Our final episode takes on the central question of this entire podcast: When there is so much work to do in combatting medical racism, why is it still critical to start with history? We talk with community leaders, historians, medical students, and Duke Health executives. But most of all, we hear from the living members of the Avery family—including the daughter born just a week after Maltheus Avery’s death.
We hear from Malthaus Avery Blake McDowell, the younger daughter of Maltheus Avery, and two of her first cousins, Sibyl Avery Jackson and Vida Avery, daughters of Dr. Parnell Avery.
This episode also features commentary from Duke historian of African-American studies, Professor Adriane Lentz-Smith, and Durham-area pastor Rev. Jerome Washington.
And we speak with Duke Health leadership: Dr. Mary Klotman, Dean of the School of Medicine and Dr. Craig Albanese, CEO of the health system.
UNHEALED: A Story of Race, Memory, and a Teaching Hospital
Episode 7: What Now? Why this Story Matters
Transcript
Sybil Avery Jackson: Well, my first thought was, I don't know if I want to contact them. I don't know if I want to talk to them because you mention Duke University Hospital in our family, you don't get a good response because it just brings a lot of that trauma to the surface.
Dr. Jeff Baker: That is the voice of Sybil Avery Jackson, one of the nieces of Maltheus Avery, the man at the center of this podcast. She's remembering a message she got in May, 2022 from a Duke doctor she’d never heard of.
Dr. Damon Tweedy: Yeah, that Duke doctor was me, and I'll have more to say about that in a bit. I'm Damon Tweedy, a Duke professor of psychiatry and author of the book, Black Man in a White Coat.
Dr. Jeff Baker: And I'm Jeff Baker, historian and director of the medical ethics center at Duke. And this is the seventh and final episode of UNHEALED, where we've been taken a deep dive into the story of an African-American veteran who died in 1950 after having been denied admission at Duke Hospital because of his race.
Dr. Damon Tweedy: And in this episode we're going to discuss the legacy of Maltheus’ death for the Avery family. And we're going to talk about what this story means for us today, both at Duke and in the Durham community. So Jeff, we've been at this project for over two years now. It's a long time. I mean, I never thought it would take this long to pull it off.
Dr. Jeff Baker: Seriously, it's taken a really long time. I think my hair has turned a lot grayer.
Dr. Damon Tweedy: Well, lucky you. Mine's just about all gone now. And about a month or so ago, I went back and looked at our initial outline and got to be honest, it's amazing how much we've changed things along the way.
Dr. Jeff Baker: Yeah, that's right. This all started as a project about the responsibilities of medical schools to their own communities, which we were going to center around the history of Duke Hospital in Durham.
Dr. Damon Tweedy: That topic, it just seemed too broad. And there's this one afternoon just kind of going back and forth, it sort of felt like this project was languishing. It's like, man, are we really going to get anywhere with this? Is it going to get it off the ground? And then I read this section of this book, it's called One Blood by Spencie Love, and then when I read this one particular chapter, it was like this aha moment just hit me. I knew then that we needed to center this whole podcast around this man named Maltheus Avery.
Dr. Jeff Baker: Listeners might remember that Spencie Love was the historian who rediscovered the story of Avery's death and accident while doing research for her book on Dr. Charles Drew. It is, it's such a dramatic story and it involved Duke Hospital. So you’d think that everybody here would know about it. But they don't. In fact, hardly anyone here knows who Maltheus Avery was or how he died, and that needs to change. That's really the big reason we decided to do this podcast. I truly believe that everyone who works at Duke Health needs to know who Maltheus Avery was and what happened to him.
Dr. Damon Tweedy: Agreed. And part of what struck me so much about this story was how Maltheus’ death transformed the lives of his two younger brothers. So after his military career, Waddell worked for the Department of Health and Human Services, where he helped to build hundreds of rural clinics to help those most in need. And Parnell became a surgeon. He was the kind of surgeon who treated folks without insurance and spoke out against the many injustices in our healthcare system. So Maltheus' brothers took something terrible and they used that experience to help others in their communities.
Dr. Jeff Baker: So once we decided that this was the story we wanted to tell, we of course wanted to track down Maltheus Avery's family, but that wasn't easy. We had no idea which members of his family were still alive or where they lived. Finding them was a pretty overwhelming task, but we did it. Or I should say you did it.
