As the boundaries of the unthinkable become normalized, historical consciousness is replaced by manufactured forms of historical amnesia and ignorance. As white supremacy becomes entrenched at the highest levels of power and in the public imagination, the past becomes a burden that must be shed. Disparaging, suppressing or forgetting the horrors of history has become a valued and legitimating form of political and symbolic capital, especially among the Republican Party and conservative media. Not only have history’s civic lessons been forgotten, but historical memory is also being rewritten, especially in the ideology of Trumpism, through an affirmation of the legacy of slavery, the racist history of the Confederacy, American exceptionalism, and the mainstreaming of an updated form of fascist politics.
Theodor Adorno’s insights on historical memory are more relevant than ever. He once argued that as much as repressive governments would like to break free from the past, especially the legacy of fascism, “it is still very much alive.” Moreover, there is a price to be paid with “the destruction of memory.” In this case, “the murdered are …cheated out of the single remaining thing that our powerlessness can offer them: remembrance.” Adorno’s warning rings particularly true at a time when two-thirds of young American youth are so impoverished in their historical knowledge that they are unaware that six million Jews were murdered in the Holocaust. On top of this shocking level of ignorance is the fact that “more than one in 10 believe Jews caused the Holocaust.” Historical amnesia takes a particularly dangerous turn in this case, and prompts the question of how young people and adults can you even recognize fascism if they have no recollection or knowledge of its historical legacy.
The genocide inflicted on Native Americans, slavery, the horrors of Jim Crow, the incarceration of Japanese Americans, the rise of the carceral state, the My Lai massacre, torture chambers, black sites, among other historical events now disappear into a disavowal of past events made even more unethical with the emergence of a right-wing political language and culture. The Republican Party’s attack on critical race theory in the schools which they label as “ideological or faddish” both denies the history of racism as well as the way in which it is enforced through policy, laws, and institutions. For many republicans, racial hatred takes on the ludicrous claim of protecting students from learning about the diverse ways in which racism persist in American society. For instance, Republican Governor Ron DeSantis of Florida stated that “There is no room in our classrooms for things like critical race theory. Teaching kids to hate their country and to hate each other is not worth one red cent of taxpayer money.” In this updated version of racial cleansing, the call for racial justice is equated to a form of racial hatred leaving intact the refusal to acknowledge, condemn, and confront in the public imagination the history and persistence of racism in American society
Bolstered by a former president and a slew of Vichy-type politicians, right-wing ideologues, intellectuals, and media pundits deny and erase events from a fascist past that shed light on emerging right-wing, neo-Nazi, and extremist policies, ideas, and symbols. As Coco Das points out given that 73 million people voted to re-elect Trump, it is clear that Americans “have a Nazi problem.” This was also evident in the words and actions of former president Trump who defended Confederate monuments and their noxious past, the waving of Confederate flags and the display of Nazi images during the attempted coup on the Capital on January 6th, and ongoing attempts by the Republican Party legislators to engage in expansive efforts at enabling a minority government. America’s Nazi problem is also visible in the growing acts of domestic terrorism aimed at Asians, undocumented immigrants, and people of color.
Historical amnesia also finds expression in the right-wing press and among media pundits such as Fox News commentators Tucker Carlson and Sean Hannity, whose addiction to lying exceeds the boundaries of reason and creates an echo chamber of misinformation that normalizes the unspeakable, if not the unthinkable. Rational responses now give way to emotional reactions fueled by lies whose power is expanded through their endless repetition. How else to explain the baseless claim made by them, along with a number of Republican lawmakers, right-wing pundits, and Trump’s supporters who baselessly lay the blame for the storming of the US Capitol on “Antifa.” These lies were circulated despite of the fact that “subsequent arrests and investigations have found no evidence that people who identify with Antifa, a loose collective of antifascist activists, were involved in the insurrection.”
In this case, I think it is fair to re-examine Theodor W. Adorno’s claim that “Propaganda actually constitutes the substance of politics” and that the right-wing embrace of and production of an endless stream of lies and denigration of the truth are not merely delusional but are endemic to a fascist cult that does not answer to reason, but only to power while legitimizing a past in which white nationalism and racial cleansing become the organizing principles of social order and governance.
In the era of post-truth, right-wing disimagination machines are not only hostile to those who assert facts and evidence, but also supportive of a mix of lethal ignorance and the scourge of civic illiteracy. The latter requires no effort to assess the truth and erases everything necessary for the life of a robust democracy. The pedagogical workstations of depoliticization have reached new and dangerous levels amid emerging right-wing populisms. It is not surprising that we live at a time when politics is largely disconnected from echoes of the past and justified on the grounds that direct comparisons are not viable, as if only direct comparisons can offer insights into the lessons to be learned from the past. We have entered an age in which thoughtful reasoning, informed judgments, and critical thought are under attack. This is a historical moment that resembles a dictatorship of ignorance, which Joshua Sperling rightly argues entails:
The blunting of the senses; the hollowing out of language; the erasure of connection with the past, the dead, place, the land, the soil; possibly, too, the erasure even of certain emotions, whether pity, compassion, consoling, mourning or hoping.
It is clear is that we live in a historical period in which the conditions that produced white supremacist politics are intensifying once again. How else to explain former President Trump’s use of the term “America First,” his labeling immigrants as vermin, his call to “Make America Great Again” — signaling his white nationalist ideology–his labeling of the press as “enemies of the people,” and his numerous incitements to violence while addressing his followers. Moreover, Trump’s bid for patriotic education and his attack on the New York Times’s 1619 Project served as both an overt expression of his racism and his alignment with right-wing white supremacists and neo-Nazi mobs. Historical amnesia has become racialized. In the rewriting of history in the age of Trump, the larger legacy of “colonial violence and the violence of slavery inflicted on Africans” are resurrected as a badge of honor.
America’s long history of fascist ideologies and the racist actions of a slave state, the racial cleansing espoused by the Ku Klux Klan, and an historical era that constitutes what Alberto Toscano calls “the long shadow of racial fascism” in America are no longer forgotten or repressed but celebrated in the Age of Trump. What is to be made of a former President who awarded the prestigious Medal of Freedom to a blubbering white supremacist, ultra-nationalist, conspiracy theorist, and virulent racist who labeled feminists as “Feminazis.” In this case, one of the nation’s highest honors went to a man who took pride in relentlessly disparaging Muslims, referred to undocumented immigrants as “an invading force” and an “invasive species,” demonized people of color, and recycled Nazi tropes about racial purity while celebrating the mob that attacked the Capitol as “Revolutionary War era rebels and patriots.” Under the banner of Trumpism, those individuals who reproduce the rhetoric of political and social death have become, celebrated symbols of a fascist politics that feeds off the destruction of the collective public and civic imagination.
William Faulkner once stated “The past is never dead. It’s not even past.” In its updated version, we live not only with the ghosts of genocide and slavery, but also with the ghosts of fascism—we live in the shadow of the genocidal history of indigenous inhabitants, the Ku Klux Klan, Jim Crow, and systemic police violence against people of color. And while we live with the ghosts of our past, we have failed to fully confront its implications for the present and future. To do so would mean recognizing that updated forms of fascist politics in the current moment are not a rupture from the past, but an evolution. White supremacy now rules the Republican Party and one of its tools of oppression is the militarization and weaponization of history. Fascism begins with language and the suppression of dissent, while both suppressing and rewriting history in the service of power and violence.
In the age of neoliberal tyranny, historical amnesia is the foundation for manufactured ignorance, the subversion of consciousness, the depoliticization of the public, and the death of democracy. It is part of a disimagination machine that is perpetuated in schools, higher education, and the corporate controlled media. It divorces justice from politics and aligns the public imagination with a culture of hatred and bigotry. Historical amnesia destroys the grammar of ethical responsibility and the critical habits of citizenship. The ghost of fascism is with us once again as society forgets its civic lessons, destroys civic culture, and produces a populace that is increasingly infantilized politically through the ideological dynamics of neoliberal capitalism. The suppression of history opens the door to fascism. This is truly a lesson that must be learned if the horrors of the past are not to be repeated again. Fortunately, the history of racism is being exposed once again in the protests that are taking place all over the globe. What needs to be remembered is that such struggles must make education central to politics, and historical memory a living force for change. Historical memory must become a crucial element in the struggle for collective resistance, while transforming ideas into instruments of power.
 Paul Street, “The Anatomy of Fascism Denial: 26 Flavors of Anti-Antifascism, Part 1,” Counter Punch. (Feb 7, 2021).Online https://www.counterpunch.org/2021/02/07/the-anatomy-of-fascism-denial/; Sarah Churchwell, “American Fascism: It Has Happened Again,” The New York Review of Books, [May 26, 2020].Online https://www.nybooks.com/daily/2020/06/22/american-fascism-it-has-happened-here/; Masha Gessen, Surviving Autocracy, (New York: Riverhead Books, 2020); Jason Stanley, How Fascism Works: The Politics of Us and Them, [Random House, 2018); Henry A. Giroux, American Nightmare: Facing the Challenge of Fascism (San Francisco: City Lights 2018); Carl Boggs, Fascism Old and New: American Politics at the Crossroads (New York: Routledge, 2018); Timothy Snyder, On Tyranny: Twenty Lessons from the Twentieth Century (New York: Crown, 2017)
 Adorno, Theodor W., “The Meaning of Working Through the Past,” Guilt and Defense, trans. Henry W. Pickford, (Cambridge: Harvard University Press, 2010), p. 215.
 See, for instance, Ibram X. Kendi and Keisha N. Blain, eds. Four Hundred Souls (New York: One World, 2021) and Eddie S. Glaude, Jr. Democracy in Black: How Race Still Enslaves the American Soul (New York: Crown, 2016).
 On the American origins of fascism, also see Michael Joseph Roberto, The Coming of the American Behemoth: The Origins of Fascism in the United States, 1920-1940 (New York: Monthly Review Press, 2018). Henry A. Giroux, American Nightmare: Facing the Challenge of Fascism(San Francisco: City Lights Books, 2018).
The Confederacy was a con job on whites. And still is.
By Frank Hyman
UPDATED MARCH 11, 2021 10:28 AM
I’ve lived 55 years in the South, and I grew up liking the Confederate flag. I haven’t flown one for many decades, but for a reason that might surprise you.
I know the South well. We lived wherever the Marine Corps stationed my father: Georgia, Virginia, the Carolinas. As a child, my favorite uncle wasn’t in the military, but he did pack a .45 caliber Thompson submachine gun in his trunk. He was a leader in the Ku Klux Klan. Despite my role models, as a kid I was an inept racist. I got in trouble once in the first grade for calling a classmate the N-word. But he was Hispanic.
As I grew up and acquired the strange sensation called empathy (strange for boys anyway), I learned that for black folks the flutter of that flag felt like a poke in the eye with a sharp stick. And for the most prideful flag waivers, clearly that response was the point. I mean, come on. It’s a battle flag.
What the flag symbolizes for blacks is enough reason to take it down. But there’s another reason that white southerners shouldn’t fly it. Or sport it on our state-issued license plates as some do here in North Carolina. The Confederacy – and the slavery that spawned it – was also one big con job on the Southern, white, working class. A con job funded by some of the ante-bellum one-per-centers, that continues today in a similar form.
You don’t have to be an economist to see that forcing blacks – a third of the South’s laborers – to work without pay drove down wages for everyone else. And not just in agriculture. A quarter of enslaved blacks worked in the construction, manufacturing and lumbering trades; cutting wages even for skilled white workers.
Flag Protester Talks About White Role
James Tyson was arrested with Bree Newsome in SC Confederate flag removal. BY MCCLATCHY
Thanks to the profitability of this no-wage/low-wage combination, a majority of American one-per-centers were southerners. Slavery made southern states the richest in the country. The South was richer than any other country except England. But that vast wealth was invisible outside the plantation ballrooms. With low wages and few schools, southern whites suffered a much lower land ownership rate and a far lower literacy rate than northern whites.
My ancestor Canna Hyman and his two sons did own land and fought under that flag. A note from our family history says: “Someone came for them while they were plowing one day. They put their horses up and all three went away to the War and only one son, William, came back.”
