Fresh Air - Black Doctors Consortium Founder Serves Vulnerable Communities

Episode Date: August 7, 2024

When the pandemic hit, Dr. Ala Stanford set up shop in parking lots, churches and mosques where she provided tests and vaccines to underserved Philadelphia communities like the one she grew up in.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Support for this podcast and the following message come from the NPR Wine Club, which has generated over $1.75 million to support NPR programming. Whether buying a few bottles or joining the club, you can learn more at nprwineclub.org slash podcast. Must be 21 or older to purchase. This is Fresh Air. I'm Sam Brigger, sitting in for Terry Gross. Our guest today, Dr. Ayla Stanford, has done life-saving work in the operating room and on the streets of Philadelphia, where she grew up. As a pediatric surgeon, she performed thousands of operations on children, including babies born prematurely. Her hours in the operating room took a toll on her hands, and a shoulder injury from a

car accident curtailed her work as a surgeon. But she found another life-saving calling as an activist, providing medical help for Black people in underserved Philadelphia neighborhoods. While hundreds of people were dying during the early stages of the COVID epidemic, Dr. Stanford founded the Black Doctors COVID-19 Consortium, which provided COVID tests and vaccines to tens of thousands of people in Philadelphia. After COVID became less deadly, the consortium expanded its services by setting up clinics in Black communities around the city. Ayla Stanford has written a new memoir called Take Care of Them Like My Own, Faith, Fortitude, and a Surgeon's Fight for Health Justice. She spoke with Terry earlier this week.

Dr. Ayla Stanford, welcome to Fresh Air. It's really an honor to have you on our show. I live in Philly, so I know some of the amazing work that you've done here that really kind of created a national model. So welcome to Fresh Air. Thank you for having me. I feel honored. So do I. So while you were a practicing pediatric surgeon, you were having problems with your hands, like carpal tunnel, resulting from all the surgeries you'd performed. And then you had a car accident and required shoulder surgery. And you were wondering how long you could continue as a surgeon. How much did that come into play in kind of changing course and becoming more of a medical activist, providing medical services, including vaccines and tests to underserved communities? You know, I feel like I definitely thought about it, like if I had to pivot and do something different. And my majority of my life has been as a surgeon, as a pediatric

surgeon, using my hands literally to heal. And if I didn't have my hands in my upper extremity, could I be as impactful? And I found out quickly because I know for certain I've saved more lives in a parking lot than I ever did in an operating room. And so... Let me just clarify the parking lot part. Yeah. That's where you set up vaccines. That's correct. And testing in the beginning, because... I meant testing. Yeah, I'm sorry. I meant testing. Because, yeah, the first

COVID test my husband got was in a parking lot. Oh, look at that. And one of the things you mentioned, Terri, is about underserved communities. And I should preface by saying when people were calling me in March and saying they were being turned away, they weren't from impoverished communities. They were friends of friends who had insurance, who were educated, and who had my cell phone number. And not that I don't have any friends that are impoverished, but I don't have a ton, you know. And the folks were calling me. What they had in common is that they were Black. And I thought, if people with means are having challenges, I'm sure the people who don't have access to call a doctor are really struggling. And that's when I started

asking, are you really turning people away because their doc isn't on staff? And they said, well, if they took the bus, they've got to be in a car. And, you know, if they don't have an accurate prescription, we can't accept them. We can't be responsible for calling all those people back with the results. And there was this whole list of reasons that were barriers. And so we ultimately created a barrier-free access program to get people tested against COVID. I love that the first time you tried to distribute tests. You had people call you. And then you went to their homes, like one by one by one. And then one day, because of all the driving in between, you did 12 homes. And you thought, this isn't really saving that many lives. So you changed course and figured out another system, which included the parking lots.