Dr. Damon Tweedy: Yeah, I guess you could say I put on my detective hat. I'm not sure what I was thinking, but looking back I'm really glad I did it, of course. So first I started with Parnell Avery's obituary, since he had died more recently than Waddell, his older brother. And in that obituary of course it listed the names of his children. And so I Googled them and it turns out that two of them were alumni of Spelman College. And so I sent this long email to their alumni office, wasn't sure what was going to come of it. And then I did something I had never done before or since. I actually took to social media and I sent a message to them. And then between two of those things, it didn't take long before I heard back.
Vida L. Avery, PhD: Hi, I'm Dr. Vida L. Avery and I am the manager of the Center for Grants Development. I work with Harris County Department of Education.
Sybil Avery Jackson: I'm Sybil Avery Jackson. I'm a screenwriter and author. I'm a storyteller.
Dr. Jeff Baker: So when they reached out to you, the historian in me got really excited. But I'm not sure I'd thought
enough about what it would feel like for them to get this message from Duke. Out of the blue, here's Sybil and Vida again.
Sybil Avery Jackson: Immediately I said, why now? Why are they contacting us now? I mean, I got a little angry about it because I immediately thought of our father, and he had been deceased for a few years, and it would've been so much better had he been around because it was something he was waiting on.
Vida L. Avery, PhD: He and our uncle Waddell were trying to get closure for years. And then to contact us after all these years. We were a little skeptical. What's really going on here?
Dr. Jeff Baker: Listening to that, I'm kind of amazed that they did decide to call us back.
Dr. Damon Tweedy: Yeah, I hadn't thought enough at first about how this would really impact them. I'm really being honest now. I was really in my sort of storyteller zone and I was really sort of thinking about it in that lens, not at all from the perspective of the family and potentially opening up an old wound.
Dr. Jeff Baker: Or really two old wounds. The wound from Avery's death in 1950 and a second wound when Avery's two brothers visited Spencie Love's history class in 1990.
Dr. Damon Tweedy: So we're not sure exactly what happened on that trip to Duke, but Waddell and Parnell clearly expected to meet with senior Duke Hospital leadership, and that didn't happen. And so they left Duke very disappointed. And once I really kind of understood that background and that history, it made sense to me that Sybil and Vida questioned whether the family wanted to open themselves up to anything like that again.
Vida L. Avery, PhD: Are we going to end up going through the same things that Daddy and Uncle Waddell went through with Spencie to dispense information about our family or the trauma and then we get nothing in return from Duke as far as accountability? it is generational trauma, but in a sense it wasn't our trauma. So it was making us have to think about whether we wanted to live our father's trauma all over again.
Sybil Avery Jackson: Over all over again.
Dr. Damon Tweedy: Reluctantly, the two sisters agreed to meet us on Zoom. After about 90 minutes, it was a long meeting of Jeff and I talking and explaining who we were, introducing ourselves and what we wanted to do with this project. They told us they didn't want to go forward with an interview or anything like that without first talking to the rest of the family.
Dr. Jeff Baker: There was another family member who wasn't on that call, the most important of all.
Dr. Damon Tweedy: And that's the daughter of Maltheus Avery, who was born one week after his death.
Dr. Jeff Baker: That's right. She was named Malthaus after her father. And the sisters told us they wanted a lot more time before they were ready to even consider letting us talk to her.
Dr. Damon Tweedy: They wanted to know a lot more about our project, in particular what our motives were for wanting to tell this part of Duke's history. And so we set up another Zoom meeting where we did our best to explain ourselves.
Dr. Jeff Baker: I think they wanted to be sure that this wouldn't be a repetition of 1990. They didn't want to raise any false hopes.
Dr. Damon Tweedy: And so while we waited for the family's decision, we continued working on this podcast, and we'd send them updates. We had more Zoom calls and we had lots of discussions with them about how Duke could or should respond so many years later.
Dr. Jeff Baker: Yeah, we really began to ask ourselves, was Duke Hospital finally ready to acknowledge in public Avery's tragic death? But we took that question to what seemed like a never-ending run of meetings. It was exhausting, not because anyone threatened to shut us down. In fact, a lot of people, even senior leaders, expressed support. But every meeting seemed to end with someone saying, you really need to talk to so-and-so, and that person would say, you need to talk to this person in this office, and on and on.