Like Canna, most Southerners didn’t own slaves. But they were persuaded to risk their lives and limbs for the right of a few to get rich as Croesus from slavery. For their sacrifices and their votes, they earned two things before and after the Civil War. First, a very skinny slice of the immense Southern pie. And second, the thing that made those slim rations palatable then and now: the shallow satisfaction of knowing that blacks had no slice at all.
How did the plantation owners mislead so many Southern whites?
They managed this con job partly with a propaganda technique that will be familiar to modern Americans, but hasn’t received the coverage it deserves in our sesquicentennial celebrations. Starting in the 1840s wealthy Southerners supported more than 30 regional pro-slavery magazines, many pamphlets, newspapers and novels that falsely touted slave ownership as having benefits that would – in today’s lingo – trickle down to benefit non-slave owning whites and even blacks. The flip side of the coin of this old-is-new trickle-down propaganda is the mistaken notion that any gain by blacks in wages, schools or health care comes at the expense of the white working class.
Today’s version of this con job no longer supports slavery, but still works in the South and thrives in pro trickle-down think tanks, magazines, newspapers, talk radio and TV news shows such as the Cato Foundation, Reason magazine, Rush Limbaugh and Fox News. These sources are underwritten by pro trickle-down one-per-centers like the Koch brothers and Rupert Murdoch.
For example, a map of states that didn’t expand Medicaid – which would actually be a boon mostly to poor whites – resembles a map of the old Confederacy with a few other poor, rural states thrown in. Another indication that this divisive propaganda works on Southern whites came in 2012. Romney and Obama evenly split the white working class in the West, Midwest and Northeast. But in the South we went 2-1 for Romney.
Lowering the flag because of the harm done to blacks is the right thing to do. We also need to lower it because it symbolizes material harm the ideology of the Confederacy did to Southern whites that lasts even to this day.
One can love the South without flying the battle flag. But it won’t help to get rid of an old symbol if we can’t also rid ourselves of the self-destructive beliefs that go with it. Only by shedding those too, will Southern whites finally catch up to the rest of the country in wages, health and education.
Frank Hyman lives in Durham,where he has held two local elected offices. He’s a carpenter and stonemason and policy analyst for Blue Collar Comeback. This essay originally appeared in the Richmond Times-Dispatch and is reprinted with permission.
This is longer than a 140-character Tweet, but I respectfully ask that all who participated in exchanges over a statement I made on Twitter on February 4, 2021 concerning #PureReparations, that aroused a firestorm of responses, please read this from start to finish.
This is longer than a 140-character Tweet, but I respectfully ask that all who participated in exchanges over a statement I made on Twitter on February 4, 2021, concerning #PureReparations, that aroused a firestorm of responses, please read this from start to finish. Some of the responses to my statement were serious, thoughtful, and critical, but others were so hostile. I am convinced many of them were written by people who only had, at best, second- or third-hand knowledge of the content of my message.
Let me be clear, I remain steadfast that African American reparations in the United States should be designated specifically for black Americans who are descendants of persons enslaved in the United States. It is a position that I have maintained for upwards of 20 years, first articulated with the eligibility criteria I presented in an article published with Dania Frank in 2003 in the American Economic Review.
The criteria expressed at the time were twofold: 1. An American citizen would have to demonstrate they have at least one ancestor enslaved in the United States. 2. An American citizen would have to demonstrate that for at least ten years before the adoption of a reparations program they self-classified as black, negro, or African American. The first criterion is a lineage standard; the second is an identity standard. Both standards must be met to merit receipt of reparations payments.
In our recent book, From Here to Equality (FHTE), Kirsten Mullen and I modify the identity standard to lengthen the time to at least twelve years (two Senatorial terms) and to include the adoption of a study commission for reparations as one of two events that would trigger the time count on self-classification.
The core objective always has been to include all persons, and their descendants, who have been subjected to the cumulative, intergenerational effects of slavery, legal segregation and white terrorist violence, and post-Civil Rights Era mass incarceration, police executions of unarmed blacks, and ongoing discrimination in the justice claim. This is the community whose ancestors were denied the promised 40 acres as restitution for the years of bondage and as a material springboard for entry into full citizenship in the United States.
Kirsten and I argue further, in FHTE, the best economic indicator of the combined effects of these atrocities is the racial wealth gap. We propose that elimination of the gap yields the baseline value for a reparations plan—demanding a federal government expenditure of $10 to $12 trillion. It is a key aspect of our project to generate a research-based standard for determining the size of the bill that is due. We do not identify an upper bound for the bill.
We also insist that priority be given to mobilization of the funds in the form of direct payments to eligible recipients, whether cash transfers, trust accounts, other types of endowments, or some combination thereof.
The two eligibility criteria necessarily exclude many Americans. The lineage standard will exclude all blacks in the United States who migrated to the United States and became citizens after the end of the Civil War. Their descendants also will not be eligible, in the absence of a parent’s or grandparent’s intermarriage with black Americans having ancestry anchored in US slavery. Counting among blacks excluded would be the relatively small group that migrated to the United States during the Jim Crow years (estimated to be, according to a Smithsonian study, to the right of the decimal point). Also excluded is a much larger group of black immigrants (now approaching ten percent of the nation’s black population) who arrived after 1964, especially coming in large numbers from the 1980s onward.
The identity standard excludes all persons who self-identified as non-black, inclusive of all white Americans, at a point where there was no apparent financial benefit from classifying oneself as black.
Meeting the lineage standard necessitates serious genealogical research. As a result, in FHTE, Kirsten Mullen and I recommend the federal government establish an agency with genealogists with expertise in African American ancestry to provide free services to all persons seeking to establish their reparations claim. Despite that recommendation, we continue to get substantial push back from those who say many black Americans with ancestors enslaved in the US will hit a wall in getting past the 1870 Census to identify their particular ancestors who were held in bondage before 1865. Therefore, I have been giving more thought to modifications in the criterion that would make it easier for all black American descendants of U.S. slavery to be assured of inclusion.
One possibility that seemed reasonable is the one I advanced that stirred the pot to a boil—include black immigrants who came during the Jim Crow years on the eligibility list. Let me emphasize, I advanced this to prompt discussion. I even referred to this in a later post as a “trial balloon,” which left me open to the somewhat humorous charges that the balloon popped or, quite the opposite, the balloon was made of lead.
Here is the thinking that I pursued: Allowing pre-1950s black immigrants onto the reparations roll eases genealogical proof required of black American descendants of U.S. slavery to establish their lineage claim. You necessarily have a tradeoff between letting a small number of otherwise excluded black folk in the door versus keeping the strong genealogical standard that will demand going past the 1870 “wall.” Under the former case, with the relaxed lineage standard, a person would have to demonstrate, say, that they have at least two black ancestors who were citizens of the USA before 1950 or 1960.
Then, eligibility would be much easier to establish for all black American descendants of U.S. slavery at the “price” of including a small number of black immigrants who arrived during legal segregation. Let a few in who do not meet the original lineage standard to ensure that all make it in who meet the original lineage standard.
No Mission Creep
I reject the “slippery slope” argument that has it that making this exception opens the gates for every other group to piggyback onto the reparations’ claim. Conditions can be drawn so precisely that no additional groups will become eligible.
Nevertheless, I do take seriously, the following critical response to my “trial balloon”: The limitation of African American reparations to black American descendants of US slavery is a matter of principle that should not be compromised. America’s history of racial injustice has targeted this community so consistently and with such ferocity that we should brook no modification in the criteria, even it remains more difficult for each individual to establish eligibility for the merited compensation.
In fact, I take it so seriously, in a later message, I indicate that I would not advance as an option the proposal any longer, and I will stand committed solely to the original criterion. Unlike what is suggested in a number of messages on Twitter, I never proposed that recent black immigrants should be eligible for reparations from the U.S. government. Nor do I anticipate reneging on that position. . . ”
In a time of racial reckoning, a new film looks at a very personal attempt to address racial injustices in this country.
“Ashes to Ashes” are the final words in typical African American funeral services. Many of those who were murdered by the Klan to maintain the reign of white supremacy never received their “Ashes to Ashes”.
Ashes to Ashes, the film, is an endearing portrait of Winfred Rembert, an avid Star Wars fan and master leather-work artist who survived an attempted lynching in 1967. This moving short documentary showcases the incredible friendship he has forged with Dr. Shirley Jackson Whitaker, as she creates and establishes an interactive art exhibit to memorialize the more than 4,000 African Americans who were lynched during the Jim Crow era. Taking all of her experiences from her love of medicine, art and people, Dr. Shirley J. Whitaker, MD, created the Ashes to Ashes program that will provide for a real memorial (funeral) service for the over 2 million lost during the Middle Passages.
FROM 1882-1968, 4,743 LYNCHINGS OCCURRED IN THE UNITED STATES. OF THESE PEOPLE THAT WERE LYNCHED 3,446 WERE BLACK (72%). THE MAJORITY OCCURING IN THE SOUTH (79%). This too is Black History.
The goal of the project by Dr. Shirley Jackson Whitaker is to acknowledge and mourn the African Americans who were racially terrorized during the Jim Crow era after the Civil War and until this very day. Some endured lynching and other forms of brutalization and therefore, they never received a proper burial. The ceremony was a celebration of thousands of African Americans. As we must. #BlackHistoryMonth2021
Dr. Whitaker will join us this week. Mr. Rembert is unable to join us tonight. We will host him soon.
Dr. Whitaker is the seventh child of Eddie and Charlie Mae Jackson from Waycross, Georgia. Dr. Whitaker attended Clark Atlanta University completing a BS degree with honors in Biology. She attended Yale University School of Medicine-Department of Public Health and obtained her medical degree form Emory University School of Medicine, the only female African American in her class. A kidney specialist by trade, an artist trained under Leonard Baskin, and a healer by passion, her Ashes to Ashes project was developed to provide hope for a better American future, one in which races of varying color and heritage can understand the importance of each other’s American history, empathize with each other’s sacrifices and tragedies, realize the legacy of impacts from suffered injustices and accept that healing is a process as much a cure, and recognize and lay to rest the 4,000 victims of vigilante justice perpetrated against a predominantly black population for simply desiring the most basic of American rights of obtaining an education, ownership of land, fair competition in commerce, the uniquely American right of voting for our governing institutions and for an equal stake in the American experience. She is currently working on the second phase of A2A: The Noose: Tread of Hate and Resilience. This will center on American history through the lens of lynching and will include an International Speak My Name Day to speak the names of the lynched.
Mr. Rembert grew up in rural Georgia, in a farm laborer’s house and later in the small town of Cuthbert. Raised by his great-aunt, Rembert worked with her in the cotton fields during much of his childhood, and received little formal education. As a teenager he got involved in the 1960s Civil Rights Movement. Jailed for fleeing for his life in a stolen car, nearly lynched and then cut down to serve as an example to others, Rembert was sentenced to 27 years in the Georgia Penal System. Despite the cruel prison circumstances, Rembert learned to read and write and managed to meet and write letters to his would-be wife Patsy as well as to congressmen, with the hope of gaining early release. He also learned the craft of hand-tooling leather from a fellow-prisoner. After seven years, most of which was spent on chain gangs, Rembert was released from prison, but it wasn’t until 1997, at the age of 51, that he began to work more seriously with leather as his artistic medium, creating tooled and dyed canvases that tell the stories of his life. His paintings have been exhibited at galleries across the country—including the Yale University Art Gallery, the Adelson Galleries New York, and the Hudson River Museum—and have been profiled in The New York Times and elsewhere. Rembert is the recipient of a 2017 USA Fellowship, and in 2015 was an honoree of Bryan Stevenson’s Equal Justice Initiative. Rembert’s full-color memoir, Chasing Me to My Grave: An Artist’s Memoir of the Jim Crow South, is forthcoming from Bloomsbury in 2021.
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The doctor put up billboards in the Mississippi Delta.
Amputation Prevention Institute, they read.
He could save their limbs, if it wasn’t too late.
The Black American Amputation Epidemic
by Lizzie Presser
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IT WAS A FRIDAY EVENING in the hospital after a particularly grueling week when Dr. Foluso Fakorede, the only cardiologist in Bolivar County, Mississippi, walked into Room 336. Henry Dotstry lay on a cot, his gray curls puffed on a pillow. Fakorede smelled the circumstances — a rancid whiff, like dead mice. He asked a nurse to undress the wound on Dotstry’s left foot, then slipped on nitrile gloves to examine the damage. Dotstry’s calf had swelled to nearly the size of his thigh. The tops of his toes were dark; his sole was yellow, oozing. Fakorede’s gut clenched. Fuck, he thought. It’s rotten.
