種族隔離下的自力救濟--美國進步時期黑人、肺結核病與醫療照顧之研究

Self-help during Segregation: The Case Study of the Blacks' Tuberculosis and Health Care during the Progressive Era in the United States

本文是從美國黑人、肺結核病與公共衛生政策做為切入點，討論種族歧視下，黑人如何透過自力救濟的途徑，滿足黑人病患所需的醫療照顧，和引起白人社會的關注。種族歧視與對肺結核病解讀不同，影響了公共衛生政策對於黑人肺結核病患的照顧。在1890年到1930年之間，自力救濟是黑人解決醫療需求最佳途徑。諸如透過宣導病菌無種族之別，希望白人重視黑人醫護照顧，並推動「全國黑人清潔週」運動，將清潔的觀念付諸行動。此外，興建黑人專屬醫院及培育黑人家訪護士，以提供黑人肺結核病患居家醫療照顧，滿足病人基本的需求。黑人醫療照顧的自力救濟是在種族隔離下進行，表現出妥協的精神，但也滿足了黑人的需求。黑人病患除了可以獲得較佳的醫療照顧，還可藉此提升黑人醫護人員的素質。黑人家訪護士更在提供醫護服務外，凝聚了社區的團結與力量。黑人在醫療照顧中自力救濟的表現，證明在爭取健康相關福利中，黑人不只是接受救助的身分或受害者，他們勇於面對，並尋求解決之道。他們所做的醫療照顧自力救濟並非站在社會改革的前線，而是在既有的社會框架中滿足黑人病患的需求，即使成果有限，但也展現了黑人在國家醫療照顧不足下所做的努力。

Under conditions of racial segregation in America, medical authorities did not attend to the needs of black TB patients. Neither hospitals nor sanatoria would offer them assistance. Hence, blacks practiced self-help in TB health care during the period 1890-1930. They emphasized that viruses observed no color lines in their appeals to the whites, publicizing their needs in health care. They promoted National Black Health Week urging their people to live in cleaner circumstances. And, they built a black only hospital and educated black female visiting nurses to teach basic medical knowledge and help black TB patients receive proper home care. Self-help during segregation was a compromise, but it satisfied the black TB patient needs. The black TB patients could get better medical care. It also improved the quality of black medical professionals; the black female visiting nurses themselves were a concrete expression of the power of the black community, not to mention their medical services. Self-help during segregation proved that the blacks were not merely victims. They knew what they wanted in urging equal treatment in TB medical care, and found the solutions for themselves. Most importantly, they undertook self-help medical care not in pursuit of social reform but within the established social context. Their success was limited, but they fulfilled the responsibilities of good citizens.