Dr. Damon Tweedy: And so while there was this general support, and in some cases enthusiasm for our project, many times it felt like we were just kind of going in circles and I just wondered if we were ever going to get anything accomplished.
Dr. Jeff Baker: That's right. But I think one of the hardest moments was a Zoom conference call with a community advisory group. It was a really skeptical group, and they were angry. I'll never forget how one pastor came out and said, we don't need to hear more stories about what Duke has done to Black people. Duke needs to stop talking and start doing things.
Dr. Damon Tweedy: Well, I've heard many people say the exact same thing: less talk, more action. There's no time for all this history and dwelling on the past. Let's focus on the present, the here and now and what we're going to do in the future.
Dr. Jeff Baker: Fair enough. So I thought I'd take this question to another historian, one who has really thought about these issues a lot.
Professor Adriane Lentz-Smith: I am Adriane Lentz-Smith. I'm an associate professor of history and African and African-American Studies at Duke.
Dr. Jeff Baker: I asked her this exact question. After all, we've got a lot of people here at Duke who are studying things like health inequities. Why do we need to spend time and resources on history?
Professor Adriane Lentz-Smith: Inequity is a simple term with a lot of layers, a lot of histories, a lot of factors that feed into it. So the more ways we come at the problem, the better. One of the things that I think it's always important for people to understand is that you can't find a solution if you don't actually understand what your problem is, and you don't know what your problem is if you haven't spent a lot of time figuring out what went into making the problem in the first place.
Dr. Damon Tweedy: Maybe I'm a little biased, but that makes perfect sense to me. But I could also see that people might say, sure, we do need to know what's happening in our community the last say ten or twenty years. But Maltheus Avery died over seventy years ago. Is that really relevant to us now?
Dr. Jeff Baker: Yeah. Well, I asked her that question as well, and she did answer like a true historian.
Professor Adriane Lentz-Smith: Seventy years isn't actually as long as we think it is. It's a lifetime. It's less than a lifetime, increasingly for people. I think many of us know folks who were alive when this happened. Many of us know folks who were being born in hospitals or whose loved ones were dying in hospitals when this happened.
Dr. Damon Tweedy: Well, that's certainly true with our story, which leads us back to the Avery family because their answer to this question is the most important of all. Several months after our initial meeting, Vida and Sybil set up another Zoom call to introduce us to their first cousin and Maltheus Avery's daughter, Malthaus. During that meeting, they told her that they would go along with whatever she decided.
Dr. Jeff Baker: So I know I keep talking about difficult Zoom meetings, but I think this was the most memorable Zoom call of all. There were a lot of questions about just what it was we were trying to do, what were our motives, and most of all, what were we trying to get out of it all?
Dr. Damon Tweedy: There really were a lot of Zoom calls and Zoom meetings, just kind of the reflection of the times. And I kind of wondered what it would've been like if we would've had a chance to talk to them in person. But yes, these meetings were very difficult and particularly on Zoom talking about something so tough. They were talking about how they wondered that we were doing this for financial profit or to pad our resumes or to kind of make Duke look good in some kind of public relations sort of way. So it was very tough.
Dr. Jeff Baker: Yeah, it was emotionally draining. And after about an hour on that call, I started to wonder myself if really all of this was such a good idea. So I took a breath and I asked them directly, should we just call this off? Well, things got really quiet, and I remember the other sisters, they turned to Malthaus and asked her, what do you want to do? There was another long pause and then Malthaus looked straight at us and said, I'll do it. She would do it because her grandmother, Hazel Avery, Maltheus’ mother, would want her to do it.
Dr. Damon Tweedy: I definitely won't forget that moment.
Dr. Jeff Baker: It was a turning point. So we began to think about an interview, but she still wanted to meet us in person. I'm from Atlanta, so I drove down I-85 one weekend to meet her at a coffee shop outside the city. And I have to say after all my worrying about how she'd receive me, she turned out just to be an absolutely gracious, lovely person. We just had this wonderful talk together. She told me a lot about her life and when it was all over, she agreed to schedule a trip to Durham to come back and do a formal interview. So just a few months ago, Damon and I had the honor of hosting her here at Duke.
