Community Care:It’s All Family Medicine
My name is Vincent Webb. I am the Director of Operations and Clinical Services for Seven Hills Family Medicine. As you may know, we are a new inclusive family medicine practice located in downtown Richmond seeking to expand access to high-quality primary care that sees, respects and treats the whole patient. Our work includes taking care of things like sneezes and sniffles or check-ups as well as providing gender-affirming therapies, mental health services, treatment for chronic illnesses and reproductive healthcare, including abortion services for people of all genders and identities.
When my partners and I were talking about what this new thing we were creating would be called, using the term “family medicine” immediately became paramount. Just as there is no singular or correct way to be a human being, no one body type, creed, color or ability, there is no one way to be a family, and queer people know that better than anyone else. Our chosen families are no less real. Our partnerships are valid whether the state recognizes them or not. Two mommies, two daddies, a Mapa, a nibling, the names and configurations don’t matter anywhere near as much as the love and support that people give to each other. My husband and I have two sweet, silly, wonderful kids that I was fortunate enough to carry by choice and bring into this world. They have a rainbow of aunties, uncles and cousins that they do not share a single drop of blood with, people that would do absolutely anything for them. I love each and every one of these folks with my entire being, through every triumph and heartache. Our trans and queer family is beautiful, but it is not always welcomed. Whether someone else decides if we are or aren’t, the whole of our family is worthy of care, respect and safety. All people deserve these things. This truth is of special importance in healthcare environments where we may be at our most vulnerable. Our personal information is on display through metrics and records. We offer the home that is our body for examination in the hope we’ll receive answers, alleviation of symptoms or a cure. Few situations require more faith or trust. Dr. Arnold and I honor this understanding in our mission at Seven Hills, but we didn’t arrive at this point spontaneously or without precedent. Just as queer people have thrived within our chosen families, it is our community and our allies that have held and propelled us all into this current moment. None of us can make it by ourselves, but none of us are alone.
I want to briefly highlight some of the history of queer healthcare in and around Richmond. While this isn’t by any means a complete telling, and I won’t take us all the way back to when the cobblestones were laid, I will take us back to 1958, a little ways west of the city, at a cocktail party in Farmville, Virginia where two men who would later become Dr. Waverly Cole and Dr. John Cook met for the first time. Both saw each other from across the room and liked the view. Both had served in the Army Medical Corp during WWII, and both were part of the invasion of Normandy. John actually came ashore on Omaha beach on D-Day, and miraculously, made it off again alive. They shared that experience and an immediate affinity. That meeting would change the rest of their lives, as well as the lives of a great many others. The pair would move together to Richmond in 1960, and are considered by many (including themselves) to be the first out gay couple in the city. Whether that is categorically true or not would be a very hard thing to pin down, but they certainly made no secret of who they were individually or to each other. Dr. Cole was in anesthesiology and Dr. Cook was in counseling, and twenty-five years after coming to the city, the pair started the first ever AIDS fund to help Virginians with HIV get access to the medical care they required. It was 1985, around 15,000 people had died of the disease, yet all the way up until September of that year, President Reagan hadn’t even said, “AIDS.” Here were two people ready to help their community because they saw the need, they could, and they cared. This fund was lifesaving to those that needed it. This has been, and still is, the story of queer healthcare, the dual tale of those that look the other way and of those that don’t. If you’d ever like to see it, you can view Waverly Cole’s Doctor bag in town at The Valentine museum over on Clay Street.
Around ten years after Doctors Cook and Cole came to Richmond, two other doctors, a nurse and minister started a small community clinic inspired by the counterculture of 1960s San Francisco and the free university movement. They set up in Richmond’s historic fan district, so naturally, they called it Fan Free Clinic. In the 1970s, they were vocal about providing safe birth control, including oral contraceptives. During marches and protests, people from the clinic would wear arm-bands to identify themselves as medics, providing care to those that needed it in the fray. In the 80s, they were again at the forefront, caring for those affected by the HIV/AIDS epidemic when so many victims of the crisis were cruelly ostracized and turned away. Black and Latino gay men and transgender women were particularly hard hit and in need of help.
In August of 1990, the Ryan White CARE Act was passed, named after a 17 year old teenager that had died four months prior. Ryan contracted the virus after a blood transfusion when he was 13. Despite being given six months to live, he made it to his senior year, though not without difficulty, He and his family faced discrimination from those at his school that wanted to exclude him. Some of the arguments for wanting to keep Ryan out of school are unfortunately eerily similar to calls to keep transgender students away from their cis peers at some Virginia schools today. Ryan ended up having to fight for his right to attend even as he was fighting the disease. The act passed in his name would expand access to medical care, medications and support for people with HIV nationwide and here in Virginia.