Absolutely. But also churches. Yeah. I mean, so as a physician scientist, which I am, all of the data where people were having higher incidence of disease, the demographics, it was all on phila.gov. I mean, you could look it up in any city. Now, when you asked about it, you didn't hear about it in the media per se, but you could dig and find it. So that's what I did. Once I had those zip codes, I put them in order of sickest to least sick. And then I said, okay, it's black people in the city of Philadelphia

that are three times more likely to contract the disease and die. So where do they trust? And for me, in my experience, it's mosques, it's churches, it's community centers. And so I asked my pastor to help me identify a church or a mosque in each zip code where people lived and the disease was the highest. And that's where we targeted. We went to where the need was the greatest. And we set up shop right there. It's amazing to me that you actually were able to get tests. This was during the period when you set up.

It was during the period when no one had access to tests. It was so hard to get tests. And the place that was supposed to be like the big mass testing site turned out to be a scam, even though the city was a partner with it. That's too complicated to get into right now. That's a whole other story. But, you know, people weren't getting tests and none seemed to be available. How did you get enough? So first of all, some of my friends will call me pushy. That is kind of my personality. And I kept calling. Now, remember, Terry, I am or was a private practice pediatric surgeon, meaning I had my own business, my own malpractice, my own employees. And though I was on staff at different hospitals

in the city where I operated, I worked for myself, which meant I had an account with LabCorp and Quest, and I could request tests just like a hospital could. And, of course, they told me no multiple times because I'm a surgeon and it's predominantly primary care docs that were doing COVID tests. But I kept calling saying the need is so great and you're missing sections of the country that are not having access to these tests. And finally, I got the right person at the right time that sent me 500 testing kits. And we used every single one of them in the first two days. And every time we used them, we sent in our specimens. They would send us a new box of 500. And for them, yes, they were doing the right

thing to help, but it was also revenue generating for them. And because I said, you're going to bill me when they said, how are you going to pay for it? I said, you're going to bill me. And by me, you meant you personally. Me personally. I said, listen, I have a practice and in good standing. I've been a doc with your company for years, which was true. And so I certainly got those hundred, two hundred thousand dollar bills for all of the COVID test processing that LabCorp was doing. Why were you willing to pay for it out of your own pocket? Because at the time, the people that I would say get paid to do it, city, state, federal government were not. And it wasn't, there was so much bureaucracy and red tape to cut through to get the, particularly the underserved, uninsured or uninsurable people did not have access. And some people with insurance couldn't get it. And I wanted it to be barrier free. If you had insurance, great. I didn't even accept insurance. I just said, if you have been exposed

and you need a COVID test, come to us. That's it. That was the only requirement and a way that I could reach you with your results. And when we didn't know if tomorrow was coming, you know, if we were all going to be dead, I wasn't worried about a $50 or $100 test. I was worrying about saving a life. And that's where the priority was. You thought that if anybody was actually doing triage in terms of who needed tests and who

really needed vaccines, that the Black community wasn't taken into consideration, that underserved communities weren't taken into consideration. Where do you think underserved communities should have fit in a triage mentality? The health department, regardless of what governmental level it is, or in a health system, I believe you go to the most vulnerable. You go to who needs a safety net, who can't advocate for themselves. It's like how we take care of our babies and our seniors because they may need some extra help. So when you're saying to everyone, shelter in place and don't go out into the public, but you can't afford to shelter in place because you have to go out into the public to

support your family when you're saying buy a bunch of food for a month and keep it stored, and people don't have the money to do that. It's sort of like the adage of telling a bootless man to pull himself up from his own bootstraps. It's like the recommendations were applicable for certain socioeconomic tiers in society and not for others. And so in my mind, I hope we never have another pandemic again or a public health crisis, but those who have the greatest need are where you put the emphasis. And it's not to say that you can't take care of everybody at the same time, but there should be more emphasis on where you will see the greatest death and disease. You were sometimes told as well, black people distrust the vaccines. They're not going to get them. So we're not going to send them to you. We're not going to send vaccines to you. Which is crazy.

What was your response to that? So again, being the physician scientist, I said, why don't we ask them? So it was October of 2020 and it was flu season. And so in addition to doing COVID tests, we were also doing flu shots. And we told folks, this flu shot is not going to protect you from COVID. But when they came in, we did a survey, a psychometric tool, to use the proper language, and we asked them, if a vaccine were available today, what would make you take it? What would you be concerned about? And from that data, we used all of our messaging was what people's fears were or what their strengths were.