Fakorede, who’d been asked to consult on the case, peeled off his gloves and read over Dotstry’s chart: He was 67, never smoked. His ultrasound results showed that the circulation in his legs was poor. Uncontrolled diabetes, it seemed, had constricted the blood flow to his foot, and without it, the infection would not heal. A surgeon had typed up his recommendation. It began: “Mr. Dotstry has limited options.”
Fakorede scanned the room. He has quick, piercing eyes, a shaved head and, at 38, the frame of an amateur bodybuilder. Dotstry was still. His mouth arched downward, and faint eyebrows sat high above his lids, giving him a look of disbelief. Next to his cot stood a flesh-colored prosthetic, balancing in a black sneaker.
Fakorede explained that he wasn’t the kind of doctor who cuts. He was there because he could test circulation, get blood flowing, try to prevent any amputation that wasn’t necessary. He hated that doctors hadn’t screened Dotstry earlier — when he’d had the stroke or lost his leg. “Your legs are twins,” he said. “What happens in one happens in the other.”
Dotstry needed an immediate angiogram, an imaging test that would show blockages in his arteries. He also needed a revascularization procedure to clean them out, with a thin catheter that shaves plaque and tiny balloons to widen blood vessels. His foot was decaying, fast. Though Fakorede ran an outpatient practice nearby, when doctors consulted him on inpatients at Bolivar Medical Center, the local hospital, he expected to use its facilities.
He asked his nurse to schedule the procedures. But by the time he had driven home to his ranch house on the northern edge of town, he hadn’t received an answer. Nor had he when he woke up on Saturday at 3:30 a.m., as he did every morning. By sunrise, he was restless at his kitchen counter, texting the hospital’s radiology director, explaining the need for an intervention on Monday, Martin Luther King Jr. Day. Within a few hours, he got a response: “I don’t have the staff or the supplies. I’m sorry.”
Now Fakorede was mad, walking briskly into his office, dialing friends on speaker phone, pacing around his conference room. He’d been raised in Nigeria, moved to New Jersey as a teenager and had come to practice in Mississippi five years earlier. He’d grown obsessed with legs, infuriated by the toll of amputations on African Americans. His billboards on Highway 61, running up the Delta, announced his ambitions: “Amputation Prevention Institute.”
Nobody knew it in January, but within months, the new coronavirus would sweep the United States, killing tens of thousands of people, a disproportionately high number of them black and diabetic. They were at a disadvantage, put at risk by an array of factors, from unequal health care access to racist biases to cuts in public health funding. These elements have long driven disparities, particularly across the South. One of the clearest ways to see them is by tracking who suffers diabetic amputations, which are, by one measure, the most preventable surgery in the country.
Look closely enough, and those seemingly intractable barriers are made up of crucial decisions, which layer onto one another: A panel of experts decides not to endorse screening for vascular disease in the legs; so the law allows insurance providers not to cover the tests. The federal government forgives the student loans of some doctors in underserved areas, but not certain specialists; so the physicians most critical to treating diabetic complications are in short supply. Policies written by hospitals, insurers and the government don’t require surgeons to consider limb-saving options before applying a blade; amputations increase, particularly among the poor.
Despite the great scientific strides in diabetes care, the rate of amputations across the country grew by 50% between 2009 and 2015. Diabetics undergo 130,000 amputations each year, often in low-income and underinsured neighborhoods. Black patients lose limbs at a rate triple that of others. It is the cardinal sin of the American health system in a single surgery: save on preventive care, pay big on the backend, and let the chronically sick and underprivileged feel the extreme consequences.
Fakorede grabbed his car keys and headed to the hospital. He walked straight to the lab. As he suspected, it had all the supplies that he needed. Why won’t they give me staff? he wondered. They wouldn’t do that to a surgeon.
He has little tolerance for this kind of transgression. He is militaristic, to an extreme. To him, nonhealing wounds are like heart attacks. “Time is muscle,” he repeats. He calls huddles when nurses forget to check a patient’s ankles: “If you haven’t assessed both legs, I don’t want to walk into that room.” He considers each of his procedures an act of war. When people stand in his way, he sends a barrage of text messages, punctuated by exclamation marks. And he uses his cellphone to collect evidence that the system is working against his patients, and his efforts.
He pulled out his iPhone and photographed the hospital’s wires and catheters, IVs and port protectors. He shot the images over to the hospital’s radiology director. Fakorede’s private practice was closed for the holiday weekend. He calculated that he had only a few days to carry out some plan before Dotstry’s remaining leg was amputated.
TWO MAPS EXPLAIN why Fakorede has stayed in the Mississippi Delta. One shows America’s amputations from vascular disease. The second shows the enslaved population before the Civil War; he saw it at a plantation museum and was stunned by how closely they tracked. On his phone, he pulls up the images, showing doctors, or history buffs, or anyone who will listen. “Look familiar?” he asks, toggling between the maps. He watches the realization set in that amputations are a form of racial oppression, dating back to slavery.
Fakorede was initially tempted to move to the Delta while practicing in Tennessee. He befriended a medical device sales rep named Maurice Hampton who had grown up in the Mississippi region. Hampton talked about how black families were leery of local hospitals and how few black doctors in the Delta specialized in vascular work. “It’s the norm to go to Walmart and see an amputation or a permacath in the neck,” he’d told Fakorede. “If you don’t see one, then you didn’t stay but two minutes.”
Then, a little over a year into his Tennessee job, Fakorede found himself at loose ends. He’d raised concerns that he was being billed for expenses that weren’t his and asked for an audit; though the audit later found that the clinic where he worked had claimed over $314,000 in improper expenses, he was quickly terminated. Fakorede sued the clinic for retaliation under the False Claims Act and lost. (The clinic’s lawyer said his client had no comment, but there were “numerous” reasons for Fakorede’s departure.) In the spring of 2015, he had a mortgage, a quarter of a million dollars in student debt and four months of severance pay. He also had an impulse to understand the Delta.
Fakorede spent four days driving through its long, flat stretches of farmland dotted with small towns and shotgun houses. The wood-slat homes and bumpy roads reminded him of his grandparents’ village in the Nigerian state of Ondo, where he’d spent summers as a kid. He drove scores of miles on the Mississippi highways without seeing a single grocery store; fast-food chains lit the busiest intersections. He was startled by the markers of disease — the missing limbs and rolling wheelchairs, the hand-built plywood ramps with metal rails. He thought of amputees like “an hourglass,” he said, “that was turned the day they had their amputation.” Mortality rates rise after the surgeries, in part, because many stop walking. Exercise improves circulation and controls blood sugar and weight. The less activity a person does, the higher the risk of heart attacks and strokes. Within five years, these patients were likely to be dead.
Fakorede weighed taking a lucrative job up north, near his parents, who had both been diagnosed with diabetes. He had professional connections there; he’d gone to Rutgers Robert Wood Johnson Medical School and done a residency at NewYork-Presbyterian Weill Cornell Medical Center. But the South, he felt, needed him. About 30 million people in America had diabetes, and Mississippi had some of the highest rates. The vast majority had Type 2; their bodies resisted insulin or their pancreas didn’t produce enough, making their blood sugar levels rise. Genetics played a role in the condition, but so did obesity and nutrition access: high-fat meals, sugary foods and not enough fiber, along with little exercise. Poverty can double the odds of developing diabetes, and it also dictates the chances of an amputation. One major study mapped diabetic amputations across California, and it found that the lowest-income neighborhoods had amputation rates 10 times higher than the richest.
The Delta was Mississippi’s poorest region, with the worst health outcomes. Fakorede had spent years studying health disparities: African Americans develop chronic diseases a decade earlier than their white counterparts; they are twice as likely to die from diabetes; they live, on average, three years fewer. In the Delta, Fakorede could treat patients who looked like him; he could find only one other black interventional cardiologist in the entire state. A growing body of evidence had shown how racial biases throughout the medical system meant worse results for African Americans. And he knew the research — black patients were more responsive to, and more trustful of, black doctors. He decided after his trip that he’d start a temporary practice in Mississippi, and he rented an apartment deep in the Delta.
He fantasized about building a cardiovascular institute and recruiting a multidisciplinary team, from electrophysiologists to podiatrists. But as he researched what it would take, he found a major barrier. Medical specialists with student debt, who graduate owing a median of $200,000, generally could not benefit from federal loan forgiveness programs unless they got jobs at nonprofit or public facilities. Only a few types of private practice providers — primary care, dentists, psychiatrists — qualified for national loan forgiveness. The Delta needed many other physicians. Though Bolivar County was at the center of a diabetes epidemic, there wasn’t a single diabetes specialist, an endocrinologist, within 100 miles.
Fakorede leased a windowless space in the Cleveland Medical Mall, a former shopping center that had been converted to doctors’ offices. People came to him with heart complaints, but he also asked them to remove their socks. Their legs alarmed him. Their toes were black and their pulses weak. Their calves were cold and hairless. Some had wounds but didn’t know it; diabetes had numbed their feet. Many had been misdiagnosed with arthritis or gout, but when Fakorede tested them, he found peripheral artery disease, in which clogged arteries in the legs limit the flow of blood.
This is what uncontrolled diabetes does to your body: Without enough insulin, or when your cells can’t use it properly, sugar courses through your bloodstream. Plaque builds up faster in your vessels’ walls, slowing the blood moving to your eyes and ankles and toes. Blindness can follow, or dead tissue. Many can’t feel the pain of blood-starved limbs; the condition destroys nerves. If arteries close in the neck, it can cause a stroke. If they close in the heart, a heart attack. And if they close in the legs, gangrene.
Within a month, Bolivar Medical Center had credentialed Fakorede, allowing him to consult on cases and do procedures in the hospital. His most complicated patients came in through the emergency room. Some arrived without any inkling that they had gangrene. One had maggots burrowing in sores. Another showed up after noticing his dog eating the dead flesh off the tips of his toes. Fakorede took a photo to add to his collection. “It was a public health crisis,” he told me. “And no one was talking about amputations and the fact that what was happening was criminal.”
On weekends, Fakorede had been driving back to his five-bedroom home in Tennessee, but in August of 2015, he decided to go all-in on Bolivar County. He sold his house and black Mercedes G-Wagon, and applied for funding to build a practice in the Delta: Cardiovascular Solutions of Central Mississippi. He pitched himself as a heart guy and a plumber, removing buildup in the arteries. Four banks denied him loans, so he borrowed money from friends. He gave himself a two-year window to reduce amputations and publish his outcomes.
THE DELTA FLOOD PLAIN runs 7,000 square miles along the northwestern edge of the state, with sweet-smelling, clay-like soil cordoned between bluffs and the banks of the Mississippi River. By the 19th century, the primeval forests had been transformed into a cotton empire; at the start of the Civil War, more than 80% of people in many Delta counties were enslaved. Sharecropping emerged after emancipation, and black farmers cultivated small plots in return for a portion of their crop. They lived on credit — for food and feed and clothing — until the harvest, but even then, their earnings rarely covered their expenses.
For decades, African Americans in the South struggled to find and afford health care. The American Medical Association excluded black doctors, as did its constituent societies. Some hospitals admitted black patients through back doors and housed them in hot, crowded basements. Many required them to bring their own sheets and spoons, or even nurses. Before federal law mandated emergency services for all, hospitals regularly turned away African Americans, some in their final moments of life.
Fakorede was drawn to Bolivar County, in part, because of its history. He’d run out of gas there when he was first scouting the region, and later that evening, he’d Googled its background. For a brief moment, Bolivar was the center of a movement for public health care, driven by the conviction that racial equality was not possible without justice in health. In 1964, when a group of physician activists traveled to the Delta, Robert Smith, a black doctor from Jackson, saw rocketing rates of intestinal parasites and maternal death. “I understood for the first time what it truly meant to be black in Mississippi,” he told a magazine. Under President Lyndon B. Johnson’s War on Poverty, a Boston doctor secured funding to open a community health center in Bolivar, which he grew with the help of Smith. Clinicians worked with residents to take on housing, sanitation, exercise and nutrition. Its success spawned a national project of more than a thousand Federally Qualified Health Centers for the underserved. But funding shrank under President Richard Nixon, and the centers’ initiatives were scaled back to basic primary care.