Malthaus Avery Blake McDowell: I am Malthaus Avery Blake McDowell. I am the youngest daughter of Matheus Avery. My father's name was Maltheus Avery, but the family called him Sonny. I was born December the 9th, 1950 in Henderson, North Carolina soon after Maltheus was involved in a car accident, after he died.
Dr. Damon Tweedy: She told us what she learned from family about the week her father died, how her mother Nannie had been waiting at her home in Henderson for her husband to arrive, about the knock at the door and the news of the car accident, the trip to Durham to find out what happened. And then Malthaus' birth just a week later, just after The Carolina Times put her father's picture on the front page. She talked about what all that must have been like for her mother Nannie.
Malthaus Avery Blake McDowell: So that week of December 1st to December 9th, I would call that a week of hell for her.
Dr. Jeff Baker: And after she was born, Nannie took her two daughters, Malthaus and her sister Regina, to her own mother's home in Charlottesville, where they were raised by her grandmother, Bertha Jackson Collins. Everyone in the house called her Big Mama. She ran a strict but loving household. Malthaus remembered Nannie, her mother, as a quiet and beautiful woman who never recovered from the loss of her husband.
Malthaus Avery Blake McDowell: She was up under pressure. She had the weight of the world on her back. She was let down; she was put down. She had no hope. She was full of sadness.
Dr. Jeff Baker: And all of the family tried to protect Malthaus from knowing what had happened to her father until one day, when she was about eight years old, she and her sister came across a picture.
Malthaus Avery Blake McDowell: On a Saturday morning, I'll never forget, we were upstairs cleaning, came across a desk. It was the desk that just sat in the corner upstairs in the hallway, and we dusted it. Well, I'm being adventurous. What's in that desk? So I opened the drawer, which you know is a no-no, you don't do that back then. And I came across these pictures and I pulled them out, showed them to my sister. I said, who is this in this casket? Who's this man? Black and white pictures. It was about three or four of them. And I said, look a little bit like me. Who is this? Just who is this person? And I could see by the look on her face, wow, okay. This is your father, I remember my grandmother saying. This was the first picture I ever saw of my father in a casket. Her goal was to protect my sister and I as much as she could from pain, what she saw her daughter was going through.
Dr. Damon Tweedy: And that protection continued as Malthaus got older. When Malthaus was a teenager, she went to see a doctor with some medical issues.
Malthaus Avery Blake McDowell: The doctor said to her, well, we just need to do a hysterectomy. Oh my word. Big Mama jumped up. She said, oh, not on my granddaughter. So she was like, oh no, this is not happening. Reflection probably of what happened to my dad went through her mind.
Dr. Damon Tweedy: Our listeners should know that Malthaus quickly recovered and years later had two healthy children and she's now a proud grandmother. So that doctor's advice was terribly wrong. And for a bit of context here, this was during the 1960s, when unnecessary sterilization by hysterectomy, often without real consent, was so common for Black women throughout the South that it had its own term, the “Mississippi Appendectomy.”
Dr. Jeff Baker: Yeah, that's a sad and terrible truth. So it's safe to say that Big Mama saved Malthaus in that moment and really over and over again throughout her childhood. And in later years, Malthaus paid that back to her.
Malthaus Avery Blake McDowell: I was attending Norfolk State University and I got the call that I could not come back to school because Big Mama needed care.
Dr. Damon Tweedy: She had to put aside her own dreams. That's a big sacrifice for a young person to make.
Malthaus Avery Blake McDowell: But it was the fact that what happened December 1st, 1950 just followed my life.
Dr. Damon Tweedy: Wow. Hearing that again brings me to that moment she told us that story. It's bittersweet.
Dr. Jeff Baker: Yeah, I think we can say that was true for the whole visit. You and I walked with her to the old part of Duke Hospital, and we stood outside the old entrance to the emergency room where her father had been turned away. And later we drove down to the empty lot where Lincoln Hospital once stood, and we walked out there together, and we stood in the spot where he had died on a stretcher just after the ambulance had brought him in.
Malthaus Avery Blake McDowell: I mean imagine, he is traveling all these living places. He's bleeding, couldn't have been clean, the sheets he was on. It was cold; it was raining. He wasn't given that opportunity here to be laid in a clean bed, to die in a clean bed, in a warm environment.
