Black Angels remind us of centuries of injustices plaguing the TB response

Shobha Shukla, Bobby Ramakant-CNS
"Death from TB is caused by human choice. It is caused by human-built systems. And so that is terrifying and horrifying and deeply upsetting. It means we are not doing a good job of assigning equal value to every human life," said the famous American author John Green at a panel discussion during United Nations General Assembly last year.
This is so very true. What else will explain 10.8 million people suffering with TB disease last year when we had the tools and evidence to prevent every single case of TB transmission ? What will explain 1.1 million people dying of TB last year when we have the best of tools to diagnose, treat and care for those with TB ?
TB is a sad but real story of inequity and injustice. We conveniently refer to it as a 'disease of the poor' but shy away from saying the truth- that those who enjoy privileges, rights, entitlements and live a life free from hunger, poverty, homelessness and other forms of discriminations, are much less vulnerable to TB. It is the inequity that puts people at risk of TB. It is the social injustices that deny them timely and accurate diagnosis, deny them the best of treatments, deny them social support and security that puts them at heightened risk of TB and even TB death (along with a range of other human rights abuses and violations).
These injustices have been existing since time immemorial and have played a big role in damping the TB response.
Ela Gandhi, a South African peace activist who fought against apartheid with Nelson Mandela and others and was a Member of Parliament of South Africa from 1994 to 2004, (she is also the grand daughter of Mahatma Gandhi), said that while she was reading about the discovery of Mycobacterium tuberculosis (bacterium that causes TB) in 1882, she realised it mentions that TB killed one out of every seven people living in the USA and Europe in those days.
"But there was absolutely no mention of the people dying of TB in Asia and Africa or other parts of the world. This is the pattern we see all through the ages. Black lives do not matter and when I say ‘black,’ it is inclusive of all non-whites - we are still grappling with health inequities," she said.
During 1913-1961, Seaview Hospital (which was a sanatorium too) in Staten Island New York, USA, was taking care of people with TB. In those days, TB was a leading cause of death among New Yorkers killing thousands of people every year. Of course, back then there was no cure for TB. And to top it all, the white nursing staff refused to work there for fear of contracting the dreaded disease.
So, Seaview Hospital recruited Black nurses. These nurses earned the name of "Black Angels" - black because of their skin colour, and angels because they broke racial barriers and risked their lives to take care of the people with TB.
Recently, in September 2024, we met Virginia Allen - one of those Black Angel nurses who served in Seaview Hospital.
Now over 93 years old, Virginia (who still drives her own car) joined Seaview Hospital as a 16-year-old trainee nurse in 1947 and worked there for 10 years. She was assigned to the children’s building, to take care of the children with TB, despite the constant threat of getting infected herself.
“Seaview Hospital provided an opportunity for Black nurses - who in those days were unable to find jobs otherwise in the profession that they were trained in, because of racism and the segregation of hospitals. Out of 29 hospitals in New York City, Seaview Hospital was one of the four hospitals that would hire Black nurses. These nurses served the patients diligently, even though their own lives were in danger," recalled Virginia Allen while speaking at one of the End TB Dialogues hosted by CNS (Citizen News Service).
"We were on the frontlines of the fight against TB long before the cure came, doing what nurses do – take care of the patients to the best of our ability and follow the doctors’ orders. I took care of the children with TB. They were like any other child who would have been at home-very inquisitive - and anxious too about being away from their parents. They did require a lot of care, not only because they were sick but also because of being separated from their families. But I loved the children and I loved my job. As I grew older, I realised how important it is to remember those nurses who came before us," said Virginia.
Have you read the book Black Angels?
Maria Smilios, Adjunct Lecturer at Columbia University Mailman School of Public Health, has helped immortalise the work of the Black Angel nurses through her book "The Black Angels: The untold story of the nurses who helped cure tuberculosis," that was published in 2023. The book celebrates works that affirm the highest value of the human spirit. It won the 2024 Christopher Award in Literature; was a finalist for the prestigious Gotham Book Prize; and chosen as an NPR Science Friday Summer Read for 2024. The book was also selected as one of the two finalists for the National Association of Science Writers Journalism Award 2024.
"When I was a child, I wanted to study Science. I had a sixth-grade Science teacher who had given back my final exam result with a big '42' written on the top. He looked at me and said – "that is okay, you have a 'girl brain' and girl brains do not do Science. Girl brains do poetry and get married." I did not study Science then. I studied literature. Later while freelance editing for Springer Science, I got back to Science in a way," shared Maria. “When recently I learnt I was a finalist for National Association of Science Writers Journalism Award, I just thought if that teacher was alive and could see that girls could do Science too." Gender-based harmful stereotypes and social norms need to be countered and dismantled if we are to achieve health and gender justice.
Gabriela Leone, the co-curator of the exhibition titled "Taking Care: The Black Angels of Seaview Hospital" (which is open for public view till 29 December 2024 at Staten Island Museum), said that Maria’s book “Black Angels” greatly informed and inspired the exhibition.
Isoniazid study to cure TB
In 1951, Seaview Hospital conducted the clinical study of isoniazid (one of the two most powerful first-line anti-TB drugs even today). Seaview’s Black Angel nurses and other support staff conducted the study- counselling the patients and seeking consent from every study participant, administering medicines, monitoring and observing patients, and reporting results to the two doctors-in-charge (Dr Edward Robitzek and Dr Irving Selikoff). This was a landmark study as isoniazid was shown to work in curing TB when other therapies did not. It could be used in combination with other drugs for improved treatment outcomes.

(To be contd)