honor and dignity of all the students that they’re teaching and the patients that they’re going to serve, or even to policymakers, making them understand that health is in all policies. … So I tasked different groups, even white health professionals. I said, this is not just our problem. This is not just the problem of your Black colleagues. This is not just the problem of your Black patients. They are dying prematurely. It is up to you also to speak up. It’s also up to you, to us to work on behalf of our communities. I think ultimately every health professional would say I want the best for my patients, right? But that is not happening.

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Sam Briger and Thea Chaloner produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth adapted it for the web.

Lifestyle

If you loved ‘Sinners,’ here’s what to watch next

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If you loved ‘Sinners,’ here’s what to watch next

Michael B. Jordan plays twin brothers Smoke and Stack in Sinners.

Warner Bros. Pictures


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What to watch if you loved…

Ryan Coogler’s supernatural horror stars Michael B. Jordan playing twin brothers who open a 1930s juke joint in Mississippi. Opening night does not go as planned when vampires appear outside. “In a straightforward metaphor for all the ways Black culture has been co-opted by whiteness, the raucous pleasures and sonic beauty of the juke joint attract the interest of a trio of demons … they wish to literally leech off of the talents and energy of Black folks,” writes critic Aisha Harris. The film made history with a record 16 Academy Award nominations.

We asked our NPR audience: What movie would you recommend to someone who loved Sinners? Here’s what you told us:

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Near Dark (1987)
Directed by Kathryn Bigelow; starring Adrian Pasdar, Jenny Wright, Lance Henriksen
If you want another cool vampire movie with Western kind of vibes, check out Kathryn Bigelow’s Near Dark — super underseen and kind of hard to find, but really gritty and sexy and another very different take on what you might think is a genre that had been wrung dry. – Maggie Grossman, Chicago, Ill.

30 Days of Night (2007)
Directed by David Slade; starring Josh Hartnett, Melissa George, Danny Huston
It follows a group of people in a small Alaskan town as they struggle to survive an invasion of vampires who have taken advantage of the month-long absence of the sun. Both this and Sinners revolve around a vampire takeover and the people’s fight to outlast the “night.” – Nathan Strzelewicz, DeWitt, Mich.

The Wailing (2016)
Directed by Na Hong-jin; starring Kwak Do-won, Hwang Jung-min, Chun Woo-hee, Jun Kunimura
In this South Korean supernatural horror film, a mysterious illness causes people in a quiet rural village to become violent and murderous. A local police officer investigates while trying to save his daughter, who begins showing the same disturbing symptoms. The film blends folk horror, religion, and psychological dread, exploring themes of faith, evil, and moral weakness. Like Sinners, it centers on a supernatural force corrupting a close-knit community, builds slow-burning tension, and examines spiritual conflict and human frailty. – Amy Merke, Bronx, N.Y.

Fréwaka (2024)
Directed by Aislinn Clarke; starring Bríd Ní Neachtain, Clare Monnelly, Aleksandra Bystrzhitskaya
In this Irish folk horror film, a home care worker, Shoo, is assigned to stay with an elderly woman who’s convinced she’s under siege by malevolent fairies. Like Sinners, Fréwaka blends folk traditions and social commentary with horror. The social failures Shoo copes with (untreated mental health issues, religious abuse) are just as frightening as the supernatural forces. – Kerrin Smith, Baltimore, Md.

And a bonus pick from our critic:

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Ma Rainey’s Black Bottom (2020)
Directed by George C. Wolfe; starring Viola Davis, Chadwick Boseman, Glynn Turman
This is an adaptation of August Wilson’s play about a legendary blues singer (Viola Davis) muscling through a recording session with white producers who want to control her music. Chadwick Boseman’s blistering in his final role. – Bob Mondello, NPR movie critic

Carly Rubin and Ivy Buck contributed to this project. It was edited by Clare Lombardo.

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Solar energy for renters has taken off in 10 states. Not in California

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Solar energy for renters has taken off in 10 states. Not in California

The tiny town of West Goshen, Calif., was exactly the kind of place that community solar was designed for.

Near Visalia, most of its 500 residents live in mobile homes, where companies won’t install rooftop panels without a solid foundation. And until recently, they used propane for heating and cooking, with price fluctuations in the winter posing hardships for low-income families.