By the time Fakorede moved to the Delta, in 2015, the state had the nation’s lowest number of physicians per capita. It had not expanded Medicaid to include the working poor. Across the country, 15% of African Americans were still uninsured, compared with 9% of white Americans. That year, Jennifer Smith, a professor at Florida A&M University College of Law, wrote in the National Lawyers Guild Review what Fakorede saw firsthand: “While the roots of unequal and inequitable health care for African Americans date back to the days of slavery, the modern mechanisms of discrimination in health care has shifted from legally sanctioned segregation to inferior or non-existent medical facilities due to market forces.”
Fakorede understood that to reach patients, he needed referrals, so he met primary care providers at hospitals and clinics. He asked them to screen for vascular disease, measuring blood pressure at the ankle and the arm. Many didn’t have the time; given the shortage of local physicians, some were seeing up to 70 patients a day. Others didn’t know much about peripheral artery disease or why it was important to diagnose. Some were offended by Fakorede’s requests. Michael Montesi, a family doctor, was grateful for the help, but he found it brash for the new doctor in town to start telling the veterans what to do. He recalled thinking, “Where were you the first 12 years of my practice, when I needed a cardiologist, when I needed an OB-GYN, when I needed a surgeon, when I had to do an amputation in the ER, or deliver a baby that was 23 weeks and watch the baby die because there was nobody there that could take care of him?”
The brushoffs disturbed Fakorede, but when he dug deeper, he realized that the doctors weren’t only overwhelmed; they had no guaranteed payment for this vascular screening. The Affordable Care Act mandates that insurers cover all primary care screenings that are recommended by the U.S. Preventive Services Task Force, an independent panel of preventive care experts. The group, though, had not recommended testing anybody without symptoms, even the people most likely to develop vascular disease — older adults with diabetes, for example, or smokers. (Up to 50% of people who have the disease are believed to be asymptomatic.) As specialists, cardiologists are reimbursed if they screen patients with risk factors. But by the time patients got to Fakorede, the disease was sometimes too far along to treat. Many already had a nonhealing wound, what’s known as “end stage” peripheral artery disease, the last step before an amputation.
When Luvenia Stokes came to Fakorede, she had already lost her right leg at the age of 48. Like many Delta residents, she grew up in a food desert, and without money for fresh produce, she’d developed diabetes at a young age. She said that a pedicurist nicked her toe, and the small cut developed an infection. Without good blood flow, it began bubbling with pus. Stokes told Fakorede that no doctor had performed an angiogram to get a good look at the circulation or a revascularization to clean out the arteries. A surgeon removed her second toe. Without cleared vessels, though, the infection spread. Within weeks, a new surgeon removed her leg.
Stokes lived in a single-wide trailer with her mother. Her wheelchair could not fit in the doorways, so she inched through sideways with a walker. Because she could hardly exercise, she gained 48 pounds in two years. The amputation hadn’t treated her vascular disease, and a stabbing pain soon engulfed her remaining leg, “like something is clawing down on you,” she said. When she finally made it to Fakorede, she told him that one doctor had prescribed neuropathy medication and another had diagnosed her with arthritis. “I’m not letting them get that other leg,” Fakorede told her. Stokes’ grandmother, Annie, who lives in a nearby trailer, had lost both her legs, above the knee, to diabetes. Her cousin Elmore had lost his right leg, too.
General surgeons have a financial incentive to amputate; they don’t get paid to operate if they recommend saving a limb. And many hospitals don’t direct doctors to order angiograms, the most reliable imaging to show if and precisely where blood flow is blocked, giving the clearest picture of whether an amputation is necessary and how much needs to be cut. Insurers don’t require the imaging, either. (A spokesperson for America’s Health Insurance Plans, a leading industry trade association, said, “This is not an area where there is likely to be unnecessary surgery.”) To Fakorede, this was like removing a woman’s breast after she felt a lump, without first ordering a mammogram.
Nationwide, more than half of patients do not get an angiogram before amputation; in the Delta, Fakorede found that the vast majority of the amputees he treated had never had one. Now, he was determined to make sure that no one else lost a limb before getting the test. This wasn’t a controversial view: The professional guidelines for vascular specialists — both surgeons and cardiologists — recommend imaging of the arteries before cutting, though many surgeons argue that in emergencies, noninvasive tests like ultrasounds are enough. Marie Gerhard-Herman, an associate professor of medicine at Harvard Medical School and a cardiologist at Brigham and Women’s Hospital, chaired the committee on guidelines for the American College of Cardiology and the American Heart Association. She told me that angiography before amputation “was a view that some of us thought was so obvious that it didn’t need to be stated.” She added: “But then I saw that there were pockets of the country where no one was getting angiograms, and it seemed to be along racial and socioeconomic lines. It made me sick to my stomach.”
Stokes wasn’t at immediate risk of losing her left leg when she met Fakorede, but pain prevented her from walking. She had a severe form of the disease, and Fakorede booked her for an angiogram and revascularization. He inserted a wire into her arteries and cleaned out the clogged vessels, letting oxygen-rich blood rush to her remaining foot. While she was recovering in Fakorede’s lab, she thought about her neighbors who had the same problems. “I really don’t like what’s happening to us,” she said to me. “They’re not doing the tests on us to see if they can save us. They’re just cutting us off.”
Patients didn’t know about vascular disease, or why their legs throbbed or their feet blackened, so Fakorede went to church. The sales rep, Hampton, introduced him to pastors, and several times each month, he stood before a pulpit. He told the crowds that what was happening was an injustice, that they didn’t need to accept it. He told them to get screened, and if any surgeon wanted to cut off their limbs, to get a second opinion. In the lofty Pilgrim Rest Baptist Church, in Greenville, he asked the congregation, “How many of you know someone or know of someone who’s had an amputation?” Almost everyone raised their hands.
At first, Fakorede took a confrontational approach with colleagues. Some seemed skeptical that he could “prevent” amputations; it’s a tall claim for a complex condition. Once, when a doctor had disregarded his advice, he’d logged it in the electronic health record, so the oversight would be on display for anyone who looked up his patient’s chart. Fakorede could fume when people questioned his authority; self-confidence carried him, but it sometimes blinded him to his missteps. Over time, though, Fakorede tried to rein in the arrogance. “You peel off a layer that may be comprised of: I’m from up North, I know it all, you should be thankful we’re here to provide services that you probably wouldn’t get before.” He picked up some Southern manners. Fakorede began texting doctors with photos of their patients’ feet along with X-rays of their arteries, before his intervention and afterward. Referrals picked up, and within a year, he’d seen more than 500 patients.
But Bolivar Medical Center, he learned, was turning away people who couldn’t pay a portion of their revascularization bill upfront. Several former employees told me the same. “It’s a for-profit hospital, it’s no secret, it’s the name of the game,” Fakorede said. “But a for-profit hospital is the only game in town in one of the most underserved areas. So what happens when a patient comes in and can’t afford a procedure that’s limb salvage? They eventually lose their limbs. They’ll present back to the emergency room with a rotten foot.” And a surgeon would have no choice but to amputate. (A hospital spokeswoman said that last year, it gave $25 million in charity care, uncompensated care and uninsured discounts. Asked if it turned away patients who couldn’t pay for revascularization, she did not respond directly: “We are dedicated to providing care to all people regardless of their ability to pay.”)
The practice was discriminatory, he reasoned, and also financially backward. At $237 billion in medical costs each year, diabetes is the most expensive chronic disease in the country; one of every four health care dollars is spent on a person with the condition. Left untreated, the costs pile on. Medicare spendsmore than $54,000 a year for an amputee, including follow-ups, wound care and hospitalizations; the government program is the country’s largest payer. Then come the uncounted tolls: lost jobs, a dependence on disability checks, relatives who sacrifice wages to help with cooking and bathing and driving.
By the time Carolyn Williams came to see Fakorede, in 2016, she’d been uninsured with diabetes for 20 years; she’d worked at a housing nonprofit and for a food assistance program, but neither had offered coverage. At the age of 36, she’d needed a triple bypass surgery, and at 44, she had three toes amputated. Untreated leg pain left her needing a wheelchair; she pulled out of Delta State University, where she was pursuing a degree in social work. Fakorede reconstituted blood flow in her legs and got her walking. But the diabetes was already destroying her kidneys. She joined the government’s disability rolls. She also went on dialysis, at a yearly cost to Medicare of $90,000.
On the days when Fakorede wanted to give up and leave, he drove to an Emmett Till memorial in Money, Mississippi. After 14-year-old Till was mutilated and murdered, in 1955, his mother had insisted on opening his casket. “Let the people see what I’ve seen,” she said, and his image brought national outrage to racist violence in the South. Fakorede thought often about how that decision sparked the Civil Rights movement. He thought about it as he exhibited his photos of rotten feet and limbless bodies, his own proof of what he considered a modern atrocity. He didn’t want to live by Bolivar Medical’s policies. He decided that in order to treat as many people as possible, irrespective of income or insurance, he needed to build a lab of his own.
THIS JANUARY, THAT LAB was now Dotstry’s best shot. The hospital’s consulting surgeon expected to amputate his leg below the knee. He had written that because Dotstry’s kidneys were impaired, the contrast dye in an angiogram would be dangerous. But Fakorede could replace the dye with a colorless gas, which wouldn’t jeopardize Dotstry’s health.
It would have made the most sense to perform the procedure at the hospital; Dotstry had been admitted and was occupying a bed. But after Fakorede opened his outpatient lab and hired away two techs and a nurse, a spokeswoman said the hospital stopped doing certain interventions. She told me it shouldn’t have surprised Fakorede that they couldn’t schedule Dotstry’s case, and that if he had been unable to treat a patient in his lab, the hospital could have worked with him to find another. Fakorede told me he’d never received such a message. When a doctor asks him to treat an inpatient with an acute condition, his responsibility, as he sees it, is to do it in the hospital. “If I don’t have a hospital that wants to coordinate,” he asked, “what do I do?”
The answer, at least this time, was to get his patient out of there. He called Dotstry’s doctor and convinced her to discharge him for the intervention. Then, at noon on Saturday, Fakorede walked back into Room 336. Dotstry’s sister, Judy, was standing by his bed. She wore tall leather boots over acid-washed jeans, with a thick, black wig in a braid down her back.
Fakorede handed over his card. “I called the hospital to see if we can do this case on Monday,” he said, “and they said no.”
Judy inhaled. “What now?”
Fakorede laid out the plan for a Monday morning angiogram in his own procedure room. He would open up as many vessels as he could. If he could get circulation to Dotstry’s foot, he might be able to save it. He wasn’t sure about the toes.
When Dotstry had suffered his stroke several years back, Judy had become his caregiver. She’d stopped taking jobs in home care and supported her brother without pay — shuttling him to doctors’ appointments, controlling his sugars, managing his medications. After his amputation, she’d helped him learn to walk again. In place of a salary, she’d drawn disability for an old work injury; she’d been electrocuted while operating a machine, and the nerves in her arm were damaged, making her hands tremble. But she couldn’t stay unemployed forever. This past fall, she had gone back to work, cleaning the local post office.
After Fakorede left, Judy looked over at her brother, who sat slumped over the side of the cot, a blue gown slipping off his bony shoulders. Their father had been a sharecropper, and Dotstry had dropped out of elementary school to help on the farm, harvesting soybeans, rice and cotton. Of 10 kids, he was the oldest boy, and he took care of the others, bringing in cash and cooking them dinner. They almost never saw a doctor. Instead, they’d relied on cod liver oil, or tea from hog hoofs, parched over a fire.
Dotstry had spent his career driving tractors, hauling crops and plowing fields, but he wasn’t insured and still rarely saw doctors. At 60, when he was diagnosed with Type 2 and prescribed insulin, he didn’t know how to manage the medicine properly; he had never learned to read. Insulin pumps were too expensive —more than $6,000. His blood sugar levels often dropped, and he sometimes passed out or fell on the job. Little by little, his employer cut back his duties. In 2015, he had a stroke; diabetes had raised his risk. A year later, his right foot blackened and was amputated at the ankle. The infection kept spreading, and soon, his lower leg went. He could no longer work.