But what I learned more than anything is that the majority of people said that they did trust the government to produce a vaccine. And yes, they would take it. And so then it became using objective data to dispel a subjective narrative. And that became my quest. And so once I couldn't get it from the city right away, I had the young people in the consortium create a survey or doodle poll online and had people sign up to get the vaccine. And I said, I don't have it yet, but I'm starting to create a list. And in 48 hours, we had over 3,000 people sign up. And because we were collecting demographics, we could see the majority were African-American. And then I could go to the city and say, people want it. I put this out, you know, on Monday, on Wednesday, we've got thousands of people signed up. And so I had to, rather than lament, rather than complain or cry

about it, I backed it up with the data. And that's what helped support us getting it. Has it ever been awkward? I remember when you couldn't get a vaccine, it was so hard to get, that people were going to underserved communities because there were vaccines there, they were probably your vaccines. So was it ever awkward when a white, middle class person showed up asking for a vaccine, when you had gotten these vaccines specifically for underserved communities? It was ridiculously awkward. My gosh. What did you do? It was so awkward. Well, I mean, you sort of heard these rumblings and conversations because what happened, Terry, is that all of our registration was initially online. And so and you would see predominantly people of color coming in.

The people who didn't have access to online registration started getting pushed further and further to the end of the line. And so what ended up happening is they would just show up at five o'clock in the morning and wait in line and figure, well, if I'm here, they're not going to turn me away. And they were right. And because they didn't have access to make those online appointments. Now, let me go back to your question. And so when I started seeing, you know, Teslas and Range Rovers in the parking lot in North Philly, I was like, what is going on here? Because most people take public transportation anyway. And these were some very expensive cars in my parking lot. And I would say

it doesn't help if you come to this community and take a vaccine and go back to your place in the suburbs or wherever where you're sheltering in place in your own bubble and you're not interfacing with the public and then the people who are interfacing with the public and they're going to work and they're more exposed and they're more likely to contract the disease don't have it. It doesn't make the pandemic end any sooner if you do that, right? It's not going to allow you to go on vacation any sooner if you take from those who are the ones who are most at risk. I tried to explain that. Nobody wanted to hear it, you know, but I did try. And what we started to do was oversample from the zip codes where the positivity rate was the highest. And people told me I was

discriminating. And who was I? I didn't have the right to do that. And I said, this is a public health crisis. And a public health crisis, you go to those who have the greatest disease, the greatest morbidity, mortality, and death. That's where we went, right? And later, the city did the same thing. But for me, I got lots of sort of hate texts and direct messengers and all those sorts of things. But I knew it was the right thing to do. So I just pressed on. And there was a lot going on that was wrong inside her teeny little body. It sounds like an incredibly delicate, complicated, and unusual surgery. Would you describe in layman's terms what made this operation so delicate, so complicated? So what made it so delicate is one, the infant is less than a pound. So that's how much they weigh. Their circulating blood volume is about two shot glasses or 60 mLs or 60 cc's. So you can't afford to lose any blood. The blood vessels are smaller or skinnier than angel hair pasta, and the lungs are fragile like tissue paper. And in your intestine, when you're premature, in all of us, in all of our intestine, we have stool and waste that goes through that. When you're premature, infants can develop something called necrotizing enterocolitis, which can cause a hole or perforation, which means all of that bacteria that was running through your bowel is now leaking into your abdominal cavity, causing you to have bacteria in your blood and in your abdomen.

And so we needed to wash it out. We needed to find the hole. When there's so much disease, you can't just sew it back together. And even if you do sew it back together, it's smaller than your pinky finger, what you're sewing. So if you sew it too tight you'll cause a blockage if you sew it too loose it'll fall apart and every move matters because the stress on a baby the longer you have their abdomen open the more likely that will manifest with poor vital signs and so forth and then all of, this premature child that was born into the world was born to unhoused parents. And I was working at a hospital where there were very few people of color.

