Dr. Ginette Okoye was already studying to be a dermatologist when she decided to visit one for herself – seeking help for a scalp concern.
The dermatologist “had a great bedside manner and obviously knew what they were doing,” recalled Dr. Okoye, now a dermatologist at Howard University Hospital and chair of Howard University’s Department of Dermatology.
But when the time came to set a course of treatment, the specialist prescribed a shampoo and instructed Dr. Okoye to use it daily.
“I realized, ‘They must just not know that Black women don’t wash their hair every day,’” she said.
And in that realization, she saw a path forward for herself. “I like dermatology, I love dermatology. I could also bring this cultural context that seems to be missing from the field,” she remembered thinking.
So she decided to specialize in treating skin of color, which was – and still is – under-represented in research, education, and practice, Dr. Okoye said.
She studied the work of trailblazers in the field and developed relationships with the relatively small community of doctors who specialized in skin of color.
Today, Dr. Okoye works to provide culturally and economically appropriate care for patients of color – and to teach frontline health care providers to do the same.
Less access, worse outcomes
The Vaseline Healing Project, an aid effort to heal the skin of people around the world affected by poverty or emergency, is a partnership between Vaseline and Direct Relief. Partnering with the telehealth nonprofit The MAVEN Project, the Vaseline Healing Project is currently hosting a series of three trainings designed to teach staff members at health centers and clinics to effectively treat skin of color.
“At Vaseline, we know systemic racism and health care inequities disproportionately impact black and brown communities,” said Carmen Barker, global brand manager for Vaseline. “To remedy this, we will be training dermatologists and medical practitioners to help improve skin healthcare outcomes for people with Black and brown skin.”
“We know that the demographics of the U.S. are changing. And so, no matter where you practice currently, you will be seeing more Black and brown skin in the next few years,” Dr. Okoye said during an October 16 webinar focused on helping these frontline health providers effectively diagnose and manage eczema.
Racial and ethnic minorities are disproportionately likely to be low-income, to lack health insurance, and to experience worse health outcomes than white patients. Many of them are served by the nation’s community health centers and clinics, which provide everything from primary to dental care.
That makes these health organizations the first stop for many low-income Black and brown patients – including those currently experiencing a skin or scalp issue.
“Dermatologic disparities are also very real,” Dr. Okoye said at the webinar. “Patients with skin of color tend to have poorer outcomes with dermatologic disease.”
Because referral to a specialist often means a long wait time – Dr. Okoye cited wait times of up to six months for some dermatologists – being able to treat a skin disease quickly and effectively in a clinic can make a significant difference.
Because it’s less expensive, “we usually try to deal with it in-house” when a patient comes in with a skin condition, said Dr. Martha Thigpen, an internist and the CEO of Gulf Coast Health Center in Port Arthur, Texas, who attended the webinar. “If it doesn’t work, then we’ll try to do a referral.”
Dr. Thigpen said that 40% of her patients are people of color. Approximately 60% lack health insurance.
Those who have skin conditions and need a specialist are often treated by a local academic medical center that takes charitable cases, she explained.
Treating skin of color
Dermatological concerns, left untreated, can cause long-lasting issues, Dr. Okoye said.
Dr. Okoye offered the example of a ten-year-old patient whose eczema was keeping her – and her parents – up at night, making it difficult for her to concentrate during school and placing added strain on her family.
“All of a sudden, their skin disease is absolutely impacting who they can become,” Dr. Okoye said during the webinar. “You don’t want this child to wait four months to see somebody. You can help her sleep – tonight.”
When it comes to treating skin of color, Dr. Okoye sees two major differences.
One is biological. Darker skin, she said, is more likely to develop disorders of hyperpigmentation, and to present some skin issues, including eczema, differently.
“We always have to wonder, is there a biological difference here?” she told Direct Relief in a separate conversation.
But some skin disorders that seem to particularly affect darker skin may also do so because of socioeconomic factors, including access to health care and medication, she said.
The bottom line
Strikingly, Dr. Okoye’s presentation focused heavily on an aspect of patient care that’s often undiscussed: cost. An effective treatment regimen, she showed, can be assembled out of the lowest-cost medications available at nationwide pharmacies.
Because so many of her patients are economically disadvantaged, she told Direct Relief, it’s essential to pay attention to whether they’ll be able to fulfill a prescription or stick to a regimen.
“My clinic is always running an hour behind. I sit and I talk to patients,” she said. “I started hearing from patients about their challenges in getting medications that I thought were easy to come by.”
She started paying attention to individual insurers’ formularies – the prescriptions covered by their drug plans – including those of Medicaid and other public insurance plans. And she encourages other physicians, whether they’re dermatologists or primary care providers, to do the same.
Dr. Okoye also encourages fellow doctors to spend time with their patients and ask open-ended questions to help uncover barriers to treatment. “I sit there and I let them talk, and I think that that alone opens the door,” she said.
On this particular front, health centers and clinics may be a step ahead. “I get the sense that the clinics we work with go above and beyond to advocate for their patients and to really meet them where they are,” Dr. Okoye said.
Behind her commitment to working with frontline providers is an awareness of the essential role they play in treating the nation’s most vulnerable people.
“Without these people, we would be nowhere as a society,” Dr. Okoye said. “They are doing really good work, and I respect them and I want to empower them.”
Rose Levy contributed reporting to this story.