By the time Margaret M. Barnes arrived at Temple University’s medical school in 1977, she had already lived in enough places to be aware of the tremendous discrepancies in the world, the great divide between the haves and the have-nots.

But as a medical student, she saw something much deeper and more disturbing among the Black and brown patients coming into Temple University Hospital from the surrounding neighborhoods in North Philadelphia.

“It was the first time in my life that I had really seen suffering, real suffering” she said.

Fast forward to the summer of 2020, when Black Lives Matter protests were sweeping the nation following the death of George Floyd, a Black man in Minneapolis who died under the knee of a white police officer.

“Last summer pointed out to me that the suffering has not changed substantially,” despite the passage of 40-plus years, she said.

The other big headline, the COVID-19 pandemic gripping the nation, shone a spotlight on another harsh race-related disparity. Black and brown Americans were contracting and dying of the coronavirus at much higher proportions than whites.

“This was all part of this big snowball rolling around in my mind,” Dr. Barnes said.

The virus had prompted her to retire a bit earlier than she had planned because she feared bringing the illness home to her partner. And her retirement in August 2020 propelled her to act on her long-planned wish to give back to the Lewis Katz School of Medicine, which had given her so many opportunities.

Dr. Barnes chose the medical school’s Center for Urban Bioethics as the recipient of a $1 million legacy bequest and a $50,000 donation. The funds will be used to help the Center expand its education of medical students and professionals and advocacy initiatives aimed at mitigating racism in medicine.

“In a year like no other, this generous commitment from Dr. Barnes allows us to advance our commitment to diversity, equity, inclusion and justice initiatives” said Nina Weisbord, Chief Advancement Officer. “Dr. Barnes is a true champion for building a just and anti-racist society, and we are privileged to partner with her in this important work.”

It was the Center’s vision of promoting health equity – the concept that everyone has a fair and just opportunity to be as healthy as possible, in dense, diverse and economically and socially disparate urban populations - that grabbed her heart.

“This is a significant field of medicine and study in health-care delivery,” Dr. Barnes said. “This is a new area of awareness for our larger society and supporting it is something I could do that realistically will translate into major improvements for a very large segment of our population.”

Dr. Barnes, a radiation oncologist who later also was certified in hospice and palliative medicine, received her medical degree from Temple in 1981. Throughout her years of practice, she had remained especially proud that her medical school class had admitted a substantial number of women and more older, non-traditional students than the other medical schools in the city at the time.

And since then, she has seen a profound change in the gender composition of medical school classes nationwide, and this gives her hope for the ongoing evolution of medicine. She sees the Center for Urban Bioethics likewise perfectly positioned at the forefront of another round of transformative change.

“There is tremendous leadership in Temple’s willingness to say, ‘We’re opening up knowledge. We want to learn about these other, much more subtle forms of holding people back. We’re going to study it. We’re going to make it better.’ Temple is one of the best schools situated to do that work,” she said.

Located at the Lewis Katz School of Medicine, Temple’s Center for Urban Bioethics, founded 10 years ago, is home to the nation's only master’s degree in Urban Bioethics.

“Our mission is the creation of health equity through community-engaged education and research,” said Dr. Kathleen Reeves, Senior Associate Dean for Health Equity, Diversity and Inclusion and the Center’s founding director. The Center teaches “practical skills to make a real-time difference,” she said.

Dr. Reeves said poverty is often cited in academic arenas as a key social determinant of health, but residents of North Philadelphia have an expanded set of concerns: violence, imprisonment, food insecurity, maternal health, general healthcare access difficulties, substance misuse and more. The Center has ongoing research in all these areas."

“One of the big social determinants of health, which we never really talk about, is racism in medicine," she said. "It’s not just race and racism. It’s oppression of all different identities that people have." 

Dr. Reeves is quick to acknowledge that Temple works hard on these issues and those who choose to enter a career in medicine “are very good, caring people, who intend to do good things.” At the same time, she said, “medicine is still a very white profession.”

Compounding this disparity is that “the least healthy people in our country often live in the shadows of our best academic medical centers,” Dr. Reeves said. “Most of these centers don’t have enough people of color or Latinx people in leadership roles as physicians and clinicians and caregivers. So, it’s mostly white people treating Black and brown people.”

“There’s racism in medicine,” she said. “It’s been documented again and again. Sometimes it’s in how we calculate numbers because we want to equate race and biology and that’s just not true. Our biology really isn’t different, except with the gene that creates melanin.”

And then there are the cultural assumptions and the biases in society that come into play. “It’s well documented that we physicians quickly assume worse behaviors when patients are Black and brown than we do when they’re white.” Dr. Reeves said.

A path forward, she said, is to engage people from communities of color in longitudinal studies and make sure they have a strong voice at the table whenever patient-centered care is being discussed.

Dr. Reeves expects the current gift from Dr. Barnes to enable Nicolle Strand, Assistant Director for Research at the Center and Assistant Professor, to work toward strengthening the activist arm of the Center. Professor Strand said she hopes to “push for changes in policy and practice.”

Dr. Reeves said she hopes to lead the Center “to try to really educate people within health care — the caregivers — that racial bias exists, to acknowledge it, recognize it, change it.”

Dr. Barnes said she was especially excited to learn of the education aspect of the Center’s work. “When they told me this institute was working on educating people … I thought ‘this is ideal because the more we educate who then become educators, will create exponential growth to make things better,’” she said. It’s a point of pride that Temple’s medical school has made great strides in recruiting students of color into its classes, and the Center is actively involved in helping to support the medical school’s minority students. Dr. Reeves said it’s important to recognize that their voices are important, “and will help us take better care of our patients.”

The influx of students of color has brought with it a critical mass of students who are no longer afraid of speaking out when something is said or happens within the School community that offends them or is at odds with their own lived experience, Professor Strand said.

So, one of the programs Professor Strand offers is a workshop that raises faculty members’ awareness and helps them “understand the history of race and racism in America, of medical apartheid and what that means for our current Black students,” she said.

After graduation from Temple, Dr. Barnes completed her internship at Walter Reed Army Medical Center and her residency in radiation oncology at the National Cancer Institute, National Institutes of Health. She was a clinician, teacher and researcher at the Hospital of the University of Pennsylvania and Thomas Jefferson University School of Medicine before heading west to St. Peter’s Cancer Treatment Center in Helena, Mont. She was in practice as a radiation oncologist at the Cancer Care and Research Center in Fergus Falls, Minn., for a decade.

The progressive and social justice philosophy underlying the Center’s bioethics work dovetails nicely with Dr. Barnes’ own worldview and the discrimination she has faced because she is a lesbian. Dr. Barnes, 66, has retired with her partner, Ardie Dalton, in Grantsville, Utah, a suburb of Salt Lake City. They enjoy hiking in the nearby mountains, collecting rock specimens and looking with awe at the natural beauty.

Dr. Barnes plans to read extensively about issues in urban bioethics, race and racism and have ongoing conversations with the Center’s educators. She expects to remain open to their ideas about how her bequest might one day be used to make transformative change.

“I would really like those folks to have the reins,” she said. “I’m kind of along for the ride.”

Openness is an expression of her deep commitment to the betterment of the profession to which she dedicated so many years of her life and which has given her so much in return.

“I do think we need to make medicine better,” she said. “It should be better every Monday morning than it was the previous Friday. One way of making sure it continues to improve is to acknowledge the mistakes we’ve made and try to correct them.”