Suit bag in one hand and suitcase in the other, I strolled away from my final residency interview to catch my bus from Port Authority. How could I come to Brooklyn and not swing by a West Indian roti shop? Some sweet-and-spicy doubles and curry chicken seemed like the perfect way to celebrate before heading back to my apartment in Providence, Rhode Island. Like the nameless protagonist in Ellison’s Invisible Man upon finding a hot buttered yam, the tamarind chutney and pepper sauce overtook me with joy and nostalgia. I escaped the January frost and transported back to warmer days in Trinidad and Tobago with my partner’s family, to memories of the highs and lows of medical school. If there is one thing I have learned in the long journey to become a doctor in America, it is to hold on tightly to these moments of rapture.
Fast forward to March 20, surrounded by family in my parents’ living room and friends tiled across my laptop screen, I learned that I would be returning to Brooklyn. Due to COVID-19, the long-anticipated tradition of Match Day — with its red envelopes, champagne glasses and electricity in the air connecting everyone gathered together — had gone virtual. Now, weeks later, with the need to continue social distancing to flatten the curve on COVID-19, virtual has become the new normal.
These days in lockdown and in anticipation of moving to a new city, I find myself browsing for an apartment on sites recommended by friends and co-residents, like StreetEasy. But I had imagined traveling back to Brooklyn, now the epicenter of the epicenter for COVID-19, to explore the many different neighborhoods and maybe even try a few more roti shops. Instead, my apartment search is now confined to the imagination of commercial travel guides and the sterility of price filters as well as descriptions of building amenities. Do not get me wrong: it is a great privilege to even be able to social distance. But looking to move to a new city this way also feels like a strange privilege.
When I moved to Providence for medical school, I also did not have the opportunity to explore the city beforehand. Studying abroad in Quetzaltenango, Guatemala, I met my future roommate on the admitted students’ Facebook page, and he found us a place in the Fox Point neighborhood. It was a student’s dream: an easy bike ride from the medical school and local hospitals and within steps of coffee shops and pizza-by-the-slice. However, only later did we encounter a documentary film, “Some Kind of Funny Porto Rican,” unveiling the history of gentrification that displaced a Cape Verdean community from what was now our new home.
While possibly not entering the American mainstream until the arrival of harpooner Daggoo in Melville’s Moby Dick, Cape Verdeans have been coming to the United States as early as the late eighteenth century, prominently to southern New England cities to work on whaling ships. By the turn of the twentieth century, Providence was home to the second-largest community of Cape Verdeans in America, and the Fox Point neighborhood was its “cultural heart.” On Sundays, residents would gather around Mamãe and Papai’s famous jag, the Cape Verdean soul food of rice and beans; the longshoreman, who formed the first Black workers union in New England in 1933, could be seen strutting in their finest attire on their day off. However, the destiny of Fox Point for future generations was forever changed in the 1960s. At the behest of city planners, under the guise of a “renewal project,” a new vision for Fox Point was underway. Cape Verdean renters were evicted and homeowners scared away to make way for renovations by private developers and demolitions for the expansion of I-195, fracturing Fox Point into two pieces. Hundreds of families were displaced and the “cultural heart” of the Cape Verdean community was broken and scattered across Rhode Island and Massachusetts. Now, despite being home to many medical students and residents, this history of Fox Point has largely been erased and remains outside the consciousness of medical school and residency curricula.
As I prepare to move for residency, the tragedy of Fox Point feels eerily similar to the story of a gentrifying Brooklyn. The race and class dynamics of Brooklyn’s changing landscape are being explored in great depth by social scientists. In the early 1900s, Brooklyn became home to an increasing number of communities of color, particularly Black residents. They hailed from descendants of the enslaved in Kings County, the most heavily enslaved place in New York state in 1790; other New York City enclaves like Harlem; the American South to escape Jim Crow; and the Caribbean, along with Puerto Rican residents following their American citizenship in 1917. As all Americans experienced devastating hardship during the Great Depression, these new and old Brooklynites of color were systematically excluded from homeownership loans, one of the most successful policies of Franklin Delano Roosevelt’s New Deal. In a process known as redlining, government-sponsored lenders consistently downgraded neighborhoods with residents of color, describing “Colored infiltration [as] a definitely adverse influence on neighborhood desirability.” Yet, in recent years, renewed interest from White and wealthy people are now pushing out these communities of color that survived. The last decade has been defined by rezoning, “economic development plans” and the erection of tax-abated luxury condos. The irony could not be more apparent. Despite racist policies, Black and Brown communities, including immigrants arriving after the removal of quotas by the Immigration and Nationality Act of 1965, revitalized “undesirable” neighborhoods only for White and wealthy Americans to reclaim it for themselves. Downtown Brooklyn, once home to profitable Black- and Brown-owned small businesses and iconic in the rise of hip-hop, is a prime case study of how political and corporate interests have aligned to fundamentally transform who belongs in the borough.
As a soon-to-be resident of Brooklyn, I am left questioning if I am also part of the problem of gentrification. Clearly, medical students and residents contribute a valuable service to their communities as part of the healthcare workforce. This has not been more evident than in the time of COVID-19 with residents on the frontlines and medical students stepping up in creative ways, such as supporting contact tracing or even graduating early. However, many medical students and residents like myself drift from city to city to receive training. How many of us sign leases or buy homes without much thought beyond maximizing convenience and comfort to make it through board exams and call schedules? The arduous process to become a doctor does not make it easy to lay down roots in any one location or venture far from the hospital or clinic in our limited spare time. But that does not feel like an excuse to overlook the historical and present-day forces impacting our neighborhoods and, ultimately, our patients.
The histories of Fox Point and Brooklyn reveal how where we call home is deeply intertwined with identity, power and privilege. They tell the story of structural racism — a patterned, “normative, sometimes legalized” process by which communities of color are marginalized. The sequelae of structural racism have dire health implications at the neighborhood-level. While existing neighborhood health disparities research has largely not been designed with enough precision to draw causal inferences with respect to structural racism, there is robust data linking neighborhood disadvantage to a number of poor health outcomes, including low birth weight, cancer incidence and heart disease mortality. And now, with early data suggesting increased mortality from the novel coronavirus in Black and Latinx populations relative to other racial groups, how might legacies of “segregation, discrimination and devaluation” have disproportionately produced vulnerabilities during this pandemic?
Recognizing gentrification as only one process in a larger machine of structural racism has been overwhelming and, at times, paralyzing. Finding an ethical path forward has not been easy, but learning about reparations has been a good first step. History may be written into books and cityscapes by the victors, but as physicians-in-training we have the privilege and responsibility to listen to our patients who have suffered and continue to suffer from structural violence. We owe it to ourselves and to them to not be complicit in perpetuating these harms in our clinics as well as our homes.