Dr. Damon Tweedy: Of course, as doctors, we're trained to focus on the people in front of us and to figure out what's wrong with them. But Malthaus is reminding us to also think about how the people we see are connected to others outside of the hospital or clinic.
Malthaus Avery Blake McDowell: Maybe that patient roll in, think of it as a person. Someone is waiting for that person to come home. He had a family that loved him. He was a father, a brother, he was a friend, he was a husband, he was a son, and I miss him.
Dr. Jeff Baker: She made me think about how easy it is in a busy place like an emergency room to see a stranger just like a body, not a person. And how important it is that we listen to the stories that are told in the community.
Malthaus Avery Blake McDowell: For them to be able to serve the person that is coming in, the patient that is coming in, yeah they don't know the history, but if they have been properly trained and listened to stories, not just my dad’s, but other stories of the community that they are serving, that's a major advancement, I think.
Dr. Jeff Baker: So we know that almost no one here at Duke remembers what happened to Maltheus Avery, but we wondered if the same was true for people who live in Durham. At about that time, we met somebody who could answer that question.
Pastor Jerome Washington: I'm Pastor Jerome Washington and I’m at the Mount Vernon Baptist Church in Durham. I've been here for 17 years and I'm excited about the project you're working on.
Dr. Damon Tweedy: The pastor told us that around 2010 during a Bible study class, some of his older members were talking about their medical problems and a few of them voiced their concerns about their healthcare system.
Pastor Jerome Washington: The name of Avery came up, and because I'm not from this area, I started asking questions and they told the story of this A&T student who was in a horrible accident and was taken to Duke, turned away, and sent to Lincoln Hospital, and as a result died.
Dr. Damon Tweedy: For those parishioners, the story of Maltheus Avery was evidence that Duke and places like it couldn't always be trusted by those in the Black community. According to Pastor Washington, it also reinforced their own experiences.
Pastor Jerome Washington: Because many of them had formally or informally experienced some of these things, the stereotypes, being seen as a non-person, even by someone in healthcare profession.
Dr. Damon Tweedy: And Avery's story of being a young Black man denied fair treatment sounds all too familiar even today.
Pastor Jerome Washington: Let me just say, doctor, that whenever one of these things, any of this happens in the African-American community, one is made to say out loud or to themselves, this could have been me. You know, he didn't deserve it; it could have been me.
Dr. Damon Tweedy: So even if Duke and its doctors have forgotten the Avery story or have never heard of it in the first place, the treatment of Maltheus Avery and others like him has an impact on how our patients see us. And so while many of us might simply want to turn the page on history and live in the present, Pastor Washington cautions us.
Pastor Jerome Washington: To leave the past alone is dangerous.
Dr. Jeff Baker: I'm thinking about those words “to leave the past alone is dangerous” because it's also true that to stir up the past is dangerous. We've already talked about how it brings back trauma for the family. And I'm sure something that worries the family is, since we work for Duke, how are we going to tell this story? This story belongs to the Avery family. Yeah, Duke is part of that story, but how do we tell the story without taking it from the family? Well, the historian Adriane Lentz-Smith had some good words on this too.
Professor Adriane Lentz-Smith: There's a way that someone like Avery can easily be a symbol, symbolic of systemic racism, symbolic of a World War II vet on the cusp of a post-war Civil Rights Movement. And all of those symbols mean something. They’re someone else's version of him. But for the sake of the people who knew and loved him, or wanted to know and wish they'd had a chance to love him, you want to kind of hold onto a sense of the person, and who that person was before he became all of the other things that history made him.
Dr. Damon Tweedy: Those are good points. We've certainly tried to portray Maltheus Avery and his family as real people as much as we could, but yes, it's probably tempting for many to put him in this symbolic victim role.
Dr. Jeff Baker: That's right. And she's also right that sometimes we love to tell stories about how terrible the past was, just to show how much better we are today.
Professor Adriane Lentz-Smith: I imagine that many people who mistrust a Duke affiliate wanting to do this is because they assume that it's going to be a look how far we've come in the past 70 years story.