In fact, the only two black women, black mothers in that neonatal intensive care unit were me and this mom. And as I'm explaining all these complicated things and I'm thinking she's getting me, but I know all she's really thinking about is her baby. She looked at me and said, take care of her, take care of my baby. And I said, I will take care of her like my own. And I do that with every child I operate on, with every adult that I cared for during COVID and beyond, just family members or friends of friends that call and need help. I just try to treat them like I would pray someone would treat my children and my husband. The baby survived. You did a follow-up surgery a few months later.

Just curious, how small are the stitches and how fine is the needle that you have to use? It's so small. So I use, so the suture is, depending on how large the number is, how small it is. So I use something called 4-0 or 5-0 proline or vicryl, which is, you know what? It's about as thick as an eyelash. That's about how thick it is. Wow. All right.

Let's take another break here. If you're just joining us, my guest is Dr. Ayla Stanford. She is a pediatric surgeon who became a healthcare activist serving underserved communities. Her new memoir is called Take Care of Them Like My Own. We'll be right back after a short break. I'm Terry Gross, and this is Fresh Air. fresh air. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees. Download the WISE app today or visit wise.com. T's and C's apply. So I want to talk about how you grew up and how that relates to the work you've been doing in underserved communities of people of color. When you were born, your mother was 14, your father 17. You tell the story of the circumstances of your mother's labor.

And I want you to describe that for us. Well, my mom was the same age as my twins right now, 14. And she was in labor, and she tried to get a cab down in front of Wanamaker's, and no one would stop for her. And her water broke, and she had, you know, water going down her legs, and I would presume blood, and did what she knew,

and she took the Broad Street subway. And so from City Hall, she took the subway up however many miles, maybe six or eight, to Einstein Hospital where I was born. And when she got there, she was in a lot of pain. And she has described to me that when she woke up, her stomach was flat and she was in a pool of blood and I was gone. And so that is how I came into the world. You were gone because you were with the preemies? Yeah. Yeah. Or with the babies that had eventful births, so to speak. Like almost being born on the Broad Street subway. Yeah. And her mother didn't want to take her in because she warned her about getting pregnant and was very angry with her for getting pregnant. How were your parents able to provide for you and for themselves? So we had and have an extended family that are like extra parents to me that took my mom in, that taught me, that potty trained me, that fed us.

And that was how, you know, my father's mother, my grandmother was also part, and my father's mother's mother, my great-grandma. So that was how, but honestly, my mom did, my mom was the one who at a young, young age was going to high school, taking care of me. I mean, people helped on the periphery, but she was, she was it. I mean, she, she did a lot. She had no childhood because she had us and decided that she was going to raise us as best she could. Us as your brother who was four or five years younger than you. Yeah, my brother Kamau, yes. So you lived through times of no electricity and hardly any food, ironing sheets

to stay warm at night, roaches, rats, shoplifting when you really needed something. You were even arrested once. So just talk about the shoplifting briefly and what your motivation was and what kind of things you lifted. Do you mind me asking? Because you've come so far from there that I think it's instructive to hear why you did it. Well, the short answer is I was hungry.

Right down from Germantown and Mount Pleasant, there was an Acme there. I think the Acme is still there. And I was with my brother who was five years. So if I was nine or eight, he would have been four. And I stole some tasty cakes is what I took because I was hungry. And, you know, granted, my brother was like a baby. He was four or five. And I was arrested and they put handcuffs on my wrist on the back and put me in the back of a paddy wagon. And my brother had to walk home by himself. We lived at Germantown and Johnson, which was kind of far for him to walk by himself.

