Mama Might be Better Off Dead: The Failure of Health Care in Urban America (review)

196 Review MAMA MIGHT BE BETTER OFFDEAD: THE FAILURE OF HEALTH CARE IN URBAN AMERICA By Laurie Kaye Abraham, pp. 289. Chicago: University of Chicago Press, 1993, $22.50. Mama Might Be Better Off Dead is a powerful and revealing ethnography of one African American family and its struggle with the prevailing health care system in the United States. Author Laurie Kaye Abraham, in the role of an objective observer, provides a gripping account of four generations of the Baneses, an impoverished urban Chicago family, as they survive multiple medical catastrophies. Somehow, though, they always seem to make it to the next day. Mama Might Be Better Off Dead also reveals how government health care polides fundion when they "hit the streets." The book follows the Banes family for one year, chronicling the family's experiences through home and community life, dialysis counseling and treatment , hospital visits, and dodors' appointments. The author guides the reader through a myriad of complex medical issues that confront some of America's poor on a daily basis. Each chapter describes in detail yet another medical-sodal scenario in which the Baneses are forced to adjust to their dismal plight. Abraham also vigorously reports on the radal inequalities and politics of substandard living conditions, dialysis treatment, government insurance, patient and caregiver issues, mental health issues, inner-dty emergency room care, personal responsibility, preventive care, organ donation and transplantation , interaction with medical professionals, right to life, quality-of-life issues, and how treating the poor is "bad" for business. Embedded within each of these issues, however, is a complex array of other aspeds facing the Baneses, including the administration of social services, employment, intergenerational issues, transportation, long-term care, and, to a lesser extent, family and personal relationships. The Baneses live in North Lawndale, one of Chicago's poorest inner-dty (a term that is often a euphemism for areas inhabited primarily by poor blacks) neighborhoods. Only 8 percent of the neighborhood's 8,937 buildings are habitable. The rest are abandoned, on the verge of collapse, or in need of repair. North Lawndale is a community surrounded by numerous medical facilities, including urban and university hospitals, private medical complexes, the Veterans Aclministration Medical Center, clinics, dialysis centers, mental health facilities, and sodal service offices. The VA center has the highest Journal of Health Care for the Poor and Underserved · Vol. 9,No. 2 · 1998 ________________________________________________________(Quails 197 concentration of hospital beds in the United States, some 3,000 among its four institutions. But while this location may at first appear to be ideal as far as access to medical services is concerned, it is ironic that the poor, espedally African Americans, in this Chicago-area neighborhood are more likely to be underserved than any other group seeking the same medical services within this community. Such is the case with the Baneses, as Mama Might Be Better Off Dead vividly tells the story of "their access (or lack of access) to medical care." Unfortunately, there are many "Baneses" throughout urban America. The family is headed by Jackie Banes, who cares for her diabetic grandmother ; her husband, Robert, who suffers from kidney failure; a sick and dependent father; and three children. The family lives in the crowded condition of a small apartment dwelling. Throughout most of the year chronided in the book, Jackie does not work outside the home, although later she gets a job at a local school. Most of her time is spent caring for the physical, finandal, and emotional needs of her grandmother and providing support for her husband and father. Consequently, her children are forced to grow up quickly and become caregivers themselves, often assisting with their grandmother's care. Although Jackie does not appear to be bothered by the fad that her husband is unable to give her much physical or financial support, she does susped (and rightly so) that he is using drugs. She acts on her suspicions by not giving him a key to their apartment. One senses that Jadde probably hopes that Robert will just take care of himself and stay out of trouble. Robert could not get reliable, ongoing medical coverage until his kidneys failed when he was...