Dr. Damon Tweedy: I think that's absolutely true, and some of those voices might push in the opposite direction. They would argue that Avery's story could basically happen today, and then not really much has changed in America since 1950. It seems to me that there's always this tension between a progress story and a no-progress story.
Dr. Jeff Baker: This is going to drive a lot of people crazy, but I think we have to tell both stories. We've got to own the bad stuff but also remember the good. And in Duke's case, we have to tell the history in a way that takes into account both what we aspired to be and how far we fell short of that vision. We've got to talk about people like the founders of the Duke Endowment, which when it was created was the only southern-based foundation that promoted healthcare for Black people in the Carolinas. That was a big deal. And yet we also have to remember that Duke Hospital's leaders had no trouble treating Black and white people in separate wards.
Dr. Damon Tweedy: I think you're right. Nuance is hard. But I think we do have to tell both stories. It's often really hard for those of us there who are deeply embedded inside the system to ask the tough questions, those probing questions. And so you could see how some people here at Duke over the years just want to put this history to rest. I talked about this issue with Dr. Kirsten Simmons, the recent Duke med school grad and student activist that we met in the last episode, and she talked about why, from the student perspective, it was important that we don't simply let go of the past and instead actively embrace and learn about it.
Dr. Kirsten Simmons: Once we learn about the history of our country, our campus, our community, both good and bad, I think we will then begin to answer or be able to answer some of the questions of why gaps of care and health disparities exist among the patients we serve.
Dr. Damon Tweedy: Kirsten wasn't taught about the Avery story during her time at Duke, and she sees this as a clear gap in her education, one that we are trying to correct for future generations of Duke medical students. Nicholas Hastings is a current medical student at Duke who's heard this story of Maltheus Avery from us. Here's what he said on why the Avery story is important for us today.
Nicholas Hastings: It's such a privilege to know your own history and the history of your people, and so I think that really speaks to the ways that Black communities around the US in particular really have such a trouble learning about their history and the history of their people. That story really was so moving to me and really shaped the way that I see interactions with a patient who might be 70, 80 years old, that these narratives are so much more close to what we are currently living than I think what our minds tell us.
Dr. Jeff Baker: So we've heard from the family, from the community, from historians, from students. We've talked a lot about medical racism in this podcast and why learning this history is important.
Dr. Damon Tweedy: But in the end, we need to address the question we've heard so often: what is Duke actually doing to address racism within its walls and in the community?
Dr. Jeff Baker: That question really goes way above us. So we took it all the way up to the senior leadership.
Dean Mary Klotman: I'm Mary Klotman, Executive Vice President for Health Affairs at the university and Dean of the School of Medicine and Chief Academic Officer in Duke Health.
Dr. Craig Albanese: I'm Craig Albanese, the Chief Executive Officer of the Duke University Health System.
Dr. Jeff Baker: We met with them in the medical school's recording studio.
Dr. Damon Tweedy: Which is located in the old Duke Hospital building. And get this, the room we sat in was on the same hallway that, back in 1950, was a segregated surgery ward. I mean, given our topic, I couldn't imagine a more fitting place for us to have talked about Maltheus Avery and his legacy.
Dr. Jeff Baker: You just can't make these things up. And that's where we asked her, what's Duke doing to address racism?
Dr. Mary Klotman: So there are many areas of work that's ongoing that are important for our community to know. Just going back to the summer of 2020, we launched a movement across all Duke Health called Moments to Movements. And that was an opportunity to ask, within Duke, how we were doing. So we engaged our faculty, our staff, our students, and they looked very deeply at our culture and gave us some tough feedback. There were certainly areas of our culture that didn't live up to the values that we want to live by, and we've used that as a
roadmap to improve within Duke what we do, because if we don't do that we can't be a good partner outside of Duke.
Dr. Damon Tweedy: She's referring to the initiative we talked about in our first episode, "Moments to Movements," which is about building a more inclusive workplace within Duke.
Dr. Jeff Baker: She also talked about a new way the medical school is thinking about how to engage the community in research.
Dean Mary Klotman: But then what are we doing externally to build trust? During COVID, we had to build trust rapidly. We were one community, whether you're internal to Duke or external, and that meant really partnering effectively with the community around education, around vaccine rollout. Part of that work showed us that we weren't physically in the community to allow engagement, so we built a clinical trial site outside of the walls of Duke, easier access, more convenient, allows the community to really participate with us in research. We are looking at a lot of the opportunities in research that the community is bringing to us as opposed to us going to the community. Listening better.
