Report — From the June 2017 issue

Where Health Care Won’t Go

A tuberculosis crisis in the Black Belt

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Several months after the state’s paid testing, I drove into Marion. I passed a residential area with beautifully restored antebellum mansions, and the town’s courthouse, a gracious building with magnificent columns. But as I wandered around the commercial strip of Washington Street, which runs two miles between the health department and the Hill, the sights revealed themselves gloomily. The door of a red building on a corner had years ago opened to the Ole Theater Cafe. There had been a clothing store, a stationery store, an auto-body shop, a restaurant or two. Now their storefronts were closed and battered-looking.

When I reached the Hill, I turned left at a weather-beaten used cars sign, parked, and made my way toward the site of the health department’s ill-fated fair. An old Buick was parked there; four men sat inside drinking beers and bobbing their heads to Michael Jackson’s “Black or White.” I went up to the window. The man sitting in the front passenger seat kept his hand firmly planted on a rifle resting against his left thigh.

Left: The Hill neighborhood. Center: Washington Street in downtown Marion. Right: The Hill’s basketball court

I was there, I said, to see Orlando Moore, who lived in the neighborhood. We’d met before, and had made arrangements to discuss the TB testing. The man wasn’t sure where Moore was, but eventually I spotted him — a short, scrawny guy with a fade and a gold hoop in his left ear — sitting in a white car nearby. Moore, who was thirty-one, used to drive a truck and mow lawns. Now he had no job, and was expecting his first child — a boy — with his girlfriend, Charnissa, who was in the driver’s seat. He nodded as I approached the window. “Hey, you found me,” he said. There was a woman in the back, who introduced herself as his cousin.

Moore invited me over to his apartment. In the kitchen, he pulled a bottle of juice from the refrigerator and sat down. The women hovered around us, quiet at first. I asked about the testing. “The Hill’s used to being targeted,” he said. “Have you ever had to deal with white people? They look at us as one of the lowest families in Marion.” The Moores had been there for generations. He told me that he got tested when the health department offered a cash reward, but added quickly that the results were negative and that he didn’t know anyone who had the disease. His cousin, wearing a rainbow-striped dress, chimed in to agree.

Charnissa was incensed over the way the health workers had zeroed in on their neighborhood. “They’re singling us out,” she said, her voice rising. “Just because we’re around! Nobody here had it!” Exasperated, she stormed outside.

I took that as my cue to go. As I headed off, I bumped into Marsha White, a middle-aged woman in a pink-and-white summer dress and knee-high boots, sitting on a kitchen chair outside her apartment. I asked her about the outbreak, and she told me candidly that she had been diagnosed with TB and had gone through treatment. “I’m not ashamed of it,” she said, which she acknowledged was unusual on the Hill. She’d discovered that she was infected when her sister pointed out that she appeared to have lost a lot of weight. “I took all my clothes off, looked in the mirror, and I started crying,” she recalled. “And every time I walked or talked, I got short of breath.” She was a patient in Lee’s clinic, and she praised the health department workers for looking after her. Without them, she said, “I think I would’ve died.”

We talked for a while, and after a few minutes, Moore’s car appeared on the block. He and Charnissa half-waved at me. His cousin jumped out of the back seat and greeted White with a kiss on the cheek, grabbing some cigarettes from her pocket before dashing off again. “That’s my baby girl,” White explained.

I hadn’t realized that they were family. Lowering my voice to a whisper, I asked if she had kept her TB diagnosis from her daughter.

She chuckled and slapped her thigh. “My daughter? She knew I had it! Her boyfriend also had it!”

I was confused — I told her that, moments earlier, they’d all said that they were healthy, and so was everyone they knew.

“Them folk don’t want you to know what’s going on with them,” she said. “She just told you a lie.”

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is a physician and an assistant professor of medicine at Columbia University. Her article “Hashtag Prescription” was published in the June 2016 issue of Harper’s Magazine.

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