Community solar, in which residents get a discount on their bills for subscribing as a group to small solar arrays nearby, was designed to help low-income residents, apartment dwellers, renters and others who can’t put panels on their own roofs.

Over the last 11 years, New York, Maine, Minnesota, Massachusetts and other states have built thriving community solar programs. But California has built, at most, only 34 projects since 2015, and experts say that’s a generous accounting.

“We’ve had community solar for a dozen years, and it simply has not produced anything of scale and anything of note,” said Derek Chernow, director of Californians for Local, Affordable Solar and Storage, a developer trade group that’s pushing to get a more robust program off the ground. “Projects don’t pencil out.”

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The West Goshen residents were among the lucky few, becoming part of a community solar project in 2024.

“It has kind of allowed us to kind of breathe a little bit,” said resident and community organizer Melinda Metheney. Her bill has dropped by about $300 in the summer months, thanks to the 20% community solar discount, stacked with other low-income discounts and clean energy incentives, she said.

West Goshen’s panels sit about 10 miles out of town, in a field surrounded by farms. Energy and climate experts agree California must add much more clean energy to its grid, some 6 gigawatts by 2032, the California Public Utilities Commission said in a new plan last week.

Assemblymember Christopher M. Ward (D-San Diego), who in 2022 authored a bill to create a more effective community solar program, said the state needs to double its annual solar installation rate to reach that goal and is not on track to do that using only large utility-scale solar farms and individual rooftop arrays.

“We need mid-scale community solar,” he said.

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Aerial view of solar panels installed on top of Extra Space Storage in Pico Rivera

Energy and climate experts agree California must add much more clean energy to its grid, some 6 gigawatts by 2032, the California Public Utilities Commission said in a new plan last week. Above, solar panels at Extra Space Storage in Pico Rivera.

(Kayla Bartkowski / Los Angeles Times)

He and a coalition of environmental groups, solar developers and the Utility Reform Network, a ratepayer advocacy group, worked to put his 2022 law into effect. They coalesced around requiring utilities to pay community solar developers and customers for the electricity they feed to the grid using the same formula they use for people who install rooftop solar.

But in May 2024, the California Public Utilities Commission decided to go with a late-in-the-game proposal backed by the state’s investor-owned utilities to pay community solar at a lower rate.

The agency, along with its public advocate’s office, argued that crediting solar developers at the higher rate would raise bills for customers who don’t have solar, who would still have to shoulder the cost of grid maintenance. It’s similar to the argument they’ve made to cut incentives for rooftop solar.

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The new program relied on federal money, including the Biden administration’s Solar for All, to sweeten the deal for developers. But the utilities commission spent very little of the $250 million available under that grant before the Trump administration tried to claw it back last summer, and now it is held up in litigation.

At a legislative oversight hearing last week, Kerry Fleisher, the commission’s director of distributed energy resources, blamed the loss for the new program’s failure to launch.

“There’s been a tremendous amount of uncertainty in terms of the Solar for All funding that was intended to supplement this program,” Fleisher said. “That’s part of the reason why this has taken longer than normal.” She said the commission still plans to release a program in the next several months.

Ward, the San Diego lawmaker who wrote the community solar bill, called the program “fatally flawed” in an interview.

He’s now considering a bill to bring the community solar program more in line with what he initially envisioned — higher incentives, requirements for battery storage, and compliance with state law that mandates new houses be built with solar.

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A study last year funded by a solar trade group found that could save California’s electric system $6.5 billion over 20 years. But Ward’s effort to revive his program last year failed to pass the Assembly appropriations committee.

“All the other states in our country that have adopted similar community solar program models, they are working,” said Ward, adding that 22 states have programs comparable to the one solar advocates want in California. “The writing on the wall suggests that, exactly as we feared years ago, this was not the way to go.”

California Public Utilities Commission spokesperson Terrie Prosper called California “a leader in cost-effective, least-cost solar deployment overall compared to any other state,” in an emailed statement.

Under the commission’s definition, the state has brought on 34 projects, representing 235 megawatts of community solar. But studies from groups such as the Institute for Local Self-Reliance and Wood Mackenzie use different definitions for community solar, and they show California far behind at least 10 other states.

Meanwhile, advocates and developers involved in successful community solar projects in California say they were difficult to get off the ground.