Dr. Damon Tweedy: That's certainly important. Research has been a source of a lot of mistrust in the Black community.
Dr. Jeff Baker: And of course, the really big question, the most practical one is how to provide better and more equal patient care. That question takes us beyond the medical school really to the health system. As head of the health system, Dr. Albanese is quite aware that we at Duke have a lot of work to do.
Dr. Craig Albanese: Mary and I understand why members of the community would be skeptical. Our community members, especially those in the Black community, have lived experiences where Duke has broken their trust. And trust is fundamental to doing any of this work, to delivering healthcare, to being a good partner, to being the employer of choice if you want to work in healthcare for community members.
Dr. Jeff Baker: He also shared how Duke Health has partnered with community organizations. He had many stories to share. We asked him to pick just one.
Dr. Craig Albanese: So let's look at an example. Complications during pregnancy, also called maternal morbidity. We partnered with the community and found that, through data, that Black moms were nearly two times more likely to experience a complication in pregnancy compared to white moms. Hispanic and Asian moms had lower rates of complications. Black moms were more likely to bring pre-existing chronic medical conditions to their pregnancy, less likely to make their third trimester visits. They were often dependent on bus schedules and were often late for appointments. Embarrassingly, Duke had a policy that if you are 30 minutes late, you needed to reschedule, so you missed a clinic appointment. While Black moms did not indicate food insecurity, they had a higher incidence of nutritional anemias indicating a lack of healthy food.
So we implemented several changes over the past two years, and these changes resulted in reducing maternal morbidity by 48% among Black moms. And now Durham, the county of Durham, has a maternal morbidity rate that is lower than the state average. What did we do? Pretty simple things. We implemented a care coordinator to help get access to Duke specialists when they do arrive. We again navigated them through that system during that
single appointment to see not only their obstetrician but specialists. We changed the scheduling process to be more patient-centric. In fact, simple question. We asked them, when is it most convenient for you to come to an appointment rather than giving them a time slot. We eliminated the late policy so they wouldn't be penalized if they show up late. And we implemented an organic food program with the community.
Dr. Damon Tweedy: It's a good story. So long as we remember that it's just a start.
Dr. Craig Albanese: So I would just end by saying we've come a long way since the 1950s, and we recognize that we still have more work to do and we will do this together. We're not leading alone. We are leading with the community and with our talent force, both in Duke Health as well as Durham.
Dr. Damon Tweedy: Toward the end of our conversation, I wanted to bring it back to Matheus Avery. I told Dr. Klotman and Dr. Albanese that I went through four years of medical school at Duke and four additional years of residency training here without once hearing about Avery's story, or frankly, any other specific examples of Duke's past racial transgressions. I told them how knowing this history might've been useful in situations where it felt to me like Black patients, for any number of reasons, weren't getting the best care.
Dean Mary Klotman: And so sharing Maltheus' story is very important learning, but we want to expand that in the future. And so one of those strategies is to develop a lecture series that is focused on health inequities going forward. And I think that not only honors his life, but also carries forward, so that we can really develop a much deeper understanding of how healthcare outcomes vary and how we can be a better institution delivering health.
Dr. Damon Tweedy: Jeff, the concept of an ongoing lecture series is something that you and I have discussed with the Avery family several times, and it's really a fitting way to honor Maltheus Avery and his legacy.
Dr. Jeff Baker: And it's a fitting way to start wrapping up this podcast.
Dr. Damon Tweedy: Yeah, we may be finishing this podcast, but the story of how Duke will respond to the Avery story, it's just starting.
Dr. Jeff Baker: Even though we've been working on this for two years, it was the historian, Professor Lentz-Smith, who came up with a medical metaphor for why this work is so important.
Recording, Professor Adriane Lentz-Smith: So I feel a little self-conscious making this analogy to a doctor. But one of the things that I often say when people say, why pick at this? Why are you opening up what they say, old wounds or what have you? It's like, well, wounds heal from the inside out, and if you don't give them space to breathe a little bit, they can fester. If you paper over something without having healed that wound, then actually you're letting a lot of really nasty stuff sit inside. And just because you or I don't want to talk about something unpleasant, that doesn't mean that there's not someone who does that, that there's not someone who remembers it, I mean, that it's not actually still doing some kind of damage that we just don't know how to locate or wrap our heads around.