Two of his sisters had died after complications of diabetes. Judy had stood over their beds like she was now standing over Dotstry’s. He’s still here, she reminded herself.
She pulled out her phone and called another brother. “They gonna amputate his foot, cause it’s bad,” she said. “Toe’s rotted.”
Dotstry looked up from the bed. “No!” he shouted. “They can’t take that off. Why?”
“Why you think your foot look like that? Why you think it smells? It stinks!” she said. Dotstry reached down to unwind the gauze. Judy wondered why he hadn’t told her that his foot was infected sooner. She lowered her voice. “You were doing pretty good. If you wasn’t, I could have tried to get back in there and do something.”
Her daughter, Shequita, ran into the room, huffing. She was loud and pissed off. “Whose foot is that?” she shrieked. She kneeled by the cot and helped Dotstry scoot up onto his pillow, stretching out his legs. He was usually a prankster, a hard-headed contrarian, the uncle who’d picked her up and spun her around like an airplane. She was thrown off by how quiet he’d become.
“Your daughter wants to know if you want to come stay with her, if you want to come to Texas,” Shequita told him.
Dotstry knew the offer was on the table, but he hadn’t yet accepted. A few days earlier, a tornado had torn the roof from his trailer, and he was, for the moment, without a home.
“She said it’s a lot better doctors up there,” Shequita continued, “and if she gotta stop working to take care of you, she can do that.” She gripped her hands around the frame of the bed and leaned over it, locking her eyes with his. “I need you to be thinking hard about this, sir. This ain’t you. I need you to get back to you.”
“He ain’t gotta go to Texas,” Judy interrupted.
Shequita shot back: “You gonna take care of him?”
Judy was silent. She knew that she couldn’t, not like before. She needed her paycheck for home repairs; a flood had warped her wooden floors. But Dotstry’s daughter was younger, and Judy thought that if she quit her job at Walmart, she’d get restless. Besides, Dotstry knew no one in Texas. She pictured him in a wheelchair, staring off, confused about where he was. Judy figured if he went, he’d go on and die.
She crossed her arms. “He’ll be all right if they don’t have to amputate that leg,” she said.
Shequita looked at her mother. She walked over to where she stood, by a shaded window, and threw her arms around her neck. Then, she left the room. Judy hoisted herself up onto the foot of her brother’s cot. She swung her legs up so that she faced him, and she laid herself down.
ABOUT EVERY FIVE YEARS, the doctors and researchers who make up the U.S. Preventive Services Task Force reassess their screening guidelines. In 2018, the members returned to peripheral artery disease and the blood flow tests that Fakorede had asked local primary care doctors to conduct. Once again, the panel declined to endorse them, saying there was not enough evidence that the tests benefited the average asymptomatic American.
In their statement, they acknowledged that public commenters had raised concerns that the disease “is disproportionately higher among racial/ethnic minorities and low-socioeconomic populations” and that this recommendation “could perpetuate disparities in treatment and outcomes.” In response, the panel said it needed better evidence. But as the National Institutes of Health has found, minorities in America make up less than 10% of patients in clinical trials.
Dr. Joshua Beckman, the director of vascular medicine at Vanderbilt University Medical Center, was an expert reviewer of the evidence base for the task force, and its final report struck him as irresponsible. It hardly noted the advantages of treatment after screening; the benefits were right there in the data that he saw. The panel discounted the strongest study, a randomized control trial, which demonstrated that vascular screening, for men ages 65 to 74, reduced mortality and hospital days. (The study bundled peripheral artery disease screening with two other tests, but in Beckman’s eyes, the outcomes remained significant.) He was confused about why the task force had published its evaluation of screening the general public, when it was clear that the condition affects specific populations. Several American and European professional society guidelines recommended screening people with a higher risk. “You wouldn’t test a 25-year-old for breast cancer,” he told me. “Screening is targeted for the group of women who are likely to get it.”
Dr. Alex Krist, the chair of the task force, repeated the group’s position in an email that the data was not strong enough to endorse screening, even for at-risk patients. “The Task Force does not do its own research, so we can’t fix these research gaps, but we can — and did — ring the alarm bell to raise awareness of this vital issue among researchers and funders.”
Vascular surgeons who have spent their careers studying limb salvage have come to see preventive care as perhaps more important than their own last-ditch efforts to open blood vessels. Dr. Philip Goodney, a vascular surgeon and researcher at Dartmouth and White River Junction VA Medical Center, made a name for himself with research that showed how the regions of the country with the lowest levels of revascularization, like the Delta, also had the highest rates of amputation. But revascularizations aren’t silver bullets; patients still must manage their health to keep vessels open. Now, Goodney believes his energy is better spent studying preventive measures earlier in the disease’s progression, like blood sugar testing, foot checks and vascular screening. Many patients have mild or moderate disease, and they can be treated with medicine, counseled to quit nicotine, exercise and watch their diet. “We need to build a health system that supports people when they are at risk, when they are doing better and when they can keep the risk from coming back,” he told me. “And where there’s a hot spot, that’s where we need to focus.”
Fakorede scrolled through the task force’s statement. “You want more data? Really? Who has the highest amputation rates in America?” he asked. “That’s your data.” He had taken to the national stage, speaking at conferences about what he’d witnessed in Bolivar. On behalf of the Association of Black Cardiologists, he testified before Congress, convincing U.S. Rep. Donald M. Payne Jr., a Democrat from New Jersey, along with U.S. Rep. Gus Bilirakis, a Republican from Florida, to start a Congressional Peripheral Artery Disease Caucus. The group is pushing for the task force to reevaluate the evidence on screening at-risk patients, for federal insurers to start an amputation prevention program and for Medicare to ensure that no amputation is allowed before evaluating arteries. Other groups are advocating for legislation that would require hospitals to publicly report their amputation rates.
In Bolivar, Fakorede had seen more than 10,000 cardiovascular patients from around the Delta. Dr. DeGail Hadley, a primary care provider in town, told me that before Fakorede arrived, he wasn’t sure what was best to do for patients with rotting feet. “It was always a process of transferring the patients to Jackson or Memphis, which can be difficult.” Both cities were two hours away. Now, Fakorede was performing about 500 angiograms annually in town. Last year, he published a paper in Cath Lab Digest describing an 88% decrease in major amputations at Bolivar Medical Center, from 56 to seven. (Fakorede did not provide me with all of his sources.) The hospital has different internal figures, which also reflect a significant decrease. Between 2014 and 2017, the hospital recorded that major amputations had fallen 75% — from 24 to six.
Fakorede couldn’t catch everyone in time, and he was haunted by the patients who got to him too late. A week before he’d met Dotstry, Sandra Wade had come in with an open sore on her right big toe. She came from a family of diabetics. Her mother had died after a diabetic coma. Her cousin had just lost a leg. Her oldest sister, who’d raised her, had given up on walking when a tired, burning, itching sensation consumed her legs. Now, Wade felt it, too.
“I don’t want to give up like that,” Wade had said, reclining in a cot in Fakorede’s pre-procedure room. “I want my toes. I don’t want to lose not one limb. I choose life.” She elongated her O’s. She was 55 and had a high, gentle voice, a wide smile and big, curled lashes under loose, curled hair. She had spent most of her career in food service and retail, recently managing a Family Dollar, but after diabetes took her eyesight, she’d had to quit. She wondered if the sodas and chips that had fueled her at the store had accelerated her disease. Or if she’d focused so much on her son, who was developmentally disabled, that she’d neglected herself. She didn’t like to offload blame onto her genes. “Somebody’s gotta try to change the cycle,” she’d said. “I really want to be the one.”
Fakorede inserted an IV into the top of her leg. He opened up each of her blocked arteries, one at a time, until he got to the most important one, which ran along her inner calf. It was supposed to supply blood to her open wound, and she needed it to heal. Without it, she’d likely lose her toe. If she didn’t control her sugars, she could lose her lower leg next. Fakorede was hopeful as he slid a wire through the vessel in her knee, and into that crucial artery in her calf. But then, about a third of the way down, it stopped. It was as if the vessel itself had evaporated.
UNDER A CRISP, WIDE SKY, on Martin Luther King Jr. Day, churches around town were opening their doors for services. Fakorede’s office was scheduled to be closed, but he’d called in his nurses and radiology technicians, even those out hunting deer, to staff Dotstry’s case.
“What’s up, young man?” Fakorede greeted Dotstry, who was slowly fading into his Ambien, and he handed Judy a diagram of a leg. “The prayer is that we can find this many vessels to open up,” he said, pointing to the paper. “As soon as I’m done, I’ll let you know what I find.”
In the procedure room, he put on his camouflage-patterned lead apron, and with an assistant, he inserted an IV near Dotstry’s waist. He wound a wire across Dotstry’s iliac artery, into the top of his left leg. The femoral artery was open, even though it had hardened around the edges, a common complication of diabetes. They shot a gas down the arteries in Dotstry’s lower leg so the X-ray could capture its flow. Fakorede looped his thumbs into the top of his vest, waiting for the image. Other than a small obstruction, circulation to the toes was good. “They don’t need to whack off the knee,” he said, staring at the screen. Dotstry would lose one toe.
After they’d cleaned out the plaque, Fakorede called Judy into the lab and pulled up the X-rays. Dotstry snored in the background. The doctor showed Judy a playback of the blood moving through the vessels. She could tell that his foot had enough flow. She folded over, running her palms along her thighs. “Y’all have done a miracle, Jesus.”
Dotstry would need aggressive wound care, help controlling his sugars and a month in rehab following his toe amputation. In the meantime, Judy and her daughter would have to learn to manage his antibiotics and find him an apartment. He’d still be able to tinker with his cars, as he did most afternoons. And as far as Judy was concerned, he wasn’t moving to Texas.
Fakorede scrubbed out. He sat at his desk to update Dotstry’s doctors. He called an infectious disease specialist, 35 miles south, to check on whether he could see Dotstry the following morning. Then, he dialed the hospital and asked for one of the nurses. He explained what he’d found: that Dotstry didn’t need a leg amputation.
“Oh, great,” the nurse replied. “The surgeon was calling and asking about that. He called and tried to schedule one.”
Fakorede had been typing up notes at the same time, but now he stopped. “He was trying to schedule it when?” he asked.
“He was trying to schedule it today.”
ABOUT THE REPORTING
For this story, Lizzie Presser spent over a month in Mississippi, in December and January, speaking with dozens of patients and shadowing doctors, in clinic and in procedures. She interviewed over a dozen medical professionals whose work has intersected with Fakorede’s, including nurses, limb-salvage specialists, primary care providers and the hospital’s consulting surgeon, Dr. Roger Blake, who corroborated all facts related to his treatment plan for Henry Dotstry. She asked Bolivar Medical Center if it believed it provided Dotstry with adequate care. Even with Dotstry’s permission, the hospital declined to comment on his case, citing patient privacy.
The scenes in the story are informed by her own observations and interviews with the subjects to fill in details, including their thoughts at the time.
To put her observed reporting into national context, she reviewed the salient medical research and interviewed more than a dozen experts in all corners of the health care system, from those who treat diabetic patients to those who inform and set policies around care.
Lizzie Presser covers health, inequality and how policy is experienced for ProPublica.
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During the past two years, U.S. counterterrorism officials held meetings with their European counterparts to discuss an emerging threat: right-wing terror groups becoming increasingly global in their reach.
American neo-Nazis were traveling to train and fight with militias in the Ukraine. There were suspected links between U.S. extremists and the Russian Imperial Movement, a white supremacist group that was training foreigners in its St. Petersburg compounds. A gunman accused of killing 23 people at an El Paso Walmart in 2019 had denounced a “Hispanic invasion” and praised a white supremacist who killed 51 people at mosques in Christchurch, New Zealand, and who had been inspired by violent American and Italian racists.
But the efforts to improve transatlantic cooperation against the threat ran into a recurring obstacle. During talks and communications, senior Trump administration officials steadfastly refused to use the term “right-wing terrorism,” causing disputes and confusion with the Europeans, who routinely use the phrase, current and former European and U.S. officials told ProPublica. Instead, the FBI and Department of Homeland Security referred to “racially or ethnically motivated violent extremism,” while the State Department chose “racially or ethnically motivated terrorism.”