And it was black in there and it was cold and there were no windows. And they took me to Broad and Champlist and put me in a cell. I thought to myself, I'm like nine, eight. And I really didn't want them to call my mom because I knew how hard she was working to put food on the table. And I knew I was going to get spanked when she caught up to me. And she was so, I know she was disappointed. But again, it was, you know, at the time it was because I was hungry. And I guess what I would say, you know, so often when you see kids taking something, and even though it may not be food,

it could be clothes or sneakers or whichever, if they're taking 10 of them, it's not because they want to wear it, okay? It's so they can sell it to get something else, which a lot of times is shelter and food and maybe things to make them feel like a kid, like a phone, sneakers. I don't know. So it's, I mean, it's actually hard to talk about some of this stuff, but I put it there so maybe as adults we won't be so dismissive of these young folks that we feel like won't amount to anything and they'll just end up in jail or in juvie and will be menaces to society. But maybe if we, you know, the time it took to,

I don't know, put me in handcuffs in the back of a paddy wagon and take me down to a precinct, you know, that same amount of time learning something on a computer, reading a book, you know, having me come back to the police station once a week and, you know, show me, expose me to other things that may be an option, I think could have been pretty pivotal for my life as well. I mean, I turned out OK, but I guess I'm saying that for all the other kids out there that don't get that opportunity. Well, let me reintroduce you again. If you're just joining us, my guest is Dr. Ayla Stanford. Her new memoir is called Take Care of Them Like My Own. We'll be right back. This is Fresh Air.

Your mother joined the group, the Black Humanist Fellowship, and you went to their school from the time you were one year old through second grade. And it was a school designed for black children to, among other things, teach them a little bit about black history, to instill a sense of pride in themselves and in their history. Would you describe the school and some of the ways in which you think that really helped you get a good start in life? Oh, my goodness. I'm going to say three things that I know that it helped me with. One was a sense of pride of being black in America, because that's not what I saw on the news.

It's not what I heard on the radio. You know, black was bad growing up. But when we were in the school and we saw pictures of kings and queens on the walls and our teachers were black and they greeted us and they were happy to see us and we could have African names and no one wanted to change those names. African names like yours. Like mine. And no one wanted to change it or call me something else. It was a beautiful, beautiful thing. So I would say the pride in myself and in people in realizing that we were a community that reached back to help others. And that's where that foundation for me came. That's number one. The other thing that I learned was conflict resolution, which I feel like is lacking so

much in our communities where everything is solved with a knife, with a gun, with, you know, saying something horrible about someone on social media that they don't want to wake up to see the next day. I remember if you fought with someone in your class, like sort of fist fought or said something smart. Do you know what the teachers used to do? What? The teachers would take a string and wrap it around both of our wrists and tie the string together. And you had to do everything with that person the entire day. This was in... At Nathamu Sasa, at that African Free School right on Queen Lane in Germantown.

We, and so it meant one of you had to stand outside the stall while the other went to the bathroom. It meant if you had to tie your shoe, it meant if you wanted to play at recess, you had to do everything together. And by the time the end of that day was done, whatever you were fighting about was squashed. Whatever beef it was, was done. There was no carrying it over to the next day or I'm going to get my somebody to beat you up after school. There was none of that. Because you had to learn how to cooperate with each other. Absolutely. Absolutely,

absolutely. And those are some of the things that I remember. We would, you know, sing songs in the morning that were about uplifting one another. And it wasn't like, oh, we are so good. White people are so bad. It was nothing like that at all. It was just about an affirmation that you are beautiful, that you deserve to be here, that every opportunity you could conceive in your mind can be afforded to you if you work hard. It was just, it was that. And, you know, that they had high expectations for us. And I think because they knew that the rest of the world would not see us as a beautiful black boy or a beautiful black girl, they wanted to make sure that when we were in that space with them from 9 o'clock to 3 o'clock, that we were loved on, that we had something to be proud of, our heritage, and wanted us to take that out. And so we would be prepared for what the world would dish out. But after you went to that special school, in second or third grade, you went to public school. What was it like to suddenly be put into public school in a totally different kind of environment? Oh, it was so different. It was different from, you know, the teachers, how they interacted with me. There was no bubbly, happy to see me. It was more like, you know, what trouble are you going to get into today?

