Bring it to the barbershop: Black nurses power a grassroots response to addressing health gaps

The atmosphere was pretty awkward inside Mouton’s Barbershop off Louisiana Avenue one Saturday morning in June 2011. Graciana Breaux, a registered nurse and member of the Acadiana Black Nurses Association, was seated in the waiting area beside another nurse. It was National Men’s Health Month, and Kevin Mouton, the owner of the shop, had agreed to have ABNA come in and visit with the mostly middle-aged guys who showed up on Saturdays. Breaux  brought some portable health gear, and while most of it was benign enough — a blood pressure cuff, a glucose meter — other items were of a slightly more sensitive nature. Like, for example, a model of the lower male anatomy designed to help folks find and identify potentially cancerous testicular lumps.

Suffice it to say, the men were skeptical. Breaux asked if any of them wanted their blood pressure taken. Most declined. 

“We didn’t push them,” Breaux says. Instead, they began a casual conversation, discarding the clinical jargon for a chat more comfortable in a barbershop.    

Providers say a big part of the deadly racial health disparities exposed during the pandemic comes down to lack of information that would empower folks to make healthy decisions and advocate for themselves in a medical setting. 

For the past decade, ABNA has responded to that problem by bringing resources directly to minority communities in trusted spaces throughout Acadiana: churches, community centers, barbershops, salons. Using direct, compassionate and accessible language, this grassroots approach aims to improve health literacy from the ground up. And although it’s challenging to quantitatively measure its success over the past decade, anecdotal evidence suggests it’s working. 

More than half of Black men over 18 have high blood pressure (also called hypertension). To the men of Mouton’s Barbershop, Breaux described it as the “silent killer” because symptoms are often overlooked or virtually absent. Over time, high pressure within the arteries can cause a person’s blood to flow so forcefully that it scours away bits of accumulated fat, called plaque, and dislodges them, pushing them up the artery and into the brain. In other words, the person has a stroke.

Black Americans are 50% more likely to have a stroke than their white counterparts, and 70% more likely to die from it. Breaux and her fellow nurses detailed these risks to the one man willing to talk directly with them about it. While he had been prescribed medication for his high blood pressure, he didn’t take it, admitting that he didn’t care for the side effects, which can include fatigue and, well, erectile dysfunction.

Breaux laughs, remembering it. “I mean, when I tell you nobody was talking, even the barbers had stopped clipping hair,” she says. “But they were paying attention.”

Breaux, who also teaches nursing at SLCC, was accustomed to talking students and patients through touchy medical subjects. So she kept at it, asking more questions, informing the guys of alternative blood pressure medications that might not cause undesirable side effects. Eventually, the men began to warm up. More agreed to have their blood pressures taken. Some of the men Breaux wrapped the cuff around that day had systolic blood pressure readings above 200, well above the 180 reading considered a hypertensive crisis. One or two of them went straight to the emergency room after their haircut.

Not something one expects after his Saturday morning trim-up, concedes the president of ABNA, Dr. Iris Malone. “But at least you’re looking good when you get there,” Malone says.

The past year has put racial health disparities in the spotlight. Black communities were hit harder by the coronavirus, and vaccination efforts have been slower to reach people of color, too. But the disparities long precede the pandemic, particularly cardiovascular conditions.

There are a variety of reasons why heart disease, stroke and high blood pressure are so deadly among Black Americans — genetic sensitivities to salt, lack of fresh unprocessed foods due to supermarket redlining in African American neighborhoods, poor access to health insurance. 

The American Rescue Act, which expands certain provisions of Medicaid, may partially address this latter issue. But improving access to healthcare is about more than just handing folks an insurance card or getting them into a doctor’s office. For minority patients, Malone says clinical settings can feel like a foreign country.

Woman receives first dose of covid vaccine
Iris Malone, President of the Acadiana Black Nurses Association, administers the first dose of the Moderna COVID-19 vaccine to Donna Tolbert, a fellow nurse.

“You’re in this strange place where no one speaks your language,” she says. Finding a medical professional who you can understand and relate to can give a patient that sense of trust they need to take action on the medical advice they’re given.

Some of this “language barrier” comes with the territory of medicine, where unfamiliar terms are everywhere. But in a field dominated by white providers, racism is often a part of it. Within the healthcare system, white physicians and nurses sometimes treat Black patients — especially Black men — as threats. This bias, Breaux notes, is revealed in the language often used to describe Black men who don’t take their medication.

“In the medical world, people are quick to say a person is ‘noncompliant,’” she says. When providers assume patients are being purposely oppositional, they likely won’t follow up about why their patients aren’t holding to their treatment plans.

Rather than blaming patients for being “noncompliant,” nurses like Breaux with ABNA search out the reasons behind their decision-making at events like the one in Mouton’s barbershop. Beyond side effects, some of the men hadn’t filled their prescriptions because they were too expensive. Others didn’t have health insurance or a primary care doctor. Once she knew their reasoning, Breaux could address each issue in turn. She informed the guys that they could call their providers to ask for cheaper, generic brands of medications. She shared with them lists of affordable medical providers of color in the area.

Research on similar community-based health initiatives has suggested the efficacy of ABNA’s approach. A 2016 review published in the American Journal of Public Health investigated data from more than 150 studies of such interventions by community-based health workers in low-income, underserved and racial and ethnic minority communities across the U.S. Researchers found these interventions were not only affordable, but also measurably effective at improving cancer prevention and cardiovascular risk reduction.

In addition to this promising data, both Breaux and Malone shared anecdotal evidence that points to the value of their approach. Breaux helped an older man realize he had cancer and begin treatment before it progressed just by talking with him about one of the teaching models she’d brought along to 100 Black Men and ABNA’s annual Health Expo at the Progressive Baptist Community Center. Malone also shared multiple stories of helping patients detect life-threatening conditions by partnering with churches and hosting a health literacy event in a salon.

One limitation of this approach is the groups’ finite capacity to host events and follow up with the folks they screen. Most members of ABNA work fulltime in the healthcare field, and those who are retired “are up in age,” says Breaux. Finding a way to follow up with people who had high glucose levels or hypertension would drastically improve their health outcomes.

The pandemic has also made in-person community events more challenging. ABNA has adapted to providing healthcare literacy in a virtual format. They plan to partner with insurer United Healthcare for a virtual event on vaccine education. 

Interactions like the ones Breaux described having with men at Mouton’s Barbershop are difficult to imagine happening on a digital platform. She describes one man at the barbershop event in 2011, for example, who confessed that he’d come to accept the prospect of a stroke by focusing on the fact that his life insurance would provide for his family if he died.

Beaux says her colleague spoke very calmly in response: “I’m sure if you asked your wife, that’s not what she wants. She wants you. Your children want you. To be a part of the family, to go on vacations. To be around.”

Something shifted as those words sank in, Breaux recalls. One of the barbers ran out to his car to take his meds.

But do these interventions hold up over time? Curious, I called Mouton’s Barbershop almost a decade after ABNA visited the first time. The man who answered the phone told me to hold on, called, “Hey, Pop,” and a moment later, Kevin Mouton got on the line.

“Oh yeah,” he said, his voice was backdropped by the Friday morning bustle of his shop. “It’s a silent killer, you know, how high blood pressure can affect you.” Before 2011, he hadn’t been taking his meds with any regularity. After ABNA came in, though, he changed his mind about it.

“I started taking my blood pressure pill every day,” Mouton said.