“We did have problems with the Europeans,” one national security official said. “They call it right-wing terrorism and they were angry that we didn’t. There was a real aversion to using that term on the U.S. side. The aversion came from political appointees in the Trump administration. We very quickly realized that if people talked about right-wing terrorism, it was a nonstarter with them.”
The U.S. response to the globalization of the far-right threat has been slow, scattered and politicized, U.S. and European counterterrorism veterans and experts say. Whistleblowers and other critics have accused DHS leaders of downplaying the threat of white supremacy and slashing a unit dedicated to fighting domestic extremism. DHS has denied those accusations.
In 2019, a top FBI official told Congress the agency devoted only about 20% of its counterterrorism resources to the domestic threat. Nonetheless, some FBI field offices focus primarily on domestic terrorism.
Former counterterrorism officials said the president’s politics made their job harder. The disagreement over what to call the extremists was part of a larger concern about whether the administration was committed to fighting the threat.
“The rhetoric at the White House, anybody watching the rhetoric of the president, this was discouraging people in government from speaking out,” said Jason Blazakis, who ran a State Department counterterrorism unit from 2008 to 2018. “The president and his minions were focused on other threats.”
Other former officials disagreed. Federal agencies avoided the term “right-wing terrorism” because they didn’t want to give extremists legitimacy by placing them on the political spectrum, or to fuel the United States’ intense polarization, said Christopher K. Harnisch, the former deputy coordinator for countering violent extremism in the State Department’s counterterrorism bureau. Some causes espoused by white supremacists, such as using violence to protect the environment, are not regarded as traditionally right-wing ideology, said Harnisch, who stepped down this week.
“The most important point is that the Europeans and the U.S. were talking about the same people,” he said. “It hasn’t hindered our cooperation at all.”
As for the wider criticism of the Trump administration, Harnisch said: “In our work at the State Department, we never faced one scintilla of opposition from the White House about taking on white supremacy. I can tell you that the White House was entirely supportive.”
The State Department focused mostly on foreign extremist movements, but it examined some of their links to U.S. groups as well.
There was clearly progress on some fronts. The State Department took a historic step in April by designating the Russian Imperial Movement and three of its leaders as terrorists, saying that the group’s trainees included Swedish extremists who carried out bombing attacks on refugees. It was the first such U.S. designation of a far-right terrorist group.
With Trump now out of office, Europeans and Americans expect improved cooperation against right-wing terrorists. Like the Islamist threat, it is becoming clear that the far-right threat is international. In December, a French computer programmer committed suicide after giving hundreds of thousands of dollars to U.S. extremist causes. The recipients included a neo-Nazi news website. Federal agencies are investigating, but it is not yet clear whether anything about the transaction was illegal, officials said.
“It’s like a transatlantic thing now,” said a European counterterror chief, describing American conspiracy theories that surface in the chatter he tracks. “Europe is taking ideology from U.S. groups and vice versa.”
International alliances make extremist groups more dangerous, but also create vulnerabilities that law enforcement could exploit.
Laws in Europe and Canada allow authorities to outlaw domestic extremist groups and conduct aggressive surveillance of suspected members. America’s civil liberties laws, which trace to the Constitution’s guarantee of free speech spelled out in the First Amendment, are far less expansive. The FBI and other agencies have considerably more authority to investigate U.S. individuals and groups if they develop ties with foreign terror organizations. So far, those legal tools have gone largely unused in relation to right-wing extremism, experts say.
To catch up to the fast-spreading threat at home and abroad, Blazakis said, the U.S. should designate more foreign organizations as terrorist entities, especially ones that allied nations have already outlawed.
A recent case reflects the kind of strategy Blazakis and others have in mind. During the riots in May after the death of George Floyd in Minneapolis, FBI agents got a tip that two members of the anti-government movement known as the Boogaloo Bois had armed themselves, according to court papers. The suspects were talking about killing police officers and attacking a National Guard armory to steal heavy weapons, the court papers allege. The FBI deployed an undercover informant who posed as a member of Hamas, the Palestinian terrorist group, and offered to help the suspects obtain explosives and training. After the suspects started talking about a plot to attack a courthouse, agents arrested them, according to the court papers. In September, prosecutors filed charges of conspiring and attempting to provide material support to a foreign terrorist organization, which can bring a sentence of up to 20 years in prison. One of the defendants pleaded guilty last month. The other still faces charges.
If the U.S. intelligence community starts using its vast resources to gather information on right-wing movements in other countries, it will find more linkages to groups in the United States, Blazakis and other experts predicted. Rather than resorting to a sting, authorities could charge American extremists for engaging in propaganda activity, financing, training or participating in other actions with foreign counterparts.
A crackdown would bring risks, however. After the assault on the Capitol, calls for bringing tougher laws and tactics to bear against suspected domestic extremists revived fears about civil liberties similar to those raised by Muslim and human rights organizations during the Bush administration’s “war on terror.” An excessive response could give the impression that authorities are criminalizing political views, which could worsen radicalization among right-wing groups and individuals for whom suspicion of government is a core tenet.
“You will hit a brick wall of privacy and civil liberties concerns very quickly,” said Seamus Hughes, a former counterterrorism official who is now deputy director of the Program on Extremism at George Washington University. He said the federal response should avoid feeding into “the already existing grievance of government overreach. The goal should be marginalization.”
In recent years, civil liberties groups have warned against responding to the rise in domestic extremism with harsh new laws.
“Some lawmakers are rushing to give law enforcement agencies harmful additional powers and creating new crimes,” wrote Hina Shamsi, the director of the ACLU’s national security project, in a statement by the organization about congressional hearings on the issue in 2019. “That approach ignores the way power, racism, and national security laws work in America. It will harm the communities of color that white supremacist violence targets — and undermine the constitutional rights that protect all of us.”
The Pivot Problem
There is also an understandable structural problem. Since the Sept. 11 attacks in 2001, intelligence and law enforcement agencies have dedicated themselves to the relentless pursuit of al-Qaida, the Islamic State, Iran and other Islamist foes.
Now the counterterrorism apparatus has to shift its aim to a new menace, one that is more opaque and diffuse than Islamist networks, experts said.
It will be like turning around an aircraft carrier, said Blazakis, the former State Department counterterrorism official, who is now a professor at the Middlebury Institute of International Studies.
“The U.S. government is super slow to pivot to new threats,” Blazakis said. “There is a reluctance to shift resources to new targets. And there was a politicization of intelligence during the Trump administration. There was a fear to speak out.”
Despite periodic resistance and generalized disorder in the Trump administration, some agencies advanced on their own, officials said. European counterterror officials say the FBI has become increasingly active in sharing and requesting intelligence about right-wing extremists overseas.
A European counterterror chief described recent conversations with U.S. agents about Americans attending neo-Nazi rallies and concerts in Europe and traveling to join the Azov Battalion, an ultranationalist Ukrainian militia fighting Russian-backed separatists. About 17,000 fighters from 50 countries, including at least 35 Americans, have traveled to the Ukrainian conflict zone, where they join units on both sides, according to one study. The fighting in the Donbass region offers them training, combat experience, international contacts and a sense of themselves as warriors, a theater reminiscent of Syria or Afghanistan for jihadis.
“The far right was not a priority for a long time,” the European counterterror chief said. “Now they are saying it’s a real threat for all our societies. Now they are seeing we have to handle it like Islamic terrorism. Now that we are sharing and we have a bigger picture, we see it’s really international, not domestic.”
The assault on Congress signaled the start of a new era, experts said. The convergence of a mix of extremist groups and activists solidified the idea that the far-right threat has overtaken the Islamist threat in the United States, and that the government has to change policies and shift resources accordingly. Experts predict that the Biden administration will make global right-wing extremism a top counterterrorism priority.
“This is on the rise and has gotten from nowhere on the radar to very intense in a couple of years,” a U.S. national security official said. “It is hard to see how it doesn’t continue. It will be a lot easier for U.S. officials to get concerned where there is a strong U.S. angle.”
A previous spike in domestic terrorism took place in the 1990s, an era of violent clashes between U.S. law enforcement agencies and extremists. In 1992, an FBI sniper gunned down the wife of a white supremacist during an armed standoff in Ruby Ridge, Idaho. The next year, four federal agents died in a raid on heavily armed members of a cult in Waco, Texas; the ensuing standoff at the compound ended in a fire that killed 76 people.Both sieges played a role in the radicalization of the anti-government terrorists who blew up the Oklahoma City federal building in 1995, killing 168 people, including children in a day care center for federal employees. Oklahoma City remains the deadliest terrorist act on U.S. soil aside from the Sept. 11 attacks.
The rise of al-Qaida in 2001 transformed the counterterrorism landscape, spawning new laws and government agencies and a worldwide campaign by intelligence agencies, law enforcement and the military. Despite subsequent plots and occasionally successful attacks involving one or two militants, stronger U.S. defenses and limited radicalization among American Muslims prevented Islamist networks from hitting the United States with the kind of well-trained, remotely directed teams that carried out mass casualty strikes in London in 2005, Mumbai in 2008 and Paris in 2015.
During the past decade, domestic terrorism surged in the United States. Some of the activity was on the political left, such as the gunman who opened fire at a baseball field in Virginia in 2017. The attack critically wounded Rep. Steve Scalise, a Republican legislator from Louisiana who was the House Majority whip, as well as a Capitol Police officer guarding him and four others.
But many indicators show that far-right extremism is deadlier. Right-wing attacks and plots accounted for the majority of all terrorist incidents in the country between 1994 and 2020, according to a study by the Center for Strategic and International Studies. The Anti-Defamation League reported in 2018 that right-wing terrorists were responsible for more than three times as many deaths as Islamists during the previous decade.
“There have been more arrests and deaths in the United States caused by domestic terrorists than international terrorists in recent years,” said Michael McGarrity, then the counterterrorism chief of the FBI, in congressional testimony in 2019. “Individuals affiliated with racially-motivated violent extremism are responsible for the most lethal and violent activity.”
During the same testimony, McGarrity said the FBI dedicated only about 20% of its counterterrorism resources to the domestic threat. The imbalance, experts say, was partly a lingering result of the global offensive by the Islamic State, whose power peaked in the middle of the decade. Another reason: Laws and rules instituted in the 1970s after FBI spying scandals make it much harder to monitor, investigate and prosecute Americans suspected of domestic extremism.
The Trump Administration and the Europeans
Critics say the Trump administration was reluctant to take on right-wing extremism. The former president set the tone with his public statements about the violent Unite the Right rally in Charlottesville, Virginia, in 2017, they say, and with his call last year telling the far-right Proud Boys group to “stand back and stand by.”
Still, various agencies increased their focus on the issue because of a drumbeat of attacks at home — notably the murders of 11 people at a synagogue in Pittsburgh in 2018 — and overseas. The Christchurch massacre of worshippers at mosques in New Zealand in March 2019 caught the attention of American officials. It was a portrait of the globalization of right-wing terrorism.
Brenton Tarrant, the 29-year-old Australian who livestreamed his attack, had traveled extensively in Europe, visiting sites he saw as part of a struggle between Christianity and Islam. In his manifesto, he cited the writings of a French ideologue and of Dylann Roof, an American who killed nine people at a predominantly Black church in South Carolina in 2015. While driving to the mosques, Tarrant played an ode to Serbian nationalist fighters of the Balkan wars on his car radio. And he carried an assault rifle on which he had scrawled the name of an Italian gunman who had shot African immigrants in a rampage the year before.
Christchurch was “part of a wave of violent incidents worldwide, the perpetrators of which were part of similar transnational online communities and took inspiration from one another,” said a report last year by Europol, an agency that coordinates law enforcement across Europe. The report described English as “the lingua franca of a transnational right-wing extremist community.”
With its long tradition of political terrorism on both extremes, Europe has also suffered a spike in right-wing violence. Much of it is a backlash to immigration in general and Muslim communities in particular. Responding to assassinations of politicians and other attacks, Germany and the United Kingdom have outlawed several organizations.
Closer to home, Canada has banned two neo-Nazi groups, Blood and Honour and Combat 18, making it possible to charge people for even possessing their paraphernalia or attending their events. Concerts and sales of video games, T-shirts and other items have become a prime source of international financing for right-wing movements, the European counterterror chief said.