I can remember the teachers wanting to call me Anna instead of Ayla because Anna was a more acceptable name and easier to pronounce. And telling my parents that and them wanting to go through the roof. I remember that the students were fighting all the time, that they were calling people the N-word, which I never heard growing up like at all and it was being used in such a negative way like like a curse word which I didn't do um and so that was that was different and you know and just because my name was Ayla not a traditional or American name that it was something to be made fun of, that, you know, my dark skin wasn't beautiful, that my natural short hair wasn't pretty. And so it was just, it was different. But, and I can't say that I always felt like, oh, because of what Nathamu

Sasa instilled in me, I was unscathed. No, I mean, every kid is a kid, and you want to have friends, and you want people to like you, and you don't want them to make fun of you. And so it hurt. But I, you know, I had my foundation. And so that definitely helped. One of the things that really scarred you when you were young is that you were sexually abused by your mother's boyfriend and also by a family quote friend. How old were you when that was happening? seven, eight, nine, gosh, 10, 11. It was through the time that I moved to Lockport, New York, which was... That's near Buffalo. Yeah. I was in eighth grade, eighth grade, ninth grade.

And then when I moved from Lockport, New York, back to New Jersey, and by then I was in high school. And by then I was like, okay, you know, I'm locking my doors. I'm going to make sure I'm not in the house. You know, there's not going to be any issues because I, you know, I know that this is wrong. You know what I mean? Like, and that's what motivated me even more to get the grades I needed, to get the scholarship I needed so I could get out of my house. And so, yeah. So it went on a long time. Did you tell anyone?

Was there anybody you trusted to tell? I, you know, obviously I told my mom. But at the time, I think the response was something like, well, I've already told everyone, so you don't need to tell anybody else kind of thing. I did things that I think a young kid would do. So, for example, we had a box fan in the summertime, and, you know, you could take the grate off or it would fall off because they were cheap. And I would, you know, put these fans around my bed so that if you walked into it, it would, like, hit your leg and hurt and then you would hopefully leave. I would, in the summertime, wear like really thick stockings that were hard to take off. Tight. Yeah.

Because my mom, like I said, was working so hard to take care of us that I didn't. I know that's why I didn't tell my dad, or maybe I thought she would talk to him. I didn't want her to get in trouble. Um, cause I knew she was, you know, working so hard to take care of us. Um, yeah. You know, in, in the memoir you write about having to do in medical school a psychiatric interview with somebody for an evaluation. And that person turned out to be a child abuser. And you were totally traumatized by it. And you decided psychiatry is not for me. I'm finding another specialty. But, you know, as a pediatric surgeon, you had to perform surgery on some children who

were abused by, you know, relatives, friends of the family. What was that like for you? That must have been pretty triggering. But on the other hand, you were there to help fix it. Right. So one, yes, triggering. But two, it was also healing for me. And I would say it was probably 10 years ago that I really understood that this gift I had in being a physician and a surgeon and a healer was healing me in some ways more than I was healing others. Because every time I got to take care of a child and a family trusted me, or, you know, sometimes they were, you know, kids of the foster care system and they didn't have parents. But every time they were in, I was responsible for them when they were in my custody, so to speak, and I got to protect them. And I was a person that they could talk to, or my team was a person they could talk to about what

might be happening or not happening in their house. And each time I was able to do that, I felt like I was healing myself. And so maybe that's why I went into the specialty I went into. But I'll definitely say my gift, I believe, from God ended up being a gift to me in that healing others, I was able to heal myself. Let me reintroduce you. If you're just joining us, my guest is Dr. Ayla Stanford. Her new memoir is called Take Care of Them Like My Own, Faith, Fortitude, and a Surgeon's Fight for Health Justice. We'll be right back. This is Fresh Air. In November 2020, a half year into the pandemic,

the American Medical Association classified racism as a public health issue. Do you think that's made a difference? Hmm. Well, do I think it's made a difference? I think it's made a difference because we talk about things maybe more. But there's so many things systemically that have more doctors of color in the health care field to acknowledging the bias that all students come to school with when they start medical school of their perceptions about pain and about understanding of different diseases of black people and Latinx people and Indian and Asian and people who are not like you. I feel like all those things need to be dispelled. Just like you're learning anatomy, all that needs to come out at the very beginning so that we can educate people about communities that they may not have been exposed to not once in their lives. And if it hasn't happened, it needs to happen when you're learning to be that doctor or the nurse or the nurse practitioner or physician assistant.