Dr. Damon Tweedy: We were amazed when she said those words. We hadn't ever told her the name of this podcast, but her description was right in line with our title, UNHEALED.
Dr. Jeff Baker: And I also remember that we had thought about a different title earlier on, HEALING OUR WOUNDS, and we decided against it.
Dr. Damon Tweedy: Yeah, looking back, I don't think that would've played out well with people who know that we have a long way to go.
Dr. Jeff Baker: Absolutely. So maybe at this point, we might each take a moment and share why this project has been important for each of us.
Dr. Damon Tweedy: For me, two reasons. First, I think people who work in healthcare need to recognize that when we meet a patient, we're walking into a story. That person brings all sorts of experiences into the room with them, some recent, others far in the past. And the more we can understand that person and the community they come from, the better we can serve them. And second, it's easy to look back 75 years later and say that what happened at Duke, what happened in North Carolina and throughout the South with regard to racial segregation, that it was all wrong and to judge harshly those who participated in that system. But I think that lets us off too easy. We should be humble enough to ask how people 75 years from now will look back on us, and be willing to challenge the status quo and speak out against the injustices that we see today. So that's a lot I just got off my chest. What about you, Jeff? Why do you think it's so important for us to remember the Avery story?
Dr. Jeff Baker: Well-- because of the family. Now, let me be clear, the history of racism at Duke Hospital is way, way bigger than this one story. There are all kinds of stories out there. This just happens to be one that a family has had the courage to share with us. We're not making a claim that this story stands for all those other stories. But something powerful happens when you take the time to listen, really listen, to a story like this. It reminds us that social justice isn't just about outcomes or numbers that we can measure. It's about the human costs of racism. It's about whether we choose to think of that patient in the emergency room or in our clinic as just a stranger or a fellow human who comes from a family and a community.
Dr. Damon Tweedy: Yes. For me, getting to know the Avery family, it's been incredibly emotional. It's made me think about my own family history, the similarities, the differences, the paths chosen and not chosen, the what might've beens. Been really powerful.
Dr. Jeff Baker: Yeah, it has been an emotional rollercoaster, and yet getting to know this family, it's been the greatest gift I've ever received in 30 years as a historian, and I don't think I'll ever practice the same way again as a doctor. The podcast is winding down, but as Damon said, the work is just starting. And we’d like to close by giving the final words to Malthaus Avery Blake McDowell, the daughter of World War II veteran Maltheus Avery, about why this work matters.
Malthaus Avery Blake McDowell: I'll tell you why I came. I came for Hazel Avery, his mother. I came for Nannie Belle Jackson Avery, his wife. I came for my sister, Evelyn Holland. I came for Dr. Parnell Avery and Lieutenant Colonel Waddell Avery, his brothers who wanted acknowledgement of what happened that night. I came for his sister, Evelyn Avery, his father, Napoleon. Yeah, it's another story. Okay, here we go again. But it's generational. It’s passed on, and it has effects from that December 1st of 1950. Here we are, and it's being passed on. It affected the lives of his wife, his children. It tore families apart. It's generational. That's why, yes, hear the story, talk about the story. Don't cut it off, because somewhere in your family there is a story that needs to be told.
Dr. Damon Tweedy: We'd like to dedicate this podcast to the memory of Maltheus Avery. Our heartfelt thanks go to the Avery family, especially Sybil Avery Jackson, Dr. Vida L. Avery, and of course, Malthaus Avery Blake McDowell. I'm Damon Tweedy.
Dr. Jeff Baker: And I'm Jeff Baker. Thanks for listening.
UNHEALED was produced by the Trent Center for Bioethics, Humanities & History of Medicine at Duke School of Medicine. Our producer is Beverley Abel. Keith Weston is mix engineer. Our project manager is Nikki Vangsnes. Marjorie Miller provided project assistance. Music by Blue Dot Sessions and Pond Five. Funding has been provided by the Josiah Charles Trent Memorial Foundation, Mary Duke Biddle Foundation, and Duke Institutional History Project. Our website is unhealed.duke.edu.