A few years later into the 1990s HIV would become something that could be managed much like other chronic illnesses. Fan Free Clinic pivoted at the time to provide testing, information, resources for prevention, and support services, coming to be known as “THE PLACE” to get help. As the world said goodbye to the 1900s, the clinic would begin treating trangender patients, becoming a hub of care to a group still often pushed to the margins. To better align with their mission and services, the Fan Free Clinic was renamed Health Brigade. Just as those bringing water bucket by bucket to douse a house-fire must work together, ever running towards the problem, to accomplish their goal, so too do those seeking to tilt the imbalances that exist in healthcare. In 2020, Health Brigade celebrated 50 years of service in Richmond, having impacted decades worth of individual human beings with effects that ripple out still in every direction.
One of those ever expanding waves rippled into the creation of The Nationz Foundation. It is located in Eastern Henrico on Finlay Street and was incorporated in 2015. It was started by Zakia K. McKensey after having previously undertaken about a decade of outreach with Fan Free Clinic where she then implemented their Transgender Clinic, changing countless lives. At the time, the majority of resources available to LGBTQ+ people in the area seemed to only become available if or after they contracted HIV, leaving many without the help that they so desperately needed. Nationz helped fill those gaps with practical support no one else was providing. The current mission of Nationz is to provide education and information related to HIV prevention and overall health and wellness, to inspire the community to take responsibility for their health, and to work towards a more inclusive Central Virginia for LGBTQIA+ identified individuals. They provide rapid HIV testing, other STI testing and have handed out over 200,000 condoms, a truly amazing feat in itself. They also act as a link to other care and run a food pantry that is open to their LGBTQIA+ clients Monday through Friday and open to the public at large twice a month. No one can be healthy with an empty belly, and the holistic approach of the Nationz Foundation to the healthcare they provide is something we truly need to see more of in the world.
The Greater Richmond LGBTQ+ Needs and Opportunity Assessment, a report from June of 2021 from the Richmond Memorial Health Fund and the Laughing Gull Foundation found that there is a significant gap in direct services related to basic needs provision: food and shelter, and that being openly queer or trans was often a barrier to employment. The rate of unemployment for the transgender population is twice that of the general population. This is not based on ability, but in discrimination. The report also highlighted what may be surprising to some, but is all too familiar to others. Though we’ve all heard of the hippocratic oath’s promise to do no harm and seen bronze plaques on hospital walls with mission statements in lofty and inspiring language, medical environments are not always places of comfort for LGBTQ+ people, especially gender-non-conforming and transgender people. This is compounded for people of color in these communities. One quarter of all lgbtq+ respondants reported experiencing mistreatment from a healthcare provider, with one out of every three transgender patients reporting the same. Some participants said they’d experienced harrassment, twice as many said they’d experienced discrimination and a few even said they had experienced violence in the places that we all go when we are sick and in need of help. The 2015 Transgender Health Survey further found that a quarter of those participants reported that they did not seek medical care when they needed it for fear of discrimination. After being verbally harassed, refused care or, in rare but significant cases, physically attacked, the places we go to be healed become the places we fear. I know that this seems like the part in the David Attenborough documentary where after showing you all the beautiful birds in the forest, I say “but” and cut to footage of a bare landscape and trees being cut to the ground. While I don’t want to end on that heavy a note, I do want to acknowledge that there is more work yet to be done, in outreach, in education and in basic compassion.
Something as simple as a poorly worded question on an intake form can trigger alarm bells in a patient that has already experienced medical trauma and harm. One member of a healthcare team without proper training or with an unwelcoming worldview, can prevent a person from ever returning for preventative care or even treatment for acute conditions. Those living at the crossroads of multiple marginalized identities often face worse health outcomes due to compounded stressors and discrimination. This understanding needs to be central to modern healthcare for us to effectively make a difference.
Our world and our city have come a very long way. The former capital of the confederacy, has become a beacon to queer people all over the commonwealth. It’s a place where many feel free to be themselves authentically for the very first time, finding friendship and love in a town vibrant with art and music. Organizations and individual visionaries have seen the connections in our collective struggles and been moved to action. Bridges have been built that continue to link those with different experiences, yet a common goal of community care. People have seen suffering and have not flinched or retreated from it, even as much of the world around pretended it did not exist. Our methods for finding resources and solving problems continue to evolve, as does our understanding of ourselves and our community, ever becoming broader and deeper, ever becoming more glittering in its many facets, ever shining in the simplicity of love.
Whether you are questioning, newly out, an ally or a queer elder, if you have the power to change something, and I guarantee that you do, know that you will never be alone should you act to help. There is a chain stretching well behind you. You link that same chain far off into the future, hand upon hand upon hand.
This week at the polls, what happens locally, can have big effects on the health and wellbeing of LGBTQ+ people. Voting for candidates that recognize our humanity is an act of care. Our most basic rights have come into question again. There are people that would exclude us from halls of learning and erase the history you’ve just read. There are those that would work to not only hide our history, but also to undo it. Honor this history by making your voice heard. It is not the only thing you can do, but it is a start. Whether it is the medicine that comes from being family or from the practice of Family Medicine, we can all do our part to take care of each other.