During the past two years, officials at the FBI, DHS, State Department and other agencies tried to capitalize on the deeper expertise of European governments and improve transatlantic cooperation against right-wing extremism. Legal and cultural differences complicated the process, American and European officials said. A lack of order and cohesion in the U.S. national security community was another factor, they said.
“There was so little organization to the U.S. counterterrorism community that everybody decided for themselves what they would do,” a U.S. national security official said. “It was not the type of centrally controlled effort that would happen in other administrations.”
As a result, the U.S. government has sometimes been slow to respond to European requests for legal assistance and information-sharing about far-right extremism, said Eric Rosand, who served as a State Department counterterrorism official during the Obama administration.
“U.S.-European cooperation on addressing white supremacist and other far-right terrorism has been ad hoc and hobbled by a disjointed and inconsistent U.S. government approach,” Rosand said.
The semantic differences about what to call the threat didn’t help, according to Rosand and other critics. They say the Trump administration was averse to using the phrase “right-wing terrorism” because some groups on that part of the ideological spectrum supported the president.
“It highlights the disconnect,” Rosand said. “They were saying they didn’t want to suggest the terrorism is linked to politics. They didn’t want to politicize it. But if you don’t call it what it is because of concerns of how it might play with certain political consistencies, that politicizes it.”
Harnisch, the former deputy coordinator at the State Department counterterrorism bureau, rejected the criticism. He said cooperation with Europeans on the issue was “relatively nascent,” but that there had been concrete achievements.
“I think we laid a strong foundation, and I think the Biden administration will build on it,” Harnisch said. “From my perspective, we made significant progress on this threat within the Trump administration.”
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One Capitol Police officer was caught taking a selfie with a member of the white supremacist mob that overtook the US Capitol last week. A second officer has been suspended for wearing a “Make America Great Again” hat and directing insurrectionists around the building rather than handcuffing them. The storming of the Capitol has revived concerns about the ties between police and white supremacists, in part because officers arrested far more Black Lives Matter protesters this summer than they did Trump supporters who broke into the legislative building with weapons, at least one Confederate flag, and bundles of zip ties.
It wasn’t just on-duty cops who raised eyebrows: Off-duty law enforcement officers were allegedly part of the mob itself, with some flashing their badges and identification cards as they rushed through the doors, according to an on-duty DC Metro Police officer who saw them. “If these people can storm the Capitol building with no regard to punishment, you have to wonder how much they abuse their powers when they put on their uniforms,” the officer wrote later on Facebook, according to Politico.
Police departments around the country are now investigating officers who are suspected of attending the rally in DC, or were caught posting racist messages on social media. Days after the attack, New York Rep. Jamaal Bowman introduced a bill that would require a commission to examine whether Capitol Police officers have white supremacist ties.
For some experts, these investigations are far too little, too late: Police departments and federal agencies have long understood that certain cops are connected to racist groups, and have largely looked the other way. “We’ve known for decades that there are racial disparities in every step of the criminal justice process, from who gets stopped to who gets arrested to who police use force against to how they get charged,” says Michael German, a former FBI agent who now studies white supremacist infiltration of police departments as a fellow at the liberal Brennan Center for Justice, a think tank. “It’s treated as implicit bias or structural bias without an acknowledgment that there’s a lot of explicit bias driving these disparities.”
As an FBI agent in the 1990s, German went undercover with white supremacist and militia groups to thwart their bomb plots. At the time, the Justice Department warned him to be careful about sharing details of his investigations with cops, because some of them had ties to white supremacist groups themselves. Even so, in the decades since then, he says the FBI has not prioritized investigating those police officers and getting them off the streets, allowing them to continue their jobs. I caught up with German this week to ask how law enforcement agencies have fallen short in identifying and firing racist officers, and what they should be doing now, in the wake of the Capitol siege, to root them out.
Do we know roughly how many cops have ties to white supremacists?
Unfortunately we don’t have a sense of the scope of the problem because no entity has made it their mission to identify the scope. But the FBI regularly warns its agents who are investigating white supremacists and far-right militants that the subjects of those investigations will often have active links to law enforcement, and that they need to alter their methodology to protect the integrity of their investigations. Those were warnings I received in the 1990s when I worked these cases, and they appear in published leaked FBI materials, including the 2015 counterterrorism policy guide.
When you say FBI agents alter their methodologies, do you mean they’re not supposed to collaborate as much with police while investigating white supremacists?
Exactly. The counterterrorism policy guide recommends that the FBI put the subjects of these investigations on a watch list with what’s called the silent-hit function; if a police officer pulls over the subject of your investigation, a silent-hit function would not tell the officer that he’s interacting with someone who’s the subject of a terrorism investigation.
If the FBI knows this is a problem of such significance that it has to alter its methodologies of investigating cases, I would argue it also has to have a strategy to protect the public from these white supremacists and far-right militants who carry a badge. The fact that they don’t even document who these police officers are shows an inexcusable lack of attention to their mission to enforce the civil rights laws of this country as well as the counterterrorism laws.
In 2006, the FBI warned that for decades, white supremacist groups had been attempting to “recruit” police officers. Can you talk about the history of this?
It’s important to understand that the United States was founded as a white supremacist nation, so our laws enforced white supremacy, so those who were sworn to enforce the law were enforcing white supremacy. After slavery ended, you had Jim Crow. After the civil rights era, you still had sundown towns, where the police enforced unwritten rules about who could stay in town past dark. To imagine there was somehow a miraculous event that cured the police of that problem is foolish.
The most egregious are examples where police officers were actually members of white supremacist groups and would go to public events representing themselves as police officers. And their membership was known to law enforcement for years and unaddressed, and it was only when the public learned about it that the police department took action.
We do so little examination of police violence in this country, but we know it disproportionately targets people who are Black or brown. How much of that is driven from actual white supremacist ideology rather than isolated incidents that happen on the job is something the Justice Department has a responsibility to investigate.
What kind of recruitment techniques do white supremacist groups use with police?
Having spent time as an FBI undercover agent, I think the term [“recruit”] doesn’t accurately describe what’s happening. It’s not so much that this group will put a pamphlet together and make a recruiting pitch and approach officers. In many cases, these are people who grew up affiliating with white supremacists. One guy went to work as a prison guard, one guy went to work in factories, and the other guy went to work as a police officer. And they are just carrying on attitudes and associating with the same people they associated with when they weren’t a police officer.
Are there any police departments that have tried themselves to root out racist cops, and any that did a good job?
The departments tend to be reactive to public outrage. Part of the problem is that most law enforcement agencies don’t have written policies specifically addressing the issue. So when the public identifies somebody who’s operating in league with a white supremacist group or far-right militant group, they end up disciplining them under broad prohibitions against engaging in public conduct detrimental to the public interest, or similarly worded policies.
Sometimes this doesn’t stand up to the due process scrutiny that’s designed to protect innocent officers from being treating unfairly. So they end up getting their jobs back after they’re fired.
What I argue is that even where the conduct is not sufficient to terminate that officer, the police department still has an obligation to mitigate the threat they pose to the community. There are plenty of jobs in police departments that don’t regularly interact with the public. Or perhaps some extra level of supervision of that officer would be warranted.
Right. Or just the lack of policy, or disparate treatment, where other officers known to engage in racist behavior weren’t fired in the past, so it’s unfair to fire this officer. Often, if the police department knew about your involvement with this white supremacist group for five years but is now trying to fire you, you can argue: “I’m not being fired because of the conduct, because the department knew about the conduct; I’m being fired because the public demanded it, and that’s not appropriate.” That’s the problem with the way we have just turned a blind eye to this problem for so many decades.
Is there anything else that government can do to address this problem?
What we need is to empower prosecutors and defense attorneys. When these [white supremacist] officers are identified by the agency or by the public, that information should be provided to prosecutors and they [the officer] should be put on no-call lists or Brady lists. Today these no-call lists are lists of officers who are known to have previously engaged in some kind of dishonest conduct that a defense attorney could use to impeach their testimony. My argument is that racist behavior is one of those categories that should be available to the defense attorney. [This can] force those agents off the street.
In an ideal world, what do you think the Justice Department or FBI’s role would be in rooting out white supremacist police officers?
What I would recommend is for the Justice Department to implement a national strategy to identify these officers, document the scope of the threat, and design programs to mitigate it. It’s a matter of priorities. If the FBI heard through the grapevine that a police officer was affiliating himself with Al Qaeda or ISIS, we can be confident the FBI would react quickly. They should act just as quickly when the police officer is associated with white supremacist and far-right militant groups.
Some people have expressed the idea that we need to create a list of designated domestic terrorist groups, but that’s a silly approach because these groups change their names regularly. In other words, writing a list of groups that are banned is not going to help. Because officers can look at the list and say, “Okay, I won’t join this group, but I’ll join this other group. Or I’ll be part of a group that previously called itself the KKK but now calls itself something else.” But it’s the same people engaged in the same racist conduct. It takes an understanding of how these groups actually organize before you can write a policy.
The officers and agents within these federal, state, and local law enforcement departments know who the racists are among them. What we need to do is make sure officers who see racist misconduct or far-right militancy within law enforcement are protected when they report it. We need to strengthen whistleblower protection laws.
You wrote in a recent report about a man in Anniston, Alabama, who applied to be a police officer, and listed on his application that he was part of the League of the South, a white supremacist secessionist group. He was hired anyway. Are cops’ racist ties often that obvious?
Yes, often it is that obvious. So it’s not that they can’t be seen, it’s that nobody is looking for them.
Update (January 15): The Capitol Police officer who wore a MAGA hat claims he put on the cap as part of a plan to save some of his colleagues who were in danger, according to a new Wall Street Journalreport.
After the Civil War, the United States searched for ways to redefine itself. But by the 1880’s, the hopes of Reconstruction had dimmed. Across the United States there was instead a push to formalize and legalize discrimination against African-Americans. The effort to marginalize the first generation of free black Americans infiltrated nearly every aspect of daily life, including the cost of insurance.
Initially, African-Americans could purchase life insurance policies on equal footing with whites. That all changed in 1881. In March of that year Prudential, one of the country’s largest insurers, announced that policies held by black adults would be worth one-third less than the same plans held by whites. Their weekly premiums would remain the same. Benefits for black children didn’t change, but weekly premiums for their policies would rise by five cents.
Prudential defended the decision by pointing out that the black mortality rate was higher than the white mortality rate. Therefore, they explained, claims paid out for black policyholders were a disproportionate amount of all payouts. Most of the major life insurance companies followed suit, making it nearly impossible for African-Americans to gain coverage. Across the industry, companies blocked agents from soliciting African-American customers and denied commission for any policies issued to blacks.
The public largely accepted the statistical explanation for unequal coverage. The insurer’s job was to calculate risk. Race was merely another variable like occupation or geographic location. As one trade publication put it in 1891: “Life insurance companies are not negro-maniacs, they are business institutions…there is no sentiment and there are no politics in it.”
Companies considered race-based risk the same for all African-Americans, whether they were strong or sickly, educated or uneducated, from the country or the city. The “science” behind the risk formula is credited to Prudential statistician Frederick L. Hoffman, whose efforts to prove the genetic inferiority of the black race were used to justify the company’s discriminatory policies.
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Hoffman had plenty of bad science to work with. Most of the available data on African-American health statistics came from Civil War-era studies of black and white soldiers. Hospital administrator J.F. Miller and other researchers consistently claimed to have proof of the inherent weakness of the black race, reporting that the internal organs, including the lungs and brain, weighed less in blacks than in whites, making them more susceptible to diseases like pneumonia, tuberculosis, and syphilis. Since most white physicians held the common belief that enslaved blacks had been relatively healthy, this proved that the constitution of the black race was incompatible with freedom:
These laws affect him in the air he breathes, the food he eats, the clothes he wears and every circumstance surrounding his habitation. In the wholesale violation of these laws after the war…was laid the foundation of the degeneration of the physical and mental constitution of the negro.
Black Americans were more likely to live in poverty and often lacked access to medical care, among many other hardships. Still, little credence was given to the theory that environmental factors were the reason for the higher black mortality rate. Hoffman’s work received widespread coverage in respected journals, including that of the American Statistical Association, a professional society where Hoffman later served as president.