That's where we've got to dispel those myths and preconceived notions that we all have about people. And so do I think that it has changed things? Yes, I've given grand rounds. And now when there's a surgical complication, one of the criteria when you say, well, was it patient disease? Was it physician error? Was it a timing? Someone can say, was it bias related? You know, how did bias, how did racism play a role in the outcome of this patient? I have seen that at many institutions. So I would say yes, but you have to acknowledge that bias exists in healthcare. So it's great that the American Medical Association says it exists. But do you believe it? As someone in healthcare? Do you believe that you play a role because of your own lived experience and bias

that you bring into the exam room and into the operating room? You wear your ID badge, your doctor ID badge for every doctor's appointment that you go to for yourself. You also wear it when you accompany your parents or children to doctor's appointments and you say, I shouldn't have to. Why do you do it? Oh my. Well, I used to say, well, whatever care my patients are getting is good enough for me. That is until I was pregnant with my first child and I was spotting and I was concerned and I went to my doctor and I could hear them saying, what do they think? This is a walk-in clinic and are we just taking people without appointments now? Now, I'm a physician. I'm not wearing my badge. I did call to say I was running. It was unexpected. I didn't know I was going to start spotting and bleeding.

So, of course, I walked in, right? And because they were so dismissive, I left. Now, for me, I knew that it was a medical. So I pushed. I ended up going to the ER. But other people might have just left and went home. And you went to the ER and the hospital where you were working. I sure did.

Everybody knew you, so you didn't have to wait there hours to be seen. I didn't have to wait, and they took care of me. And, of course, word spread that, you know, this other doc had basically talked crap about me in front of me. And there were lots of apologies and all this other stuff. But in that moment, I was a black woman who you felt did not deserve the same attention as fill in the blank, or you assumed I didn't have insurance or that I was uneducated or that I was whatever. And you didn't take care of me like I believe you would have wanted your daughter to be taken care of in that moment. And since then, I wear it. I think it's kind of tough because I don't want people to also

not explain things to me and my loved one because you're like, oh, you're a doctor, you know everything, which happens. But then I say, no, why don't you explain it for them so that they make sure they understand. But those days of not saying anything are over for me because it's tough. Dr. Stanford, thank you so much for talking with us. And thank you so much for the work that you've done and that you continue to do. Thank you, Terry, for having me. Dr. Ayla Stanford is the founder of the Philadelphia-based Center for Health Equity and the Black Doctors Consortium.

Her new memoir is called Take Care of Them Like My Own, Faith, Fortitude, and a Surgeon's Fight for Health Justice. On the next Fresh Air, life behind bars while earning applause on stage. The new film Sing Sing is about the rehabilitation through the arts program at Sing Sing Prison, which has offered a path to redemption and self-esteem for thousands of incarcerated men and women. Filmmaker Greg Quidar and actor and former inmate Clarence Divine I. Macklin will be our guests. Join us. To keep up with what's on the show and get highlights of our interviews, follow us on Instagram at NPR Fresh Air. Fresh Air's executive producer is Danny Miller.

Our technical director and engineer is Audrey Bentham. Our interviews and reviews are produced and edited by Phyllis Myers, Lauren Krenzel, Teresa Madden, Roberta Shorrock, Anne-Marie Baldonado,

Monique Nazareth, Susan Yakundi, and Joel Wolfram. Our digital media producer is Molly C.V. Nesbert. Thea Chaloner directed today's show. For Terry Gross and Tanya Mosley, I'm Sam Brigger. Who's claiming power this election?

What's happening in battleground states? And why do we still have the Electoral College? All this month, the ThruLine podcast is asking big questions about our democracy and going back in time to answer them. Listen now to the ThruLine podcast from NPR.