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A view of homes in the Avocado Heights area of Los Angeles County

Homes in the Avocado Heights area of Los Angeles County are part of a community solar project.

(Kayla Bartkowski / Los Angeles Times)

One that came online in May in the unincorporated communities of Bassett and Avocado Heights in the San Gabriel Valley provides solar electricity to about 400 low-income residents. They get 20% discounts on their electric bills for subscribing to panels installed on two Extra Space Storage building rooftops in Pico Rivera.

Organizers said it took nearly five years to find the right location and comply with utility requirements. They also got a grant in addition to funding provided by the state utilities commission’s solar program.

It “would not have happened if it hadn’t been for the grant,” said Genaro Bugarin, a director at the Energy Coalition nonprofit that proposed and coordinated the project.

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Brandon Smithwood, vice president of policy at Dimension Energy, the developer for the project in West Goshen, said he still hopes to see a community solar program in California that compensates projects for the way they help out the grid.

“We’ve seen it can work, and we know what we have won’t work,” Smithwood said at the hearing.

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Mundane, magic, maybe both — a new book explores ‘The Writer’s Room’

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Mundane, magic, maybe both — a new book explores ‘The Writer’s Room’

There’s a three-story house in Baltimore that looks a bit imposing. You walk up the stone steps before even getting up to the porch, and then you enter the door and you’re greeted with a glass case of literary awards. It’s The Clifton House, formerly home of Lucille Clifton.

The National Book Award-winning poet lived there with her husband, Fred, starting in 1967 until the bank foreclosed on the house in 1980. Clifton’s daughter, Sidney Clifton, has since revived the house and turned it into a cultural hub, hosting artists, readings, workshops and more. But even during a February visit, in the mid-afternoon with no organized events on, the house feels full.

The corner of Lucille Clifton's bedroom, where she would wake up and write in the mornings

The corner of Lucille Clifton’s bedroom, where she would wake up and write in the mornings

Andrew Limbong/NPR


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“There’s a presence here,” Clifton House Executive Director Joël Díaz told me. “There’s a presence here that sits at attention.”

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Sometimes, rooms where famous writers worked can be places of ineffable magic. Other times, they can just be rooms.

The Writer’s Room: The Hidden Worlds That Shape the Books We Love

Princeton University Press

Katie da Cunha Lewin is the author of the new book, The Writer’s Room: The Hidden Worlds That Shape the Books We Love, which explores the appeal of these rooms. Lewin is a big Virginia Woolf fan, and the very first place Lewin visited working on the book was Monk’s House — Woolf’s summer home in Sussex, England. On the way there, there were dreams of seeing Woolf’s desk, of retracing Woolf’s steps and imagining what her creative process would feel like. It turned out to be a bit of a disappointment for Lewin — everything interesting was behind glass, she said. Still, in the book Lewin writes about how she took a picture of the room and saved it on her phone, going back to check it and re-check it, “in the hope it would allow me some of its magic.”

Let’s be real, writing is a little boring. Unlike a band on fire in the recording studio, or a painter possessed in their studio, the visual image of a writer sitting at a desk click-clacking away at a keyboard or scribbling on a piece of paper isn’t particularly exciting. And yet, the myth of the writer’s room continues to enrapture us. You can head to Massachusetts to see where Louisa May Alcott wrote Little Women. Or go down to Florida to visit the home of Zora Neale Hurston. Or book a stay at the Scott & Zelda Fitzgerald Museum in Alabama, where the famous couple lived for a time. But what, exactly, is the draw?

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Lewin said in an interview that whenever she was at a book event or an author reading, an audience question about the writer’s writing space came up. And yes, some of this is basic fan-driven curiosity. But also “it started to occur to me that it was a central mystery about writing, as if writing is a magic thing that just happens rather than actually labor,” she said.

In a lot of ways, the book is a debunking of the myths we’re presented about writers in their rooms. She writes about the types of writers who couldn’t lock themselves in an office for hours on end, and instead had to find moments in-between to work on their art. She covers the writers who make a big show of their rooms, as a way to seem more writerly. She writes about writers who have had their homes and rooms preserved, versus the ones whose rooms have been lost to time and new real estate developments. The central argument of the book is that there is no magic formula to writing — that there is no daily to-do list to follow, no just-right office chair to buy in order to become a writer. You just have to write.

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