Hoffman predicted that African-Americans would eventually die off like the Native Americans before them. He surmised that they wouldn’t be able to survive in “civilized” society, outside the bonds of slavery. The theory didn’t gain any traction, but Hoffman’s broader work on the racialist science behind black mortality rates did have lasting effects. Discriminatory policies based on race were standard in the insurance industry well into the twentieth century. In a 1940 survey, over forty percent of companies did not accept black policyholders.
It’s tempting to think of the storming of the US Capitol on Wednesday as toxic masculinity run amok: a mob of mostly white men, carrying guns and wearing animal skins, trying to overthrow democracy on behalf of a president who once bragged about his ability to grab women “by the pussy.”
It’s even more tempting to embrace this narrative when, in a bizarre statement, that president’s campaign press secretary describes him as “the most masculine person, I think, to ever hold the White House.”
But focusing too much on masculinity obscures a crucial truth: Many women were either present at the riot or cheering on the insurrectionists from back home. There was Ashli Babbitt, the 35-year-old Air Force veteran and apparent devotee of QAnon ideology who was killed during the riot. There was the woman photographed with “zip-tie guy” Eric Munchel, now believed to be his mother. There was Martha Chansley, the mother of the widely photographed “QAnon shaman” who wore a horned hat and carried a spear to Congress. She wasn’t present at the riot but later defended her son in an interview, calling him “a great patriot, a veteran, a person who loves this country.”
And, of course, there were the women lawmakers who boosted conspiracy theories and false claims about the election being stolen, including Georgia Rep. Marjorie Taylor Greene, a QAnon adherent who railed against Democrats and Black Lives Matter protesters in a speech on the House floor this week while wearing a mask reading “censored.” Colorado Rep. Lauren Boebert, meanwhile, described January 6 as “1776” before the riot began, live-tweeted from the House during the attack (including a mention that House Speaker Nancy Pelosi had been removed from the chambers), and this week, refused to allow police to search her bag after it set off metal detectors outside Congress. During her campaign, Boebert promised to bring her gun with her to the House.
White women have been part of white supremacy in America since the very beginning, experts point out, dating back to their role in slavery. “They were at the table when the system was designed,” Stephanie Jones-Rogers, a history professor at UC Berkeley and author of the book They Were Her Property: White Women as Slave Owners in the American South, told Vox. “They were co-architects of the system.”
That remained true after the Civil War, through the birth and evolution of the Ku Klux Klan, and during the civil rights movement when white women were some of the most vocal opponents of school integration. And it remains true today, when women hold a key role in spreading QAnon ideology and sustaining white nationalist groups and movements. “Like other parts of our economy and society, these movements would collapse without their labor,” Seyward Darby, author of Sisters in Hate: American Women on the Front Lines of White Nationalism, told Vox.
And if we ignore the importance of women in the Capitol riot and the groups that backed and enabled it, we can’t understand white supremacy in America — let alone dismantle it. Trying to fight racism in America without looking at white women, Jones-Rogers said, is like “addressing only the right side of the body when the left side is still sick.”
White women have been part of white supremacy from the beginning
White women’s investment in white supremacy is older than the United States itself and goes back to their role in the economy of slavery. Though white women have been seen by some historians as passive bystanders to the brutalities of slavery, they were in fact active participants, as Jones-Rogers explains in They Were Her Property. Before the Civil War, white women had little economic or political power, with one big exception: They could buy and sell enslaved people. And they did so, using enslaved people as a way of building up wealth that would not simply be transferred to a husband in marriage.
Slavery gave white women “freedom, autonomy, and agency that they could not exercise in their lives without it, so they deeply invested in it,” Jones-Rogers said.
And after the Civil War, white women didn’t simply give up on white supremacy. Instead, as Jones-Rogers puts it, they doubled down.
For many, that meant becoming active participants in the KKK, which at one point had 1.5 million female members. Some women took leadership roles, like Elizabeth Tyler, who helped revive the Klan in the late 1910s and became its “most important propagandist,” according to Darby.
Women became especially important in the Klan once they gained the right to vote. After that, white men began to see their wives, daughters, sisters, and other women in their lives “as potential allies in the effort to politicize white supremacy,” Jones-Rogers said. “They began to see them as a voting bloc.”
And it wasn’t just because of organizations like the Klan that white women invested in institutional racism. They also played a core role in lynching by making false allegations of sexual harassment or assault, which wereused as a pretext to murder Black men. And they were key players in the fight against the integration of schools, with white women using their role as mothers to legitimize their victimization of Black children, Jones-Rogers said.
Indeed, throughout the 20th century, though white women could no longer profit from slavery, they were still deriving real benefits from white supremacy — namely, a sense of social and political power in a world still dominated by white men. “Through lynching, your words have the power of life and death over an African-descended man,” Jones-Rogers explained. “Your vote can secure a place in the state, in the government, for white supremacy.”
In essence, through white supremacy, white women came to “understand themselves as individuals who wield a certain kind of power that men have to respect,” Jones-Rogers said.
Understanding white women’s role is key to fighting racism today
And that dynamic has continued into the 21st century. The landscape of white supremacy has changed, with the Klan no longer a major player (though it still exists). Today, white nationalism is less about specific groups and more about “an ideology that people subscribe to from the comfort of their own desks,” Darby said.
Because of that, it’s hard to measure exactly how many women are involved in white nationalism. It’s easier to measure attitudes. Overall, about 20 percent of white Americans of all genders “feel a sense of discontent” over the status of white people in society, Darby writes in Sisters in Hate, drawing on the work of political scientist Ashley Jardina. And white women are actually more likely than white men to hold “exclusionary views about what it means to be American, preferring boundaries around the nation’s identity that maintain it in their image.”
And while they may not always be in front at rallies or riots, women remain important “recruiters and propagandists” for white nationalism, Darby said. Erica Alduino, for example, had a key role in organizing the infamous “Unite the Right” rally in Charlottesville, Virginia, in 2017. She was the one directing traffic on messaging apps and answering mundane but important questions like whether there would be shuttle buses to the rally. She didn’t speak at the event, “but that’s not the point,” Darby said. “Whether women are seen or not seen, they are such important actors in this space.”
Women have also been central to organizing pro-Trump events that spread the false claim that the election was stolen. The group Women for America First organized a “Stop the Steal” rally of thousands in November and also received a permit for a rally at the Capitol on January 6, according to the Washington Post.
Meanwhile, women have taken an even more visible role with the rise of QAnon. An ideology that began with conspiracy theories about Trump battling a “cabal” of liberals involved in child sex trafficking, QAnon has grown to include a wider array of theories and misinformation. Last year, QAnon adherents began amplifying the hashtag #SaveTheChildren, which became a vehicle for false claims about the prevalence of child sex trafficking as well as a gateway for more extreme QAnon ideas. And many of the people posting with #SaveTheChildren — including celebrities and prominent influencers — were women.
In general, QAnon has been a way to co-opt messages long targeted at women — messages about the importance of natural living or even healthy food, for example — and turn them into an indoctrination in white nationalism and xenophobia. QAnon plays into “this idea that you can cleanse yourself and your life and your family’s life of pollutants,” Darby said. Messages about avoiding genetically modified foods, for example, can slide into messages about keeping non-white children out of schools.
In the last few months, QAnon has played a key role in boosting conspiracy theories about Covid-19 restrictions and masking, and backing attempts to overturn the election. And some of the most visible proponents of QAnon have been women. Greene, for example, has been called the first QAnon member of Congress and has tweeted support for the idea of the “deep state,” a core QAnon tenet.
Meanwhile, Ashli Babbitt, the woman who was killed by police at the Capitol riot, had been posting QAnon-related content on social media for nearly a year prior to the insurrection, according to the Guardian. The day before the riot, she tweeted a defiant message full of QAnon slogans: “Nothing will stop us….they can try and try and try but the storm is here and it is descending upon DC in less than 24 hours….dark to light!”
Despite the participation of Babbitt and others, there’s been a tendency to view the riot as largely male-dominated — and, indeed, to erase the presence of women in white supremacy throughout history. “There has been a tendency, from the colonial period to the present, to frame and to position white women as perpetual victims, in spite of the evidence to the contrary,” Jones-Rogers said.
But ignoring the fact that women have long been perpetrators of white supremacy — up to and including violence — will hamper any effort to truly fight it. “When we discount these women and the often violent and brutal roles that these women play,” Jones-Rogers said, “we neglect and we negate the impact that their activities have on their victims.”
If, by contrast, we as a society can reckon with the way that white women have been not just beneficiaries but designers of the system of white supremacy, she said, we will be better able “to dismantle the system and to address the ways in which the system has really pervaded all of our lives.”
The violent insurrection by domestic terrorists last week at the U.S. Capitol was not Black people’s fight.
But make no mistake: It was all about Black people. Because white supremacy is about Black people.
The Oxford dictionary defines white supremacy as “the belief that white people constitute a superior race and should therefore dominate society, typically to the exclusion or detriment of other racial and ethnic groups, in particular Black or Jewish people.”
What else explains how people can think it’s perfectly within their rights to try to overthrow the government because their guy didn’t win?
But it was about more than an election. President Donald Trump exhorted the armed, angry and violent extremists to “fight like hell, or you’re not going to have a country anymore.” The mob went through with their plans, breaking into the Capitol with crowbars, sledgehammers and ropes, destroying property, assaulting Americans, taking selfies, gleefully posting on social media, waving Confederate flags in the Capitol vestibule,beating a police officer to death, and fully expecting to walk out with impunity. In case those actions didn’t tell the story enough, they wore Camp Auschwitz shirts and other racist and anti-Semitic branding, and hung a noose.
Had the foaming mobs gotten their hands on a member of Congress, God only knows what could have happened.
The assault on our democracy was a culmination of what the supremacists see as a larger threat: the election of Joe Biden and Kamala Harris, the first Black, Asian and female vice president. It was an election decided, in large part, by Black voters, turning out in large cities with Black populations, such as Philadelphia, Milwaukee, Detroit and Atlanta. Not coincidentally, those were the cities where Trump sought to strip electoral votes from.
State-sanctioned racial violence to keep Black people from attaining power is nothing new. After all, wasn’t that what the Civil War was about? Black voter suppression has always been embedded into our democracy’s shameful history.
You don’t need to look any further than Philadelphia. Octavius Catto, Black American educator and activist was on his way to vote in 1871 when he was murdered by a white man who opposed Catto’s politics and very existence. The murderer was not charged, and the police were later found to be aiding and abetting the mob to keep Black people from voting.
Suppression through violence and intimidation continued throughout history: States employed tactics such as poll taxes, literacy tests and grandfather clauses, all to keep Black people from voting. In 1920, a Florida mob of white men, aided by the Ku Klux Klan, massacred as many as 50 Black people on Election Day, because a single Black man was intent on casting his ballot.
It took civil rights activists marching in the streets — some sacrificing their lives — to force Congress to enact the Voting Rights Act only 55 years ago, which was supposed to ensure that cherished right.
But even today, voting rights are under attack through restrictions of voter ID laws and polling place shutdowns.
“When you look at every portion of American history where we’ve made gains toward easing some of the burdens of that oppression, we’ve seen some type of violent backlash,” said Timothy Welbeck, a Philadelphia civil rights attorney and Temple University professor. “And because of the history of Black voter disenfranchisement in this country, I guess that allowed some whites to think that the election was rigged, even though it was fair and free.”
So, when we watched in horror as the orgy of violence unfolded at the Capitol, well, I was shocked. But I couldn’t say I was surprised.
Yes, Trump has been impeached for the second time, but it doesn’t stop there.
White supremacy will always rear its ugly head. We’ve seen it take all kinds of forms in these dangerous times. It comes in the defiant refusal of folks to mask up during a global pandemic because, well, their personal freedom is at stake, never mind they’re putting their fellow citizens in harm’s way, particularly people of color. It comes not only from far-right extremists living in rural communities, but in suit-wearing CEOs, cops, teachers, real estate agents, nurses, military men and women and even a gold-medal Olympian.
It comes from lawmakers, too. And now we’re learning it might even come from right inside of Congress, from the very people who took a vow to uphold our democracy.